1
|
O'Sullivan DE, Ruan Y, Farah E, Hutchinson JM, Hilsden RJ, Brenner DR. Risk factors for early-onset colorectal cancer: A Canadian prospective cohort study. Cancer Epidemiol 2024; 91:102578. [PMID: 38749340 DOI: 10.1016/j.canep.2024.102578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The incidence of early-onset (<50 years of age) colorectal cancer (eoCRC) has been steadily increasing in high-income countries including Canada. Despite this increase in incidence, the etiology of eoCRC remains unclear and prospective cohort studies of potential risk factors are limited. METHODS We examined two prospective cohorts of healthy individuals (<50 years of age) who completed baseline questionnaires in the Ontario Health Study and Alberta's Tomorrow Project. We examined the associations between demographic characteristics, chronic health conditions, and lifestyle behaviours with the development of eoCRC using Cox proportional hazard models. Cohorts were analyzed separately and hazard ratios for each risk factor were pooled with random effects meta-analyses. RESULTS During an average follow-up of 6.63 years, 98 eoCRC cases occurred among study participants (n=127,852). A family history of CRC alone or with a history of other cancer types was associated with an increased risk of developing eoCRC (HR: 2.76, 95% CI: 1.43-5.32), but a family history of a non-CRC cancer only was not (HR: 1.18, 95% CI: 0.61-2.30). Heavy smokers (≥ 10 pack-years) at baseline had a higher risk of eoCRC compared to non-smokers (HR: 1.87, 95% CI: 1.00-3.52). Sex, socioeconomic factors, diabetes, alcohol consumption, among other factors were not significantly associated with the risk of eoCRC. CONCLUSION Our findings indicate that specific CRC risk factors are also associated with developing eoCRC. The data in the study offers valuable insights that could be integrated in future meta-analyses. Additional prospective cohort studies are required to understand the etiology of eoCRC.
Collapse
Affiliation(s)
- Dylan E O'Sullivan
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta T2N 1N4, Canada; Department of Oncology, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta T2N 1N4, Canada; Department of Oncology, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Eliya Farah
- Department of Oncology, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - John M Hutchinson
- Department of Oncology, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Robert J Hilsden
- Department of Medicine, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| |
Collapse
|
2
|
Nottage MK, Taylor EV, East KA, McNeill A, Thrasher JF, Reid JL, Hammond D, Simonavičius E. Packaging of disposable vaping products and e-liquids in England, Canada and the United States: A content analysis. Addiction 2024. [PMID: 38970447 DOI: 10.1111/add.16611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/09/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND AND AIMS Vaping product packaging is varied and often features bright colours and novel designs, particularly among recently marketed disposable vapes. This study provides an overview of attributes found on the packaging of popular disposable vapes and e-liquid bottles in England, Canada and the United States (US) and assesses compliance with local packaging regulations. DESIGN Content analysis. SETTING Brick-and-mortar and online shops in England (London), Canada (Ontario) and the US (New Hampshire and South Carolina). CASES 108 vaping products (including packaging) from 76 brands in a range of flavours and nicotine levels. Specifically, 48 disposable vapes (15 from England, 16 from Canada, 17 from the US) and 60 e-liquid bottles (20 per country). MEASUREMENTS Textual and graphic branding and marketing elements, independently coded by two researchers and checked by a third. FINDINGS Compliance with local packaging regulations varied across countries. Health warnings were present on the packaging of all but one nicotine-containing product, although 33% of disposables and 17% of e-liquids featuring the warning did not adhere to formatting requirements. Leaflets were seldom included with e-liquid bottles, even in England (45%) where mandatory, and omitted elsewhere. Labelling of nicotine type and batch numbers was inconsistent. Vaping product packaging featured claims relating to sensory perceptions (41%), most often flavours, and some (32%) featured youth-appealing content. Common graphic elements included stylised brand fonts (80%), brand logos (54%), product representations on the external packaging (47%) and abstract graphic elements (64%). Colours on packaging, disposable vapes and e-liquid bottles were associated with product flavour. CONCLUSIONS In England, Canada and the United States, popular disposable vapes and e-liquid bottles appear to have varying compliance with local packaging regulations and inconsistent labelling of nicotine and product characteristics. The use of colourful designs, evocative descriptors and appealing graphics to promote flavours underscores the need for comprehensive packaging regulations and enforcement.
Collapse
Affiliation(s)
- Matilda K Nottage
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Eve V Taylor
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katherine A East
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Erikas Simonavičius
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
3
|
Nian Q, Hardesty JJ, Crespi E, Sinamo J, Kennedy RD, Welding K, Cohen JE. Is Maintenance or Switching Between Freebase and Nicotine Salt Liquid Associated with Electronic Nicotine Delivery Systems Dependence? Subst Use Misuse 2024:1-7. [PMID: 38918934 DOI: 10.1080/10826084.2024.2369154] [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: 06/27/2024]
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS) use one of two formulations of nicotine-freebase or nicotine salt. This study examines whether maintenance or switching between nicotine formulations is associated with ENDS dependence using longitudinal survey data. METHODS 543 U.S. adults (21+) using ENDS frequently (5+ days/week) self-reported and uploaded photos of their most used ENDS liquids in wave 3-5 online surveys from September 2021 to April 2023. Nicotine formulation from photo data was used if available; otherwise, self-reported data were used. ENDS dependence was measured in each wave by a 4-item E-cigarette Dependence Scale (EDS: range 0-4, 4 being most dependent). Data were analyzed using ANCOVA. RESULTS Participants using nicotine salt liquids in three waves reported the highest EDS in wave 5 (49.3%, EDS = 2.59), followed by participants switching from salt to freebase (3.2%, EDS = 2.58), participants switching from freebase to salt (10.1%, EDS = 2.52), participants using freebase in three waves (34.9%, EDS = 2.18), and participants changing back and forth (2.4%, EDS = 2.11). After controlling for smoking status, participants stably using nicotine salt and participants switching from freebase to salt reported significantly higher EDS than those stably using freebase (p < 0.01). CONCLUSIONS Over an 18-month period, people consistently using nicotine salt liquids and participants switching from freebase to nicotine salt were more likely to have a higher ENDS dependence than those consistently using freebase liquids. Understanding how switching between nicotine formulations relates to ENDS dependence can inform nicotine formulation and concentration regulations that may impact addiction.
Collapse
Affiliation(s)
- Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey J Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua Sinamo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
4
|
Jackson SE, Brown J, Shahab L, Arnott D, Bauld L, Cox S. Nicotine strength of e-liquids used by adult vapers in Great Britain: A population survey 2016 to 2024. Addiction 2024. [PMID: 38897583 DOI: 10.1111/add.16576] [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: 03/13/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND AIMS In March 2024, the UK government announced plans to introduce a Vaping Products Duty that will tax e-liquids based on their nicotine strength. This study examined trends in the nicotine strength of e-liquids used by adult vapers and differences in those currently used across relevant subgroups. DESIGN Nationally-representative, cross-sectional household survey, July 2016 to January 2024. SETTING Great Britain. PARTICIPANTS 7981 adult vapers. MEASUREMENTS Participants were asked whether the e-cigarette they mainly use contains nicotine (yes/no) and the e-liquid strength (no nicotine, >0-≤ 6, 7-11, 12-19 or ≥20 mg/ml). We also collected information on the main device type used (disposable/refillable/pod), age, gender, occupational social grade, history of ≥1 mental health conditions, smoking status and (among past-year smokers) level of cigarette addiction. FINDINGS The proportion of vapers in England using high-strength (≥20 mg/ml) e-liquids increased from an average of 3.8% (95% confidence interval [CI] = 2.9-5.0) up to June 2021 to 32.5% (CI = 27.9-37.4) in January 2024 (the vast majority of whom [93.3% in January 2024] reported using exactly 20 mg/ml; the legal limit). This rise was most pronounced among those using disposable e-cigarettes, those aged 18-24 years and all smoking statuses (including never smokers) except long-term (≥1y) ex-smokers. Of those surveyed in 2022-2024 in Great Britain, overall, 89.5% (CI = 88.1-90.8) said they usually used e-cigarettes containing nicotine, 8.7% (CI = 7.5-10.0) used nicotine-free e-cigarettes, and 1.8% (CI = 1.2-2.4) were unsure. The proportion using ≥20 mg/ml was higher among those mainly using disposable (47.9%) compared with pod (16.3%) or refillable (11.5%) devices; never smokers (36.0%), current smokers (28.8%) or recent (<1y) ex-smokers (27.4%), compared with long-term ex-smokers (13.9%); and younger (16-24y; 44.2%) compared with older (≥25y; range 9.4-25.1%) age groups. There were no notable differences across other subgroups of interest. CONCLUSIONS Use of high-strength nicotine e-liquids in England appears to have increased sharply in recent years. Most adult vapers in Great Britain appear to use e-cigarettes that contain nicotine but different subgroups use different strengths: nicotine strengths tend to be higher among those who mainly use disposable devices and those aged 16-24y, and lower among long-term ex-smokers.
