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Siegel M, Katchmar A. Effect of flavored E-cigarette bans in the United States: What does the evidence show? Prev Med 2022; 165:107063. [PMID: 35452711 DOI: 10.1016/j.ypmed.2022.107063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/04/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
Abstract
The United States federal government, along with many state and local governments, have passed restrictions on electronic cigarette ("e-cigarette") sales with the stated purpose of preventing youth use of these products. The justification for these restrictions includes the argument that youth e-cigarette use will re-normalize youth smoking, leading to increased rates of cigarette smoking by teenagers. However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States of America
| | - Amanda Katchmar
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118, United States of America.
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2
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Copp SR, Wilson MN, Asbridge M. Smoking Susceptibility in Canadian Adolescent Electronic-Cigarette Users. Subst Use Misuse 2022; 57:1022-1034. [PMID: 35403553 DOI: 10.1080/10826084.2022.2058702] [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] [Indexed: 10/18/2022]
Abstract
Background: E-cigarette use is increasing among Canadian youth, with experimentation especially prevalent among never-smoking youth. Among this group, there is concern e-cigarette use contributes to future initiation of smoking through a gateway effect. However, e-cigarette use and smoking share many common risk factors; a postulated mechanism to explain the apparent causal pathway from e-cigarette use to smoking initiation in previously smoking-naïve youth. A better understanding of the relationships between smoking susceptibility and e-cigarette use among never-smoking youth is needed. Purpose/objectives: The primary aim of this study was to gain a deeper understanding of the risk factors associated with smoking susceptibility in youth who have recently used e-cigarettes. Methods: This study used data (n = 40,363) from the 2018/2019 Canadian Student Tobacco Alcohol and Drug Use Survey (CSTADS) to compare the risk factor profiles of susceptible and non-susceptible never-smoking e-cigarette users, as well as susceptible and non-susceptible never-smoking youth who have never used an e-cigarette. Results: E-cigarette use, independent of susceptibility status, was associated with a sociodemographic and behavioral risk factor profile likely to confer a higher risk of initiating smoking. Among e-cigarette users, smoking susceptibility was associated with more smoking risk factors. Conclusions/importance: Study findings support a common risk-factor model, rather than e-cigarette use itself, to explain differences in the likelihood of smoking initiation among e-cigarette users. E-cigarette use and smoking initiation may be interchangeable outcomes amongst those with smoking risk factors. The risks of e-cigarette use, and their regulatory status, need to be balanced with their potential as harm reduction tools.
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Affiliation(s)
- Sebastian R Copp
- Department of Post-Graduate Medicine, Dalhousie University Faculty of Medicine, Medicine, Halifax, Nova Scotia, Canada
| | - Maria N Wilson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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3
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Barrett R, Aldamkhi H. An Evaluation of the Knowledge and Perceptions of Pharmacy Staff and Pre-Registration Students of E-Cigarettes Use: A Systematic Review. Tob Use Insights 2021; 14:1179173X211016867. [PMID: 34188579 PMCID: PMC8209790 DOI: 10.1177/1179173x211016867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/17/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pharmacy staff are a trusted source of advice on the safe and appropriate use of medicines and devices. Retail pharmacies deliver smoking cessation services and sell e-cigarettes in the UK. This review asks 'what knowledge, experience and ability do staff have to support e-cigarette users to quit smoking'. METHODS A systematic literature search was undertaken drawn on predefined eligibility criteria and a comprehensive search strategy following the PRISMA guideline. Eligible papers reported survey-research published in English from 2015 to 2020. PubMed, Google Scholar, OVID, EMBASE and MEDLINE Databases were searched. No restrictions on study design or language were applied. Two reviewers independently screened for inclusion/exclusion and then extracted the relevant information from the articles for synthesis. RESULTS Of 12 potentially eligible full-text studies, 1 was a duplicate, 7 were excluded as per eligibility criteria. Four papers were finally included in this literature review. Two studies indicated that pharmacy staff are less confident in giving advice on e-cigarette use. Knowledge on the adverse effects of e-cigarettes compared to traditional smoking cessation aids remain unclear. In one study, 42% of community pharmacists did not believe that e-cigarettes could be used for smoking cessation. Three studies identified need for specific regulations and professional support. The overall certainty of the evidence is 'low' or 'very low', with moderate levels of bias. CONCLUSION Pharmacists may be well placed to implement e-cigarette smoking cessation interventions, but most practitioners lacked knowledge and ability to support these customers citing unclear risk of harm. Pharmacists felt secure in recommending traditional cessation tools. Further regulation, guidelines and training is needed. Findings may be less generalizable in countries where e-cigarettes are banned. Their extent of knowledge, experience and ability to support users of e-cigarettes within their community to quit smoking is lacking.
