1
|
Estey D, Wanye GF, Sharp A, Takalkar R, Progovac A, Cook BL. Associations between vaping and daily cigarette consumption among individuals with psychological distress. Tob Prev Cessat 2024; 10:TPC-10-25. [PMID: 38903697 PMCID: PMC11188481 DOI: 10.18332/tpc/189769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/21/2024] [Accepted: 06/06/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Individuals with behavioral health conditions smoke at significantly higher rates and have been resistant to existing smoking cessation efforts. A clearer understanding of associations between vaping and daily cigarette consumption in this vulnerable population is warranted. METHODS We analyzed data from the 2014-2018 National Health Interview Survey (NHIS) to examine whether vaping was associated with differences in number of cigarettes smoked per day (CPD) among adults who smoke daily and have varying levels of psychological distress. RESULTS After adjustment for sociodemographic covariates, individuals who vaped every day smoked on average 1.48 fewer cigarettes per day than individuals who never vaped (p<0.01), while individuals who vaped some days and individuals who ever but no longer vaped smoked 0.77 and 1.48 more CPD, respectively, than individuals who never vaped. Differences between those who vaped every day and those who never vaped were even greater among those with moderate psychological distress (-2.21 CPD, p<0.01). CONCLUSIONS Our findings suggest that use of vaping devices may be associated with lower daily cigarette use among individuals with psychological distress, potentially supporting smoking harm reduction efforts.
Collapse
Affiliation(s)
- David Estey
- Cambridge Health Alliance, Cambridge, Massachusetts, United States
| | | | - Amanda Sharp
- Cambridge Health Alliance, Cambridge, Massachusetts, United States
| | - Rujuta Takalkar
- Cambridge Health Alliance, Cambridge, Massachusetts, United States
| | - Ana Progovac
- Cambridge Health Alliance, Cambridge, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, United States
| | - Benjamin Lê Cook
- Cambridge Health Alliance, Cambridge, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, United States
| |
Collapse
|
2
|
Palmer AM, Rojewski AM, Carpenter MJ, Klemperer EM, Baker NL, Sanford BT, Toll BA. Interest in quitting e-cigarette use by device type and smoking history in US adults. Tob Control 2024; 33:537-540. [PMID: 36650050 PMCID: PMC10350465 DOI: 10.1136/tc-2022-057710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of e-cigarettes has been increasing, especially since the introduction of 'pod' devices to the marketplace since 2018. Most adults who vape report interest in quitting. The present study examined level of interest in e-cigarette cessation between users with varying cigarette smoking histories and device types. METHODS Data obtained from wave 5 (2018-2019) of the Population Assessment of Tobacco and Health study (n=34 309). Analyses were conducted on adult current established e-cigarette users, categorised on cigarette smoking history (current, former or never) and device type (disposable, cartridge/pod, tank or mod). Participants reported if they planned to ever quit e-cigarettes, attempted to quit in the past year and attempted to quit by cutting back in the past year. RESULTS Of the 2922 established e-cigarette users, 68.21% reported plans to quit vaping; 17.27% reported attempting to quit e-cigarettes in the past year; and 29.28% reported attempting to quit by cutting back in the past year. Cartridge users had higher odds of interest in quitting than tank and mod users. Disposable and cartridge users had higher odds of reporting a past year quit attempt than tank and mod users. Individuals with no smoking history had higher odds of reporting a past year quit attempt or cutting back relative to those reporting dual use (of both e-cigarettes and cigarettes) and former smoking. CONCLUSIONS Tobacco control should consider the type of e-cigarette device that is being used, alongside users' cigarette smoking history, when developing interventions and other resources for vaping cessation.