Collapse
Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- SPECTRUM Consortium, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- SPECTRUM Consortium, United Kingdom
- Behavioural Research UK, United Kingdom
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- SPECTRUM Consortium, United Kingdom
| | - Deborah Arnott
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Action on Smoking and Health, United Kingdom
| | - Linda Bauld
- SPECTRUM Consortium, United Kingdom
- Behavioural Research UK, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- SPECTRUM Consortium, United Kingdom
- Behavioural Research UK, United Kingdom
| |
Collapse
|
5
|
Tran L, Rao G, Robertson NE, Hunsaker HC, Chiu EY, Poulin BA, Madl AK, Pinkerton KE, Britt RD, Nguyen TB. Quantification of Free Radicals from Vaping Electronic Cigarettes Containing Nicotine Salt Solutions with Different Organic Acid Types and Concentrations. Chem Res Toxicol 2024; 37:991-999. [PMID: 38778043 PMCID: PMC11187635 DOI: 10.1021/acs.chemrestox.4c00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
Electronic (e-) cigarette formulations containing nicotine salts from a range of organic acid conjugates and pH values have dominated the commercial market. The acids in the nicotine salt formulations may alter the redox environment in e-cigarettes, impacting free radical formation in e-cigarette aerosol. Here, the generation of aerosol mass and free radicals from a fourth-generation e-cigarette device was evaluated at 2 wt % nicotine salts (pH 7, 30:70 mixture propylene glycol to vegetable glycerin) across eight organic acids used in e-liquids: benzoic acid (BA), salicylic acid (SLA), lactic acid (LA), levulinic acid (LVA), succinic acid (SA), malic acid (MA), tartaric acid (TA), and citric acid (CA). Furthermore, 2 wt % BA nicotine salts were studied at the following nicotine to acid ratios: 1:2 (pH 4), 1:1 (pH 7), and 2:1 (pH 8), in comparison with freebase nicotine (pH 10). Radical yields were quantified by spin-trapping and electron paramagnetic resonance (EPR) spectroscopy. The EPR spectra of free radicals in the nicotine salt aerosol matched those generated from the Fenton reaction, which are primarily hydroxyl (OH) radicals and other reactive oxygen species (ROS). Although the aerosol mass formation was not significantly different for most of the tested nicotine salts and acid concentrations, notable ROS yields were observed only from BA, CA, and TA under the study conditions. The e-liquids with SLA, LA, LVA, SA, and MA produced less ROS than the 2 wt % freebase nicotine e-liquid, suggesting that organic acids may play dual roles in the production and scavenging of ROS. For BA nicotine salts, it was found that the ROS yield increased with a higher acid concentration (or a lower nicotine to acid ratio). The observation that BA nicotine salts produce the highest ROS yield in aerosol generated from a fourth-generation vape device, which increases with acid concentration, has important implications for ROS-mediated health outcomes that may be relevant to consumers, manufacturers, and regulatory agencies.
Collapse
Affiliation(s)
- Lillian
N. Tran
- Department
of Environmental Toxicology, University
of California, Davis, Davis, California 95616, United States
| | - Guodong Rao
- Department
of Chemistry, University of California,
Davis, Davis, California 95616, United States
| | - Nicholas E. Robertson
- Department
of Environmental Toxicology, University
of California, Davis, Davis, California 95616, United States
| | - Haylee C. Hunsaker
- Department
of Chemistry, University of California,
Davis, Davis, California 95616, United States
| | - Elizabeth Y. Chiu
- Department
of Environmental Toxicology, University
of California, Davis, Davis, California 95616, United States
| | - Brett A. Poulin
- Department
of Environmental Toxicology, University
of California, Davis, Davis, California 95616, United States
| | - Amy K. Madl
- Center
for Health and the Environment, University
of California Davis, Davis, California 95616, United States
| | - Kent E. Pinkerton
- Center
for Health and the Environment, University
of California Davis, Davis, California 95616, United States
| | - R. David Britt
- Department
of Chemistry, University of California,
Davis, Davis, California 95616, United States
| | - Tran B. Nguyen
- Department
of Environmental Toxicology, University
of California, Davis, Davis, California 95616, United States
| |
Collapse
|
6
|
North C, Loukas A, Harrell MB, Pasch KE, Marti CN, Wilkinson AV. Most commonly used vaping brands by 18-25 year old young adults in Texas-Spring 2023. PLoS One 2024; 19:e0300454. [PMID: 38820522 PMCID: PMC11142693 DOI: 10.1371/journal.pone.0300454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/27/2024] [Indexed: 06/02/2024] Open
Abstract
PURPOSE We aimed to determine (1) the most commonly used brands of electronic vaping products (EVPs) by young adults in Texas during Spring 2023, and (2) if brand preferences differ by sociodemographic characteristics, current cigarette smoking, and current cannabis vaping. METHOD Participants were 2,491 18-25-year-olds (Mean age = 20.6; 62.9% female; 29.7% sexual gender minority; 35.9% non-Hispanic White, 45.0% Hispanic/Latino, 3.5% non-Hispanic Black, 11.6% non-Hispanic Asian, and 4.0% two or more races or another race/ethnicity) enrolled in 21 Texas colleges during February-March 2023 who used EVPs in the past 30-days. RESULTS Esco Bar was the most popular EVP brand (32.5%), followed by Elf Bar (19%), Vuse (10.1%), and all other brands were used by < 10% of participants. Nearly 20% of participants reported not having a usual brand. Participants who used Esco Bar, Elf Bar, and Puff Bar were younger (i.e., 18-20 years old), female, and Hispanic/Latino. Vuse, JUUL, and Smok were used by participants who were older (i.e., 21-25 years old), male, non-Hispanic white, used EVPs daily, and currently smoked cigarettes. CONCLUSION The present study extends prior research by providing contemporary data on young adult EVP brand preferences in Texas during Spring 2023. Many of the brands commonly used by young adults (e.g., Esco Bar, Elf Bar) are not currently authorized for marketing or sale by the Food and Drug Administration. Findings underscore a need for additional enforcement efforts that prohibit the distribution and sale of these products to, in turn, prevent EVP use among young adults.
Collapse
Affiliation(s)
- Caroline North
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States of America
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States of America
| | - Melissa B. Harrell
- Department of Epidemiology, UTHealth Houston School of Public Health, Austin, TX, United States of America
| | - Keryn E. Pasch
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States of America
| | - C. Nathan Marti
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States of America
| | - Anna V. Wilkinson
- Department of Epidemiology, UTHealth Houston School of Public Health, Austin, TX, United States of America
| |
Collapse
|
7
|
Chen-Sankey J, Elhabashy M, Schroth KR. Does Brand Choice Matter: Associations Between Usual E-Cigarette Brands and E-Cigarette Use Patterns Among U.S. Youth, 2021. Health Promot Pract 2024; 25:460-467. [PMID: 37978824 PMCID: PMC11062808 DOI: 10.1177/15248399231210511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND. To inform youth about e-cigarette use prevention, it is important to understand whether using e-cigarette products from certain brands is associated with youth's differential e-cigarette use patterns and willingness to quit e-cigarettes. METHODS. Data for this study come from the 2021 U.S. National Youth Tobacco Survey (NYTS). The sample was current (past-30-day) e-cigarette users (unweighted n = 1,436). We examined the associations between users' usual e-cigarette brands (Puff, Vuse, Smoke, JUUL, and others) and e-cigarette use patterns (use frequency, use with nicotine, use with flavors) and willingness to quit, controlling for covariates. RESULTS. In 2021, 25.6%, 9.7%, 8.1%, and 6.5% of users reported Puff, Vuse, Smok, and JUUL as their usual brands, respectively. Having Smok as a usual brand increased the odds of frequent e-cigarette use compared with other brands. Using Puff, Vuse, and Smok increased the odds of using e-cigarettes with nicotine. Using Puff and Smok increased the odds of using e-cigarettes with any flavors and fruit flavors, and using Smok and JUUL increased the odds of using mint flavors. Finally, using Vuse reduced the odds of having a willingness to quit e-cigarettes. CONCLUSION. Puff products, which are likely to be used infrequently and with fruit flavors, were the most endorsed usual brand by youth users. Vuse and Smok brand users demonstrated problematic use patterns, including high-frequency use of nicotine and reduced willingness to quit. The high prevalence of using flavors, especially banned flavors (e.g., mint for JUUL products), suggests the need for tightened restrictions on youth's access to flavored e-cigarettes.
