1
|
Bremmer MP, Paladino MB, Campbell AM, Xia K, Tarran R, Hendershot CS, Girdler SS. Acute analgesic effect of nicotine vaping using three experimental pain induction tasks: a randomized, placebo-controlled laboratory study. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06669-8. [PMID: 39120697 DOI: 10.1007/s00213-024-06669-8] [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: 05/17/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024]
Abstract
RATIONALE Pain and nicotine use are co-occurring conditions with a significant impact on health. Experimental evidence supports an acute analgesic effect of nicotine which may reinforce nicotine use among those with chronic pain. Evidence for nicotine analgesia have primarily been gathered in combustible cigarette users and have not been extended to electronic nicotine delivery systems (ENDS or vaping). Furthermore, the mechanisms of nicotine analgesia in humans are not well understood. OBJECTIVES Assess the effect of acute vaped nicotine on subjective and behavioral indices of pain sensitivity using three tasks designed to probe distinct mechanisms of analgesia. METHODS This study recruited ENDS users (N = 86) to undergo a paced vaping protocol followed by pain tasks in counterbalanced order. Across four sessions, participants vaped e-liquid containing nicotine or placebo, and flavor or no-flavor in a 2 × 2 within-subject design. Assessments included cold pressor, submaximal effort tourniquet to induce ischemic pain, and temporal summation of heat pain, an index of central sensitization. RESULTS Compared to placebo, nicotine increased cold pressor pain tolerance (ηp2 = 0.031), ischemic pain threshold (ηp2 = 0.073) and tolerance (ηp2 = 0.056) but had no effect on temporal summation of pain. Flavor did not affect pain sensitivity. Females reported greater ischemic pain sensitivity (ηp2 = 0.027) and greater reductions in craving (ηp2 = 0.086). CONCLUSIONS Consistent with research from tobacco smoking, analgesia may be reinforcing and contribute to nicotine dependence among ENDS users. More research on sex differences is warranted.
Collapse
Affiliation(s)
- Michael P Bremmer
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Michael B Paladino
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alana M Campbell
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kai Xia
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert Tarran
- Division of Genetic, Environmental and Inhalational Disease, Department of Internal Medicine, Kansas University Medical Center, Kansas City, KS, USA
| | - Christian S Hendershot
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan S Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Mercincavage M, Wackowski OA, Johnson AC, Young WJ, Tan ASL, Delnevo CD, Strasser AA, Villanti AC. Associations of educational and marketing messages with beliefs about nicotine and reduced nicotine cigarettes. Prev Med 2024; 185:108056. [PMID: 38944058 DOI: 10.1016/j.ypmed.2024.108056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Widespread misperceptions about nicotine may have unintended effects on public health. We examined associations between existing messages about nicotine or tobacco and beliefs about nicotine and reduced nicotine cigarettes (RNC). METHODS 2962 U.S. 18-45-year-olds were randomized in a May 2022 web-based survey to view one of 26 text-based messages about tobacco or nicotine from three sources: ongoing research (n = 8), messages authorized by FDA for VLN cigarettes (n = 6), and FDA's "From Plant to Product to Puff" campaign (n = 12); six messages from FDA's campaign did not reference nicotine and were treated as the reference source. Analyses examined associations between messages, grouped by source and individually, with beliefs about nicotine and RNC addictiveness and harms. RESULTS Relative to FDA messages that did not reference nicotine, all message sources were associated with greater odds of a correct belief about nicotine (Odds Ratios [ORs] = 1.40-1.87, p's < 0.01); VLN messages were associated with greater correct beliefs about RNC addictiveness (b = 0.23, p < .05). No campaign produced greater correct beliefs about RNC harms. At the individual level, only five messages were associated with a correct belief about nicotine (ORs = 2.12-2.56, p-values < .01), and one with correct beliefs about RNC harms (b = 1.09, p < .05), vs. the reference message. CONCLUSIONS Few existing messages improved understanding of the risks of nicotine separately from the risks of combustible products. Communication research is needed to promote greater public understanding of nicotine while minimizing unintended effects on nicotine and tobacco use.
Collapse
Affiliation(s)
- Melissa Mercincavage
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ, United States of America; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States of America.
| | - Olivia A Wackowski
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ, United States of America; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States of America
| | - Andrea C Johnson
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States of America; Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - William J Young
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ, United States of America
| | - Andy S L Tan
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States of America; Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Cristine D Delnevo
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ, United States of America; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States of America
| | - Andrew A Strasser
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States of America; Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America; Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andrea C Villanti
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ, United States of America; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States of America
| |
Collapse
|
3
|
Cheng HG, Rose JE, Karelitz JL, Botts DR, Botts TL, Willette PN, Cohen G. Effect of Flavored on! Nicotine Pouch Products on Smoking Behaviors: Protocol for a Sequential, Multiple Assignment, Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56565. [PMID: 38905632 PMCID: PMC11226927 DOI: 10.2196/56565] [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: 01/19/2024] [Revised: 03/17/2024] [Accepted: 05/08/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Cigarette smoking is a leading cause of morbidity and mortality. For adults who smoke cigarettes and cannot or will not quit smoking, smoke-free products, such as nicotine pouches, have been recognized as a potential alternative to smoking combusted cigarettes to reduce harm due to cigarette smoking. The role of flavors in these smoke-free products in tobacco harm reduction has not been fully understood. OBJECTIVE This study evaluates the effect of flavors in on! nicotine pouch products (research products) in the reduction of cigarette smoking among adults who smoke cigarettes in their natural environment. METHODS This study uses a sequential, multiple assignment, randomized trial design. Approximately 400 eligible adults who smoke cigarettes will be enrolled and randomized to have access to either the Original (unflavored) on! nicotine pouch product only or a complete flavor profile (ie, Berry, Cinnamon, Citrus, Coffee, Mint, Original, and Wintergreen) of on! nicotine pouch products. After 3 weeks, participants in the Original-only arm will be randomized again, with half remaining in the Original-only arm and half having access to the complete flavor profile for another 3 weeks. Primary outcomes are expired-air carbon monoxide (CO) levels. Secondary outcomes are self-reported cigarette consumption and CO-verified cigarette abstinence. RESULTS Recruitment and data collection started in September 2023 and is projected to last until March 2025. We anticipate completing the data analysis in 2025. As of May 2024, we have enrolled 314 participants. CONCLUSIONS This study will provide empirical evidence about the effect that flavor availability in smoke-free products may have in reducing cigarette smoking. TRIAL REGISTRATION ClinicalTrials.gov NCT06072547; https://clinicaltrials.gov/study/NCT06072547. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56565.
Collapse
Affiliation(s)
- Hui G Cheng
- Altria Client Services, LLC, Richmond, VA, United States
| | - Jed E Rose
- Rose Research Center, LLC, Raleigh, NC, United States
| | | | - David R Botts
- Rose Research Center, LLC, Raleigh, NC, United States
| | | | | | - Gal Cohen
- Rose Research Center, LLC, Raleigh, NC, United States
| |
Collapse
|
4
|
Selya A. The "Gateway" hypothesis: evaluation of evidence and alternative explanations. Harm Reduct J 2024; 21:113. [PMID: 38849956 PMCID: PMC11157890 DOI: 10.1186/s12954-024-01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS) offer a substantial harm reduction opportunity for adults who smoke and are unlikely to quit. However, a major concern about ENDS is their use by non-smoking youth, and particularly whether ENDS are acting as a "gateway" that leads youth to later start smoking cigarettes. However, evidence for the gateway hypothesis can be interpreted in alternative ways, e.g. that youth who have certain characteristics were already predisposed to use both ENDS and cigarettes ("common liability" explanation). AIMS This commentary provides an evaluation of the gateway hypothesis that is accessible by a lay audience. This paper first reviews and evaluates the evidence interpreted as supporting the gateway hypothesis. Important alternative explanations (i.e., common liability) are discussed, as are different types of evidence (i.e., population-level trends) that can help differentiate between these competing explanations. OVERVIEW Evidence for the gateway hypothesis is based on the finding that youth who use ENDS are more likely to also smoke cigarettes. However, this evidence suffers from an important flaw: these studies fail to fully account for some youths' pre-existing tendency to use products containing nicotine, and inappropriately interpret the results as ENDS use causing some youth to smoke. Common liability studies suggest that ENDS use does not, in and of itself, directly cause youth to later smoke cigarettes, beyond their pre-existing tendency to use products containing nicotine. Population-level trends show that youth cigarette smoking declined faster after ENDS use became common, which contradicts the central prediction of the gateway hypothesis (i.e. that youth smoking would be more common following ENDS uptake, than otherwise be expected). CONCLUSION Evidence offered in support of the gateway hypothesis does not establish that ENDS use causes youth to also smoke cigarettes. Instead, this evidence is better interpreted as resulting from a common liability to use both ENDS and cigarettes. Population-level trends are inconsistent with the gateway hypothesis, and instead are consistent with (but do not prove) ENDS displacing cigarettes. Policies based on misinterpreting a causal gateway effect may be ineffective at best, and risk the negative unintended consequence of increased cigarette smoking.
Collapse
Affiliation(s)
- Arielle Selya
- Pinney Associates, Inc, 201 North Craig Street, Suite 320, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
5
|
Harrington C, Walsh E. Tobacco-free campuses - a pipe dream? A survey of current smoking cessation practice in mental health units in Ireland. BJPsych Bull 2024; 48:158-162. [PMID: 37341130 PMCID: PMC11134021 DOI: 10.1192/bjb.2023.50] [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] [Received: 02/20/2023] [Accepted: 04/23/2023] [Indexed: 06/22/2023] Open
Abstract
AIMS AND METHOD Smoking and vaping are prohibited on Ireland's Health Service Executive (HSE) campuses. The HSE states that there is no evidence to suggest vaping is less damaging than cigarettes. Recent meta-analyses have shown that e-cigarettes are in fact less dangerous and can help smokers quit. Our study analyses the current smoking policies in place in mental health 'approved centres' in Ireland, what is being done to help smokers quit while in-patients and the level of support among staff for the introduction of e-cigarettes as a harm reduction tool. Clinical nurse managers from each mental health approved centre were surveyed to assess adherence to smoking policies. RESULTS Only 5% of surveyed units enforce the HSE's Tobacco Free Campus Policy; 55% of units supported the idea of using e-cigarettes to help patients quit cigarettes. CLINICAL IMPLICATIONS Ireland's hospital campuses are not tobacco free. Changes need to be made to our smoking policies and their enforcement.
Collapse
Affiliation(s)
- Colm Harrington
- National University of Ireland, Galway, Ireland
- University Hospital Galway, Galway, Ireland
| | | |
Collapse
|
6
|
Quadri MFA, Kamel AM, Nayeem M, John T, Thacheril A, Tartaglia G, Tadakamadla S. Smokeless tobacco and periodontitis: A systematic review with meta-analysis. J Periodontal Res 2024. [PMID: 38757716 DOI: 10.1111/jre.13274] [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: 12/18/2023] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
AIM The present systematic review with meta-analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries. METHODS We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non-users. The quality of studies was evaluated using the 10-item risk-of-bias tool, and publication bias was addressed through the trim-and-fill method. Sensitivity analysis utilized the leave-one-out approach. Meta-analysis and meta-regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation. RESULTS From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta-analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non-users (OR = 2.99; 95% CI: 2.10, 4.27; p < .01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high-income countries (OR = 1.69; 95% CI: 1.20, 2.37; p < .01) and even higher in lower-middle-income and lower-income countries (OR = 3.91; 95% CI: 2.66, 5.77; p < .01). CONCLUSIONS Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT-periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.