Collapse
Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
| | - Matthew J Carpenter
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elias M Klemperer
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brandon T Sanford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| |
Collapse
|
3
|
Kim S. New opportunities with ENDS for people who smoke and do not intend to quit smoking. Intern Emerg Med 2024:10.1007/s11739-024-03677-6. [PMID: 38898216 DOI: 10.1007/s11739-024-03677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Sooyong Kim
- Pinney Associates Inc, 201 North Craig Street, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
4
|
Selya A. The "Gateway" hypothesis: evaluation of evidence and alternative explanations. Harm Reduct J 2024; 21:113. [PMID: 38849956 PMCID: PMC11157890 DOI: 10.1186/s12954-024-01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS) offer a substantial harm reduction opportunity for adults who smoke and are unlikely to quit. However, a major concern about ENDS is their use by non-smoking youth, and particularly whether ENDS are acting as a "gateway" that leads youth to later start smoking cigarettes. However, evidence for the gateway hypothesis can be interpreted in alternative ways, e.g. that youth who have certain characteristics were already predisposed to use both ENDS and cigarettes ("common liability" explanation). AIMS This commentary provides an evaluation of the gateway hypothesis that is accessible by a lay audience. This paper first reviews and evaluates the evidence interpreted as supporting the gateway hypothesis. Important alternative explanations (i.e., common liability) are discussed, as are different types of evidence (i.e., population-level trends) that can help differentiate between these competing explanations. OVERVIEW Evidence for the gateway hypothesis is based on the finding that youth who use ENDS are more likely to also smoke cigarettes. However, this evidence suffers from an important flaw: these studies fail to fully account for some youths' pre-existing tendency to use products containing nicotine, and inappropriately interpret the results as ENDS use causing some youth to smoke. Common liability studies suggest that ENDS use does not, in and of itself, directly cause youth to later smoke cigarettes, beyond their pre-existing tendency to use products containing nicotine. Population-level trends show that youth cigarette smoking declined faster after ENDS use became common, which contradicts the central prediction of the gateway hypothesis (i.e. that youth smoking would be more common following ENDS uptake, than otherwise be expected). CONCLUSION Evidence offered in support of the gateway hypothesis does not establish that ENDS use causes youth to also smoke cigarettes. Instead, this evidence is better interpreted as resulting from a common liability to use both ENDS and cigarettes. Population-level trends are inconsistent with the gateway hypothesis, and instead are consistent with (but do not prove) ENDS displacing cigarettes. Policies based on misinterpreting a causal gateway effect may be ineffective at best, and risk the negative unintended consequence of increased cigarette smoking.
Collapse
Affiliation(s)
- Arielle Selya
- Pinney Associates, Inc, 201 North Craig Street, Suite 320, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
5
|
Shiffman S, Cohen G, Liang Q, Cook DK, Karles GD. Estimating human pharmacokinetic parameters forelectronic nicotine delivery system products from chemical analyses of their aerosols. Drug Test Anal 2024. [PMID: 38808532 DOI: 10.1002/dta.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
The ability of Electronic Nicotine Delivery Systems (ENDS) to deliver nicotine is central to their function to substitute for cigarettes, allowing people who smoke to switch away from smoking, thus reducing their exposure to harmful chemicals in cigarette smoke. The nicotine concentration in ENDS e-liquid has proved to be a poor predictor of nicotine uptake in users. Using meta-analytic methods to analyze 12 pharmacokinetic studies of nicotine-salt closed-system ENDS, this paper examines whether the mass of nicotine/puff of aerosol can predict Cmax in pharmacokinetic studies. Cmax values were available for 38 products, in 58 use conditions (including both controlled [3 s] and ad libitum puffing), comprising 1769 participant observations. Nicotine/puff data reflected chemical analyses of aerosol obtained under nonintense (3 s) or intense (6 s) machine puffing. Meta-regression analyses (weighted by reliability of Cmax estimate) assessed the relationship of nicotine/puff to Cmax. In some models, empirical data were used to impute the variation in Cmax or the nicotine/puff value under intense puffing. In simple linear models, Cmax was significantly associated with nicotine/puff under all combinations of intense/nonintense and controlled/ad-libitum conditions, with R2 values of 0.71-0.77. More complex models based on quadratic effects or log[nicotine/puff] did not generally improve upon more parsimonious linear models. Application of the model illustrates the divergence between nicotine concentration in e-liquids and expected Cmax when other ENDS parameters vary. The meta-analytic model may have utility in settings where clinical pharmacokinetic data are not available, including product development.