Collapse
Affiliation(s)
- Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854
| | - Maryam Elhabashy
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901
| | - Kevin R.J. Schroth
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854
| |
Collapse
|
8
|
Han DH, Harlow AF, Feldstein Ewing SW, Audrain-McGovern JE, Unger JB, Sussman SY, McConnell R, Barrington-Trimis JL, Leventhal AM. Disposable E-Cigarette Use and Subsequent Use Patterns in Adolescents and Young Adults. Pediatrics 2024; 153:e2023063430. [PMID: 38463010 PMCID: PMC10979299 DOI: 10.1542/peds.2023-063430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Disposable electronic cigarettes (e-cigarettes) are widely used by adolescents and young adults (AYAs). Whether using disposable devices is associated with future e-cigarette use patterns is unknown but important for informing e-cigarette regulation. METHODS Prospective longitudinal study combining data from adolescent (14-17 years) and young adult (21-24 years) cohorts from Southern California surveyed at baseline and approximately 8-month follow-up during 2021 to 2022. The analyses included AYAs who used e-cigarettes in the past 30 days at baseline and had exposure and outcome data (N = 403; adolescent n = 124, young adult n = 279). RESULTS In the pooled sample of AYAs who used e-cigarettes at baseline (57.2% cis-gender female, 56.2% Hispanic), 278 (69.0%) reported past 30-day disposable e-cigarette use, and 125 (31.0%) used only nondisposable e-cigarettes. Baseline use of disposable (versus only nondisposable) devices was associated with higher odds of continued e-cigarette use (adjusted odds ratio = 1.92; 95% confidence interval = 1.09-3.42) and a greater number of times used e-cigarettes per day at follow-up (adjusted incidence rate ratio = 1.29; 95% confidence interval = 1.02-1.63). In supplemental analyses, disposable e-cigarette use was associated with greater odds of no changes (versus reductions) in e-cigarette use frequency and puffs per episode from baseline to follow-up but was not associated with increases in use frequency and intensity. No differences in e-cigarette use outcomes were found between those with poly-device (disposable and nondisposable) versus only disposable device use. CONCLUSIONS Use of disposable e-cigarette devices among AYAs may be associated with higher risks for persistent e-cigarette use patterns, which should be considered in tobacco product regulation designed to protect AYAs.
Collapse
Affiliation(s)
- Dae-Hee Han
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Alyssa F Harlow
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | | | | | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Steve Y Sussman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
- Department of Psychology
- School of Social Work, University of Southern California, Los Angeles, California
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
- Department of Psychology
| |
Collapse
|
9
|
East K, Taylor EV, Simonavičius E, Reid JL, Burkhalter R, McNeill A, Hammond D. Use of 'Elf Bar' among youth and young adults who currently vape in England: cross-sectional associations with demographics, dependence indicators and reasons for use. Addiction 2024. [PMID: 38515247 DOI: 10.1111/add.16463] [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: 08/24/2023] [Accepted: 01/31/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Elf Bar is currently the leading e-cigarette (vape) brand in Great Britain. This study examined youth and young adults' use of Elf Bar, socio-demographic characteristics and dependence indicators and reasons for use over other brands. DESIGN Cross-sectional survey. SETTING AND PARTICIPANTS Online 2022 International Tobacco Control Project Youth Tobacco and Vaping Survey (N = 1355 16-29-year-olds in England who had vaped in the past 30 days). MEASUREMENTS Currently using Elf Bar most often (versus other brands) and associations with: socio-demographics, owning a vaping device, dependence indicators and reasons for brand choice. Logistic regressions were used. FINDINGS Among 16-29-year-olds who vaped in the past 30 days, 48.4% (n = 732) reported Elf Bar as the brand they used most often. Among 16-17-year-olds, 40.7% used Elf Bar over other brands; this was lower than among 18-19-year-olds (60.1%) and 20-29-year-olds (47.4%) (P ≤ 0.002). Using Elf Bar over other brands was higher among those who were female (55.2 versus 41.5% male), identified as White (53.1 versus 30.9% other/mixed), a student (54.5 versus 44.3% not), did not own a vape (66.7 versus 44.4% who did) and typically vaped 5-8 hours after waking (62.7 versus 36.8% within 5 min) (P ≤ 0.044). Most who vaped but had never smoked used Elf Bar (64.3%), although use did not significantly differ from those who currently (45.4%), formerly (42.3%) or experimentally (48.7%) smoked (all P ≥ 0.060). Popular reasons for choosing Elf Bar over other brands were better flavour/taste (47.5%), less expensive (28.7%), easier to get (26.1%), smoother to inhale (24.0%) and popularity (23.1%). 'Better for quitting smoking' (10.1%) was least frequently selected reason for choosing Elf Bar over other brands. CONCLUSIONS Elf Bar brand e-cigarettes were used by approximately half of 16-29-year-olds who vaped in England in 2022 and was mainly chosen over other brands for subjective responses (e.g. flavour/taste), rather than for quitting smoking.
Collapse
Affiliation(s)
- Katherine East
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Canada
| | - Eve V Taylor
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Erikas Simonavičius
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica L Reid
- School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Canada
| | - Robin Burkhalter
- School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Canada
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Canada
| |
Collapse
|
10
|
Do EK, Diaz MC, Bertrand A, Liu S(M, Hair EC. E-Cigarette Brand Trends in the United States: An Investigation of Data From a Youth and Young Adult Sample and the E-Cigarette Retail Market (2022). Tob Use Insights 2024; 17:1179173X241237216. [PMID: 38455141 PMCID: PMC10916459 DOI: 10.1177/1179173x241237216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024] Open
Abstract
Background Electronic cigarettes (e-cigarettes) remain the most used tobacco product among young people in the United States (US). Given the need for current data on popular e-cigarette products, the current study leverages data from a rapid surveillance survey of young people and examines whether the top e-cigarette brands identified from this source align with US market data. Methodology Data were obtained from current e-cigarette users (N = 4145) participating in the Truth Continuous Tracker Online (CTO; a cross-sectional tracking survey of 15-24 year-olds sourced from the national Dynata panel) and NielsenIQ retail scanner data, collected in 2022 and aggregated by quarter (Q1, Q2, and Q3). The top 15 e-cigarette brands were determined from respondents' endorsement in the Truth CTO and ranked total sales in NielsenIQ in nominal dollars. Results Overall, 58% of e-cigarette brands overlapped across the Truth CTO and NielsenIQ data (60% for Q1, 47% for Q2 and 67% for Q3). Pod-based (JUUL; VUSE) and disposable (Hyde; Breeze Smoke) brands appeared as top brands in both datasets. Top brands were fairly consistent within and across quarters; though, more variability was found in the Truth CTO, relative to NielsenIQ. Many top brands were disposable. Conclusions Results suggest that data from rapid surveillance and retail data can be used complementarily to characterize the popular e-cigarette brands currently on the US market. Many of these popular e-cigarette brands have yet to receive marketing granted orders under the US Food and Drug Administration, suggesting the need to continue monitoring e-cigarette brands among young people.
Collapse
Affiliation(s)
- Elizabeth K. Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Megan C. Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | | | - Elizabeth C. Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
11
|
Ma S, Kaareen A, Park H, He Y, Jiang S, Qiu Z, Xie Z, Li D, Chen J, O'Connor RJ, Fong GT, Shang C. How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study. JMIR Form Res 2024; 8:e47570. [PMID: 38416562 PMCID: PMC10938231 DOI: 10.2196/47570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/31/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. OBJECTIVE To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. METHODS In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. RESULTS As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. CONCLUSIONS As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers' marketing behaviors, and identify regulatory impacts.
Collapse
Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Aadeeba Kaareen
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Hojin Park
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Shuning Jiang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| |
Collapse
|
12
|
Simonavičius E, East K, Taylor E, Nottage M, Reid JL, Arnott D, Bunce L, McNeill A, Hammond D. Impact of E-liquid Packaging on Vaping Product Perceptions Among Youth in England, Canada, and the United States: A Randomized Online Experiment. Nicotine Tob Res 2024; 26:370-379. [PMID: 37542732 PMCID: PMC10882429 DOI: 10.1093/ntr/ntad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/21/2023] [Accepted: 08/04/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Vaping is not risk-free but can help those who smoke to reduce harm to health and stop smoking. However, packaging of vaping products, including e-liquids, appeals to youth and might facilitate vaping among nicotine-naïve people. Standardized packaging of vaping products could moderate the appeal of vaping among youth. This study assessed how youth interest in trying and perceived health harms of using e-liquids are associated with branded or standardized (white or olive) e-liquid packaging with different nicotine levels displayed. AIMS AND METHODS A between-subject experiment with three packaging and two nicotine level conditions included youth (n = 13801) aged 16 to 19 from England, Canada, and the United States as a part of a cross-sectional online survey in August-September 2021. Participants' interest in trying and perceived harm of e-liquids were analyzed using logistic and multinomial regressions adjusted for age, sex, race or ethnicity, country, vaping, and smoking status. RESULTS Compared with branded e-liquid packs, more youth reported no interest in trying e-liquids in white (aOR = 1.48, 95% CI = 1.34 to 1.64) or olive (aOR = 1.62, 95% CI: 1.47 to 1.80) standardized packs. Compared with branded e-liquid packs, more youth inaccurately perceived e-liquids in white (aOR = 1.22, 95% CI: 1.11 to 1.34) or olive (aOR = 1.29, 95% CI: 1.18 to 1.41) standardized packs as equally or more harmful than smoking. E-liquid nicotine levels displayed on packs were not associated with youth interest in trying or harm perceptions of using e-liquids. CONCLUSIONS Among 16- to 19-year-old youth from England, Canada, and the United States, standardized packaging of e-liquids was associated with lower interest in trying and higher health risk perceptions. IMPLICATIONS Branded packaging of vaping products appeal to youth and might prompt nicotine use among those who had never smoked. This study suggests that restricting branding elements on e-liquid packaging is associated with youth's lower interest in trying e-liquids and higher misperceptions that vaping is equally or more harmful than smoking. Standardized packaging might reduce appeal of vaping among youth, but its potential to discourage vaping for harm reduction should also be considered.