Collapse
Affiliation(s)
- Mir Faeq Ali Quadri
- Texas Tech University of El Paso, El Paso, Texas, USA
- Saveetha Dental College and Hospitals, Chennai, India
- University of Milan, Milan, Italy
| | | | | | - Tenny John
- Saveetha Dental College and Hospitals, Chennai, India
| | | | | | - Santosh Tadakamadla
- Dentistry and Oral Health, La Trobe University, Bendigo, Victoria, Australia
| |
Collapse
|
7
|
Zamora Goicoechea J, Boughner A, Cirion Lee JJ, Mahajan A, Yeo K, Sproga M, Patel T, Saitta C, Russell C, Coughlan M, Caponnetto P, Polosa R. A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study. JMIR Res Protoc 2024; 13:e54236. [PMID: 38546715 PMCID: PMC11009848 DOI: 10.2196/54236] [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: 11/02/2023] [Revised: 12/19/2023] [Accepted: 01/31/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. OBJECTIVE We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. METHODS This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. RESULTS Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. CONCLUSIONS This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54236.
Collapse
Affiliation(s)
- Jeffrey Zamora Goicoechea
- International Network of Nicotine Consumer Organisations, Vejle, Denmark
- Asociación de Reducción de Daños del Tabaquismo, Bogota, Colombia
- Asociación de usuarios de vaporizadores y métodos de reducción de daños por tabaquismo de Costa Rica, San José, Costa Rica
| | - Allison Boughner
- American Vapor Manufacturers, Prescott, AZ, United States
- South Carolina Vapor Association, Charleston, SC, United States
| | | | | | - Kurt Yeo
- Vaping Saved My Life, Benoni, Gauteng, South Africa
- World Vapers Alliance, Miami, FL, United States
| | | | - Tasmin Patel
- Confidosoft Ltd, Leatherhead, London, United Kingdom
| | | | | | | | - Pasquale Caponnetto
- Section of Psychology, Department of Science of Education, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catana, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catana, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
8
|
Weiger C, Cohen JE, David Kennedy R, Moran MB. Testing messaging strategies to correct beliefs about nicotine and relative harm perceptions of non-cigarette tobacco products compared to cigarettes: A 2 × 2 factorial experiment of factsheets. Addict Behav 2024; 150:107915. [PMID: 38042048 DOI: 10.1016/j.addbeh.2023.107915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION The misperception that nicotine is a major cause of cancer is common and may relate to inaccurate relative harm perceptions about tobacco products. To assess if messaging can correct these misperceptions, we tested factsheets that manipulated presences vs absence of (1) a causal alternative (i.e., combustion, not nicotine, causes disease) and/or (2) a reason for the misinformation (i.e., nicotine is the focus of many health messages). METHODS We used an online 2 × 2 factorial experiment of n = 193 adults who smoke and believe nicotine causes cancer to assess the effect of different message strategies on perceptions of tobacco products and switch intention. Pre-post differences and between-condition differences were assessed. RESULTS Strength of agreement with the statement that nicotine is a major cause of cancer decreased and switch intentions increased after message exposure. The proportion of participants with low relative harm perceptions increased for e-cigarettes and smokeless tobacco (p <.0001) and decreased for very low nicotine cigarettes compared to cigarettes. The message with both strategies decreased agreement that nicotine causes cancer more than the message with only the causal alternative. There was no significant effect of condition on relative harm beliefs or switch intentions. CONCLUSIONS Messages with both corrective strategies can reduce the belief that nicotine causes cancer to a greater extent than messaging that only contains a causal alternative. Belief accuracy increased after any message exposure, but these findings should be interpreted cautiously given the study design. Combined strategies should be further investigated in larger samples.
Collapse
Affiliation(s)
- Caitlin Weiger
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States.
| | - Joanna E Cohen
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| | - Ryan David Kennedy
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| | - Meghan B Moran
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| |
Collapse
|
9
|
Bremmer MP, Campbell AM, Xia K, Tarran R, Girdler SS, Hendershot CS. Effects of Nicotine Content and Preferred Flavor on Subjective Responses to E-cigarettes: A Randomized, Placebo-controlled Laboratory Study. Nicotine Tob Res 2024; 26:307-315. [PMID: 37539752 DOI: 10.1093/ntr/ntad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Evidence suggests that e-liquid flavor and nicotine concentration are important factors in the initiation and maintenance of e-cigarette use (vaping). Flavors may increase the initiation and maintenance of vaping, and nicotine content is a factor in e-cigarette dependence and the efficacy of e-cigarettes for cigarette smoking cessation. Few human laboratory studies have assessed the joint and interactive effects of flavor and nicotine on subjective responses to e-cigarettes. METHODS Regular e-cigarette users (N = 89) completed a multi-session study involving a paced vaping procedure with e-liquid cartridges containing their preferred flavor (berry, menthol, or tobacco) or no flavor, with or without nicotine (18 mg). Subjective effects of vaping (satisfaction, reward, aversion, airway sensations, and craving relief) were assessed. RESULTS Nicotine significantly increased psychological reward and craving relief, whereas flavor significantly increased vaping satisfaction and taste. Nicotine dependence severity moderated the effect of nicotine on reward, such that those with the greatest dependence severity reported the greatest reward. CONCLUSIONS These findings support differential and noninteractive effects of e-liquid nicotine content and flavor on reinforcing effects of e-cigarettes. IMPLICATIONS E-liquid flavor and nicotine content have independent, non-interactive effects on subjective responses to vaping under controlled laboratory conditions. Among regular e-cigarette users, vaping a preferred flavor increased taste and satisfaction, but did not interact with nicotine to alter reward or craving. Further research on the ways in which these subjective effects may motivate vaping behavior among different populations of e-cigarette users would be useful to inform regulatory policy of ENDS products.
Collapse
Affiliation(s)
- Michael P Bremmer
- Department of Psychology & Neuroscience, Chapel Hill, NC, USA
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alana M Campbell
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kai Xia
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert Tarran
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, NC, USA
| | - Susan S Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christian S Hendershot
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
10
|
Hanewinkel R, Ulbricht S. [Intended and unintended effects of e-cigarettes in clinical studies: a plea for (more) transparency]. Pneumologie 2024. [PMID: 38266746 DOI: 10.1055/a-2243-9399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
E-cigarettes are used in clinical trials to facilitate smoking cessation. Due to the health risks associated with the use of e-cigarettes, the results of clinical trials should be fully reported, including continued exclusive use and dual use of tobacco and e-cigarettes. Nicotine cessation outcomes should be reported as the primary endpoint as well as the analysis of tobacco cessation alone. As there is currently no robust evidence that reducing cigarette consumption provides substantial health benefits, cigarette consumption reduction should not be used as a health outcome in clinical trials. Continued nicotine dependence should be included as an "adverse event" in the reporting of trial results.
Collapse
Affiliation(s)
- Reiner Hanewinkel
- IFT-Nord gGmbH, Institut für Therapie- und Gesundheitsforschung, Kiel, Deutschland
| | - Sabina Ulbricht
- Institut für Community Medcine, Abteilung Präventionsforschung und Sozialmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
| |
Collapse
|
11
|
Xie W, Mridha MK, Gupta A, Kusuma D, Butt AM, Hasan M, Brage S, Loh M, Khawaja KI, Pradeepa R, Jha V, Kasturiratne A, Katulanda P, Anjana RM, Chambers JC. Smokeless and combustible tobacco use among 148,944 South Asian adults: a cross-sectional study of South Asia Biobank. BMC Public Health 2023; 23:2465. [PMID: 38071311 PMCID: PMC10709928 DOI: 10.1186/s12889-023-17394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Tobacco use, in both smoking and smokeless forms, is highly prevalent among South Asian adults. The aims of the study were twofold: (1) describe patterns of SLT and combustible tobacco product use in four South Asian countries stratified by country and sex, and (2) assess the relationships between SLT and smoking intensity, smoking quit attempts, and smoking cessation among South Asian men. METHODS Data were obtained from South Asia Biobank Study, collected between 2018 and 2022 from 148,944 men and women aged 18 years and above, living in Bangladesh, India, Pakistan, or Sri Lanka. Mixed effects multivariable logistic and linear regression were used to quantify the associations of SLT use with quit attempt, cessation, and intensity. RESULTS Among the four South Asian countries, Bangladesh has the highest rates of current smoking (39.9% for male, 0.4% for female) and current SLT use (24.7% for male and 23.4% for female). Among male adults, ever SLT use was associated with a higher odds of smoking cessation in Bangladesh (OR, 2.88; 95% CI, 2.65, 3.13), India (OR, 2.02; 95% CI, 1.63, 2.50), and Sri Lanka (OR, 1.36; 95% CI, 1.14, 1.62). Ever SLT use and current SLT use was associated with lower smoking intensity in all countries. CONCLUSIONS In this large population-based study of South Asian adults, rates of smoking and SLT use vary widely by country and gender. Men who use SLT products are more likely to abstain from smoking compared with those who do not.
Collapse
Affiliation(s)
- Wubin Xie
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Malay Kanti Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Anaya Gupta
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
| | - Dian Kusuma
- School of Health & Psychological Sciences, City University of London, London, UK
| | | | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Soren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Marie Loh
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
| | | | - Rajendra Pradeepa
- The Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Vinita Jha
- Max Helathcare Institute, Patparganj, Delhi, India
| | | | | | - Ranjit Mohan Anjana
- The Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - John C Chambers
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
| |
Collapse
|
12
|
White D, Bush A, Smyth AR, Bhatt JM. Why and how should children be protected from the deluge of vaping related media and marketing overexposure? Breathe (Sheff) 2023; 19:230141. [PMID: 38125806 PMCID: PMC10729810 DOI: 10.1183/20734735.0141-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023] Open
Abstract
E-cigarettes are products delivering nicotine via inhalation and are devised to mimic tobacco smoking. While they were initially introduced as a device putatively to aid with smoking cessation, their use is now far broader than that. Use by children is significantly increasing. There is growing evidence of the potential harms of vaping. E-liquids used for e-cigarettes contain a wide range of harmful substances, and the clinical consequences of this are now being increasingly demonstrated, such as the rise in cases of e-cigarette- or vaping-associated lung injury. In addition, early use may result in long-term nicotine addiction. Vaping companies utilise marketing methods that distinctly target young people, and weak legislation in the UK allows them free rein to expose children to vaping. In this review we demonstrate why children must be protected from vaping. We must have stringent legislation to prevent easy access to e-cigarettes, including banning the convenience and affordability disposable vapes provide, and prevent marketing that does not warn about the potential health effects. The Australia approach of prescription or pharmacy only access for smoking cessation should be considered to limit exposure of children and minimise use by nonsmokers.