Collapse
Affiliation(s)
- Saul Shiffman
- Pinney Associates, Inc, Pittsburgh, Pennsylvania, USA
| | - Gal Cohen
- JUUL Labs, Inc, Washington, District of Columbia, USA
| | - Qiwei Liang
- JUUL Labs, Inc, Washington, District of Columbia, USA
| | - David K Cook
- JUUL Labs, Inc, Washington, District of Columbia, USA
| | | |
Collapse
|
6
|
van der Zee K, Van Walbeek C. Interactions between ENDS and cigarette use: evidence from a 2022 national telephone survey in South Africa. Tob Control 2024:tc-2023-058521. [PMID: 38789264 DOI: 10.1136/tc-2023-058521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Electronic nicotine delivery systems (ENDS) may serve as a cessation tool for people who smoke cigarettes. However, for people who do not smoke, ENDS may be a gateway to nicotine addiction and cigarette use. This paper aims to quantify these behaviours in South Africa. METHODS We analysed a nationally representative telephone survey of 21 263 South Africans living in urban areas. For those respondents who had used both products (N=771), we developed a typology that describes the sequence in which cigarette and ENDS initiation occurred. 'On-rampers' describe people who used ENDS first and later initiated cigarette smoking. 'Off-rampers' describe people who used cigarettes first, took up ENDS and later quit cigarettes while still using ENDS. 'Failed off-rampers' describe people who started using ENDS while smoking cigarettes but later quit using ENDS. 'Continuing dual consumers' describe people still using both products at the time of the interview. RESULTS Of the overall sample (N=21 263), 1.7% used or had used ENDS but had no history of using cigarettes. Of dual consumers (N=771), 8.8% were classified as 'on-rampers', 13.9% as 'off-rampers', 20.9% as 'failed off-rampers' and 56.4% as 'continuing dual consumers'. Roughly half of those classified as off-rampers, failed off-rampers or continuing dual consumers stated that they started using ENDS to help them quit cigarettes. CONCLUSIONS The typology reveals a multifaceted relationship between ENDS and cigarette use in South Africa. Policy interventions should aim to minimise on-ramping and maximise off-ramping. Given the high prevalence of continued dual use and failed off-ramping, targeted cessation support should be provided for people who use ENDS and are trying to quit cigarettes.
Collapse
Affiliation(s)
- Kirsten van der Zee
- Research Unit on the Economics of Excisable Products, School of Economics, University of Cape Town, Rondebosch, South Africa
| | - Corné Van Walbeek
- Research Unit on the Economics of Excisable Products, School of Economics, University of Cape Town, Rondebosch, South Africa
| |
Collapse
|
7
|
Borm FJ, Cohen S, Cohen D. Electronic Nicotine-Delivery Systems for Smoking Cessation. N Engl J Med 2024; 390:1829-1830. [PMID: 38749043 DOI: 10.1056/nejmc2403709] [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] [Indexed: 05/18/2024]
Affiliation(s)
- Frank J Borm
- Leiden University Medical Center, Leiden, the Netherlands
| | - Sophie Cohen
- University Medical Center of Utrecht, Utrecht, the Netherlands
| | - Danielle Cohen
- Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
8
|
He Y, Yang Q, Alish Y, Ma S, Qiu Z, Chen J, Wagener T, Shang C. Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model. JMIR Form Res 2024; 8:e49276. [PMID: 38723251 PMCID: PMC11117130 DOI: 10.2196/49276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/07/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations. OBJECTIVE This study will examine how product features are associated with the prices of devices sold in web-based vape shops. METHODS We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container-only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices. RESULTS EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device-only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers. CONCLUSIONS A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products.