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Affiliation(s)
- Ravina Barrett
- School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, UK
- Visiting Researcher in Pharmacy Practice, School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK
| | - Hajar Aldamkhi
- School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, UK
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4
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Hernandez ML, Burbank AJ, Alexis NE, Rebuli ME, Hickman ED, Jaspers I, Guidos G. Electronic Cigarettes and Their Impact on Allergic Respiratory Diseases: A Work Group Report of the AAAAI Environmental Exposures and Respiratory Health Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:1142-1151. [PMID: 33547027 PMCID: PMC8232370 DOI: 10.1016/j.jaip.2020.12.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
Abstract
The explosive rise in popularity of electronic cigarette (e-cig) devices over the past decade has led to controversies over the role of these devices in smoking cessation and harm reduction from combustible cigarette smoking. Increased recognition of potential direct harms of e-cigs, including life-threatening and fatal cases of e-cig and vaping product use-associated lung injury, has emphasized the need to curb use until safety can be established. Of particular concern is the steep rise in e-cig use among teenagers and young adults who have never smoked and among individuals with underlying lung disease, such as asthma. In this report, we describe the different types of e-cig devices available, summarize the available data on the potential health benefits and detriments of e-cig use, and highlight the findings of studies examining e-cigs as smoking cessation tools. Because e-cigs have only gained popularity in the last few years, very few studies have been able to demonstrate an impact of e-cig use on harm reduction related to combustible cigarettes. Moreover, the health effects of e-cigs at a population level must be balanced against the harms of e-cig use, which include nicotine dependence and promoting initiation of cigarette use amongst "never smokers." With respect to smoking cessation, e-cigs appear to serve as switching products that may help individuals reduce or quit cigarette use, but do not address nicotine addiction. Finally, we discuss our recommendations for ways that health care providers can screen and counsel patients on e-cig use. The goal of this report is to provide health care providers with the most recent information on this topic so that they can educate patients on the potential pros and cons of e-cig use.
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Affiliation(s)
- Michelle L Hernandez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
| | - Allison J Burbank
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Neil E Alexis
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Meghan E Rebuli
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Elise D Hickman
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Ilona Jaspers
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Guillermo Guidos
- Department of Immunology, School of Medicine, Instituto Politecnico Nacional, Mexico City, Mexico
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5
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Bush A, Lintowska A, Mazur A, Hadjipanayis A, Grossman Z, Del Torso S, Michaud PA, Doan S, Romankevych I, Slaats M, Utkus A, Dembiński Ł, Slobodanac M, Valiulis A. E-Cigarettes as a Growing Threat for Children and Adolescents: Position Statement From the European Academy of Paediatrics. Front Pediatr 2021; 9:698613. [PMID: 34737999 PMCID: PMC8562300 DOI: 10.3389/fped.2021.698613] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/08/2021] [Indexed: 12/02/2022] Open
Abstract
As the tobacco epidemic has waned, it has been followed by the advent of electronic nicotine delivery devices (ENDS) primarily manufactured by the tobacco industry to try to recruit replacements for deceased tobacco addicts. This document sets out the ten recommendations of the European Academy of Paediatrics (EAP) with regard to e-cigarettes and children and young people (CYP). The EAP notes that nicotine is itself a drug of addiction, with toxicity to the foetus, child and adult, and were ENDS only to contain nicotine, their use to create a new generation of addicts would be rigorously opposed. However, e-cigarettes include numerous unregulated chemicals, including known carcinogens, whose acute and long term toxicities are unknown. The EAP asserts that there is incontrovertible evidence that the acute toxicity of e-cigarettes is greater than that of "traditional" tobacco smoking, and a variety of acute pulmonary toxicities, including acute lung injuries, have been recorded due to e-cigarettes usage. The chronic toxicity of e-cigarettes is unknown, but given the greater acute toxicity compared to tobacco, the EAP cannot assume that e-cigarettes are safer in the long term. The high uptake of e-cigarettes by CYP, including under-age children, is partly fuelled by deceitful marketing and internet exposure, which is also unregulated. Although proposed as aids to smoking cessation, there is no evidence that e-cigarettes add anything to standard smoking cessation strategies. In summary, the EAP regards these devices and liquids as very dangerous, and ineluctably opposed to their use, and their direct or indirect marketing.