Collapse
Affiliation(s)
- Erikas Simonavičius
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Katherine East
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eve Taylor
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matilda Nottage
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
13
|
Mercier C, Pourchez J, Leclerc L, Forest V. In vitro toxicological evaluation of aerosols generated by a 4th generation vaping device using nicotine salts in an air-liquid interface system. Respir Res 2024; 25:75. [PMID: 38317149 PMCID: PMC10845662 DOI: 10.1186/s12931-024-02697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Electronic cigarettes (EC) have gained popularity, especially among young people, with the introduction of fourth-generation devices based on e-liquids containing nicotine salts that promise a smoother vaping experience than freebase nicotine. However, the toxicological effects of nicotine salts are still largely unknown, and the chemical diversity of e-liquids limits the comparison between different studies to determine the contribution of each compound to the cytotoxicity of EC aerosols. Therefore, the aim of this study was to evaluate the toxicological profile of controlled composition e-liquid aerosols to accurately determine the effects of each ingredient based on exposure at the air-liquid interface. METHODS Human lung epithelial cells (A549) were exposed to undiluted aerosols of controlled composition e-liquids containing various ratios of propylene glycol (PG)/vegetable glycerin (VG) solvents, freebase nicotine, organic acids, nicotine salts, and flavoured commercial e-liquids. Exposure of 20 puffs was performed at the air-liquid interface following a standard vaping regimen. Toxicological outcomes, including cytotoxicity, inflammation, and oxidative stress, were assessed 24 h after exposure. RESULTS PG/VG aerosols elicited a strong cytotoxic response characterised by a 50% decrease in cell viability and a 200% increase in lactate dehydrogenase (LDH) production, but had no effects on inflammation and oxidative stress. These effects occurred only at a ratio of 70/30 PG/VG, suggesting that PG is the major contributor to aerosol cytotoxicity. Both freebase nicotine and organic acids had no greater effect on cell viability and LDH release than at a 70/30 PG/VG ratio, but significantly increased inflammation and oxidative stress. Interestingly, the protonated form of nicotine in salt showed a stronger proinflammatory effect than the freebase nicotine form, while benzoic acid-based nicotine salts also induced significant oxidative stress. Flavoured commercial e-liquids was found to be cytotoxic at a threshold dose of ≈ 330 µg/cm². CONCLUSION Our results showed that aerosols of e-liquids consisting only of PG/VG solvents can cause severe cytotoxicity depending on the concentration of PG, while nicotine salts elicit a stronger pro-inflammatory response than freebase nicotine. Overall, aerosols from fourth-generation devices can cause different toxicological effects, the nature of which depends on the chemical composition of the e-liquid.
Collapse
Affiliation(s)
- Clément Mercier
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France.
| | - Jérémie Pourchez
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
| | - Lara Leclerc
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
| | - Valérie Forest
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
| |
Collapse
|
14
|
Brouwer AF, Jeon J, Jimenez-Mendoza E, Land SR, Holford TR, Friedman AS, Tam J, Mistry R, Levy DT, Meza R. Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of adults in the PATH Study in 2017-2019 vs 2019-2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.20.23297320. [PMID: 37905028 PMCID: PMC10614990 DOI: 10.1101/2023.10.20.23297320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Introduction The use of cigarettes and electronic nicotine delivery system (ENDS) has likely changed since 2019 with the rise of pods and disposables, the outbreak of lung injuries related to vaping THC, flavor bans, and the COVID pandemic. We analyzed patterns of initiation, cessation, and transitions between cigarettes, ENDS, and dual use before and after 2019. Methods Using the Population Assessment of Tobacco and Health (PATH) Study, we applied a multistate transition model to 28,061 adults in Waves 4-5 (2017-19) and 24,751 adults in Waves 5-6 (2019-21), estimating transition rates for initiation, cessation, and switching products for each period overall and by age group. Results Cigarette initiation among adults who never used either product decreased from 2017-19 to 2019-21, but ENDS initiation did not significantly change. Persistence of ENDS-only use remained high, with 75-80% still using ENDS only after 1 year. Cigarette-only use transitions remained similar, with about 88% remaining, 7% transitioning to non-current use, and 5% transitioning to dual or ENDS-only use. In contrast, dual use to ENDS-only transitions increased from 9.5% (95%CI: 7.3-11.7%) to 20.1% (95%CI: 17.5-22.7%) per year from 2017-19 to 2019-21, decreasing the persistence of dual use. The dual use to cigarette-only transition remained at about 25%. These changes were qualitatively similar across adult age groups, though adults ages 18-24 years exhibited the highest probability of switching from cigarette-only use to dual use and from dual use to ENDS-only use. Conclusions Persistence of ENDS use among adults remained high in 2019-21, but a larger fraction of dual users transitioned to ENDS-only use compared to 2017-19. Because the fraction of cigarette-only users switching to dual use remained low, the public health implications of the increased dual use to ENDS-only transition are minimal.
Collapse
Affiliation(s)
- Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Stephanie R. Land
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States
| | | | - Abigail S. Friedman
- Department of Health Management and Policy, Yale University, New Haven, CT, United States
| | - Jamie Tam
- Department of Health Management and Policy, Yale University, New Haven, CT, United States
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - David T. Levy
- Department of Oncology, Georgetown University, Washington, DC, United States
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
15
|
Gong JY, Ghosh M, Hoet PH. Association between metal exposure from e-cigarette components and toxicity endpoints: A literature review. Regul Toxicol Pharmacol 2023; 144:105488. [PMID: 37657743 DOI: 10.1016/j.yrtph.2023.105488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/03/2023]
Abstract
Electronic cigarette is often promoted and perceived as an 'healthy' alternative compared to conventional cigarettes. However, growing body of evidence indicate the possible adverse health effect associated with e-cigarette. Here we reviewed the literature with a focus on metal exposure in relation to e-cigarette use and related toxicity endpoints. Twenty-nine studies were identified for full text screening after applying the screening criteria of which 5 in vitro studies and 11 epidemiological studies were included for data extraction. Cr, Cu, Ni, Sn are the most found metal in all studies. In vitro, metal from e-cigarette (liquid or aerosols) induced cytotoxicity, oxidative stress, genotoxicity and pro-inflammatory responses. It was observed that the presence of nicotine can influence metal-induced in vitro toxicity. Based on epidemiological studies, the metal burden in e-cigarette users showed to be elevated in different populations (including e.g. NHANES). However, most often such studies were limited by the missing user characteristics, and information of other potential sources of metal exposure. In general, metals from e-cigarette use can be associated with toxicity endpoints but to uncover the metal related hazard of e-cigarette in users, more detailed data on metals in vapors and e-liquids; user habits and user demographics are needed.
Collapse
Affiliation(s)
- Jia-You Gong
- Laboratory of Toxicology, Unit of Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Manosij Ghosh
- Laboratory of Toxicology, Unit of Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
| | - Peter Hm Hoet
- Laboratory of Toxicology, Unit of Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
| |
Collapse
|
16
|
Cho YJ, Brinkman MC, Hinton A, Nshimiyimana JD, Mehta T, Adeniji A, Norton K, El Hellani A, Wagener TL. The sweet spot study-Developing e-liquid product standards for nicotine form and concentration to improve public health: Protocol for a randomized, double-blinded, crossover study. PLoS One 2023; 18:e0291522. [PMID: 37699050 PMCID: PMC10497122 DOI: 10.1371/journal.pone.0291522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/01/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES E-cigarettes pose significant risks to youth, but smokers may benefit from switching to e-cigarettes by reducing their exposure to toxicants, which creates a challenge for the Food and Drug Administration (FDA) in regulating e-cigarettes to protect population health. This study aims to develop e-liquid product standards for nicotine form and concentration that reduce the appeal of e-cigarettes to young people while keeping e-cigarettes available as a safer alternative for smokers. DESIGN AND PARTICIPANTS A single-visit, double-blinded, randomized crossover design will be used to examine the effects of e-liquids with varying fractions of free-base nicotine (5%, 25%, 45%, 65%, 85%) among a sample of 66 young adult EC users and 66 older adult smokers, across ecologically valid total nicotine concentrations (20 mg or 50 mg/mL). INTERVENTIONS AND OUTCOMES A 2-puff session will be conducted to test each of the 10 e-liquids in randomly assigned sequences, followed by a 10-minute washout period and participant ratings on appeal and sensory attributes such as throat hit and harshness, as well as behavioral intentions for continued use. Generalized linear mixed models will be used to determine a free-base nicotine level that has limited or no appeal to young adult e-cigarette users while remaining acceptable to smokers. CONCLUSIONS This study will provide the FDA with scientific evidence regarding the effect of product standards that mandate a minimum threshold for the fraction of free-base nicotine. TRIAL REGISTRATION The study is registered on clinicaltrials.gov under the identifier NCT05864586.