Collapse
Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Qian Yang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yousef Alish
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Theodore Wagener
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Medical Oncology Division, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Medical Oncology Division, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
9
|
Mohammad MS, Aburezq M, AlSaeed N, Abdullah Z, Fayrouz S, Almunefi K, Bahdila D. Electronic nicotine delivery system use and its relation to waterpipe smoking among youth in seven Arab countries. Prev Med 2024; 182:107945. [PMID: 38574972 DOI: 10.1016/j.ypmed.2024.107945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Electronic Nicotine Delivery System (ENDS) use and Waterpipe Tobacco Smoking (WTS) are reported to be a growing strain of tobacco epidemic among youth in the Arab world. Therefore, we aimed to: (1) estimate the regional prevalence of ENDS use among youth in 7 Arab countries and, (2) to explore the bidirectional relationship between ENDS use and WTS among Arab adolescents. METHODS We analyzed data from the World Health Organization Global Youth Tobacco Survey (GYTS 2014-2018) of 18,536 schoolchildren aged 12-16 from Iraq, Mauritania, Morocco, Oman, Qatar, Tunisia, and Yemen. The weighted prevalence was calculated to generate nationally representative estimates. Adjusted multilevel logistic regression models were conducted to assess the association between ENDS use and WTS. RESULTS The pooled weighted prevalence of ENDS use was 9.5%. Higher odds of ENDS use were significantly associated with WTS (AOR: 5.26, 95%CI: 4.28-6.46), smoking conventional cigarettes (AOR: 1.54, 95%CI: 1.23-1.94) and first tobacco use prior to the age of 12 (AOR: 1.40, 95%CI: 1.14-1.72). Females and children who were taught in school the dangers of tobacco had less odds of using ENDS. CONCLUSION WTS was associated with increased odds of ENDS use by >5 folds, and vice versa. Tobacco consumption at age younger than 12 years was associated with higher odds of ENDS use, but less odds of WTS. Females and those who were taught in school the dangers of tobacco were less likely to report ENDS use.
Collapse
Affiliation(s)
- Mohammad S Mohammad
- Department of General Dentistry, North Sabah Al-Salem Hospital, Ministry of Health, Kuwait
| | - Maryam Aburezq
- Department of Pediatric, Farwanyia Hospital, Ministry of Health, Kuwait
| | - Noura AlSaeed
- Department of Pediatric, Farwanyia Hospital, Ministry of Health, Kuwait
| | - Zahraa Abdullah
- Department of Pediatric, Amiri Hospital, Ministry of Health, Kuwait
| | - Sarah Fayrouz
- Department of Pediatric, Jaber Hospital, Ministry of Health, Kuwait
| | - Khalifa Almunefi
- Department of Pediatric, Amiri Hospital, Ministry of Health, Kuwait
| | - Dania Bahdila
- Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
| |
Collapse
|
10
|
Goldenson NI, Shiffman S, Sembower MA, Black RA. Assessment of abuse liability and switching potential of menthol-flavored pod-based electronic nicotine delivery systems among US adults who smoke cigarettes. Drug Alcohol Depend 2024; 258:111279. [PMID: 38614020 DOI: 10.1016/j.drugalcdep.2024.111279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Menthol-flavored electronic nicotine delivery systems (ENDS) are a focus of public health and regulatory policy considerations. The abuse liability of five menthol-flavored pod-based ENDS was compared to combustible cigarettes, and switching potential of ENDS was also evaluated. METHODS 215 US adults who smoke cigarettes (34.4% female; mean age[SD]=29.60[8.75]; 40.9% non-Hispanic White; mean cigarettes/day[SD]=12.04[8.52]) completed a randomized 6-arm within-person cross-over product-use study. Participants used five pod-based menthol-flavored ENDS (JUUL2 Polar Menthol 1.5%, JUUL2 Prototype Fresh Menthol 3.0%, JUUL Menthol 5.0%, Vuse Alto Menthol 5.0%, NJOY Ace Menthol 5.0%) and their usual brand (UB) cigarette for 20minutes ad libitum. After each product use, subjective reinforcing effects relevant to abuse liability and associated with switching away from cigarettes (e.g., satisfaction, product liking) were assessed. RESULTS All ENDS products were rated substantially and statistically significantly lower than UB cigarette on measures of subjective reinforcing effects (ps<0.001). Satisfying effects of JUUL2 1.5% were rated significantly higher than other ENDS products. JUUL2 Prototype 3.0% and Vuse Alto 5.0% did not significantly differ (ps>0.05), and both were rated significantly higher than JUUL 5.0% and NJOY Ace 5.0% (ps<0.05). Differences in subjective responses to study products did not significantly differ by preference for menthol cigarettes or by current ENDS use. CONCLUSIONS Abuse liability of all menthol-flavored ENDS in this study was substantially lower than combustible cigarettes. Abuse liability of JUUL2 1.5% was within the range of currently marketed pod-based menthol-flavored ENDS products. JUUL2 1.5% likely has high potential for facilitating switching among US adults who smoke.
