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Hayrumyan V, Sargsyan Z, Torosyan A, Dekanosidze A, Grigoryan L, Alayan N, Kegler MC, Sturua L, Petrosyan V, Bazarchyan A, Haardörfer R, Cui Y, Berg CJ. The inclusion of e-cigarettes and heated tobacco products in smoke-free home and car rules: A cross-sectional survey of adults in Armenia and Georgia. Tob Induc Dis 2024; 22:TID-22-99. [PMID: 38835513 PMCID: PMC11149400 DOI: 10.18332/tid/189200] [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: 02/20/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Understanding who includes e-cigarettes and heated tobacco products (HTPs) in smoke-free home or car rules could inform public health interventions, particularly in countries with high smoking prevalence and recently implemented national smoke-free laws, like Armenia and Georgia. METHODS In 2022, we conducted a cross-sectional survey among 1468 adults in 28 Armenian and Georgian communities (mean age=42.92 years; 51.4% female, 31.6% past-month smoking). Multilevel regression (accounting for clustering within communities; adjusted for sociodemographics and cigarette use) examined e-cigarette/HTP perceptions (risk, social acceptability) and use intentions in relation to: 1) including e-cigarettes/HTPs in home and car rules among participants with home and car rules, respectively (logistic regressions); and 2) intention to include e-cigarettes/HTPs in home rules (linear regression, 1 = 'not at all' to 7 = 'extremely') among those without home rules. RESULTS Overall, 72.9% (n=1070) had home rules, 86.5% of whom included e-cigarettes/HTPs; 33.9% (n=498) had car rules, 81.3% of whom included e-cigarettes/HTPs. Greater perceived e-cigarette/HTP risk was associated with including e-cigarettes/HTPs in home rules (AOR=1.28; 95% CI: 1.08-1.50) and car rules (AOR=1.46; 95% CI: 1.14-1.87) and next-year intentions to include e-cigarettes/HTPs in home rules (β=0.38; 95% CI: 0.25-0.50). Lower e-cigarette/HTP use intentions were associated with including e-cigarettes/HTPs in home rules (AOR=0.75; 95% CI: 0.63-0.88). While perceived social acceptability was unassociated with the outcomes, other social influences were: having children and no other household smokers was associated with including e-cigarettes/HTPs in car rules, and having children was associated with intent to include e-cigarettes/HTPs in home rules. CONCLUSIONS Interventions to address gaps in home and car rules might target e-cigarette/HTP risk perceptions.
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Affiliation(s)
- Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Republic of Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Republic of Armenia
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, Ministry of Health, Yerevan, Republic of Armenia
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
- Tbilisi State Medical University, Tbilisi, Georgia
| | - Lilit Grigoryan
- National Institute of Health named after academician S. Avdalbekyan, Ministry of Health, Yerevan, Republic of Armenia
| | - Nour Alayan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Republic of Armenia
| | - Michelle C Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, United States
| | - Lela Sturua
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Republic of Armenia
| | - Alexander Bazarchyan
- National Institute of Health named after academician S. Avdalbekyan, Ministry of Health, Yerevan, Republic of Armenia
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, United States
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University
- George Washington Cancer Center, George Washington University, Washington, United States
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Yayan J, Franke KJ, Biancosino C, Rasche K. Comparative systematic review on the safety of e-cigarettes and conventional cigarettes. Food Chem Toxicol 2024; 185:114507. [PMID: 38331086 DOI: 10.1016/j.fct.2024.114507] [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: 12/03/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND This systematic review evaluated the health risks of electronic cigarettes (e-cigarettes) compared to traditional cigarettes. It examines various studies and research on the subject to provide a comprehensive analysis of potential health risks associated with both smoking methods. METHODS The systematic review, incorporating searches in PubMed, Scopus, Web of Science, and the Cochrane Library up to July 2023, examines the results obtained in relevant studies, and provides a critical discussion of the results. RESULTS E-cigarettes exhibit reduced exposure to harmful toxins compared to traditional cigarettes. CONCLUSION However, concerns persist regarding respiratory irritation and potential health risks, especially among youth, emphasizing the need for comprehensive, long-term research and protective legislation.