Collapse
Affiliation(s)
- David White
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, UK
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, National Heart and Lung Institute, London, UK
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Imperial Centre for Paediatrics and Child Health, London, UK
| | - Alan R. Smyth
- NIHR Biomedical Research Centre, Nottingham, UK
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Jayesh Mahendra Bhatt
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, UK
| |
Collapse
|
13
|
Lang AE, Kathuria H, Braillon A, Ewart G, Dagli E, Stepp EL, Galiatsatos P, Deepak J, Jordt SE, Hayes D. England Is Handing out E-Cigarettes: Is the "Swap to Stop" Tobacco Control Scheme Harm Reduction or Harm Production? Am J Respir Crit Care Med 2023; 208:1024-1025. [PMID: 37682082 PMCID: PMC10867939 DOI: 10.1164/rccm.202308-1354vp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/08/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Adam Edward Lang
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Hasmeena Kathuria
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | - Gary Ewart
- American Thoracic Society, Washington, DC
| | - Elif Dagli
- Marmara University, Health Institute Association, Istanbul, Turkey
| | - Evan L. Stepp
- Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Highlands Ranch, Colorado
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Janaki Deepak
- Veterans Affairs Maryland Health Care System, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sven E. Jordt
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina; and
| | - Don Hayes
- Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
14
|
Stjepanović D, Phartiyal P, Leung J, Lim CCW, Sun T, Chung JYC, Gartner CE, Hall WD, Chan GCK. Efficacy of smokeless tobacco for smoking cessation: a systematic review and meta-analysis. Tob Control 2023; 32:757-768. [PMID: 35197366 DOI: 10.1136/tobaccocontrol-2021-057019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/10/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Smoking remains prevalent in many countries despite rigorous tobacco control strategies. The use of Swedish snus, a type of low-nitrosamine smokeless tobacco, has been promoted as a tobacco harm reduction strategy. DATA SOURCES AND STUDY SELECTION Three databases were searched for studies that assessed the effectiveness of snus in promoting smoking abstinence. A total of 28 studies were reviewed (5 randomised controlled trials (RCTs), 7 longitudinal and 16 cross-sectional studies). DATA EXTRACTION Separate meta-analyses were conducted by study type, pooling effect estimates where outcome measures and design were sufficiently comparable. Study details and quality assessment (Risk of Bias 2 for RCTs, Newcastle-Ottawa Scale for observational studies) are provided for each study. DATA SYNTHESIS While the meta-analysis of RCTs did not show a significant association between snus use and smoking cessation (risk ratio (RR)=1.33, 95% CI 0.71 to 2.47 and RR=0.62, 95% CI 0.27 to 1.41), the results of the meta-analysis of longitudinal cohort studies (RR=1.38, 95% CI 1.05 to 1.82, p=0.022) and cross-sectional studies (OR=1.87, 95% CI 1.29 to 2.72, p=0.001) indicated that use of snus was associated with an increased likelihood of quitting or having quit smoking. There was significant heterogeneity in the cross-sectional studies, and leave-one-out analysis indicated that the longitudinal cohort results were driven by one study. Most studies examined were subject to an elevated risk of bias. CONCLUSION There is weak evidence for the use of snus for smoking cessation. Better RCTs and longitudinal studies are needed; meanwhile, existing cessation aids may be better placed than snus to promote abstinence.
Collapse
Affiliation(s)
- Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Preeti Phartiyal
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Jack Yiu Chak Chung
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Queensland Alliance for Environmental Health Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
- Queensland Alliance for Environmental Health Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| |
Collapse
|
15
|
Xu T, Niu ZY, Xu J, Li XD, Luo Q, Luo A, Huang YL, Jiang XT, Wu ZH. Chemical analysis of selected harmful and potentially harmful constituents and in vitro toxicological evaluation of leading flavoured e-cigarette aerosols in the Chinese market. Drug Test Anal 2023; 15:1156-1163. [PMID: 35712913 DOI: 10.1002/dta.3337] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022]
Abstract
Use of electronic cigarettes (e-cigarettes) has increased significantly over the past decade due to consumer perception that these products represent a less risky alternative to combustible cigarettes. E-liquids generally contain a simple mix of vegetable glycerin, propylene glycerol, nicotine, organic acids, and flavourings. Regulators require that harmful and potentially harmful constituents (HPHCs) that might cause harm to the consumer must be monitored in the aerosol generated by e-cigarettes and in cigarette smoke (CS). To quantify HPHCs in aerosols from commercial flavoured e-cigarettes in Chinese market, this study has systematically compared levels of HPHCs, including eight carbonyls, five volatile organic compounds, four tobacco-specific nitrosamines, 16 polycyclic aromatic hydrocarbons, and seven heavy metals, in the aerosols of four market-leading flavoured e-cigarettes and mainstream CS, alongside in vitro cytotoxicity and mutagenicity assays. The vast majority of HPHCs were either undetected or significantly lower in the e-cigarette aerosols than in commercial CS or reference CS (3R4F). Where HPHCs were detected, there were small variations among the different flavoured e-cigarettes. In the neutral red uptake and Ames assays, aqueous extracts of the e-cigarette aerosols did not induce obvious cytotoxicity or mutagenicity, whereas CS aqueous extract showed dose-related cytotoxicity and mutagenicity. Collectively, these results indicate that use of e-cigarettes might potentially lead to a significant reduction in exposure to harmful substances, with fewer cytotoxic and mutagenic effects, as compared with conventional smoking. Further studies based on human puffing conditions and longer evaluation periods will be needed to substantiate this potential.
Collapse
Affiliation(s)
- Te Xu
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| | - Zhen-Yu Niu
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| | - Jing Xu
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| | - Xin-Duo Li
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| | - Quan Luo
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| | - An Luo
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| | - Yi-Lan Huang
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| | - Xing-Tao Jiang
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| | - Ze-Hong Wu
- RELX Science Center, Shenzhen RELX Tech. Co,. Ltd., Shenzhen, China
| |
Collapse
|
16
|
Vedøy TF, Lund KE. How do Smokers in a Snus-Prevalent Society Consider E-cigarettes, Snus, and Nicotine Replacement Therapy Products as Relevant Replacements for Cigarettes in the Event They Should Stop Smoking? Nicotine Tob Res 2023; 25:1753-1761. [PMID: 37410922 PMCID: PMC10475606 DOI: 10.1093/ntr/ntad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Around 50 percent of the tobacco in Norway is consumed in the form of snus, a smokeless oral tobacco. We examined Norwegian smokers' openness, and thereby the potential reach, to use e-cigarettes, nicotine replacement therapy products (NRT), and snus in the event of quitting smoking, in a society where snus use is common. METHODS Using data from an online survey of 4073 smokers from 2019 to 2021, we calculated predicted probabilities of smokers' being open, undecided, and not open to use e-cigarettes, snus, and NRT in the event they should quit smoking. RESULTS Among daily smokers, the probability of being open to use e-cigarettes in the event of quitting smoking was .32. The corresponding probabilities for using snus and NRT were .22 and .19. Snus was the product with the highest probability of not being open (.60). NRT had the highest probability of being undecided (.39). Among smokers who had never used e-cigarettes or snus, the probabilities of being open were .13 for e-cigarettes, .02 for snus and .11 for NRT. CONCLUSIONS In a snus-friendly norm climate where smokers have traditionally used snus as an alternative to cigarettes, the probability of using e-cigarettes in the event of smoking cessation was higher compared to both snus and NRT. However, among smokers who had never used e-cigarettes or snus, the likelihood of being open to use of NRT was similar to e-cigarettes, and higher than snus, which suggests that NRT may still play a role in smoking cessation. IMPLICATIONS In a snus-prevalent country in the endgame phase of the cigarette epidemic, where robust infrastructure for tobacco control in combination with the availability of snus has reduced smoking to a minimum, the remaining smokers seem to prefer e-cigarettes to snus if they should quit smoking. This indicates that availability of several nicotine alternatives might increase the likelihood of a future product replacement within the small group of remaining smokers.
Collapse
Affiliation(s)
- Tord Finne Vedøy
- Department Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Karl Erik Lund
- Department Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
17
|
Coutts J, Langley RJ. Toxic and addictive effects of nicotine on children and adolescents: are we sleepwalking into a public health disaster? Arch Dis Child 2023; 108:691-692. [PMID: 35948404 DOI: 10.1136/archdischild-2022-323891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/04/2022]
Affiliation(s)
| | - Ross John Langley
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| |
Collapse
|
18
|
Dolan SB, Bradley MK, Johnson MW. E-cigarette Price Impacts legal and Black-Market Cigarette Purchasing Under a Hypothetical Reduced-Nicotine Cigarette Standard. Nicotine Tob Res 2023; 25:1556-1564. [PMID: 37195268 PMCID: PMC10439485 DOI: 10.1093/ntr/ntad067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/29/2023] [Accepted: 05/14/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION The Tobacco Control Act gives the U.S. Food and Drug Administration authority to establish a reduced-nicotine content standard in combusted cigarettes. This future potential regulation may pose a significant public health benefit; however, black markets may arise to meet demand for normal-nicotine content cigarettes among smokers unwilling to transition to or use an alternative product. AIMS AND METHODS We determined the behavioral-economic substitutability of illicit normal-nicotine content cigarettes and e-cigarettes for reduced-nicotine content cigarettes in a hypothetical reduced-nicotine regulatory market. Adult cigarette smokers were recruited online to complete hypothetical cigarette purchasing tasks for usual-brand cigarettes, reduced-nicotine content cigarettes, and illicit normal-nicotine content cigarettes, as well as a cross-commodity task in which reduced-nicotine content cigarettes were available across multiple prices and illicit cigarettes were concurrently available for $12/pack. Participants completed two three-item cross-commodity purchasing tasks in which e-cigarettes were available for $4/pod or $12/pod alongside reduced-nicotine content cigarettes and illicit cigarettes. RESULTS Usual-brand cigarette purchasing was greater than illicit normal-nicotine content cigarettes and less than reduced-nicotine content cigarettes. In the cross-commodity purchasing tasks, illicit cigarettes and e-cigarettes both served as economic substitutes for reduced-nicotine content cigarettes; however, when e-cigarettes were available for $4/pod, they were purchased at greater levels than illicit cigarettes and resulted in greater reductions in reduced-nicotine content cigarettes purchasing than when available for $12/pod. CONCLUSIONS These data suggest that some smokers are willing to engage in illicit cigarette purchasing in a reduced-nicotine regulatory environment, but e-cigarette availability at lower prices may reduce black-market engagement and shift behavior away from combusted cigarette use. IMPLICATIONS E-cigarettes available at low, but not high, prices were stronger substitutes for legal, reduced-nicotine content cigarettes than illegal, normal-nicotine content cigarettes in a hypothetical reduced-nicotine tobacco market. Our findings suggest the availability of relatively inexpensive e-cigarettes may reduce illicit cigarette purchasing and combusted cigarette use under a reduced-nicotine cigarette standard.
Collapse
Affiliation(s)
- Sean B Dolan
- The Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa K Bradley
- The Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew W Johnson
- The Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
19
|
DeAtley T, Johnson AC, Stone MD, Audrain-McGovern J, Mercincavage M, Strasser AA. Effects of Modified Tobacco Risk Products with Claims and Nicotine Features on Perceptions among Racial and Ethnic Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6454. [PMID: 37568996 PMCID: PMC10418819 DOI: 10.3390/ijerph20156454] [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: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023]
Abstract
Research suggests consumers may misunderstand modified risk tobacco product (MRTP) claims. We examined the effects of nicotine content across four tobacco products with and without MRTP claims among a racially and ethnically diverse sample of adults who do and do not smoke. Adults (n = 1484) aged 21-65 completed an online experiment using a 2 × 2 × 4 mixed factorial design to examine the effects of tobacco product (Classic White Snus, IQOS, JUUL e-cigarette, and VLN cigarette) and nicotine content (high vs. low) stratified by MRTP claim (present vs. absent) across four outcomes: (1) likely to try (2) serious disease if used regularly, (3) least addictive, and (4) ease of quitting smoking. Not including an MRTP claim resulted in an increased likelihood of trying a product, decreased concern of serious disease, lower perceived addictiveness, and increased ease of quitting smoking. Participants selected low nicotine IQOS without a claim as the least likely to cause serious disease. Low nicotine JUUL, without a claim, was selected as least addictive and most likely to facilitate quitting. Intentions to try were highest for low nicotine JUUL. Participants selected low-nicotine products as less addictive than high nicotine products. Regulatory efforts should consider how MRTP claims interact with different product characteristics. Subtle differences exist across outcomes between racial and ethnic groups, which indicates that further research is warranted.