Collapse
|
11
|
Yao T, Lea Watkins S, Sung HY, Wang Y, Gu D, Chen Lyu J, Lightwood J, Max W. Association between tobacco product use and respiratory health and asthma-related interference with activities among U.S. Adolescents. Prev Med Rep 2024; 41:102712. [PMID: 38586468 PMCID: PMC10995971 DOI: 10.1016/j.pmedr.2024.102712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024] Open
Abstract
Tobacco use adversely affects long-term respiratory health. We examined the relationship between sole and dual tobacco product use and both respiratory health and respiratory-related quality of life during adolescence in the U.S. Using adolescent data (baseline age 12-17) from Waves 4.5 (data collected from December 2017-December 2018) and 5 (data collected from December 2018-November 2019) of the Population Assessment of Tobacco and Health Study, we examined the associations between combustible (i.e., cigarette or cigar), vaped, and dual (i.e., both cigar/cigarette and e-cigarette) tobacco/nicotine use at baseline and two respiratory symptoms (all adolescents, n = 11,748) and new asthma diagnosis (adolescents with no baseline diagnosis, n = 9,422) at follow-up. Among adolescents with asthma (Wave 5, n = 2,421), we estimated the association between current tobacco use and the extent to which asthma interfered with daily activities. At follow-up, 12.3 % of adolescents reported past 12-month wheezing/whistling, 17.4 % reported past 12-month dry cough, and 1.9 % reported newly diagnosed asthma. Baseline current cigarette/cigar smoking was associated with subsequent wheezing/whistling and baseline report of another tobacco product use pattern was associated with subsequent asthma diagnosis. Among adolescents with asthma, 5.7 % reported it interfering with activities some of the time and 3.1 % reported interference most/all of the time in the past 30 days. Past 30-day sole cigarette/cigar smoking and dual use was positively associated with asthma-related interference with activities compared to never tobacco use and sole e-cigarette use. Combustible and dual tobacco use pose direct risk to respiratory health and indirect risk to quality of life through respiratory health.