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Affiliation(s)
- Josef Yayan
- Witten/Herdecke University, Witten, Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic Wuppertal, Germany.
| | - Karl-Josef Franke
- Department of Internal Medicine, Pulmonary Division, Internal Intensive Care Medicine, Infectiology, and Sleep Medicine, Märkische Clinics Health Holding Ltd, Clinic Lüdenscheid, Lüdenscheid, Witten/Herdecke University, Germany
| | - Christian Biancosino
- Witten/Herdecke University, Witten, Department of Thoracic Surgery, HELIOS Clinic Wuppertal, Germany
| | - Kurt Rasche
- Witten/Herdecke University, Witten, Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic Wuppertal, Germany
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Amalia B, Fu M, Tigova O, Ballbè M, Paniello-Castillo B, Castellano Y, Vyzikidou VK, O'Donnell R, Dobson R, Lugo A, Veronese C, Pérez-Ortuño R, Pascual JA, Cortés N, Gil F, Olmedo P, Soriano JB, Boffi R, Ruprecht A, Ancochea J, López MJ, Gallus S, Vardavas C, Semple S, Fernández E. Exposure to secondhand aerosol from electronic cigarettes at homes: A real-life study in four European countries. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 854:158668. [PMID: 36099951 DOI: 10.1016/j.scitotenv.2022.158668] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
Electronic cigarette (e-cigarette) use emits potentially hazardous compounds and deteriorates indoor air quality. Home is a place where e-cigarettes may frequently be used amid its increasing prohibition in public places. This study assessed the real-life scenario of bystanders' exposure to secondhand e-cigarette aerosol (SHA) at home. A one-week observational study was conducted within the TackSHS project in four countries (Greece, Italy, Spain, and the United Kingdom) in 2019 including: 1) homes of e-cigarette users living together with a non-user/non-smoker; and 2) control homes with no smokers nor e-cigarette users. Indoor airborne nicotine, PM2.5, and PM1.0 concentrations were measured as environmental markers of SHA. Biomarkers, including nicotine and its metabolites, tobacco-specific nitrosamines, propanediol, glycerol, and metals were measured in participants' saliva and urine samples. E-cigarette use characteristics, such as e-cigarette refill liquid's nicotine concentration, e-cigarette type, place of e-cigarette use at home, and frequency of ventilation, were also collected. A total of 29 e-cigarette users' homes and 21 control homes were included. The results showed that the seven-day concentrations of airborne nicotine were quantifiable in 21 (72.4 %) out of 29 e-cigarette users' homes; overall, they were quite low (geometric mean: 0.01 μg/m3; 95 % CI: 0.01-0.02 μg/m3) and were all below the limit of quantification in control homes. Seven-day concentrations of PM2.5 and PM1.0 in e-cigarette and control homes were similar. Airborne nicotine and PM concentrations did not differ according to different e-cigarette use characteristics. Non-users residing with e-cigarette users had low but significantly higher levels of cotinine, 3'-OH-cotinine and 1,2-propanediol in saliva, and cobalt in urine than non-users living in control homes. In conclusion, e-cigarette use at home created bystanders' exposure to SHA regardless of the e-cigarette use characteristics. Further studies are warranted to assess the implications of SHA exposure for smoke-free policy.
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Affiliation(s)
- Beladenta Amalia
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain.