Collapse
Affiliation(s)
- Yoo Jin Cho
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Marielle C. Brinkman
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Alice Hinton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Jean D. Nshimiyimana
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Toral Mehta
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Ayomipo Adeniji
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Kaila Norton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Ahmad El Hellani
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| |
Collapse
|
17
|
Bautista M, Mogul AS, Fowler CD. Beyond the label: current evidence and future directions for the interrelationship between electronic cigarettes and mental health. Front Psychiatry 2023; 14:1134079. [PMID: 37645635 PMCID: PMC10460914 DOI: 10.3389/fpsyt.2023.1134079] [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: 12/29/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Electronic cigarette use has dramatically increased over the last decade. With this recent technological development and wide range of constituents in various products, putative adverse effects on the brain and body have been largely unexplored. Here, we review current evidence linking electronic nicotine cigarette use with potential health consequences and provide evidence supporting an association between drug use and depression in humans. We also examine the biological effects of individual constituents in electronic cigarette aerosols, which include labeled ingredients, such as propylene glycol, vegetable glycerin, nicotine, and flavorants, as well as unlabeled ingredients found in the aerosols, such as carbonyls and heavy metals. Lastly, we examine the effects of electronic cigarette use on endogenous metabolism via changes in cytochrome P450 enzymes, which can thereby impact therapeutic outcomes. While the current evidence offers insight into the potential effects of electronic cigarette use on biological processes, further studies are necessary to determine the long-term clinical relevance of aerosol inhalation.
Collapse
Affiliation(s)
| | | | - Christie D. Fowler
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
| |
Collapse
|
18
|
Dewhirst T. 'Proudly Canadian' and 'no Big Tobacco affiliation': STLTH e-cigarette advertising and positioning in Canada. Tob Control 2023:tc-2023-057960. [PMID: 37208170 DOI: 10.1136/tc-2023-057960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Timothy Dewhirst
- Department of Marketing and Consumer Studies, Gordon S. Lang School of Business and Economics, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
19
|
Chien JY, Gu YC, Liu CH, Tsai HM, Lee CN, Yang AC, Huang J, Wang YL, Wang JK, Lin CH. Rapid detection of nicotine and benzoic acid in e-liquids with surface-enhanced Raman scattering and artificial intelligence-assisted spectrum interpretation. J Pharm Biomed Anal 2023; 233:115456. [PMID: 37285659 DOI: 10.1016/j.jpba.2023.115456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/07/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
Electronic cigarettes have rapidly gained acceptance recently. Nicotine-containing electronic cigarette liquids (e-liquids) are prohibited in some countries, but are permitted and simply available online in others. A rapid detection method is therefore required for on-site inspection or screening of a large amount of samples. Our previous study demonstrated a surface-enhanced Raman scattering (SERS)-based approach to identify nicotine-containing e-liquids; without any pre-treatment, e-liquid can be directly tested on our solid-phase SERS substrates, made of silver nanoparticle arrays embedded in anodic aluminium oxide nanochannels (Ag/AAO). However, this approach required manual determination of spectral signatures and negative samples should be validated in the second round detection. Here, after examining 406 commercial e-liquids, we refined this approach by developing artificial intelligence (AI)-assisted spectrum interpretations. We also found that nicotine and benzoic acid can be simultaneously detected in our platform. This increased test sensitivity because benzoic acid is usually used in nicotine salts. Around 64% of nicotine-positive samples in this study showed both signatures. Using either cutoffs of nicotine and benzoic acid peak intensities or a machine learning model based on the CatBoost algorithm, over 90% of tested samples can be correctly discriminated with only one round of SERS measurement. False negative and false positive rates were 2.5-4.4% and 4.4-8.9%, respectively, depending on the interpretation method and thresholds applied. The new approach takes only 1 microliter of sample and can be performed in 1-2 min, suitable for on-site inspection with portable Raman detectors. It could also be a complementary platform to reduce samples that need to be analyzed in the central labs and has the potential to identify other prohibited additives.
Collapse
Affiliation(s)
- Jun-Yi Chien
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei, Taiwan
| | - Yong-Chun Gu
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei, Taiwan
| | - Chun-Hao Liu
- Department of Health, New Taipei City Government, New Taipei City, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Hsin-Mei Tsai
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei, Taiwan
| | - Chieh-Ning Lee
- Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Albert C Yang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Yuh-Lin Wang
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei, Taiwan
| | - Juen-Kai Wang
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei, Taiwan; Center for Condensed Matter Sciences, National Taiwan University, Taipei, Taiwan
| | - Chi-Hung Lin
- Department of Biological Science & Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Institute of Microbiology & Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
20
|
Brouwer AF, Jeon J, Jimenez-Mendoza E, Land SR, Holford TR, Friedman AS, Tam J, Mistry R, Levy DT, Meza R. Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of youth and adults in the PATH Study in 2015-2017 vs 2017-2019. Tob Control 2023:tc-2022-057905. [PMID: 36977570 PMCID: PMC10533746 DOI: 10.1136/tc-2022-057905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION It is unknown how recent changes in the tobacco product marketplace have impacted transitions in cigarette and electronic nicotine delivery system (ENDS) use. METHODS A multistate transition model was applied to 24 242 adults and 12 067 youth in waves 2-4 (2015-2017) and 28 061 adults and 12 538 youth in waves 4 and 5 (2017-2019) of the Population Assessment of Tobacco and Health Study. Transition rates for initiation, cessation and product transitions were estimated in multivariable models, accounting for gender, age group, race/ethnicity and daily versus non-daily product use. RESULTS Changes in ENDS initiation/relapse rates depended on age, including among adults. Among youth who had never established tobacco use, the 1-year probability of ENDS initiation increased after 2017 from 1.6% (95% CI 1.4% to 1.8%) to 3.8% (95% CI 3.4% to 4.2%). Persistence of ENDS-only use (ie, 1-year probability of continuing to use ENDS only) increased for youth from 40.7% (95% CI 34.4% to 46.9%) to 65.7% (95% CI 60.5% to 71.1%) and for adults from 57.8% (95% CI 54.4% to 61.3%) to 78.2% (95% CI 76.0% to 80.4%). Persistence of dual use similarly increased for youth from 48.3% (95% CI 37.4% to 59.2%) to 60.9% (95% CI 43.0% to 78.8%) and for adults from 40.1% (95% CI 37.0% to 43.2%) to 63.8% (95% CI 59.6% to 67.6%). Youth and young adults who used both products became more likely to transition to ENDS-only use, but middle-aged and older adults did not. CONCLUSIONS ENDS-only and dual use became more persistent. Middle-aged and older adults who used both products became less likely to transition to cigarette-only use but not more likely to discontinue cigarettes. Youth and young adults became more likely to transition to ENDS-only use.
Collapse
Affiliation(s)
| | - Jihyoun Jeon
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Stephanie R Land
- Tobacco Control Research Branch, National Cancer Institute Division of Cancer Control and Population Sciences, Rockville, Maryland, USA
| | - Theodore R Holford
- Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Abigail S Friedman
- Health Management and Policy, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Jamie Tam
- Health Management and Policy, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Ritesh Mistry
- Health Behavior Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Rafael Meza
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
- Integrative Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada
| |
Collapse
|
21
|
Staal YCM, Li Y, Gerber LS, Fokkens P, Cremers H, Cassee FR, Talhout R, Westerink RHS, Heusinkveld HJ. Neuromodulatory and neurotoxic effects of e-cigarette vapor using a realistic exposure method. Inhal Toxicol 2023; 35:76-85. [PMID: 36053669 DOI: 10.1080/08958378.2022.2118911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most direct effects of inhaled harmful constituents are the effects on the airways. However, inhaled compounds can be rapidly absorbed and subsequently result in systemic effects. For example, e-cigarette vapor has been shown to evoke local effects in the lung, although little is known about subsequent effects in secondary target organs such as the brain. Traditionally, such effects are tested using in vivo models. As an alternative, we have combined two in vitro systems, which are Air-Liquid-Interface (ALI) cultured alveolar cells (A549) and rat primary cortical cultures grown on multi-well microelectrode arrays. This allows us to assess the neurological effects of inhaled compounds. We have used exposure to e-cigarette vapor, containing nicotine, menthol, or vanillin to test the model. Our results show that ALI cultured A549 cells respond to the exposure with the production of cytokines (IL8 and GROalpha). Furthermore, nicotine, menthol, and vanillin were found on the basolateral side of the cell culture, which indicates their translocation. Upon transfer of the basolateral medium to the primary cortical culture, exposure-related changes in spontaneous electrical activity were observed correlating with the presence of e-liquid components in the medium. These clear neuromodulatory effects demonstrate the feasibility of combining continuous exposure of ALI cultured cells with subsequent exposure of neuronal cells to assess neurotoxicity. Although further optimization steps are needed, such a combination of methods is important to assess the neurotoxic effects of inhaled compounds realistically. As such, an approach like this could play a role in future mechanism-based risk assessment strategies.