Collapse
Affiliation(s)
- Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Shannon Lea Watkins
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Yingning Wang
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Dian Gu
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Wendy Max
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| |
Collapse
|
12
|
Li W, Kalan ME, Kondracki AJ, Gautam P, Jebai R, Osibogun O. Longitudinal impact of perceived harm and addiction on e-cigarette initiation among tobacco-naïve youth: Population Assessment of Tobacco and Health study (Waves 1-5). Public Health 2024; 230:52-58. [PMID: 38507916 PMCID: PMC11025441 DOI: 10.1016/j.puhe.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES This study investigates the effect of e-cigarette-related harm and addiction perceptions on e-cigarette initiation among US tobacco-naïve adolescents. STUDY DESIGN This is a longitudinal study. METHODS Using data from five waves (2013-2019) of the Population Assessment of Tobacco and Health Study, we created a longitudinal data set for 2775 youth aged 12-17 years who had no prior use of tobacco products at Wave 1. E-cigarette initiation was defined as transitioning from non-use at Wave 1 to ever use in subsequent waves. Kaplan-Meier survival and Cox proportional hazard regression models were used to assess the impact of harm and addiction perceptions on e-cigarette initiation. RESULTS Our analytic sample comprised 63.1% of youth who had never used tobacco products at Wave 1 and consequently initiated e-cigarette use in subsequent waves. Over time, fewer individuals perceived e-cigarettes as harmless (14.1%-2.1%), whereas more perceived them as likely to cause addiction (53.7%-76.6%). Compared with perceiving e-cigarettes as a lot of harm, those perceiving some harm (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.12-1.52), little harm (aHR = 1.42, 95% CI: 1.20-1.68), or no harm (aHR = 2.09, 95% CI: 1.64-2.65) were more likely to initiate e-cigarette use. Demographic factors for initiation included being Black or Hispanic ethnicity (vs White), younger age (12-14 vs15-17 years), and receiving over $20 per week (vs $0) in pocket money, with P-values <0.05. However, in adjusted results, addiction perceptions did not significantly impact e-cigarette initiation (P-values >0.05). CONCLUSIONS Among youth without prior tobacco/nicotine use, perceiving e-cigarettes as having low harm significantly predicted initiation over time. Effective prevention strategies, including targeted risk communication interventions, are essential for discouraging e-cigarette use among youth.
Collapse
Affiliation(s)
- W Li
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
| | - M E Kalan
- School of Health Professionals, Eastern Virginia Medical School, Norfolk, VA, USA
| | - A J Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Savannah, GA, USA
| | - P Gautam
- Texas State Board of Pharmacy, Austin, TX, USA
| | - R Jebai
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, MA, USA
| | - O Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| |
Collapse
|
13
|
Cai J, Bidulescu A. E-cigarette use or dual use of E-cigarette and combustible cigarette and mental health and cognitive impairment: Findings from the National Health Interview Survey, 2020-2021. J Affect Disord 2024; 351:878-887. [PMID: 38211743 DOI: 10.1016/j.jad.2024.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 12/14/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Studies on the association between e-cigarette use and mental health are mostly among adolescents and young adults, leaving limited evidence of this association among general US adults. Besides, few studies have examined how e-cigarette use or dual use of e-cigarette and combustible cigarette is related to cognitive function. METHODS Cross-sectional data of 56,734 adults from the 2020-2021 National Health Interview Survey were analyzed. Weighted multivariable logistic regression models were applied to examine the independent association between e-cigarette use or dual use and anxiety symptoms, depression symptoms, serious psychological distress (SPD), and cognitive impairment. RESULTS Compared with never e-cigarette users, current e-cigarette users had 2.10-fold (95 % CI: 1.84, 2.39), 2.53-fold (95 % CI: 2.13, 3.00), 2.02-fold (95 % CI: 1.47, 2.76), and 2.00-fold (95 % CI: 1.47, 2.72) higher odds of reporting anxiety symptoms, depression symptoms, SPD, and cognitive impairment, respectively. Former e-cigarette use was also associated with all three mental conditions and cognitive impairment (AOR ranged from 1.38 to 2.53, all P < 0.01). Dual users were more likely to report all three mental conditions and cognitive impairment than those who never used combustible cigarette and e-cigarette (AOR ranged from 1.89 to 2.83, all P < 0.01). Dual users also had a greater likelihood of having anxiety or depression symptoms than exclusive combustible cigarette users (AOR ranged from 1.46 to 1.47, all P < 0.01). CONCLUSIONS E-cigarette use or dual use is associated with poor mental health and cognitive impairment among US adults. Regulations on e-cigarette use are needed to prevent mental illness and improve cognitive function.
Collapse
Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America.