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Blanca Paniello-Castillo
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Vergina K Vyzikidou
- Hellenic Cancer Society - George D. Behrakis Research Lab - HCS, Athens, Greece
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, United Kingdom of Great Britain and Northern Ireland
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, United Kingdom of Great Britain and Northern Ireland
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - Chiara Veronese
- IRCCS Istituto Nazionale dei Tumori - INT Foundation, Milan, Italy
| | - Raúl Pérez-Ortuño
- Hospital del Mar Medical Research Institute - IMIM, Barcelona, Spain
| | - José A Pascual
- Hospital del Mar Medical Research Institute - IMIM, Barcelona, Spain; Department of Experimental and Health Sciences, University Pompeu Fabra - UPF, Barcelona, Spain
| | - Nuria Cortés
- Agència de Salut Pública de Barcelona - ASPB, Barcelona, Spain
| | - Fernando Gil
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada - UG, Granada, Spain
| | - Pablo Olmedo
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada - UG, Granada, Spain
| | - Joan B Soriano
- CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Respiratory Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Roberto Boffi
- IRCCS Istituto Nazionale dei Tumori - INT Foundation, Milan, Italy
| | - Ario Ruprecht
- IRCCS Istituto Nazionale dei Tumori - INT Foundation, Milan, Italy
| | - Julio Ancochea
- CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Respiratory Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Maria J López
- Agència de Salut Pública de Barcelona - ASPB, Barcelona, Spain; CIBER de Epidemiología y Salud Pública - CIBERESP, Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau - IIB St. Pau, Barcelona, Spain
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece; Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, United Kingdom of Great Britain and Northern Ireland
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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Stefaniak AB, Ranpara AC, Virji MA, LeBouf RF. Influence of E-Liquid Humectants, Nicotine, and Flavorings on Aerosol Particle Size Distribution and Implications for Modeling Respiratory Deposition. Front Public Health 2022; 10:782068. [PMID: 35372219 PMCID: PMC8968757 DOI: 10.3389/fpubh.2022.782068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2022] [Indexed: 01/10/2023] Open
Abstract
Electronic cigarette, or vaping, products are used to heat an e-liquid to form an aerosol (liquid droplets suspended in gas) that the user inhales; a portion of this aerosol deposits in their respiratory tract and the remainder is exhaled, thereby potentially creating opportunity for secondhand exposure to bystanders (e.g., in homes, automobiles, and workplaces). Particle size, a critical factor in respiratory deposition (and therefore potential for secondhand exposure), could be influenced by e-liquid composition. Hence, the purposes of this study were to (1) test the influence of laboratory-prepared e-liquid composition [ratio of propylene glycol (PG) to vegetable glycerin (VG) humectants, nicotine, and flavorings] on particle size distribution and (2) model respiratory dosimetry. All e-liquids were aerosolized using a second-generation reference e-cigarette. We measured particle size distribution based on mass using a low-flow cascade impactor (LFCI) and size distribution based on number using real-time mobility sizers. Mass median aerodynamic diameters (MMADs) of aerosol from e-liquids that contained only humectants were significantly larger compared with e-liquids that contained flavorings or nicotine (p = 0.005). Humectant ratio significantly influenced MMADs; all aerosols from e-liquids prepared with 70:30 PG:VG were significantly larger compared with e-liquids prepared with 30:70 PG:VG (p = 0.017). In contrast to the LFCI approach, the high dilution and sampling flow rate of a fast mobility particle sizer strongly influenced particle size measurements (i.e., all calculated MMAD values were < 75 nm). Dosimetry modeling using LFCI data indicated that a portion of inhaled particles will deposit throughout the respiratory tract, though statistical differences in aerosol MMADs among e-liquid formulations did not translate into large differences in deposition estimates. A portion of inhaled aerosol will be exhaled and could be a source for secondhand exposure. Use of laboratory-prepared e-liquids and a reference e-cigarette to standardize aerosol generation and a LFCI to measure particle size distribution without dilution represents an improved method to characterize physical properties of volatile aerosol particles and permitted determination of MMAD values more representative of e-cigarette aerosol in situ, which in turn, can help to improve dose modeling for users and bystanders.