Collapse
Affiliation(s)
- Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Andrea C. Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA;
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Andrew A. Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| |
Collapse
|
20
|
Kanobe MN, Nelson PR, Brown BG, Chen P, Makena P, Caraway JW, Prasad GL, Round EK. Changes in Biomarkers of Exposure and Potential Harm in Smokers Switched to Vuse Vibe or Vuse Ciro Electronic Nicotine Delivery Systems. TOXICS 2023; 11:564. [PMID: 37505530 PMCID: PMC10384956 DOI: 10.3390/toxics11070564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/05/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023]
Abstract
Electronic nicotine delivery systems (ENDS) have the potential to provide nicotine to tobacco consumers while reducing exposure to combustion-related toxicants. Here, we report changes in biomarkers of exposure (BoE) and biomarkers of potential harm (BoPH) in smokers who completely switched to Vuse Vibe and Vuse Ciro ENDS products, or to smoking abstinence in a randomized, controlled clinical study. Thirteen BoE (12 urinary and one blood) that indicate exposure to harmful and potentially harmful toxicants (HPHCs) were evaluated at baseline on day 5. Urinary BoPH linked to oxidative stress, platelet activation, and inflammation were also assessed at baseline, and on day 5 and day 7. Nicotine exposure was lower in Vuse Vibe and Vuse Ciro groups compared to baseline values. Urinary non-nicotine BoE decreased significantly (52.3-96.7%) in the Vuse ENDS groups, and the reductions were similar in magnitude to those observed in the abstinence group. Blood carboxyhemoglobin decreased 52.8-55.0% in all study groups. Decreases (10-50%) in BoPH were observed in all study groups. Thus, smokers who switch exclusively to Vuse Vibe or Vuse Ciro products or completely abstain from smoking are exposed to substantially lower levels of HPHCs, and experience improvements in BoPH of oxidative stress and inflammation pathways.
Collapse
Affiliation(s)
- Milly N Kanobe
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Paul R Nelson
- Former Employees of RAI Services Company, 105 Bowes Road, Winston Salem, NC 27106, USA
| | - Buddy G Brown
- Former Employees of RAI Services Company, 5714 Wonderous Lane, Durham, NC 27712, USA
| | - Peter Chen
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Patrudu Makena
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - John W Caraway
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Gaddamanugu L Prasad
- Former Employees of RAI Services Company, 490 Friendship Place Ct, Lewisville, NC 27023, USA
- Prasad Scientific Consulting LLC, 490 Friendship Place Ct, Lewisville, NC 27023, USA
| | - Elaine K Round
- BAT (Investments) Limited, Globe House, 1 Water Street, London WC2R 3LA, UK
| |
Collapse
|
21
|
Lee PN, Coombs KJ, Hamling JS. Evidence relating cigarette, cigar and pipe smoking to lung cancer and chronic obstructive pulmonary disease: Meta-analysis of recent data from three regions. World J Meta-Anal 2023; 11:228-252. [DOI: 10.13105/wjma.v11.i5.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There is a need to have up-to-date information for various diseases on the risk related to the use of different smoked products and the use of other nicotine-containing products. Here, we contribute to the information pool by presenting up-to-date quantitative evidence for North America, Europe and Japan and for both lung cancer and chronic obstructive pulmonary disease (COPD) on the relative risk (RR) relating to current vs never product use for each of the three smoked tobacco products, cigarettes, cigars and pipes.
AIM To estimate lung cancer and COPD current smoking RRs for the three products using recent data for the three regions.
METHODS Publications in English from 2010 to 2020 were considered that, based on epidemiological studies in the three regions, estimated the current smoking RR of lung cancer and/or COPD for one or more of the three products. The studies should involve at least 100 cases of the disease considered, not be restricted to specific lung cancer types or populations with specific medical conditions, and should be of cohort or nested case-control study design or randomized controlled trials. Literature searches were conducted on MEDLINE separately for lung cancer and for COPD, examining titles and abstracts initially, and then full texts. Additional papers were sought from reference lists of selected papers, reviews and meta-analyses. For each study identified, the most recent available data on each product were entered on current smoking, as well as on characteristics of the study and the RR estimates. Combined RR estimates were derived using random-effects meta-analysis. For cigarette smoking, where far more data were available, heterogeneity was studied by a wide range of factors. For cigar and pipe smoking, a more limited heterogeneity analysis was carried out. Results were compared with those from previous meta-analyses published since 2000.
RESULTS Current cigarette smoking: For lung cancer, 44 studies (26 North American, 14 European, three Japanese, and one in multiple continents), gave an overall estimate of 12.14 [95% confidence interval (CI) 10.30-14.30]. The estimates were higher (heterogeneity P < 0.001) for North American (15.15, CI 12.77-17.96) and European studies (12.30, CI 9.77-15.49) than for Japanese studies (3.61, CI 2.87-4.55), consistent with previous evidence of lower RRs for Asia. RRs were higher (P < 0.05) for death (14.85, CI 11.99-18.38) than diagnosis (10.82, CI 8.61-13.60). There was some variation (P < 0.05) by study population, with higher RRs for international and regional studies than for national studies and studies of specific populations. RRs were higher in males, as previously reported, the within-study male/female ratio of RRs being 1.52 (CI 1.20-1.92). RRs did not vary significantly (P ≥ 0.05) by other factors. For COPD, RR estimates were provided by 18 studies (10 North American, seven European, and one Japanese). The overall estimate of 9.19 (CI 6.97-12.13), was based on heterogeneous data (P < 0.001), and higher than reported earlier. There was no (P > 0.1) variation by sex, region or exclusive use, but limited evidence (0.05 < P < 0.1) that RR estimates were greater where cases occurring shortly after baseline were ignored; where bronchiectasis was excluded from the COPD definition; and with greater confounder adjustment. Within-study comparisons showed adjusted RRs exceeded unadjusted RRs. Current cigar smoking: Three studies gave an overall lung cancer RR of 2.73 (CI 2.36-3.15), with no heterogeneity, lower than the 4.67 (CI 3.49-6.25) reported in an earlier review. Only one study gave COPD results, the RR (2.44, CI 0.98-6.05) being imprecise. Current pipe smoking: Four studies gave an overall lung cancer RR of 4.93 (CI 1.97-12.32), close to the 5.20 (CI 3.50-7.73) given earlier. However, the estimates were heterogeneous, with two above 10, and two below 3. Only one study gave COPD results, the RR (1.12, CI 0.29-4.40), being imprecise. For both diseases, the lower RR estimates for cigars and for pipes than for current smoking of cigarettes aligns with earlier published evidence.
CONCLUSION Current cigarette smoking substantially increases lung cancer and COPD risk, more so in North America and Europe than Japan. Limited evidence confirms lower risks for cigars and pipes than cigarettes.
Collapse
Affiliation(s)
- Peter Nicholas Lee
- Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
| | - Katharine J Coombs
- Statistics, P.N.Lee Statistics and Computing Ltd, Sutton SM2 5DA, Surrey, United Kingdom
| | - Jan S Hamling
- Statistics, RoeLee Statistics Ltd, Sutton SM2 5DA, United Kingdom
| |
Collapse
|
22
|
Vu GT, Stjepanović D, Sun T, Leung J, Chung J, Connor J, Thai PK, Gartner CE, Tran BX, Hall WD, Chan G. Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies. Tob Control 2023:tc-2022-057748. [PMID: 37295941 DOI: 10.1136/tc-2022-057748] [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: 09/12/2022] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation. DATA SOURCE AND STUDY SELECTION Four databases were searched for modelling studies of e-cigarette use on population health published between 2010 and 2023. A total of 32 studies were included. DATA EXTRACTION Data on study characteristics, model attributes and estimates of population impacts including health outcomes and smoking prevalence were extracted from each article. The findings were synthesised narratively. DATA SYNTHESIS The introduction of e-cigarettes was predicted to lead to decreased smoking-related mortality, increased quality-adjusted life-years and reduced health system costs in 29 studies. Seventeen studies predicted a lower prevalence of cigarette smoking. Models that predicted negative population impacts assumed very high e-cigarette initiation rates among non-smokers and that e-cigarette use would discourage smoking cessation by a large margin. The majority of the studies were based on US population data and few studies included factors other than smoking status, such as jurisdictional tobacco control policies or social influence. CONCLUSIONS A population increase in e-cigarette use may result in lower smoking prevalence and reduced burden of disease in the long run, especially if their use can be restricted to assisting smoking cessation. Given the assumption-dependent nature of modelling outcomes, future modelling studies should consider incorporating different policy options in their projection exercises, using shorter time horizons and expanding their modelling to low-income and middle-income countries where smoking rates remain relatively high.
Collapse
Affiliation(s)
- Giang T Vu
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Jack Chung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Discipline of Psychiatry, The University of Queensland, Brisbane, Queensland, Australia
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
23
|
Abstract
This paper deals with the question of whether electronic cigarettes (e-cigarettes) can minimize the proven harm of smoking tobacco or may lead to a long-term harm. While the British Royal College of Physicians recommends smokers to use e-cigarettes as a substitute for tobacco products, the German Society for Pneumology and Respiratory Medicine advises smokers against using e-cigarettes. The harm reduction strategy is based on three hypotheses. Hypothesis 1: It is assumed that e-cigarettes cause less damage to health than tobacco cigarettes. Hypothesis 2: It is postulated that smokers are motivated to switch from conventional cigarettes to e-cigarettes. Hypothesis 3: It is assumed that e-cigarettes are an effective means for quitting smoking with few side effects. Although the long-term health consequences of e-cigarette use remain unknown, there is increasing evidence that e-cigarettes are toxic, harmful to cardiovascular system, respiratory health and potentially carcinogenic. Population-representative epidemiological surveys have shown that three-quarters of all current e-cigarette users in Germany smoke tobacco at the same time. In a few randomized clinical trials, e-cigarettes showed higher success rates compared to nicotine replacement products. As over-the-counter consumer products, a large number of studies have found no advantage for e-cigarettes under real conditions. In addition, e-cigarettes prolong nicotine dependence compared to nicotine replacement products. According to the current state of knowledge, the hypotheses behind the harm minimization strategy using e-cigarettes must be regarded as refuted. It therefore appears ethically problematic when doctors recommend e-cigarettes to their patients as a substitute for smoking.
Collapse
Affiliation(s)
- Reiner Hanewinkel
- Institut für Therapie- und Gesundheitsforschung, IFT-Nord gGmbH, Kiel, Deutschland
| |
Collapse
|
24
|
From the IASLC Tobacco Control Committee. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
25
|
McKeon G, Scott JG. Smoke and mirrors: Support from psychiatrists for nicotine e-cigarette availability in Australia. Aust N Z J Psychiatry 2023; 57:169-180. [PMID: 36120959 DOI: 10.1177/00048674221126458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Royal Australian and New Zealand College of Psychiatrists' (RANZCP) 2018 position statement supports increased, regulated availability of e-cigarettes (ECs) as a harm-reduction measure and recommends further research into their use. Aligned with this recommendation, we aimed to critically evaluate the RANZCP's stance on this issue through a literature review focused on the areas identified in the position statement as requiring further investigation: (1) the adverse health effects attributable to ECs; (2) use of ECs for smoking cessation (particularly for people living with severe mental illness); and (3) EC-associated risks for nicotine naïve young people. We identified and summarised evidence of harm attributable to ECs that is particularly relevant to young people through direct adverse health sequelae, onset of nicotine dependence and increased risk of combustible cigarette (CC) use. A small number of studies suggest ECs can be used for harm-reduction purposes in people diagnosed with nicotine dependence and severe mental illness. However, these results must be considered alongside robust evidence supporting the effectiveness of existing pharmacological interventions for smoking cessation in people with severe mental illness. The position statement is in urgent need of review in line with the available evidence.