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America
| |
Collapse
|
14
|
Buss VH, Shahab L, Bauld L, Kock L, Cheeseman H, Brown J. 'Stopping the start': support for proposed tobacco control policies - a population-based survey in Great Britain 2021-2023. Tob Control 2024:tc-2023-058571. [PMID: 38609176 DOI: 10.1136/tc-2023-058571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES This study assessed public support for four proposed tobacco control policies in Great Britain: (1) Raising the sales age of tobacco by 1 year every year (Smokefree Generation); (2) Raising the sales age of tobacco from 18 years to 21 years; (3) Providing prescription e-cigarettes as smoking cessation aids to adults who smoke; (4) Restricting e-cigarette advertising to prevent youth uptake. DESIGN Repeat cross-sectional population-based survey weighted to match the population of Great Britain. SETTING The survey was conducted in England, Scotland and Wales in September 2021, October 2022 and October 2023. PARTICIPANTS 6541 adults living in Great Britain. MAIN OUTCOME MEASURES Support for each policy and year and prevalence ratios (PRs) comparing support between years and subgroups. RESULTS The most popular policy each year was restricting e-cigarette advertising (74%/79%/85%), followed by raising the sales age to 21 years (50%/58%/64%), providing prescription e-cigarettes (45%/44%/47%) and Smokefree Generation (34%/44%/49%). The largest increases were for policies about the age of sale (Smokefree Generation: 2021/2022 PR=1.28, 95% CI 1.18 to 1.40, 2022/2023 PR=1.12, 95% CI 1.04 to 1.20; raising the age to 21 years: 2021/2022 PR=1.16, 95% CI 1.09 to 1.23, 2022/2023 PR=1.11, 95% CI 1.05 to 1.17). Only 30% opposed Smokefree Generation in 2023 down from 41% in 2021. CONCLUSIONS Support for each policy increased each year, except for providing prescription e-cigarettes. Restricting e-cigarette advertising was the most popular policy, while support for age of sale policies, in particular for a Smokefree Generation, grew most. TRIAL REGISTRATION The study protocol was published on the Open Science Framework (https://osf.io/46z2c/) prior to starting the analysis.
Collapse
Affiliation(s)
- Vera Helen Buss
- Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Lion Shahab
- Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Linda Bauld
- SPECTRUM Consortium, Edinburgh, UK
- Usher Institute and UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Loren Kock
- Behavioural Science and Health, University College London, London, UK
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
| | - Hazel Cheeseman
- SPECTRUM Consortium, Edinburgh, UK
- Action on Smoking and Health, London, UK
| | - Jamie Brown
- Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| |
Collapse
|
15
|
Ma S, Yang Q, Ahn S, Park H, He Y, Bridges JFP, Shang C. Cost Comparison and Spending on Tobacco Products: Evidence from A Nationally Representative Sample of Adult E-Cigarette Users. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.03.24305296. [PMID: 38633785 PMCID: PMC11023667 DOI: 10.1101/2024.04.03.24305296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Over 20 states and local jurisdictions in the U.S. have imposed e-cigarette taxes. It is important to evaluate how adult vapers, including those who also smoke respond to e-cigarette taxation. The purpose of this study is to examine factors associated with adult vapers' cost perception of e-cigarettes relative to cigarettes and budget allocations between two products. Methods We recruited a nationally representative sample of 801 adult e-cigarette users in the U.S., who participated in an online survey in April and May 2023. Nested-ordered logit models and ordinary least squares regressions were used in the analysis. Results On average, monthly e-cigarette spending was $82.22, and cigarette spending was $118.77 among dual users. Less frequent e-cigarette use and higher state-level e-cigarette taxes were associated with perceiving smoking as cheaper than vaping. Age and exclusive use of tank systems were associated with perceiving vaping as cheaper than smoking. Exclusive use of tank systems was also associated with lower e-cigarette spending. Adults who used e-cigarettes more frequently preferred to report weekly budget on e-cigarettes ( p < 0.01), and among dual users, everyday smokers preferred to report weekly (versus monthly) budget on cigarettes compared to someday smokers ( p < 0.001). Conclusion Among US adult vapers, frequencies of tobacco use and e-cigarette device type are closely related to cost measures; and e-cigarette taxes are associated with cost perception of e-cigarettes relative to cigarettes, suggesting potential financial disincentive for vaping. Policymaker may consider imposing differential taxes by e-cigarette product types due to their different costs to consumers.