Collapse
Affiliation(s)
- Yvonne C M Staal
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Yixuan Li
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Lora-Sophie Gerber
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Paul Fokkens
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Hans Cremers
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Flemming R Cassee
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Reinskje Talhout
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Remco H S Westerink
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Harm J Heusinkveld
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| |
Collapse
|
22
|
Thirlway F. Subculture wars: The struggle for the vape industry. THE BRITISH JOURNAL OF SOCIOLOGY 2023; 74:3-16. [PMID: 36329664 PMCID: PMC10092283 DOI: 10.1111/1468-4446.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/25/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Drawing on a 2-year study, I argue that the UK vape industry is engaged in a classificatory struggle between a subcultural industry and its "other", the mainstream industry. I build on Thornton's analysis of club culture to characterize the subcultural vape industry as a community of taste built round a masculine aesthetic and a commitment to authenticity and DIY practice. Its attachment to complex systems and masculine spaces risked excluding customers without specialist knowledge or interest. The mainstream industry included tobacco companies which promoted vaping as a complementary category to smoking, linking their own vaping products to historic meanings of the cigarette as a lifestyle product. This task was hampered by the toxic legacy of combusted tobacco and its increasing reversion to a generic category rather than a branded product. Finally, the success of the price-focused vaping industry has been largely overlooked, but suggests that for most consumers, electronic cigarettes are still a contrasting category to combusted tobacco and are purchased largely on price. I conclude that the exclusion of a feminized, classed "other" is a defining element of subcultural formation, itself an overwhelmingly male mechanism of group identity construction.
Collapse
|
23
|
Wu S, Kim E, Vethanayagam D, Zhao R. Indoor partitioning and potential thirdhand exposure to carbonyl flavoring agents added in e-cigarettes and hookah tobacco. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2022; 24:2294-2309. [PMID: 36408779 DOI: 10.1039/d2em00365a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Flavoring agents added to the e-cigarettes and hookah tobacco have increased the attractiveness of novel nicotine products. Many widely used flavorings are carbonyls, which are toxic to humans. In an indoor environment, residents can be exposed to such harmful flavorings previously emitted to the surrounding environment, through a process termed thirdhand exposure. The recent discovery of a large volume of indoor reservoirs emphasizes the importance of indoor partitioning, which is responsible for thirdhand exposure. Indoor partitioning can be expressed with partitioning coefficients, such as Henry's law solubility constant (H). However, reliable H values for many key flavorings are currently lacking. To better understand their environmental behavior, this study experimentally determined the effective Henry's law constant (Hcps,eff) using the inert gas stripping (IGS) method. Further, the influence of the hydration process for target flavorings was quantified using proton nuclear magnetic resonance (1H NMR) spectroscopy. We found that hydration of α-dicarbonyls (diacetyl and 2,3-pentanedione) enhanced their Hcps,eff from their intrinsic Henry's law constant (Hcps) by a factor of 3.52 and 2.88, respectively. The two-dimensional partitioning plots were employed to simulate the indoor phase distribution and evaluate the pathways of human exposure. Our findings show that the indoor partitioning of many harmful flavorings is highly sensitive to temperature and the size of indoor reservoirs, indicating that residents are likely to experience third-hand exposure.
Collapse
Affiliation(s)
- Shuang Wu
- Department of Chemistry, University of Alberta, Edmonton, Alberta, T6G 2G2, Canada.
| | - Erica Kim
- Department of Chemistry, University of Alberta, Edmonton, Alberta, T6G 2G2, Canada.
| | - Dilini Vethanayagam
- Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G2, Canada
| | - Ran Zhao
- Department of Chemistry, University of Alberta, Edmonton, Alberta, T6G 2G2, Canada.
| |
Collapse
|
24
|
Huang P, Zheng W, Shi Y, Shi L, Wu W, Lin X, Zeng X, He F, Liu M, Chen X. Beliefs and perceptions of electronic cigarettes among medical staff in respiratory departments of Fujian Province, China, in 2021. Tob Induc Dis 2022; 20:111. [PMID: 36561425 PMCID: PMC9743794 DOI: 10.18332/tid/156038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Due to the popularity of e-cigarettes, more and more patients ask about e-cigarettes, and it is particularly important to understand doctors' beliefs and perceptions on e-cigarettes. The aim was to evaluate the belief and perception of electronic cigarettes among medical staff in the respiratory department of medical institutions located in Fujian Province. METHODS The electronic questionnaires were conveyed to the medical staff of the respiratory department in Fujian Province during March to April 2021. Descriptive statistics were calculated for all questions, and the relationship between relevant factors and the perception of e-cigarette-related statements was analyzed by logistic regression analysis. RESULTS Among 1028 medical staff in the respiratory departments of Fujian Province, 90.5% of medical staff agreed that electronic cigarettes are harmful to the human body; 61.4% of medical staff agreed that e-cigarettes cannot be regarded as a type of smoking cessation treatment; 71.7% of medical staff agreed that e-cigarettes could be a 'gateway' to other tobacco use; and 69.2% of medical staff agreed that electronic cigarettes are in 'Three No' states. The multivariate logistic regression analysis showed that the respondents' perception of 'e-cigarettes cannot be regarded as a type of smoking cessation treatment' were related to gender, professional title and whether they participated in the cessation clinic. CONCLUSIONS The medical staff of the respiratory department in Fujian Province put more emphasis on the adverse effects of e-cigarettes on health, but lack the cognition of the effect of e-cigarette smoking cessation. In order to better carry out smoking cessation work, it is necessary to strengthen the training of respiratory medical staff at all levels of medical institutions on e-cigarette knowledge.
Collapse
Affiliation(s)
- Pengxiang Huang
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Wanyu Zheng
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yangzhen Shi
- Department of Pulmonary and Critical Care Medicine, Jinjiang Municipal Hospital, Quanzhou, China
| | - Liyong Shi
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Weijing Wu
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiaoping Lin
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiaohong Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Fei He
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Maolin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaoyang Chen
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| |
Collapse
|
25
|
Aly AS, Mamikutty R, Marhazlinda J. Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth-A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1678. [PMID: 36360406 PMCID: PMC9689130 DOI: 10.3390/children9111678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 08/16/2023]
Abstract
BACKGROUND Recognising the association between the perceived risks of e-cigarettes and e-cigarette usage among youth is critical for planning effective prevention and intervention initiatives; thus, a systematic review and meta-analysis were performed. METHODS Fourteen databases were searched for eligible studies from the Inception of database until March 2022 to examine the effect estimates of the association between perceptions of harmfulness and addictiveness and overall e-cigarette usage among adolescents and youth. RESULTS The meta-analysis showed that in comparison to non-users, young people who were ever e-cigarette users were two times more likely to disagree that e-cigarettes are harmful (OR: 2.20, 95% CI: 1.41-3.43) and perceived e-cigarettes as less harmful than tobacco cigarettes (OR: 2.01, 95% CI 1.47-2.75). Youths who were ever e-cigarette users were also 2.3 and 1.8 times more likely to perceive e-cigarettes as less addictive (OR: 2.28, 95% CI: 1.81-2.88) or perceive e-cigarettes as more addictive (OR: 1.82, 95% CI: 1.22-2.73) than tobacco cigarettes, as compared with non-users. The subgroup analysis reported that adolescents were more likely to believe that e-cigarettes are less harmful than tobacco cigarettes, while youth users perceived otherwise. CONCLUSION the risk perceptions of e-cigarettes are associated with e-cigarette use among adolescents and youth and could be the focus of health promotion to prevent and curb the uptake of e-cigarettes among young people.