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Amalia B, Fu M, Tigova O, Ballbè M, Castellano Y, Semple S, Clancy L, Vardavas C, López MJ, Cortés N, Pérez-Ortuño R, Pascual JA, Fernández E. Environmental and individual exposure to secondhand aerosol of electronic cigarettes in confined spaces: Results from the TackSHS Project †. INDOOR AIR 2021; 31:1601-1613. [PMID: 33905602 DOI: 10.1111/ina.12841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Secondhand electronic cigarette (e-cigarette) aerosol (SHA) might impair indoor air quality and expose bystanders. This study aims to investigate exposure to SHA in controlled conditions of enclosed settings simulating real-world scenario. An experiment was performed in a car and in a room, in which SHA was generated during a 30-minute ad libitum use of an e-cigarette. The experiment was replicated on five consecutive days in each setting. We measured PM2.5 , airborne nicotine concentrations, and biomarkers of exposure to SHA, such as nicotine metabolites, tobacco-specific nitrosamines, propylene glycol, and glycerol in bystanders' saliva samples before, during, and after the exposure period. Self-reported health symptoms related to exposure to SHA were also recorded. The results showed that the highest median PM2.5 concentration was recorded during the exposure period, being 21 µg/m3 in the room setting and 16 µg/m3 in the car setting-about twofold increase compared to the baseline. Most concentrations of the airborne nicotine and all biomarkers were below the limit of quantification in both settings. Bystanders in both settings experienced some short-term irritation symptoms, expressed as dry throat, nose, eyes, and phlegm. In conclusion, short-term use of an e-cigarette in confined spaces increased indoor PM2.5 level and caused some irritation symptoms in bystanders.
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Affiliation(s)
- Beladenta Amalia
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, Scotland
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | | | - Maria J López
- Evaluation and Intervention Methods Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research group on Evaluation of Public Health Policies and Programs, Institut d'Investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
| | - Nuria Cortés
- Laboratory, Agència de Salut Pública de Barcelona, Spain
| | - Raúl Pérez-Ortuño
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - José A Pascual
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
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Amalia B, Rodríguez A, Henderson E, Fu M, Continente X, Tigova O, Semple S, Clancy L, Gallus S, Fernández E, López MJ. How widespread is electronic cigarette use in outdoor settings? A field check from the TackSHS project in 11 European countries. ENVIRONMENTAL RESEARCH 2021; 193:110571. [PMID: 33278471 DOI: 10.1016/j.envres.2020.110571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
Exposure to secondhand aerosol from electronic cigarettes (e-cigarettes) may pose harms to bystanders, but they are used in many indoor settings. Less evidence exists on e-cigarette use in outdoor settings. This study aims to assess the use of e-cigarettes in outdoor settings in Europe. A cross-sectional study was conducted at the entrances of primary schools (N = 200), children's playgrounds (N = 200), and outdoor hospitality venues (N = 220) during 2017-2018 in major cities of 11 European countries. We performed 30-min observations and recorded e-cigarette use at three-time points: at 0 min, 15 min, and 30 min. We described the number and proportion of settings with e-cigarette use observed at any of the three-time points according to country and other contextual variables. Results showed that there were 22 (11.0%) school entrances, eight (4.0%) playgrounds, and 47 (21.3%) outdoor hospitality venues where e-cigarette use was observed at any time point. School entrances and outdoor hospitality venues with observed e-cigarette use were more frequently found in countries with a higher prevalence (≥1.4%) of e-cigarette use (school entrances: 18.0% vs. 4.0%; p = 0.002, outdoor hospitality venues: 26.7% vs. 15.0%, p = 0.036). In conclusion, the outdoor setting with the highest visibility of e-cigarette use was outdoor areas of hospitality venues. Although still limited, e-cigarettes were also used in outdoor settings frequented by children. Governments should consider measures to restrict e-cigarette use outdoors to protect the health of bystanders, particularly in areas where children may be present.