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Affiliation(s)
- Andrew Bush
- Imperial College Centre for Paediatrics and Child Health, National Heart and Lung Institute, Royal Brompton Harefield NHS Foundation Trust, London, United Kingdom
| | - Agnieszka Lintowska
- Department of Health Promotion, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Artur Mazur
- Institute of Medical Sciences, Medical College, University of Rzeszów, Rzeszow, Poland.,European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium
| | - Adamos Hadjipanayis
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Medical School, European University of Cyprus, Nicosia, Cyprus
| | - Zacchi Grossman
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Adelson School of Medicine, Ariel University, Ariel, Israel.,Maccabi Health Services, Tel Aviv, Israel
| | - Stefano Del Torso
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Pediatra di Famiglia ULSS 16, Padua, Italy
| | - Pierre-André Michaud
- Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland
| | - Svitlana Doan
- Department of Public Health and Microbiology, Kyiv Medical University, Kyiv, Ukraine
| | - Ivanna Romankevych
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Monique Slaats
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Pediatric Pulmonology, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Łukasz Dembiński
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | | | - Arunas Valiulis
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Clinic of Children's Diseases, Institute of Clinical Medicine, and Department of Public Health, Institute of Health Sciences, Vilnius University Medical Faculty, Vilnius, Lithuania
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6
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Antin TMJ, Hess C, Kaner E, Lipperman-Kreda S, Annechino R, Hunt G. Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California. Nicotine Tob Res 2020; 22:722-727. [PMID: 30820569 DOI: 10.1093/ntr/ntz028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/22/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Existing research on youth's adoption of alternative nicotine delivery systems (ANDS) has focused on identifying pathways of nicotine product use, specifically examining whether vaping encourages progression to smoking. Few studies have considered other pathways of initiation. Qualitative studies suggest that meanings of vaping vary significantly, suggestive of the need for a more nuanced understanding of the role of vaping for youth with different pathways into vaping and smoking. METHODS We conducted in-depth qualitative interviews with 49 Californian youth between 15 and 25 years old who reported ever vaping nicotine to gain a deeper understanding of their initiation pathways of vaping and smoking, paying special attention to youth's experiences and reasons for ANDS initiation and use. Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, we then compared the meaning and role of vaping across three distinct pathways of use: (1) smoking to vaping, (2) vaping to smoking, and (3) vaping only. RESULTS The most common pathway reported was smoking to vaping (74%), eight participants began vaping before smoking, and five participants reported only vaping but never smoking. Analysis of participants' narratives emphasized that youth in our study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products considering relative risks. CONCLUSION Findings from this study suggest that ANDS serve as a transitional tool for youth who are keenly aware of the health consequences of smoking, thus challenging conventional discourses about ANDS as a threat to youth's health. IMPLICATIONS This qualitative study queries concerns about the potential of alternative nicotine delivery systems (ANDS) to serve as a gateway into cigarette smoking for youth and young adults. Findings suggest that most of the youth participants discussed and considered relative risks in their pathways of initiation, highlighting the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation.