Collapse
Affiliation(s)
- Ameera Syafiqah Aly
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Oral Health Program, Ministry of Health, Putrajaya 62590, Malaysia
| | - Rokiah Mamikutty
- Oral Health Program, Ministry of Health, Putrajaya 62590, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| |
Collapse
|
26
|
Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
Collapse
Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
| |
Collapse
|
27
|
Abstract
Policy Points The commercial determinants of health (CDoH) concept, which currently focuses on markets that harm health, should be expanded to refer to the interface between commerce and health, which can sometimes have positive public health consequences. The regulatory stances framework helps us classify public health preferences for regulating specific markets related to CDoH, based on the intended effects of regulations on market size. The regulatory stances a jurisdiction can adopt can be classified as ranging from prohibitionist through contractionist, permissive, and expansionist, to universalist. The regulatory stances framework increases the usefulness of the CDoH concept by expanding the conversation beyond negative determinants of health and providing a fuller view of the tools at the disposal of society to alter markets and improve health. CONTEXT The effects of commerce on the public health are omnipresent. The commercial determinants of health (CDoH) represent a burgeoning area of scholarly debate and activist policymaking to redress markets that adversely affect public health. The CDoH debate is a logical extension of the tobacco control movement, but, to its detriment, the CDoH conversation remains primarily focused policies and proposals that are analogous to historical tobacco control strategies. METHODS This paper argues that for the CDoH to develop further and broaden its appeal, it should expand to cover markets with conditional and positive impacts on health. To explain and order this conversation, a comparative framework for regulatory policy is introduced: the regulatory stances. The regulatory stances classify a regulatory policy based on the intended effect of policy on the size of a market in the future relative to the present. FINDINGS Some markets that interface between commerce and health do not inherently harm health. Regulatory policy toward these markets should be different in intent than regulatory policy for markets with negative health effects. CONCLUSIONS By using the regulatory stances framework to encompass markets that have positive or conditional effects on health as well as those that have adverse health effects, the CDoH conversation can shift away from the exclusive focus on strategies to shrink markets with adverse health impacts to consider a wider array of policy options.
Collapse
Affiliation(s)
- ALEX C. LIBER
- Georgetown University Lombardi Comprehensive Cancer Center
| |
Collapse
|
28
|
Romm KF, Henriksen L, Huang J, Le D, Clausen M, Duan Z, Fuss C, Bennett B, Berg CJ. Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas. Prev Med Rep 2022; 28:101901. [PMID: 35855926 PMCID: PMC9287473 DOI: 10.1016/j.pmedr.2022.101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022] Open
Abstract
Given the 2020 federal restrictions on flavored cartridge-based e-cigarettes and increasing state/local flavored e-cigarette sales restrictions, this mixed-methods study examined US young adult e-cigarette users' responses to flavored e-cigarette sales restrictions (e.g., changes in use, products used, access). We descriptively analyzed Fall 2020 survey data from 726 past 6-month e-cigarette users (Mage = 24.15, 51.1% female, 4.4% Black, 10.2% Asian, 12.1% Hispanic, 35.5% sexual minority), and qualitatively analyzed Spring 2021 semi-structured interview data among 40 participants (Mage = 26.30, 35.0% female, 5.0% Black, 22.5% Asian, 12.5% Hispanic, 45.0% sexual minority). Across all participants (i.e., survey and interview participants), ≥80% most commonly used non-tobacco flavors; ≥40% used tank-based devices. Survey participants most commonly reported that the federal restrictions did not impact their use: 35.8% used available flavors (i.e., tobacco, menthol), 30.4% continued to use tank-based e-cigarettes, and 10.1% switched to tank-based e-cigarettes. Only 8.4% reduced their e-cigarette use. Among interview participants, some indicated no impact on their e-cigarette use because they stocked up or obtained flavors from alternative sources (e.g., online). Some filled their own pods with e-liquids, switched to menthol/tobacco flavors, switched e-cigarette devices or brands, and/or reduced use. Regarding the anticipated impact of comprehensive flavor restrictions, some participants reported that they would: 1) quit vaping; 2) switch to cigarettes; or 3) not change their use (e.g., stock up on flavors). The potential unintended reactions to flavored e-cigarette sales restrictions (e.g., continued use of flavored cartridge-based e-cigarettes) underscore the need for ongoing surveillance of retail and consumer behavior to inform policy and compliance/enforcement efforts.
Collapse
Affiliation(s)
- Katelyn F. Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jidong Huang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Daisy Le
- George Washington Cancer Center, George Washington University, Washington, DC, USA
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, Washington, DC, USA
| | - Michelle Clausen
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, Washington, DC, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
| | - Caroline Fuss
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Breesa Bennett
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| |
Collapse
|
29
|
Coats EM, Farrelly MC, Henes AL, Pikowski JM, Brown EM, Nonnemaker JM. Youth vaping beliefs and behaviors: evidence from New York. HEALTH EDUCATION RESEARCH 2022; 37:254-265. [PMID: 35727195 DOI: 10.1093/her/cyac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Current use of vaping products has increased in recent years among youth in the United States. We conducted cross-sectional surveys of vaping product users aged 15-17 in New York in 2017 and 2019 to assess vaping freqency, reported nicotine content of vaping products used, risk perceptions of vaping and openness to vaping cannabis (2019 survey only). Between 2017 and 2019, the proportion of youth vapers who were frequent vaping product users increased from 16.8% to 26.2% (P < 0.05). The proportion of youth vapers who usually used high-nicotine vaping products also increased, from 12.6% to 40.0% (P < 0.05). In both years, the use of high-nicotine vaping products was positively associated with frequent use (P < 0.05). The perceived likelihood of harm from vaping increased (P < 0.05), but respondents' perception of harm from using tobacco-flavored vaping products remained higher than that from using menthol/mint or sweet flavors. In 2019, 60.6% of respondents reported having tried vaping cannabis. Results suggest shifts in youth vaping behavior toward more frequent use and use of higher nicotine vaping products, support previous findings about youth misperceptions about health risks of flavored vaping products and highlight openness to vaping cannabis among youth vaping product users.
Collapse
Affiliation(s)
- Ellen M Coats
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - Matthew C Farrelly
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - Amy L Henes
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - Jessica M Pikowski
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - Elizabeth M Brown
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - James M Nonnemaker
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| |
Collapse
|
30
|
Hammond D, Reid JL, Burkhalter R, Bansal Travers M, Gravely S, Hyland A, Kasza K, McNeill A. E-Cigarette Flavors, Devices, and Brands Used by Youths Before and After Partial Flavor Restrictions in the United States: Canada, England, and the United States, 2017‒2020. Am J Public Health 2022; 112:1014-1024. [PMID: 35622007 PMCID: PMC9222458 DOI: 10.2105/ajph.2022.306780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the impact of US restrictions implemented in February 2020 prohibiting flavors other than menthol and tobacco in cartridge-based e-cigarettes. Methods. We analyzed 5 cross-sectional waves of the International Tobacco Control Policy Evaluation Project Youth Tobacco and Vaping Surveys, conducted online with youths aged 16 to 19 years in the United States, Canada, and England, for differences in usual e-cigarette flavor, device, and brand reported by past-30-day vapers (n = 9512) before (2017, 2018, 2019), during (February 2020), and after (August 2020) implementation of US flavor restrictions. Results. In August 2020, 78.7% of vapers in the United States reported using a flavor prohibited in cartridges or pods, versus 86.3% in Canada (adjusted odds ratio [AOR] = 1.73; 95% CI = 1.25, 1.40) and 79.8% in England (AOR = 1.10; 95% CI = 0.78, 1.55). Disposable e-cigarettes (exempt from flavor restrictions) increased to a greater extent among vapers in the United States (13.2% to 36.8%) versus Canada (7.7% to 14.2%; AOR = 2.01; 95% CI = 1.33, 3.04) and England (10.8% to 16.4%; AOR = 2.33; 95% CI = 1.52, 3.57). Puff Bar (disposable) emerged as the most popular brand in the United States. Conclusions. Usual flavors used by youth vapers in the United States were unchanged after 2020 restrictions on cartridge-based e-cigarettes. Youths used brands and devices exempt from the restrictions. (Am J Public Health. 2022;112(7):1014-1024. https://doi.org/10.2105/AJPH.2022.306780).