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Affiliation(s)
- Beladenta Amalia
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | | | - Elisabet Henderson
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Xavier Continente
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, Scotland, United Kingdom
| | - Luke Clancy
- TobaccoFree Research Institute Ireland (TFRI), Dublin, Ireland
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Maria J López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
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Alnajem A, Redha A, Alroumi D, Alshammasi A, Ali M, Alhussaini M, Almutairi W, Esmaeil A, Ziyab AH. Use of electronic cigarettes and secondhand exposure to their aerosols are associated with asthma symptoms among adolescents: a cross-sectional study. Respir Res 2020; 21:300. [PMID: 33198741 PMCID: PMC7670675 DOI: 10.1186/s12931-020-01569-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Globally, a surge in electronic cigarette (e-cigarette) use has been observed in recent years, with youth being the most susceptible group. Given their recent emergence, studies assessing the health consequences of using e-cigarettes and exposure to their secondhand aerosols (SHA) are limited. Hence, this study sought to assess associations between e-cigarette use and household exposure to SHA from e-cigarettes with asthma symptoms among adolescents. Methods A school-based cross-sectional study was conducted by enrolling high school students (n = 1565; aged 16–19 years) in Kuwait. Participants self-completed a questionnaire on tobacco products use (e-cigarettes and cigarettes) and asthma symptoms. Current e-cigarette use and cigarette smoking were defined as any use in the past 30 days. Household exposure to SHA from e-cigarettes in the past 7 days was reported as none (0 days), infrequent (1–2 days), and frequent (≥ 3 days). Asthma symptoms included current (past 12 months) wheeze, current asthma (history of clinical diagnosis and current wheeze and/or medication use), and current symptoms of uncontrolled asthma (≥ 4 attacks of wheeze, ≥ 1 night per week sleep disturbance from wheeze, and/or wheeze affecting speech). Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. Results Among the analytical study sample (n = 1345), current e-cigarette use and cigarette smoking was reported by 369 (27.4%) and 358 (26.6%) participants, respectively. Compared to never e-cigarette users and never cigarette smokers, current e-cigarette users with no history of cigarette smoking had increased prevalence of current wheeze (aPR = 1.54, 95% CI 1.01–2.45) and current asthma (aPR = 1.85, 95% CI 1.03–3.41). Moreover, the frequency of exposure to household SHA from e-cigarettes was associated with asthma symptoms. For example, compared to those with no exposure to household SHA, frequent exposure to household SHA was associated with current wheeze (aPR = 1.30, 95% CI 1.04–1.59), current asthma (aPR = 1.56, 95% CI 1.13–2.16), and current uncontrolled asthma symptoms (aPR = 1.88, 95% CI 1.35–2.62). Conclusions E-cigarette use and their household SHA exposure were independently associated with asthma symptoms among adolescents. Hence, such observations indicate that e-cigarette use and passive exposure to their aerosols negatively impact respiratory health among adolescents.
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Affiliation(s)
| | - Abdullah Redha
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Dalal Alroumi
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Mohamad Ali
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Waad Almutairi
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali Esmaeil
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
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Vardavas CI, Kyriakos CN, McNeill A, Fong GT. Evaluating the impact of the Tobacco Products Directive within the context of the FCTC in Europe-findings from the EUREST-PLUS ITC Europe Surveys: introductory Commentary. Eur J Public Health 2020; 30:iii1-iii3. [PMID: 32918823 PMCID: PMC7526776 DOI: 10.1093/eurpub/ckaa110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Ann McNeill
- Department of Addictions, King’s College London, London, UK
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
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Amalia B, Liu X, Lugo A, Fu M, Odone A, van den Brandt PA, Semple S, Clancy L, Soriano JB, Fernández E, Gallus S. Exposure to secondhand aerosol of electronic cigarettes in indoor settings in 12 European countries: data from the TackSHS survey. Tob Control 2020; 30:49-56. [PMID: 32123139 DOI: 10.1136/tobaccocontrol-2019-055376] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/12/2019] [Accepted: 12/31/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Exposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings in 12 European countries. METHODS In 2017-2018, we conducted a cross-sectional study, the TackSHS survey, on a representative sample of the population aged ≥15 years in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). We described the prevalence and duration of exposure to SHA in several indoor settings among 11 604 e-cigarette non-users. Individual-level and country-level characteristics associated with SHA exposure were also explored using multilevel logistic regression analyses. RESULTS Overall, 16.0% of e-cigarette non-users were exposed to SHA in any indoor setting at least weekly, ranging from 4.3% in Spain to 29.6% in England. The median duration of SHA exposure among those who were exposed was 43 min/day. 'Other indoor settings' (eg, bar and restaurant) was reported as the place where most of e-cigarette non-users were exposed (8.3%), followed by workplace/educational venues (6.4%), home (5.8%), public transportation (3.5%) and private transportation (2.7%). SHA exposure was more likely to occur in certain groups of non-users: men, younger age groups, those with higher level of education, e-cigarette past users, current smokers, those perceiving SHA harmless and living in countries with a higher e-cigarette use prevalence. CONCLUSIONS We found inequalities of SHA exposure across and within European countries. Governments should consider extending their tobacco smoke-free legislation to e-cigarettes to protect bystanders, particularly vulnerable populations such as young people. TRIAL REGISTRATION NUMBER NCT02928536.