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Affiliation(s)
- Tamar M J Antin
- Critical Public Health Research Group, Prevention Research Center, Berkeley, CA
- Institute for Scientific Analysis, Alameda, CA
| | - Catherine Hess
- Critical Public Health Research Group, Prevention Research Center, Berkeley, CA
| | - Emily Kaner
- Critical Public Health Research Group, Prevention Research Center, Berkeley, CA
| | | | - Rachelle Annechino
- Critical Public Health Research Group, Prevention Research Center, Berkeley, CA
| | - Geoffrey Hunt
- Institute for Scientific Analysis, Alameda, CA
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus C, Denmark
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Glasser A, Abudayyeh H, Cantrell J, Niaura R. Patterns of E-Cigarette Use Among Youth and Young Adults: Review of the Impact of E-Cigarettes on Cigarette Smoking. Nicotine Tob Res 2020; 21:1320-1330. [PMID: 29788314 DOI: 10.1093/ntr/nty103] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/16/2018] [Indexed: 11/14/2022]
Abstract
There is concern that e-cigarette use among youth and young adults (YAs) may lead to future cigarette or other combustible tobacco product use. A synthesis of the literature on this topic is needed because existing longitudinal studies are limited in number and not consistent in their conclusions. We conducted a search in PubMed through December 31, 2017 for peer-reviewed studies related to e-cigarette patterns of use. Of 588 relevant studies, 26 had a youth or YA sample, were longitudinal in design, and assessed e-cigarette use at baseline and cigarette smoking at follow-up. Most studies followed a sample over time and compared cigarette smoking at follow-up between baseline e-cigarette users and nonusers. Other studies examined the difference at follow-up in cigarette smoking status among smokers according to e-cigarette use at baseline. Results suggest that, among never smokers, e-cigarette use is associated with the future (6 months to 2.5 years) cigarette trial; however, firm conclusions cannot be drawn because of limitations including small sample size, measurement of experimental use (ie, ever use, past 30-day use) rather than established use, and inadequate controls for potentially confounding variables. Conclusions also cannot be drawn from studies examining the impact of e-cigarette use among smokers due to the limited number of studies and additional limitations. A comprehensive understanding of this literature is needed to inform policy makers and consumers for evidence-based decision-making and to guide future research on e-cigarette use among youth and young adults. IMPLICATIONS The present article provides a review of the impact of e-cigarette use on subsequent cigarette smoking among youth and YAs. Studies presented here suggest that e-cigarette use among nonsmokers is associated with subsequent cigarette smoking, but study designs are subject to numerous limitations. Future research should focus on addressing the characteristics that put youth and YAs at the risk of using either product and how appeal and accessibility of these products are related to product use in order to inform future policy-making.
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Affiliation(s)
- Allison Glasser
- New York University College of Global Public Health, New York, NY
| | | | | | - Raymond Niaura
- New York University College of Global Public Health, New York, NY
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8
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Cheng HG, Largo EG, Gogova M. E-cigarette use and onset of first cigarette smoking among adolescents: An empirical test of the 'common liability' theory. F1000Res 2019; 8:2099. [PMID: 32724557 PMCID: PMC7366034 DOI: 10.12688/f1000research.21377.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: E-cigarettes have become the most commonly used tobacco products among youth in the United States (US) recently. It is not clear whether there is a causal relationship between e-cigarette use and the onset of cigarette smoking. The "common liability" theory postulates that the association between e-cigarette use and cigarette smoking can be attributed to a common risk construct of using tobacco products. This study aims to investigate the relationship between ever e-cigarette use and cigarette smoking onset in the US using a structural equation modeling approach guided by the "common liability" theory. Methods: The study population is non-institutionalized civilian adolescents living in the US, sampled in the longitudinal Population Assessment of Tobacco and Health study. Information about tobacco product use was obtained via confidential self-report. A structural equation modeling approach was used to estimate the relationship between e-cigarette use at wave 1 and the onset of cigarette smoking at wave 2 after controlling for a latent construct representing a "common liability to use tobacco products." Results: After controlling for a latent construct representing a "common liability to use tobacco products", ever e-cigarette use does not predict the onset of cigarette smoking (β=0.13, 95% CI= -0.07, 0.32, p=0.204). The latent "common liability to use tobacco products" is a robust predictor for the onset of cigarette smoking (β=0.38; 95% CI=0.07, 0.69; p=0.015). Conclusions: Findings from this study provide supportive evidence for the 'common liability' underlying observed associations between e-cigarette use and smoking onset.