Collapse
Affiliation(s)
- Gemma McKeon
- Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Metro North Mental Health Services, Herston, QLD, Australia
- Child and Youth Mental Health Group, UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - James G Scott
- Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Metro North Mental Health Services, Herston, QLD, Australia
- Child and Youth Mental Health Group, UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Child and Youth Mental Health Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| |
Collapse
|
26
|
Abouk R, Courtemanche C, Dave D, Feng B, Friedman AS, Maclean JC, Pesko MF, Sabia JJ, Safford S. Intended and unintended effects of e-cigarette taxes on youth tobacco use. JOURNAL OF HEALTH ECONOMICS 2023; 87:102720. [PMID: 36565585 PMCID: PMC9879683 DOI: 10.1016/j.jhealeco.2022.102720] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 05/26/2023]
Abstract
Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has contributed to aggressive regulation by state and local governments. Between 2010 and mid-2019, ten states and two large counties adopted ENDS taxes. We use two large national surveys (Monitoring the Future and the Youth Risk Behavior Surveillance System) to estimate the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth ENDS consumption, with estimated ENDS tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax effects, suggesting economic substitution between cigarettes and ENDS for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may considerably undercut or even outweigh any public health gains.
Collapse
Affiliation(s)
- Rahi Abouk
- Department of Economics, Finance, and Global Business, William Paterson University, Wayne, NJ, United States
| | - Charles Courtemanche
- Department of Economics, Gatton College of Business and Economics, University of Kentucky, Lexington, KY, United States; National Bureau of Economics Research, Cambridge, MA, United States; Institute for Labor Studies, Bonn, Germany
| | - Dhaval Dave
- National Bureau of Economics Research, Cambridge, MA, United States; Institute for Labor Studies, Bonn, Germany; Department of Economics, Bentley University, Waltham, MA, United States
| | - Bo Feng
- American Institutes for Research, Columbia, MD, United States
| | - Abigail S Friedman
- Department of Health Policy & Management, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Johanna Catherine Maclean
- National Bureau of Economics Research, Cambridge, MA, United States; Institute for Labor Studies, Bonn, Germany; Schar School of Policy and Government, George Mason University, Arlington, VA, United States
| | - Michael F Pesko
- Institute for Labor Studies, Bonn, Germany; Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, United States.
| | - Joseph J Sabia
- Institute for Labor Studies, Bonn, Germany; Center for Health Economics & Policy Studies, San Diego State University, San Diego, CA, United States
| | - Samuel Safford
- Center for Health Economics & Policy Studies, San Diego State University, San Diego, CA, United States; Department of Sociology, Michigan State University, East Lansing, MI, United States
| |
Collapse
|
27
|
Boozary LK, Frank-Pearce SG, Alexander AC, Sifat MS, Kurien J, Waring JJ, Ehlke SJ, Businelle MS, Ahluwalia JS, Kendzor DE. Tobacco use characteristics, treatment preferences, and motivation to quit among adults accessing a day shelter in Oklahoma City. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100117. [PMID: 36844157 PMCID: PMC9949321 DOI: 10.1016/j.dadr.2022.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/07/2022] [Accepted: 11/04/2022] [Indexed: 11/08/2022]
Abstract
Background Smoking rates are exceptionally high among adults experiencing homelessness (AEH). Research is needed to inform treatment approaches in this population. Methods Participants (n=404) were adults who accessed an urban day shelter and reported current smoking. Participants completed surveys regarding their sociodemographic characteristics, tobacco and substance use, mental health, motivation to quit smoking (MTQS), and smoking cessation treatment preferences. Participant characteristics were described and compared by MTQS. Results Participants who reported current smoking (N=404) were primarily male (74.8%); White (41.4%), Black (27.8%), or American Indian/Alaska Native (14.1%) race; and 10.7% Hispanic. Participants reported a mean age of 45.6 (SD=11.2) years, and they smoked an average of 12.6 (SD=9.4) cigarettes per day. Most participants reported moderate or high MTQS (57%) and were interested in receiving free cessation treatment (51%). Participants most frequently selected the following options as among the top 3 treatments that offered the best chance of quitting: Nicotine replacement therapy (25%), money/gift cards for quitting (17%), prescription medications (17%), and switching to e-cigarettes (16%). Craving (55%), stress/mood (40%), habit (39%), and being around other smokers (36%) were frequently identified as the most challenging aspects of quitting. Low MTQS was associated with White race, lack of religious participation, lack of health insurance, lower income, greater cigarettes smoked per day, and higher expired carbon monoxide. Higher MTQS was associated with sleeping unsheltered, cell phone ownership, higher health literacy, more years of smoking, and interest in free treatment. Discussion Multi-level, multi-component interventions are needed to address tobacco disparities among AEH.
Collapse
Affiliation(s)
- Laili Kharazi Boozary
- Department of Psychology, Cellular and Behavioral Neurobiology, University of Oklahoma, Norman OK 73019
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Summer G. Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adam C. Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Munjireen S. Sifat
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jasmin Kurien
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Joseph J.C. Waring
- Bloomberg School of Public of Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sarah J. Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jasjit S. Ahluwalia
- School of Public Health, Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| |
Collapse
|
28
|
Part three: a randomized study to assess biomarker changes in cigarette smokers switched to Vuse Solo or Abstinence. Sci Rep 2022; 12:20658. [PMID: 36450821 PMCID: PMC9712618 DOI: 10.1038/s41598-022-25054-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Biomarkers of exposure (BoE) can help evaluate exposure to combustion-related, tobacco-specific toxicants after smokers switch from cigarettes to potentially less-harmful products like electronic nicotine delivery systems (ENDS). This paper reports data for one (Vuse Solo Original) of three products evaluated in a randomized, controlled, confinement study of BoE in smokers switched to ENDS. Subjects smoked their usual brand cigarette ad libitum for two days, then were randomized to one of three ENDS for a 7-day ad libitum use period, or to smoking abstinence. Thirteen BoE were assessed at baseline and Day 5, and percent change in mean values for each BoE was calculated. Biomarkers of potential harm (BoPH) linked to oxidative stress, platelet activation, and inflammation were also assessed. Levels decreased among subjects randomized to Vuse Solo versus Abstinence, respectively, for the following BoE: 42-96% versus 52-97% (non-nicotine constituents); 51% versus 55% (blood carboxyhemoglobin); and 29% versus 96% (nicotine exposure). Significant decreases were observed in three BoPH: leukotriene E4, 11-dehydro-thromboxane B2, and 2,3-dinor thromboxane B2 on Day 7 in the Vuse Solo and Abstinence groups. These findings show that ENDS use results in substantially reduced exposure to toxicants compared to smoking, which may lead to reduced biological effects.
Collapse
|
29
|
Corrêa PCRP. No controversy: e-cigarettes are not a treatment for tobacco/nicotine cessation. J Bras Pneumol 2022; 48:e20220283. [PMID: 36350957 PMCID: PMC9747183 DOI: 10.36416/1806-3756/e20220283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paulo César Rodrigues Pinto Corrêa
- . Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto (MG) Brasil
- . Faculdade de Minas - FAMINAS-BH - Belo Horizonte (MG) Brasil
| |
Collapse
|
30
|
Hanewinkel R, Niederberger K, Pedersen A, Unger JB, Galimov A. Reply to: "Nicotine or tobacco abstinence?". Eur Respir Rev 2022; 31:31/166/220158. [PMID: 36323420 PMCID: PMC9724791 DOI: 10.1183/16000617.0158-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022] Open
Abstract
9 years ago, in July 2013, a group of 12 experts, many who had previously expressed support for e-cigarettes, rated the relative harm of 12 nicotine-containing products by using 14 criteria addressing harms to the users and others [1]. The group concluded e-cigarettes were substantially less harmful than combustible cigarettes. The popular media have taken up these results and promoted e-cigarettes as “95% less risky” or “95% less harmful” than combustible cigarettes. However, the authors acknowledged, “a limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria” [1]. The true impact of vaping on health will manifest over the coming decades, but the evidence to date on the deleterious effects of e-cigarettes on health justifies the recommendation to abstain from the consumption of inhaled nicotine and other productshttps://bit.ly/3Dn4riC
Collapse
Affiliation(s)
- Reiner Hanewinkel
- Institute of Therapy and Health Research, IFT-Nord, Kiel, Germany,Reiner Hanewinkel ()
| | - Kathrin Niederberger
- Clinical Psychology and Psychotherapy, Dept of Psychology, Kiel University, Kiel, Germany,Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Anya Pedersen
- Clinical Psychology and Psychotherapy, Dept of Psychology, Kiel University, Kiel, Germany
| | - Jennifer B. Unger
- Institute for Health Promotion and Disease Prevention Research, Dept of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Artur Galimov
- Institute for Health Promotion and Disease Prevention Research, Dept of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
31
|
Polosa R, Casale TB, Tashkin DP. A Close Look at Vaping in Adolescents and Young Adults in the United States. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2831-2842. [PMID: 35718259 DOI: 10.1016/j.jaip.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Vaping by adolescents and young adults is a legitimate concern as there is a risk that some may start smoking and that electronic cigarette (EC) use may have adverse effects in the developing lungs of adolescents. This commentary provides updated information on vaping patterns among adolescents and young adults in the United States, as well as the impact of EC usage on respiratory health. EC use has surged greatly among high school students and young adults over the last decade but fortunately has declined significantly since its peak in 2019. During the same time period, smoking rates have constantly fallen to new low record levels. These trends argue against EC use as a gateway to smoking. Most EC usage is infrequent and unlikely to increase a person's risk of negative health consequences. Furthermore, the majority of EC usage has happened among those who have previously smoked. There is a dearth of data on the long-term health implications of EC usage in adolescents and young adults. We do not know whether short-term or intermittent use of EC in youth can lead to negative health outcomes in adulthood, and long-term high-quality studies in well-defined groups are needed. Although vaping has been linked to respiratory symptoms, they tend to be transient and of uncertain significance. This commentary provides up-to-date information so health care providers can give objective and responsible medical advice on EC usage.
Collapse
Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy; Center for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico V. Emanuele," University of Catania, Catania, Italy; ECLAT Srl, Spin-off of the University of Catania, Catania, Italy; Institute of Internal Medicine, AOU "Policlinico V. Emanuele-S. Marco," Catania, Italy.
| | - Thomas B Casale
- Department of Medicine, Division of Allergy/Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, UCLA Health Sciences, Los Angeles, Calif
| |
Collapse
|
32
|
Wackowski OA, O'Connor RJ, Diaz D, Rashid M, Lewis MJ, Greene K. '95% less harmful'? Exploring reactions to quantitative modified risk claims for snus and e-cigarettes. Tob Control 2022; 31:730-736. [PMID: 33753549 PMCID: PMC8455704 DOI: 10.1136/tobaccocontrol-2020-056303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Studies examining perceptions of 'modified risk tobacco product' (MRTP) messages for e-cigarettes and smokeless tobacco have indicated consumers want statistics and quantification of harm reduction. However, limited research exists on reactions to quantitative MRTP messages. DESIGN We conducted 12 focus groups in the USA in 2019-6 focused on e-cigarette messages and 6 on snus messages. Eight groups were with current smokers (ages 21-66) and four with young adult (ages 18-25) non-smokers (n=57). Participants discussed messages stating that use of snus and vaping products have been estimated by scientists to be about 90% and 95% less harmful than smoking cigarettes, respectively. RESULTS Several participants agreed the messages strongly communicated that the products are less harmful than cigarettes, were attention getting and could be 'convincing'. However, participants expressed scepticism about the source and accuracy of the stated figures, and some noted the claims could be misleading and attractive to young people. Comments also reflected some claim misunderstandings (eg, that e-cigarettes only pose a 5% chance of harm). Participants also agreed that stating e-cigarette risks 'are unlikely to exceed 5% of cigarette smoking harms' was confusing and less impactful than the '95% less harmful' wording. CONCLUSIONS Quantitative claims suggesting high levels of reduced risk when comparing e-cigarettes or smokeless tobacco/snus relative to cigarettes may be successful in gaining attention and being persuasive for some audiences, particularly, if from more credible sources. However, message developers, users and evaluators should be mindful of message limitations and aim to mitigate unintended consequences.