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Affiliation(s)
- Beladenta Amalia
- Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,Department of Clinical Sciences, University of Barcelona (UB), L'Hospitalet de Llobregat, Catalonia, Spain.,CIBER Respiratory Diseases (CIBERES), Madrid, Spain
| | - Xiaoqiu Liu
- Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Marcela Fu
- Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,Department of Clinical Sciences, University of Barcelona (UB), L'Hospitalet de Llobregat, Catalonia, Spain.,CIBER Respiratory Diseases (CIBERES), Madrid, Spain
| | - Anna Odone
- School of Public Health, Universita Vita-Salute San Raffaele, Milano, Lombardia, Italy
| | - Piet A van den Brandt
- CAPHRI-School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, Scotland, UK
| | - Luke Clancy
- TobaccoFree Research Institute Ireland (TFRI), Dublin, Ireland
| | - Joan B Soriano
- CIBER Respiratory Diseases (CIBERES), Madrid, Spain.,Respiratory DepartmentH, Hospital Universitario de la Princesa, Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Catalonia, Spain .,Tobacco Control Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,Department of Clinical Sciences, University of Barcelona (UB), L'Hospitalet de Llobregat, Catalonia, Spain.,CIBER Respiratory Diseases (CIBERES), Madrid, Spain
| | - Silvano Gallus
- Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Amalia B, Fu M, Feliu A, Tigova O, Fayokun R, Mauer-Stender K, Fernández E. Regulation of Electronic Cigarette Use in Public and Private Areas in 48 Countries Within the WHO European Region: A Survey to In-country Informants. J Epidemiol 2020; 32:131-138. [PMID: 33342937 PMCID: PMC8824658 DOI: 10.2188/jea.je20200332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The objective of this study is to describe the legislation regulating the use of electronic cigarettes (e-cigarettes) in various places in European countries. Methods A survey among experts from all countries of the World Health Organization (WHO) European Region was conducted in 2018. We collected and described data on legislation regulating e-cigarette use indoors and outdoors in public and private places, the level of difficulties in adopting the legislation, and the public support and compliance. Factors associated with the legislation adoption were identified with Poisson and linear regression analyses. Results Out of 48 countries, 58.3% had legislation on e-cigarette use at the national level. Education facilities were the most regulated place (58.3% of countries), while private areas (eg, homes, cars) were the least regulated ones (39.6%). A third of countries regulated e-cigarette use indoors. Difficulty and support in adopting the national legislation and its compliance were all at a moderate level. Countries’ smoking prevalence and income levels were linked to legislation adoption. Conclusions Although most WHO European Region countries had introduced e-cigarette use legislation at the national level, only a few of the legislation protect bystanders in indoor settings.
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Affiliation(s)
- Beladenta Amalia
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat
- School of Medicine and Health Sciences, University of Barcelona
- Consortium for Biomedical Research in Respiratory Diseases
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat
- School of Medicine and Health Sciences, University of Barcelona
- Consortium for Biomedical Research in Respiratory Diseases
| | - Ariadna Feliu
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat
- School of Medicine and Health Sciences, University of Barcelona
- Consortium for Biomedical Research in Respiratory Diseases
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat
- School of Medicine and Health Sciences, University of Barcelona
- Consortium for Biomedical Research in Respiratory Diseases
| | | | | | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat
- School of Medicine and Health Sciences, University of Barcelona
- Consortium for Biomedical Research in Respiratory Diseases
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