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Affiliation(s)
- Hui G. Cheng
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
| | - Edward G. Largo
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
| | - Maria Gogova
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
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9
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Cheng HG, Largo EG, Gogova M. E-cigarette use and onset of first cigarette smoking among adolescents: An empirical test of the 'common liability' theory. F1000Res 2019; 8:2099. [PMID: 32724557 PMCID: PMC7366034 DOI: 10.12688/f1000research.21377.2] [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] [Accepted: 04/22/2020] [Indexed: 12/17/2023] Open
Abstract
Background: E-cigarettes have become the most commonly used tobacco products among youth in the United States (US) recently. It is not clear whether there is a causal relationship between e-cigarette use and the onset of cigarette smoking. The "common liability" theory postulates that the association between e-cigarette use and cigarette smoking can be attributed to a common risk construct of using tobacco products. This study aims to investigate the relationship between ever e-cigarette use and cigarette smoking onset in the US using a structural equation modeling approach guided by the "common liability" theory. Methods: The study population is non-institutionalized civilian adolescents living in the US, sampled in the longitudinal Population Assessment of Tobacco and Health study. Information about tobacco product use was obtained via confidential self-report. A structural equation modeling approach was used to estimate the relationship between e-cigarette use at wave 1 and the onset of cigarette smoking at wave 2 after controlling for a latent construct representing a "common liability to use tobacco products." Results: After controlling for a latent construct representing a "common liability to use tobacco products", ever e-cigarette use does not predict the onset of cigarette smoking (β=0.13, 95% CI= -0.07, 0.32, p=0.204). The latent "common liability to use tobacco products" is a robust predictor for the onset of cigarette smoking (β=0.38; 95% CI=0.07, 0.69; p=0.015). Conclusions: Findings from this study provide supportive evidence for the 'common liability' underlying observed associations between e-cigarette use and smoking onset.
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Affiliation(s)
- Hui G. Cheng
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
| | - Edward G. Largo
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
| | - Maria Gogova
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
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10
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Cheng HG, Largo EG, Gogova M. E-cigarette use and onset of first cigarette smoking among adolescents: An empirical test of the 'common liability' theory. F1000Res 2019; 8:2099. [PMID: 32724557 PMCID: PMC7366034 DOI: 10.12688/f1000research.21377.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 12/17/2023] Open
Abstract
Background: E-cigarettes have become the most commonly used tobacco products among youth in the United States (US) recently. It is not clear whether there is a causal relationship between e-cigarette use and the onset of cigarette smoking. The "common liability" theory postulates that the association between e-cigarette use and cigarette smoking can be attributed to a common risk construct of using tobacco products. This study aims to investigate the relationship between ever e-cigarette use and cigarette smoking onset in the US using a structural equation modeling approach guided by the "common liability" theory. Methods: The study population is non-institutionalized civilian adolescents living in the US, sampled in the longitudinal Population Assessment of Tobacco and Health study. Information about tobacco product use was obtained via confidential self-report. A structural equation modeling approach was used to estimate the relationship between e-cigarette use at wave 1 and the onset of cigarette smoking at wave 2 after controlling for a latent construct representing a "common liability to use tobacco products." Results: After controlling for a latent construct representing a "common liability to use tobacco products", ever e-cigarette use does not predict the onset of cigarette smoking (β=0.10, 95% CI= -0.09, 0.29, p=0.299). The latent "common liability to use tobacco products" is a robust predictor for the onset of cigarette smoking (β=0.42; 95% CI=0.08, 0.76; p=0.015). Conclusions: Findings from this study provide supportive evidence for the 'common liability' underlying observed associations between e-cigarette use and smoking onset.
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Affiliation(s)
- Hui G. Cheng
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
| | - Edward G. Largo
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
| | - Maria Gogova
- Regulatory Sciences, Altria Client Services, Richmond, VA, 23219, USA
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11
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Chyderiotis S, Spilka S, Beck F. [Use of electronic cigarette in France among adolescents aged 17: Results from the ESCAPAD 2017 survey]. Bull Cancer 2019; 106:1132-1143. [PMID: 31732122 DOI: 10.1016/j.bulcan.2019.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/07/2019] [Accepted: 06/20/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The use of electronic cigarettes has become relatively popular in France since 2010, including among adolescents. However, its use in relation to smoking and other factors is not well understood today. METHODS The data come from the ESCAPAD 2017 survey, a nationally representative cross-sectional survey taking place at a 1-day session of civic and military information compulsory for all French nationals around 17 (39,115 respondents). Descriptive analyses and multivariate regressions were undertaken to describe the recent use of e-cigarette at 17 and its associated factors. RESULTS e-cigarettes were experimented by 52.4 % of 17 year-olds, and used by 16.8 % in the preceding month, 1.9 % daily. Most recent users were also daily smokers (62.5 %), and only 7.6 % had never experimented cigarettes before. Among those who experimented with both products, only 13.3 % tried e-cigarettes before cigarettes. The associated uses of other products were the most striking factors: daily smoking (relative risk [RR]=2.73), ever use of hookah (RR=2.31), cannabis use in the last year (RR=1.60), regular alcohol drinking (RR=1.20) and ever use of another illicit drug (RR=1.11). Recent vapers that were also daily smokers had a more pronounced sociodemographic profile and a higher level of other drugs consumptions than recent vapers only. DISCUSSION Although a majority of French adolescents experiment with vaping, they are fewer to use it regularly and its current use is frequently associated with daily smoking. Future trends and the relationship between smoking and vaping among adolescents will have to be further investigated, including the motivations of its use.