Collapse
Affiliation(s)
- Olivia A Wackowski
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Mariam Rashid
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Kathryn Greene
- Department of Communication, Rutgers University, New Brunswick, New Jersey, USA
| |
Collapse
|
33
|
Kim S, Shiffman S, Sembower MA. US adult smokers' perceived relative risk on ENDS and its effects on their transitions between cigarettes and ENDS. BMC Public Health 2022; 22:1771. [PMID: 36123722 PMCID: PMC9484256 DOI: 10.1186/s12889-022-14168-8] [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: 05/04/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Perceived risk reduction motivates smokers to switch to electronic nicotine delivery systems (ENDS). This research examines US smokers’ relative risk perceptions and their prospective association with various behavioral stages of switching to ENDS. Methods Data from the nationally representative, longitudinal Population Assessment of Tobacco and Health (PATH) Adult survey, Waves 1 (2014) through 5 (2019), were analyzed. We assessed the association between the perceived risk of ENDS relative to cigarettes (“less harmful” vs. “equally harmful” or “more harmful”) and 1) adoption of ENDS (among never-ENDS-using smokers), 2) complete switching to ENDS (i.e., stopping smoking, among ever-ENDS-using smokers), and 3) avoiding reversion to smoking (among smokers who had switched to ENDS), at the next wave. Results The proportion of US smokers perceiving ENDS as less harmful than cigarettes continually decreased, reaching 17.4% in Wave 5 (2019). Current smokers with such belief were more likely to adopt ENDS (aOR 1.31; 95% CI 1.15–1.50) and switch completely to ENDS (aOR 2.24; 95% CI 1.89–2.65) in the subsequent wave. Among smokers who had switched within the past year, such beliefs predicted avoidance of resumption of smoking in the next wave (aOR 0.55; 95% CI 0.33–0.93). Conclusions Smokers’ beliefs about the relative risk of ENDS compared to cigarettes had a strong and consistent association with transitions between smoking and ENDS use. Addressing the growing misperception about ENDS has the potential to contribute to public health by encouraging smokers’ switching to ENDS. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14168-8.
Collapse
Affiliation(s)
- Sooyong Kim
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA.
| | - Saul Shiffman
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA
| | - Mark A Sembower
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA
| |
Collapse
|
34
|
Chapman F, McDermott S, Rudd K, Taverner V, Stevenson M, Chaudhary N, Reichmann K, Thompson J, Nahde T, O'Connell G. A randomised, open-label, cross-over clinical study to evaluate the pharmacokinetic, pharmacodynamic and safety and tolerability profiles of tobacco-free oral nicotine pouches relative to cigarettes. Psychopharmacology (Berl) 2022; 239:2931-2943. [PMID: 35732751 PMCID: PMC9217727 DOI: 10.1007/s00213-022-06178-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE Tobacco harm reduction (THR) involves encouraging adult smokers who would otherwise continue to smoke to transition to less harmful forms of nicotine delivery. These products must offer adult smokers reduced exposure to chemicals associated with tobacco combustion, satisfactory blood plasma nicotine levels and serve as an acceptable alternative. The most recent THR innovation is tobacco-free oral nicotine pouches. OBJECTIVES This study aimed to compare pharmacokinetic, pharmacodynamic and safety and tolerability profiles of two nicotine pouch variants (ZoneX #2 (5.8 mg nicotine/pouch); ZoneX #3 (10.1 mg nicotine/pouch)) with cigarette to assess the pouches' THR potential. METHODS This was a controlled use, randomised, open-label, cross-over clinical study with 24 healthy adult traditional tobacco users. Pharmacokinetic (plasma nicotine levels; up to 8 h post-use), pharmacodynamic (urge to smoke, product liking; up to 4 h post-use) and short-term safety and tolerability profiles were assessed. RESULTS Distinct nicotine pouch pharmacokinetic profiles indicated nicotine absorption via the oral mucosa. Plasma nicotine levels were lower, and time to peak slower, for the nicotine pouches compared to cigarette (Cmax cigarette: 11.6 ng/ml vs. #2: 5.2 ng/ml, p < 0.0001; #3: 7.9 ng/ml, p < 0.0003) (Tmax cigarette: 8.6 min vs. #2: 26 min; #3: 22 min). All products effectively reduced subjects' urge to smoke and presented favourable product liking scores; nicotine pouches were also well tolerated following short-term use (no serious adverse events). CONCLUSIONS Overall, the assessed ZoneX nicotine pouches may offer an acceptable alternative for adult smokers to achieve satisfactory levels of nicotine delivery and, based on the pharmacokinetic parameters and under the study conditions, likely have a lower abuse liability and addictive potential for current adult smokers compared to continued cigarette smoking. CLINICAL TRIAL IDENTIFIER NCT04891406 (clinicaltrials.gov).
Collapse
Affiliation(s)
- Fiona Chapman
- Imperial Brands PLC, 121 Winterstoke Road, Bristol, BS3 2LL, UK.
| | - Simon McDermott
- Imperial Brands PLC, 121 Winterstoke Road, Bristol, BS3 2LL, UK
| | - Kathryn Rudd
- Imperial Brands PLC, 121 Winterstoke Road, Bristol, BS3 2LL, UK
| | | | | | - Nveed Chaudhary
- Imperial Brands PLC, 121 Winterstoke Road, Bristol, BS3 2LL, UK
| | | | - Joseph Thompson
- Imperial Brands PLC, 121 Winterstoke Road, Bristol, BS3 2LL, UK
| | - Thomas Nahde
- Reemtsma Cigarettenfabriken GmbH, an Imperial Brands PLC Company, Albert-Einstein-Ring-7, 22761, Hamburg, Germany
| | - Grant O'Connell
- Imperial Brands PLC, 121 Winterstoke Road, Bristol, BS3 2LL, UK
| |
Collapse
|
35
|
Pipe AL, Mir H. E-Cigarettes Reexamined: Product Toxicity. Can J Cardiol 2022; 38:1395-1405. [PMID: 36089290 DOI: 10.1016/j.cjca.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a "harm reduction" tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and "emerging chemicals of concern" are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.
Collapse
Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Hassan Mir
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
36
|
Weiger C, Moran MB, Kennedy RD, Limaye R, Cohen J. Beliefs and Characteristics Associated With Believing Nicotine Causes Cancer: A Descriptive Analysis to Inform Corrective Message Content and Priority Audiences. Nicotine Tob Res 2022; 24:1264-1272. [PMID: 35385112 PMCID: PMC9278833 DOI: 10.1093/ntr/ntac060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/27/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Many cigarette smokers want to quit but have not. Switching to noncombustible products can reduce disease risk, but misperceptions that nicotine causes cancer might impact relative harm perceptions about noncombustible products and considering switching. Identifying which smokers are most likely to hold this misperception and associated beliefs can inform the content of and priority audiences for corrective messaging. METHODS Bivariable log binomial models were run on a sample of 9,013 adult established smokers from Wave 3 of the Population Assessment of Tobacco and Health. Post hoc testing identified groups and beliefs associated with significantly higher-than-average prevalence of the misperception. RESULTS About 61.2% of smokers believe nicotine causes cancer or don't know. Non-Hispanic Black (PR: 2.09) and Hispanic (PR: 1.73) smokers, as well as those making under $10,000 a year (PR: 1.36) had significantly higher-than-average prevalence of the misperception. Smokers who had recently used ENDS or smokeless tobacco had significantly lower-than-average prevalence of the misperception (PR: 0.70 and 0.63, respectively). Prevalence of nicotine misperceptions was significantly higher-than-average among those who recognized all ten smoking-caused diseases (PR: 1.34), believed additive-free cigarettes were more harmful than regular cigarettes (PR: 1.71), or did not report subjective norms supporting noncombustible use (PR: 1.05). CONCLUSION High perceived threat of tobacco may be overgeneralized to nicotine. High prevalence of the misperception among Non-Hispanic Black and low-income smokers is concerning, considering existing health disparities. Messaging should attempt to correct the misperception that nicotine causes cancer. Inferential reasoning after message exposure should assess accuracy of relative harm perceptions. IMPLICATIONS The current study supports the need for corrective messaging to address the misperception that nicotine causes cancer. Identifying that nicotine misperceptions are associated with higher harm perceptions about tobacco suggests that there may be unintended consequences of high perceived harm of tobacco that need to be addressed. As nicotine misperceptions are significantly more prevalent among those already at higher risk of tobacco caused diseases, care should be taken to ensure equity in message dissemination.
Collapse
Affiliation(s)
- Caitlin Weiger
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Meghan Bridgid Moran
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Ryan David Kennedy
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, 2213 McElderry St., 4th Floor, Baltimore, MD, USA
| | - Rupali Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD 21205, USA
| | - Joanna Cohen
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, 2213 McElderry St., 4th Floor, Baltimore, MD, USA
| |
Collapse
|
37
|
Sissung TM, Figg WD. Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds. FAMILY & COMMUNITY HEALTH 2022; 45:202-205. [PMID: 35385429 PMCID: PMC9156525 DOI: 10.1097/fch.0000000000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Electronic nicotine delivery systems (ENDS) represent a variety of different devices that are designed as alternatives to combustible cigarettes. A continuum of nicotine risk is becoming increasingly recognized, and many ENDS products are associated with significant harm reduction when compared to conventional tobacco products; however, ENDS products still present significant public safety concerns and regulatory challenges. While a rather large body of scientific evidence demonstrates ENDS are useful for smoking cessation efforts, a culture of ENDS use has simultaneously developed among youth users. Youth preference for ENDS is likely a function of both a variety of flavorants found in these products and social media and influencer campaigns that appealed directly to younger audiences. More recent marketing strategies have emphasized the safety of these products and promote ENDS products through “education” campaigns designed to inform youth about the dangers of tobacco use. Consequently, ENDS products are now a primary factor promoting nicotine addiction among new users, who tend to be young. As modified risk claims are now common among ENDS products, public health strategies designed to reduce nicotine use must balance the safety of ENDS and their clear appeal to youth.
Collapse
Affiliation(s)
- Tristan M Sissung
- Clinical Pharmacology Program, Office of the Clinical Director, National Cancer Institute, Bethesda, Maryland
| | | |
Collapse
|
38
|
Ensslin L, Gonçalves A, Ensslin SR, Dutra A, Longaray AA. Constructivist multi-criteria model to support the management of occupational accident risks in civil construction industry. PLoS One 2022; 17:e0270529. [PMID: 35763516 PMCID: PMC9239452 DOI: 10.1371/journal.pone.0270529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/11/2022] [Indexed: 11/19/2022] Open
Abstract
Civil construction is one of the industrial sectors with continuous growth globally, particularly in Brazil in the last 50 years. Unfortunately, it is also one of the productive segments with the highest incidence of accidents, which overshadows its merits as a driver of economic growth and job creation. The damage to workers' health caused by accidents at work results from the presence of work environment risk factors. Therefore, this study aims to manage these risk factors for the civil construction industry. The work is original with respect to building a model to support risk management in civil construction for a specific and relevant context. It is ensured by presenting an unprecedented approach to the sector that incorporates information not considered by classic generic approaches. This research, thereby, seeks to build a model to support the risk management of accidents in the workplace in the prefabricated concrete construction industry. It is a case study with a constructivist approach and an exploratory and descriptive character, incorporating the Multicriteria Methodology for Decision Aiding-Constructivist (MCDA-C). The main findings include (i) identifying the strategic objectives: occupational safety policy, work environment, machines and equipment, condition of materials, procedures and methods, and skills, which were operationalized via 58 criteria; (ii) examining the scales of the criteria such as the performance profile of the current situation and the goal, highlighting the vulnerabilities and potentials; (iii) proposing improvement actions for the vulnerabilities, thus supporting risk management in the organization. Among the contributions, managers and professionals in the field contribute to the possibility of using an instrument customized to the context and legitimate to their concerns and values stands out. Furthermore, the contributions of researchers include the challenge of improving their generic models with the knowledge of personalized models.