Collapse
Affiliation(s)
- David Hammond
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Jessica L Reid
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Robin Burkhalter
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Maansi Bansal Travers
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Shannon Gravely
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Andy Hyland
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Karin Kasza
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Ann McNeill
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| |
Collapse
|
31
|
East K, Reid JL, Burkhalter R, Wackowski OA, Thrasher JF, Tattan-Birch H, Boudreau C, Bansal-Travers M, Liber AC, McNeill A, Hammond D. Exposure to negative news stories about vaping, and harm perceptions of vaping, among youth in England, Canada, and the US before and after the outbreak of E-cigarette or Vaping-Associated Lung Injury (EVALI). Nicotine Tob Res 2022; 24:1386-1395. [PMID: 35368062 PMCID: PMC9356695 DOI: 10.1093/ntr/ntac088] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 02/02/2023]
Abstract
Introduction Little is known about the international impact of E-cigarette or Vaping-Associated Lung Injury (‘EVALI’) on youth perceptions of vaping harms. Methods Repeat cross-sectional online surveys of youth aged 16–19 years in England, Canada, and the United States before (2017, 2018), during (2019 August/September), and after (2020 February/March, 2020 August) the ‘EVALI’ outbreak (N = 63380). Logistic regressions assessed trends, country differences, and associations between exposure to negative news stories about vaping and vaping harm perceptions. Results Exposure to negative news stories increased between 2017 and February–March 2020 in England (12.6% to 34.2%), Canada (16.7% to 56.9%), and the United States (18.0% to 64.6%), accelerating during (2019) and immediately after (February–March 2020) the outbreak (p < .001) before returning to 2019 levels by August 2020. Similarly, the accurate perception that vaping is less harmful than smoking declined between 2017 and February–March 2020 in England (77.3% to 62.2%), Canada (66.3% to 43.3%), and the United States (61.3% to 34.0%), again accelerating during and immediately after the outbreak (p < .001). The perception that vaping takes less than a year to harm users’ health and worry that vaping will damage health also doubled over this period (p ≤ .001). Time trends were most pronounced in the United States. Exposure to negative news stories predicted the perception that vaping takes less than a year to harm health (Adjusted Odds Ratio = 1.55, 1.48-1.61) and worry that vaping will damage health (Adjusted Odds Ratio = 1.32, 1.18-1.48). Conclusions Between 2017 and February–March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after ‘EVALI’. Effects were seen in all countries but were most pronounced in the United States. Implications This is the first study examining changes in exposure to news stories about vaping, and perceptions of vaping harms, among youth in England, Canada, and the United States before, during, and after ‘EVALI’. Between 2017 and February–March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after ‘EVALI’. By August 2020, exposure to negative news stories returned to 2019 levels, while perceptions of harm were sustained. Exposure to negative news stories also predicted two of the three harm perception measures. Overall, findings suggest that ‘EVALI’ may have exacerbated youth’s perceptions of vaping harms internationally.
Collapse
Affiliation(s)
- Katherine East
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Ontario, Canada.,National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica L Reid
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Ontario, Canada
| | - Robin Burkhalter
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Ontario, Canada
| | - Olivia A Wackowski
- School of Public Health, Rutgers, The State University of New Jersey, NJ, USA
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Ontario, Canada
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Alex C Liber
- Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Ontario, Canada
| |
Collapse
|
32
|
Zhao D, Ilievski V, Slavkovich V, Olmedo P, Domingo-Relloso A, Rule AM, Kleiman NJ, Navas-Acien A, Hilpert M. Effects of e-liquid flavor, nicotine content, and puff duration on metal emissions from electronic cigarettes. ENVIRONMENTAL RESEARCH 2022; 204:112270. [PMID: 34717948 PMCID: PMC9140018 DOI: 10.1016/j.envres.2021.112270] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/24/2021] [Accepted: 10/21/2021] [Indexed: 05/11/2023]
Abstract
Vaping is the action of inhaling and exhaling aerosols from electronic cigarettes. The aerosols contain various amounts of toxic chemicals, including metals. The purpose of this study was to evaluate factors that can influence metal levels, including flavor and nicotine content in the e-liquid, and puff duration. Aerosols were collected from both closed-system (cartridge-based) and open-system e-cigarettes using e-liquids with different flavors (fruit, tobacco, and menthol), nicotine content (0, 6, 24, and 59 mg/mL), and different puff durations (1, 2, and 4 s). The concentrations of 14 metals in the collected aerosols were measured using inductively coupled plasma mass spectroscopy. Aerosol concentrations of As, Fe, and Mn varied significantly among fruit, tobacco, and menthol flavors in both closed-system and open-system devices. Concentrations of Al, Fe, Sn, and U were significantly higher in tobacco or menthol flavored aerosols compared to fruit flavors in closed-system devices. Aerosol W levels were significantly higher in tobacco flavored aerosols compared to fruit flavors in open-system devices. Concentrations of As, Fe, and Mn were higher in tobacco flavored aerosols compared to menthol flavors in both types of devices. The median Pb concentration decreased significantly from 15.8 to 0.88 μg/kg when nicotine content increased from 0 to 59 mg/mL, and median Ni concentration was 9.60 times higher in aerosols with nicotine of 59 mg/mL compared to 24 mg/mL (11.9 vs. 1.24 μg/kg) for closed-system devices. No significant differences were observed in aerosol metal concentrations for different puff durations. Aerosol metal concentrations varied widely between different flavors and nicotine content but not by puff duration. Flavor and nicotine content of the e-liquid could be potential factors in metal emissions. Some elements showed higher concentrations under certain conditions, highlighting the urgent need of developing strict product regulations, especially on e-liquid composition and nicotine content to inform e-cigarette users about metal exposure through vaping.
Collapse
Affiliation(s)
- Di Zhao
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; State Key Laboratory of Crop Genetics and Germplasm Enhancement, College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing, China.
| | - Vesna Ilievski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Vesna Slavkovich
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Pablo Olmedo
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Spain
| | - Arce Domingo-Relloso
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Norman J Kleiman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Markus Hilpert
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| |
Collapse
|
33
|
Ling PM, Kim M, Egbe CO, Patanavanich R, Pinho M, Hendlin Y. Moving targets: how the rapidly changing tobacco and nicotine landscape creates advertising and promotion policy challenges. Tob Control 2022; 31:222-228. [PMID: 35241592 PMCID: PMC9233523 DOI: 10.1136/tobaccocontrol-2021-056552] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/01/2021] [Indexed: 01/18/2023]
Abstract
Tobacco, nicotine and related products have and continue to change rapidly, creating new challenges for policies regulating their advertising, promotion, sponsorship and sales. This paper reviews recent commercial product offerings and the regulatory challenges associated with them. This includes electronic nicotine delivery systems, electronic non-nicotine delivery systems, personal vaporisers, heated tobacco products, nicotine salts, tobacco-free nicotine products, other nicotine products resembling nicotine replacement therapies, and various vitamin and cannabis products that share delivery devices or marketing channels with tobacco products. There is substantial variation in the availability of these tobacco, nicotine, vaporised, and related products globally, and policies regulating these products also vary substantially between countries. Many of these products avoid regulation by exploiting loopholes in the definition of tobacco or nicotine products, or by occupying a regulatory grey area where authority is unclear. These challenges will increase as the tobacco industry continues to diversify its product portfolio, and weaponises 'tobacco harm reduction' rhetoric to undermine policies limiting marketing, promotion and taxation of tobacco, nicotine and related products. Tobacco control policy often lags behind the evolution of the industry, which may continue to sell these products for years while regulations are established, refined or enforced. Policies that anticipate commercial tobacco, nicotine and related product and marketing changes and that are broad enough to cover these product developments are needed.
Collapse
Affiliation(s)
- Pamela M Ling
- Department of Medicine and Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Roengrudee Patanavanich
- Department of Community Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Mariana Pinho
- Tobacco Control Project, ACT Health Promotion (Brazil), Rio de Janeiro, Brazil
| | - Yogi Hendlin
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
34
|
Hammond D, Reid JL, Rynard VL, O'Connor RJ, Goniewicz ML, Piper ME, Bansal-Travers M. Indicators of dependence and efforts to quit vaping and smoking among youth in Canada, England and the USA. Tob Control 2021; 31:tobaccocontrol-2020-056269. [PMID: 33526441 PMCID: PMC8325708 DOI: 10.1136/tobaccocontrol-2020-056269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The current study examined indicators of dependence among youth cigarette smokers and e-cigarette users in Canada, England and the USA, including changes between 2017 and 2019. METHODS Data are from repeated cross-sectional online surveys conducted in 2017, 2018 and 2019 with national samples of youth aged 16-19 years, in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Measures included perceived addiction to cigarettes/e-cigarettes, frequency of experiencing strong urges to smoke/use an e-cigarette, plans to quit smoking/using e-cigarettes and past attempts to quit. Logistic regression models were fitted to examine differences between countries and changes over time. RESULTS The proportion of ever-users who vaped frequently was significantly higher in 2019 compared with 2017 for all outcomes in each country. Between 2017 and 2019, the proportion of past 30-day vapers reporting strong urges to vape on most days or more often increased in each country (Canada: 35.3%, adjusted OR (AOR) 1.69, 95% CI 1.20 to 2.38; England: 32.8%, AOR 1.55, 1.08 to 2.23; USA: 46.1%, AOR 1.88, 1.41 to 2.50), along with perceptions of being 'a little' or 'very addicted' to e-cigarettes (Canada: 48.3%, AOR 1.99, 1.44 to 2.75; England: 40.1%, AOR 1.44, 1.03 to 2.01; USA: 53.1%, AOR 1.99, 1.50 to 2.63). Indicators of dependence among smokers were consistently greater than e-cigarette users, although differences had narrowed by 2019, particularly in Canada and the USA. CONCLUSIONS Prevalence of dependence symptoms among young e-cigarette users increased between 2017 and 2019, more so in Canada and the USA compared with England. Dependence symptom prevalence was lower for e-cigarettes than smoking; however, the gap has narrowed over time.
Collapse
Affiliation(s)
- David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Vicki L Rynard
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| |
Collapse
|