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Affiliation(s)
- Sandra Chyderiotis
- Université Paris-Sud, Université Paris-Saclay, CESP, faculté de médecine, faculté de médecine UVSQ, Inserm, 92541 Villejuif, France; Observatoire français des drogues et des toxicomanies (OFDT), 69, rue de Varenne, 75007 Paris, France.
| | - Stanislas Spilka
- Université Paris-Sud, Université Paris-Saclay, CESP, faculté de médecine, faculté de médecine UVSQ, Inserm, 92541 Villejuif, France; Observatoire français des drogues et des toxicomanies (OFDT), 69, rue de Varenne, 75007 Paris, France
| | - François Beck
- Université Paris-Sud, Université Paris-Saclay, CESP, faculté de médecine, faculté de médecine UVSQ, Inserm, 92541 Villejuif, France; Institut national de la statistique et des études économiques, 88, avenue Verdier, CS 70058, 92541 Montrouge cedex, France
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Beaglehole R, Bates C, Youdan B, Bonita R. Nicotine without smoke: fighting the tobacco epidemic with harm reduction. Lancet 2019; 394:718-720. [PMID: 31478489 DOI: 10.1016/s0140-6736(19)31884-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Affiliation(s)
| | - Clive Bates
- Counterfactual Consulting Limited, London, UK
| | - Ben Youdan
- ASH (NZ), c/o Heart Foundation, Auckland, New Zealand
| | - Ruth Bonita
- University of Auckland, Devonport, Auckland 0624, New Zealand
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13
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Abstract
Abstract Tobacco continues to kill about 0.48 million Americans per year and there are currently 34.3 million smokers in the USA. As a consequence of the First Surgeon General’s Report on Tobacco in 1964, tobacco control interventions on part of the government led to a significant decline in conventional tobacco product usage over the last few decades. However, more recently, a new entity in the form of electronic cigarettes has risen rapidly and has exposed a younger population to a plethora of dangerous consequences. Looking at e-cigarettes from the perspective of tobacco control however raises a lot of challenges. There is little doubt that existing smokers of combustible cigarettes who switch to e-cigarettes will be switching to a less harmful product. However, if the younger generation begins using e-cigarettes as a result of targeted marketing, appealing flavors and ‘safer alternative’ perception, decades of progress made in conventional tobacco control will be negated. Governments at the federal, state, and local levels have a mandate to once again implement new public health policies to ensure that non-conventional tobacco products like e-cigarettes are available as smoking cessation tools for existing smokers but at the same time do not play a role in ruining the health of future generations through addiction and disease. Purpose of Review To review the present scenario of regulations and policies impacting public health with respect to electronic nicotine delivery systems (ENDS) with the objective of providing a meaningful and balanced view of the challenges at hand with plausible recommendations. Recent Findings Nicotine in tobacco is known to cause addiction and dependence. It is particularly potent in children and young adults. E-cigarettes can deliver high concentrations of nicotine, and these concentrations can vary depending on the numerous constituents within the e-cigarette which vary greatly from one another. Use of e-cigarettes is implicated as a risk factor for future cigarette use in young adults. Moreover, e-cigarette usage patterns also depend on several sociodemographic factors. Banning tobacco products has shown to reduce smoking risk in youth and as such, strong e-cigarette regulation measures are needed for prevention. Summary Effective regulation of ENDS faces a multitude of challenges. One such challenge is to prevent youth and non-smokers from getting habituated to nicotine through e-cigarettes. The intention of tobacco companies to sustain sales through harmful marketing strategies that tone down the risks and highlight e-cigarettes as a “much safer alternative” while promoting flavors appealing to children should be immediately prohibited. Another hazard is the endorsement of ENDS as devices meant for enhancing social interaction which opens a path for youth to make erroneous choices under peer pressure. On the other hand, several studies have reported that e-cigarettes significantly reduce an existing smoker’s risk of being exposed to toxic tobacco smoke constituents that are normally present in cigarette smoke. This leads to the conclusions that e-cigarettes can be a tool for smoking cessation for current smokers. Public policy must take a multi-dimensional approach to balance these two extremes.