Collapse
Affiliation(s)
- Leonardo Ensslin
- Department of Administration, University of Southern Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Alex Gonçalves
- Department of Administration, University of Southern Santa Catarina, Florianópolis, Santa Catarina, Brazil
- * E-mail:
| | - Sandra Rolim Ensslin
- Department of Accounting, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ademar Dutra
- Department of Administration, University of Southern Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - André Andrade Longaray
- Department of Economic, Administrative and Accounting Sciences, Federal University of Rio Grande, Rio Grande do Sul, Brazil
| |
Collapse
|
39
|
Fowler S, Bhatt J, Brown S, Fleming L, Mayell S, Sinha I, Bush A. E-cigarette company tactics in sports advertising. THE LANCET. RESPIRATORY MEDICINE 2022; 10:634-636. [PMID: 35568053 DOI: 10.1016/s2213-2600(22)00166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Stephen Fowler
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; UK and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - Jayesh Bhatt
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Sarah Brown
- Department of Paediatric Respiratory Medicine, Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Louise Fleming
- Department of Paediatric Respiratory Medicine and the Imperial Centre for Paediatrics and Child Health, Imperial College and Royal Brompton Hospital, London, UK
| | - Sarah Mayell
- Department of Paediatric Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Ian Sinha
- Department of Paediatric Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine and the Imperial Centre for Paediatrics and Child Health, Imperial College and Royal Brompton Hospital, London, UK
| |
Collapse
|
40
|
Lee PN, Fry JS. Investigating the effect of e-cigarette use on quitting smoking in adults aged 25 years or more using the PATH study. F1000Res 2022; 9:1099. [PMID: 35813077 PMCID: PMC9214270 DOI: 10.12688/f1000research.26167.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background: The evidence on harms and benefits of e-cigarettes partly concerns whether their use encourages smokers to quit. We addressed this using data from the nationally representative PATH study, with detailed accounting for potential confounding variables. Methods: We considered adults aged 25+. Our original analyses, reported in version 1 of this paper, used data for Waves 1 to 3, separate analyses considering Waves 1 to 2, 2 to 3 and 1 to 3. These related baseline ever e-cigarette use (or e-product use at Wave 2) to quitting at follow-up, adjusting for confounders derived from 55 candidates. Sensitivity analyses omitted ever other product users, linked quitting to current e-cigarette use, and used values of some predictors modified using follow-up data. Additional analyses used data for Waves 1 to 4, separately considering sustained, delayed and temporary quitting during Waves 1 to 3, 2 to 4 and 1 to 4. Sensitivity analyses considered 30-day quitting, restricted attention to smokers attempting to quit, and considered ever smokeless tobacco or snus use. Results: In the original analyses, unadjusted odds ratios (ORs) of quitting smoking for ever e-cigarette use were 1.29 (95% CI 1.01-1.66), 1.52 (1.26-1.83) and 1.47 (1.19-1.82) for the Wave 1 to 2, 2 to 3, and 1 to 3 analyses. These reduced after adjustment, to 1.23 (0.94-1.61), 1.51 (1.24-1.85) and 1.39 (1.11-1.74). Quitting rates remained elevated in users in all sensitivity analyses. The additional analyses found associations of e-cigarette use with sustained, delayed and temporary quitting, associations little affected by considering 30-day quitting, and only slightly reduced restricting attention to quit attempters. Ever use of smokeless tobacco or snus also predicted increased quitting. Conclusions: As does most evidence from clinical trials, other analyses of PATH, and other epidemiological studies, our results suggest using e-cigarettes helps adult smokers to quit.
Collapse
Affiliation(s)
- Peter N. Lee
- P.N.Lee Statistics and Computing, Sutton, Surrey, SM2 5DA, UK
| | - John S. Fry
- RoeLee Statistics Ltd, Sutton, Surrey, SM2 5DA, UK
| |
Collapse
|
41
|
Freitas-Lemos R, Stein JS, Pope DA, Brown J, Feinstein M, Stamborski KM, Tegge AN, Heckman BW, Bickel WK. E-liquid purchase as a function of workplace restriction in the experimental tobacco marketplace. Exp Clin Psychopharmacol 2022; 30:371-377. [PMID: 33630645 PMCID: PMC8384943 DOI: 10.1037/pha0000444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
E-cigarette use is prohibited in most smoke-free environments. The effect of this policy on tobacco consumption could be examined using the Experimental Tobacco Marketplace (ETM). The ETM allows observation of policy on smokers' purchasing behavior under conditions that simulate "real-world" circumstances. A within-subject design was used to evaluate the effect of workplace policy (Vaping Allowed vs. Not Allowed) and nicotine concentration (24 mg/mL vs. 0 mg/mL) on tobacco product consumption. Participants (n = 31) completed one sampling and two ETM/workplace sessions per week for 2 weeks. During the sampling session, participants were given an e-cigarette with a 2-day supply of a commercially available e-liquid of their preferred flavor. Before purchasing, participants were informed whether e-cigarette use was permitted. During the four ETM sessions, participants purchased for the following 24 hr, including the 4-hr work shift that started immediately after buying products in the ETM. The workplace session consisted of data entry tasks in a mock office environment. Participants could use any purchased tobacco products during two 15-min breaks. Condition order was counterbalanced. The results show that permitting E-cigarette use in the workplace increased e-liquid purchase on average, but nicotine concentration had no effect on e-liquid demand. Cigarette demand was unaltered across conditions. The present study suggests that allowing e-cigarette use in the workplace would increase demand for e-liquid regardless of nicotine strength. However, it would not change conventional cigarette demand. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Jeffrey S. Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Derek A. Pope
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA. Present affiliation - The Fox Foundation, Inc
| | - Jeremiah Brown
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Marc Feinstein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Kelsey M. Stamborski
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Allison N. Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Bryan W. Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| |
Collapse
|
42
|
Lee PN, Fry JS, Ljung T. Estimating the public health impact had tobacco-free nicotine pouches been introduced into the US in 2000. BMC Public Health 2022; 22:1025. [PMID: 35597944 PMCID: PMC9123784 DOI: 10.1186/s12889-022-13441-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For smokers not intending to quit, switching to a reduced-risk nicotine product should be healthier than continuing smoking. We estimate the health impact, over the period 2000-2050, had the nicotine pouch ZYN hypothetically been introduced into the US in 2000. ZYN's toxicant profile and method of use is like that for Swedish snus, a product with known health effects much less than smoking. METHODS Our modelling approach is similar to others developed for estimating potential effects of new tobacco products. It starts with a simulated cohort of 100,000 individuals in the year 2000 subdivided by age, sex, and smoking status (including years since quitting). They are followed annually accounting for births, net immigrations, deaths and product use changes, with follow-up carried out in the Base Case (ZYN not introduced) and Modified Case (ZYN introduced). Using informed assumptions about initiation, quitting and switching rates, distributions of the population over time are then constructed for each Case, and used to estimate product mortality based on assumptions about the relative risk according to product use. RESULTS Whereas in both Base and Modified Cases, the prevalence of any current product use is predicted to decline from about 22% to 10% during follow-up, in the Modified Case about 25% of current users use ZYN by 2050, about a quarter being dual users and the rest ZYN-only users. Over the 50 years, deaths at ages 35-84 from product use among the 100,000 are estimated as 249 less in the Modified than the Base Case, equivalent to about 700,000 less in the whole US. Sensitivity analyses varying individual parameter values confirm the benefits of switching to ZYN, which increase as either the switching rate to ZYN increases or the initiation rate of ZYN relative to smoking increases. Even assuming the reduction in excess mortality risk using ZYN use is 20% of that from smoking rather than the 3.5% assumed in the main analyses, the reduction in product-related deaths would still be 213, or about 600,000 in the US. CONCLUSIONS Although such model-based estimates involve uncertainties, the results suggest that introducing ZYN could substantially reduce product-related deaths.
Collapse
Affiliation(s)
- Peter N Lee
- P.N.Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.
| | - John S Fry
- RoeLee Statistics Ltd., 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK
| | - Tryggve Ljung
- Swedish Match, Sveavägen 44 8th Floor, SE-118 85, Stockholm, Sweden
| |
Collapse
|
43
|
Sæbø G, Lund I. Public support for further regulating smoking, snus and e-cigarettes in Norway, and its associations with risk perceptions and tobacco use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 101:103559. [PMID: 34952281 DOI: 10.1016/j.drugpo.2021.103559] [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: 09/15/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Public support is an indication of the legitimacy of governmental tobacco interventions. Little is known about what it is that shapes the support for various tobacco policy measures. We examine whether there are differences in public support for new measures against smoking, snus, and e-cigarettes in Norway, and whether public support is associated with user status and perceptions of the products' harm potential. DATA AND METHODS In December 2017, 4,002 people aged between 16 and 89 answered a web-based questionnaire. The sample was randomly drawn from Norstat's web panel, and pre-stratified by gender, age, region, and education in order to obtain an approximate country-representative sample. Respondents were asked to indicate their support for eight possible future measures to further restrict accessibility of tobacco (asked separately with regard to smoking tobacco, snus and e-cigarettes respectively), on a five-point scale from 1 = 'no support' to 5 = 'full support'. We utilized means and t-tests to address differences in support between measures. We then constructed sum scores to assess the total support for regulating each tobacco product and subjected these indexes to linear regression analyses, controlling for background variables. RESULTS For six of the eight proposed measures, public opinion is less supportive of e-cigarette regulations than of similar regulations for snus and, especially, smoking tobacco. In all three regression models, significant associations with risk perception, user status and gender were maintained after multiple controls. The associations with risk perceptions were stronger for support of snus and e-cigarette regulation than for smoking tobacco. CONCLUSION Overall, these findings illustrate the key role of risk perceptions in forming public opinions regarding tobacco-preventive regulations and underline the importance of information to ensure that population risk perceptions are accurate.
Collapse
Affiliation(s)
- Gunnar Sæbø
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health (NIPH), P.O. Box 222, Skøyen, N-0213 Oslo, Norway.
| | - Ingeborg Lund
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health (NIPH), P.O. Box 222, Skøyen, N-0213 Oslo, Norway
| |
Collapse
|
44
|
Talantsev A, Fasth T, Wenner C, Wolff E, Larsson A. Evaluation of pharmaceutical intervention strategies against pandemics in Sweden: A scenario‐driven multiple criteria decision analysis study. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2022. [DOI: 10.1002/mcda.1779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anton Talantsev
- Department of Computer and Systems Sciences Stockholm University Stockholm Sweden
| | - Tobias Fasth
- Department of Computer and Systems Sciences Stockholm University Stockholm Sweden
- Public Health Analysis and Data Management Public Health Agency of Sweden Solna Sweden
| | - Cenny Wenner
- Public Health Analysis and Data Management Public Health Agency of Sweden Solna Sweden
| | - Ellen Wolff
- Public Health Analysis and Data Management Public Health Agency of Sweden Solna Sweden
| | - Aron Larsson
- Department of Computer and Systems Sciences Stockholm University Stockholm Sweden
- Risk and Crisis Research Centre Mid Sweden University Sundsvall Sweden
| |
Collapse
|
45
|
El-Mahdy MA, Ewees MG, Eid MS, Mahgoup EM, Khaleel SA, Zweier JL. Electronic Cigarette Exposure Causes Vascular Endothelial Dysfunction Due to NADPH Oxidase Activation and eNOS Uncoupling. Am J Physiol Heart Circ Physiol 2022; 322:H549-H567. [PMID: 35089811 PMCID: PMC8917923 DOI: 10.1152/ajpheart.00460.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We recently reported a mouse model of chronic electronic cigarette (e-cig) exposure-induced cardiovascular pathology, where long-term exposure to e-cig vape (ECV) induces cardiac abnormalities, impairment of endothelial function, and systemic hypertension. Here, we delineate the underlying mechanisms of ECV-induced vascular endothelial dysfunction (VED), a central trigger of cardiovascular disease. C57/BL6 male mice were exposed to ECV generated from e-cig liquid containing 0, 6, or 24 mg/ml nicotine for 16 and 60 weeks. Time-dependent elevation in blood pressure and systemic vascular resistance were observed, along with an impairment of acetylcholine-induced aortic relaxation in ECV-exposed mice, compared to air-exposed control. Decreased intravascular nitric oxide (NO) levels and increased superoxide generation with elevated 3-nitrotyrosine levels in the aorta of ECV-exposed mice were observed, indicating that ECV-induced superoxide reacts with NO to generate cytotoxic peroxynitrite. Exposure increased NADPH oxidase expression, supporting its role in ECV-induced superoxide generation. Downregulation of endothelial nitric oxide synthase (eNOS) expression and Akt-dependent eNOS phosphorylation occurred in the aorta of ECV-exposed mice, indicating that exposure inhibited de novo NO synthesis. Following ECV exposure, the critical NOS cofactor tetrahydrobiopterin was decreased, with a concomitant loss of its salvage enzyme, dihydrofolate reductase. NADPH oxidase and NOS inhibitors abrogated ECV-induced superoxide generation in the aorta of ECV exposed mice. Together, our data demonstrate that ECV exposure activates NADPH oxidase and uncouples eNOS, causing a vicious cycle of superoxide generation and vascular oxidant stress that triggers VED and hypertension with predisposition to other cardiovascular disease.
Collapse
Affiliation(s)
- Mohamed A El-Mahdy
- Center for Environmental and Smoking Induced Disease and the Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Mohamed G Ewees
- Center for Environmental and Smoking Induced Disease and the Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Mahmoud S Eid
- Center for Environmental and Smoking Induced Disease and the Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Elsayed M Mahgoup
- Center for Environmental and Smoking Induced Disease and the Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Sahar A Khaleel
- Center for Environmental and Smoking Induced Disease and the Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Pharmacology and Toxicology, College of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Jay L Zweier
- Center for Environmental and Smoking Induced Disease and the Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
46
|
Livingstone-Banks J, Siddiqui F, Croucher R, Mehrotra R, Vidyasagaran A, Siddiqi K. Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev 2022; 2022. [PMCID: PMC8772273 DOI: 10.1002/14651858.cd015314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Affiliation(s)
| | - Faraz Siddiqui
- Department of Health Sciences and Hull York Medical School; York University; York UK
| | - Ray Croucher
- Department of Health Sciences and Hull York Medical School; York University; York UK
| | - Ravi Mehrotra
- Department of Health Sciences and Hull York Medical School; York University; York UK
- Centre for Health Policy and Innovation; New Delhi India
| | | | - Kamran Siddiqi
- Department of Health Sciences and Hull York Medical School; York University; York UK
| |
Collapse
|
47
|
Lee PN, Fry JS, Gilliland S, Campbell P, Joyce AR. Estimating the reduction in US mortality if cigarettes were largely replaced by e-cigarettes. Arch Toxicol 2022; 96:167-176. [PMID: 34677631 PMCID: PMC8748352 DOI: 10.1007/s00204-021-03180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent estimates indicated substantially replacing cigarettes by e-cigarettes would, during 2016-2100, reduce US deaths and life-years lost (millions) by 6.6 and 86.7 (Optimistic Scenario) and 1.6 and 20.8 (Pessimistic). To provide additional insight we use alternative modelling based on a shorter period (1991-2040), four main smoking-associated diseases, deaths aged 30-79 years, and a full product history. We consider variations in: assumed effective dose of e-cigarettes versus cigarettes (F); their relative quitting rate (Q); proportions smoking after 10 years (X); and initiation rate (I) of vaping, relative to smoking. METHODS We set F = 0.05, X = 5%, Q = 1.0 and I = 1.0 (Main Scenario) and F = 0.4, X = 10%, Q = 0.5 and I = 1.5 (Pessimistic Scenario). Sensitivity Analyses varied Main Scenario parameters singly; F from 0 to 0.4, X 0.01% to 15%, and Q and I 0.5 to 1.5. To allow comparison with prior work, individuals cannot be dual users, re-initiate, or switch except from cigarettes to e-cigarettes. RESULTS Main Scenario reductions were 2.52 and 26.23 million deaths and life-years lost; Pessimistic Scenario reductions were 0.76 and 8.31 million. These were less than previously, due to the more limited age-range and follow-up, and restriction to four diseases. Reductions in deaths (millions) varied most for X, from 3.22 (X = 0.01%) to 1.31 (X = 15%), and F, 2.74 (F = 0) to 1.35 (F = 0.4). Varying Q or I had little effect. CONCLUSIONS Substantial reductions in deaths and life-years lost were observed even under pessimistic assumptions. Estimates varied most for X and F. These findings supplement literature indicating e-cigarettes can importantly impact health challenges from smoking.
Collapse
Affiliation(s)
- Peter N Lee
- P N Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, SM2 5DA, Surrey, UK.
| | - John S Fry
- RoeLee Statistics Ltd, 17 Cedar Road, Sutton, SM2 5DA, Surrey, UK
| | - Stanley Gilliland
- Consilium Sciences, LLC, 7400 Beaufont Springs Drive, Suite 300, N. Chesterfield, 23325, VA, USA
| | - Preston Campbell
- Consilium Sciences, LLC, 7400 Beaufont Springs Drive, Suite 300, N. Chesterfield, 23325, VA, USA
| | - Andrew R Joyce
- Consilium Sciences, LLC, 7400 Beaufont Springs Drive, Suite 300, N. Chesterfield, 23325, VA, USA
| |
Collapse
|
48
|
Bertoni N, Cavalcante TM, Souza MCD, Szklo AS. Prevalence of electronic nicotine delivery systems and waterpipe use in Brazil: where are we going? REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210007. [PMID: 34910061 DOI: 10.1590/1980-549720210007.supl.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the prevalence of use of electronic nicotine delivery systems (ENDS) and waterpipe in Brazil, by population subgroups, and to evaluate the trend between 2013 and 2019. METHODS We used data from the 2019 National Health Survey to estimate the prevalence of lifetime and current use of ENDS and current use of waterpipes by socio-behavioral characteristics. Differences in prevalence over time were calculated using data from the III Brazilian Household Survey on Substance Use-2015 and the National Health Survey-2013. RESULTS For 2019, the prevalence of current use of ENDS was estimated at 0.64% (∼1 million people), of which ∼70% were in the age group of 15-24 years old. The highest prevalence was observed in the Midwest region, but the Southeast region concentrates half of these users. Almost 90% are non-smokers, with high prevalence among those who also use waterpipe and abuse alcohol. There was an increase in ENDS use between 2015 and 2019, particularly among younger people. The prevalence of current waterpipe use in 2019 was estimated at 0.47% (∼800,000 individuals), of which ∼80% were 15-24 years old. There was an increase in the prevalence of current waterpipe use between 2013 and 2019, and among young people the increase was ∼300%. CONCLUSIONS In Brazil, ENDS have been used mostly by young people, and by never smokers of manufactured cigarettes. The use of ENDS and waterpipe has been increasing even with the country's regulatory restrictions, which may compromise the successful history of the tobacco control policy.
Collapse
Affiliation(s)
- Neilane Bertoni
- National Cancer Institute, Population Research Division - Rio de Janeiro (RJ), Brazil
| | - Tania Maria Cavalcante
- National Cancer Institute, National Commission for Implementation of the Framework Convention in Brazil - Rio de Janeiro (RJ), Brazil
| | | | - Andre Salem Szklo
- National Cancer Institute, Population Research Division - Rio de Janeiro (RJ), Brazil
| |
Collapse
|
49
|
Barriers to Cigarette Smoking Cessation in Pakistan: Evidence from Qualitative Analysis. J Smok Cessat 2021; 2021:9592693. [PMID: 34853617 PMCID: PMC8592749 DOI: 10.1155/2021/9592693] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background With over 25 million tobacco users, Pakistan has one of the largest smoking populations in the world. Tobacco addiction comes with grave health consequences, especially for the poor and marginalized. Objective This study explores barriers to smoking cessation in marginalized communities of Islamabad and the possibility of their use of Harm Reduction Products (HRPs), primarily e-cigarettes. Methodology. The study has used primary data of 48 respondents from marginalized communities. Several domains have been employed to evaluate the barriers to smoking cessation in these communities. Using qualitative technique, data was organized and categorized into objective themes. Conclusion The experience of combustible smoking usually occurs in the 10-20 years' age bracket. Regular smokers in marginalized areas of Islamabad smoke 20 cigarettes or a pack per day. Their choice of cigarette brand is largely driven by affordability. Most smokers have made at least one attempt to quit smoking. Peer pressure and friendship are major barriers to smoking cessation. Lack of knowledge seems to be the major reason for not seeking medical assistance for quitting smoking. Knowledge about HRPs, especially e-cigarettes, can best be described as vague. Higher prices of the alternatives to combustible smoking are a major hurdle preventing their use for smoking cessation.
Collapse
|
50
|
Shi R, Feldman R, Liu J, Clark PI. The Dilemma of Correcting Nicotine Misperceptions: Nicotine Replacement Therapy versus Electronic Cigarettes. HEALTH COMMUNICATION 2021; 36:1856-1866. [PMID: 32762261 PMCID: PMC7864996 DOI: 10.1080/10410236.2020.1800288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many people overestimate the health risks associated with nicotine, mistakenly perceiving nicotine as the main carcinogen in cigarettes and a leading cause of smoking-related diseases. Health professionals have been calling for public education programs to correct nicotine misperceptions in the hope that a lower risk perception of nicotine could encourage the use of nicotine replacement therapy (NRT). However, a lower risk perception of nicotine could also lower perceived risk of electronic cigarettes (e-cigarettes). This paper evaluated the necessity of correcting nicotine misperceptions and explored possible intervention strategies to increase use of NRT and decrease use of e-cigarettes. In Study 1, smokers were surveyed about their perceptions of nicotine harm, and attitudes and intention toward using NRT and e-cigarettes. Results showed that overestimation of nicotine harm was associated with e-cigarette attitude and intention, but not with NRT. Informed by the survey results, three correction messages (a nicotine message, an NRT message, and an e-cigarette message) were developed and experimentally tested in Study 2 on both tobacco users and non-tobacco users. The nicotine message lowered people's perception of nicotine harm but it did not change attitude and intention toward tobacco product use. The NRT message also failed to influence NRT attitudes and intentions. The e-cigarette message significantly lowered attitudes and intentions to use e-cigarette.
Collapse
Affiliation(s)
- Rui Shi
- Department of Communication Studies, Rowan University, Glassboro, New Jersey, USA
| | - Robert Feldman
- Department of Behavioral and Community Health, University of Maryland, College Park, Maryland, USA
| | - Jiaying Liu
- Department of Communication Studies, University of Georgia, Athens, Georgia, USA
| | - Pamela I Clark
- Department of Behavioral and Community Health, University of Maryland, College Park, Maryland, USA
| |
Collapse
|