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Akinkugbe AA. Cigarettes, E-cigarettes, and Adolescents' Oral Health: Findings from the Population Assessment of Tobacco and Health (PATH) Study. JDR Clin Trans Res 2019; 4:276-283. [PMID: 30931714 DOI: 10.1177/2380084418806870] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Adolescents are a population group that actively uses tobacco products; however, limited reports are available on the effects of tobacco products on adolescents' oral health. OBJECTIVES This study investigated associations between self-reported use of cigarettes and e-cigarettes on the oral health status of a representative sample of US adolescents. METHODS Data came from 13,650 adolescents aged 12 to 17 y who participated in the 2013-2014 wave of the Population Assessment of Tobacco and Health study. Participants self-reported current use (i.e., past 30 d) and ever use of cigarettes and e-cigarettes, as well as past-year diagnoses with dental problems by a doctor, dentist, or other health professional (self-reported by parent or emancipated youth). Survey-adjusted logistic regression was used to estimate prevalence odds ratios (PORs) and 95% CIs. RESULTS The proportion of adolescents who self-reported current use of only cigarettes was 3.2%, while 1.7% reported current use of only e-cigarettes. Similarly, 1.4% reported current use of both cigarettes and e-cigarettes, while 7.1% reported ever use of both. About 22% self-reported a provider diagnosis with dental problems in the past year. The covariate-adjusted associations between current cigarette and e-cigarette use on self-reported provider-diagnosed dental problems in the past year were, respectively, POR = 1.50 (95% CI, 1.18 to 1.90) and POR = 1.11 (95% CI, 0.79 to 1.55), while self-reported current use of both was associated with POR = 1.72 (95% CI, 1.24 to 2.38). Ever use of cigarettes and e-cigarettes was likewise associated with increased prevalence odds of self-reported past-year diagnosis with dental problems, although to a lesser magnitude. CONCLUSION Findings suggest that dual use of e-cigarettes and conventional cigarettes is associated with poor oral health outcomes among adolescents. However, studies of a longitudinal nature are needed to confirm these findings. KNOWLEDGE TRANSFER STATEMENT The results of this study are relevant to public health and oral health practitioners seeking to intervene during developmental periods in which adolescents may have access to tobacco products in the home and in social settings.
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Affiliation(s)
- A A Akinkugbe
- 1 Oral Health Services Research Core, Philips Institute for Oral Health Research, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
- 2 Oral Health in Childhood and Adolescence Transdisciplinary Core, Institute for Inquiry, Innovation and Inclusion, Virginia Commonwealth University, Richmond, VA, USA
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15
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Peters MJ. Electronic cigarettes: adolescent health and wellbeing. Lancet 2018; 392:473-474. [PMID: 30129455 DOI: 10.1016/s0140-6736(18)31175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Matthew J Peters
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia.
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16
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Sumner W, Farsalinos K. Lessons and Guidance from the Special Issue on Electronic Cigarette Use and Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071338. [PMID: 29949861 PMCID: PMC6068822 DOI: 10.3390/ijerph15071338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Walton Sumner
- Retired from Department of Internal Medicine, School of Medicine, Washington University, School of Medicine, Washington University, 660 S Euclid Ave, St. Louis, MO 63110, USA.
| | - Konstantinos Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, 17674 Kallithea, Greece.
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17
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McKeganey N, Barnard M. Change and Continuity in Vaping and Smoking by Young People: A Qualitative Case Study of A Friendship Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15051008. [PMID: 29772812 PMCID: PMC5982047 DOI: 10.3390/ijerph15051008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 12/27/2022]
Abstract
This paper reports a qualitative case study of a small friendship group (n = 8) in Glasgow, Scotland. Interviewed twice at six months apart, these 16 to 17 year olds reported a substantial change in their use of and attitudes towards e-cigarettes and tobacco. At time 1, vaping generated much excitement and interest, with six out of eight individuals having their own vape device. At time 2, only two young people still vaped, with the others no longer professing any interest in continued vaping. The two regular smokers, who had been smoking before they first vaped, now only vaped privately and to reduce their tobacco intake. This small case study illustrates plasticity in the use of these devices; just as young people can move into their use, so too can they move away from them. This small study underscores the importance of differentiating between long-term, frequent, consistent use and more episodic, experimental and infrequent use by young people and for undertaking a measurement of actual e-cigarette use at multiple time points in both quantitative and qualitative studies. In addition, the case study illustrates the powerful impact which peers can have on teenagers use of e-cigarettes.
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Affiliation(s)
- Neil McKeganey
- Centre for Substance Use Research, Block 3/2 West of Scotland Science Park, Kelvin Campus, Maryhill Road, Glasgow G20 0SP, UK.
| | - Marina Barnard
- Centre for Substance Use Research, Block 3/2 West of Scotland Science Park, Kelvin Campus, Maryhill Road, Glasgow G20 0SP, UK.
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18
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Abstract
Electronic cigarettes (ECs) have been growing rapidly in popularity among youth and adults in the United States over the last decade. This increasing prevalence is driven partially by the ability to customize devices, flavors, and nicotine content and the general notion that ECs are harmless, particularly in comparison with conventional cigarettes. In vitro and in vivo murine models have demonstrated a number of harmful biological effects of e-liquids and their aerosols. However, limited clinical data exist on whether these effects translate into detrimental long-term outcomes in human subjects. The short-term harmful respiratory effects of EC use demonstrated in nonsmokers argue against their use. However, slightly more favorable data exist for the respiratory benefits of substituting conventional cigarettes with ECs and the short-term efficacy of ECs as smoking cessation tools. Nonetheless, available research is severely limited in regard to long-term outcomes and by study designs fraught with bias, pointing to the need for additional research efforts with well-designed longitudinal studies to guide US Food and Drug Administration regulatory efforts. The hurdle presented by diverse device designs and e-liquid permutations, which contribute to the inconsistency of available data, also highlights the need for legislative standardization of ECs.
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Affiliation(s)
- Amika K Sood
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Matthew J Kesic
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michelle L Hernandez
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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19
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Newton JN, Dockrell M, Marczylo T. Making sense of the latest evidence on electronic cigarettes. Lancet 2018; 391:639-642. [PMID: 29426674 DOI: 10.1016/s0140-6736(18)30202-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/23/2018] [Indexed: 12/24/2022]
Affiliation(s)
- John N Newton
- Health Improvement Directorate, Public Health England, London SE1 8UG, UK.
| | - Martin Dockrell
- Health Improvement Directorate, Public Health England, London SE1 8UG, UK
| | - Tim Marczylo
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, London SE1 8UG, UK
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20
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Cahn Z, Berg CJ. Commentary on Seyla et al. (2018): Advantages in the consideration of causal mechanisms for studies of gateway e-cigarette use. Addiction 2018; 113:334-335. [PMID: 29314402 DOI: 10.1111/add.14079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Zachary Cahn
- Department of Economic and Health Policy Research, American Cancer Society, Inc., Atlanta, GA, USA
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
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21
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Farsalinos K. Electronic cigarettes: an aid in smoking cessation, or a new health hazard? Ther Adv Respir Dis 2018; 12:1753465817744960. [PMID: 29214890 PMCID: PMC5937152 DOI: 10.1177/1753465817744960] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/07/2017] [Indexed: 12/12/2022] Open
Abstract
The issue of electronic cigarettes is one of the most controversial topics in public health. There is intense debate and dividing opinions about their use patterns, health effects and association with smoking. This is expected since they were only recently introduced to the market and they refer to a harm-reduction approach and strategy that is not universally accepted for smoking and tobacco use in the public health community. Three main factors determine the public health impact of electronic cigarettes: (1) their safety/risk profile, both relative to smoking and in absolute terms; (2) their effectiveness for smoking reduction and cessation; (3) the patterns of use by different population subgroups, especially never-smokers, and adoption of use by youth. This analysis presents a brief overview of currently available evidence and gaps in research covering these three factors.
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Affiliation(s)
- Konstantinos Farsalinos
- Department of Cardiology, Onassis Cardiac
Surgery Center, Sygrou 356, Kallithea 17674, Greece Department of Pharmacy,
University of Patras, Rio-Patras 26500, Greece National School of Public
Health, Athens, Greece
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