Collapse
|
16
|
Zvolensky MJ, Shepherd JM, Clausen BK, Redmond BY, Correa-Fernández V, Ditre JW. Combustible cigarette smokers versus e-cigarette dual users among Latinx individuals: Differences in alcohol and drug use severity. Exp Clin Psychopharmacol 2024; 32:197-206. [PMID: 37470998 PMCID: PMC10799193 DOI: 10.1037/pha0000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The Latinx population in the United States (U.S.) experiences significant tobacco and other substance use-related health disparities. Yet, little is known about the couse of combustible cigarettes and e-cigarettes (dual use) in relation to substance use behavior among Latinx smokers. The present investigation compared English-speaking Latinx adults living in the United States who exclusively smoke combustible cigarettes versus dual users in terms of alcohol use and other drug use problem severity. Participants were 297 Hispanic/Latinx daily cigarette smokers (36.4% female, Mage = 35.9 years, SD = 8.87) recruited nationally across the United States using Qualtrics Panels to complete self-report measures of behavioral health outcomes. Five analysis of covariance models were conducted to evaluate differences in overall alcohol consumption, dependence, related problems, hazardous drinking, and drug use problem severity between exclusive combustible cigarette smokers (N = 205) and dual users (N = 92). Results indicated that dual users evinced greater levels of alcohol consumption, dependence, alcohol-related problems, and hazardous drinking compared to exclusive combustible cigarette smokers (ps < .001). Dual users also reported greater levels of drug use problems relative to exclusive combustible cigarette smokers (p < .001). The current findings are among the first to document that dual cigarette and e-cigarette use status (compared to exclusive combustible cigarette smoking) may serve as a clinically relevant risk indicator for a range of deleterious substance use problems among Latinx individuals. Future research is needed to corroborate these findings and examine dual-use status as a longitudinal predictor of alcohol and other substance-related problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
- HEALTH Institute, University of Houston
| | | | | | | | | | | |
Collapse
|
17
|
Zamora Goicoechea J, Boughner A, Cirion Lee JJ, Mahajan A, Yeo K, Sproga M, Patel T, Saitta C, Russell C, Coughlan M, Caponnetto P, Polosa R. A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study. JMIR Res Protoc 2024; 13:e54236. [PMID: 38546715 PMCID: PMC11009848 DOI: 10.2196/54236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/19/2023] [Accepted: 01/31/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. OBJECTIVE We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. METHODS This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. RESULTS Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. CONCLUSIONS This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54236.
Collapse
Affiliation(s)
- Jeffrey Zamora Goicoechea
- International Network of Nicotine Consumer Organisations, Vejle, Denmark
- Asociación de Reducción de Daños del Tabaquismo, Bogota, Colombia
- Asociación de usuarios de vaporizadores y métodos de reducción de daños por tabaquismo de Costa Rica, San José, Costa Rica
| | - Allison Boughner
- American Vapor Manufacturers, Prescott, AZ, United States
- South Carolina Vapor Association, Charleston, SC, United States
| | | | | | - Kurt Yeo
- Vaping Saved My Life, Benoni, Gauteng, South Africa
- World Vapers Alliance, Miami, FL, United States
| | | | - Tasmin Patel
- Confidosoft Ltd, Leatherhead, London, United Kingdom
| | | | | | | | - Pasquale Caponnetto
- Section of Psychology, Department of Science of Education, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catana, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catana, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
18
|
Polosa R, Pluym N, Scherer M, Belsey J, Russell C, Caponnetto P, Weglarz J, Campagna D. Protocol for the "magnitude of cigarette substitution after initiation of e-cigarettes and its impact on biomarkers of exposure and potential harm in dual users" (MAGNIFICAT) study. Front Public Health 2024; 12:1348389. [PMID: 38584934 PMCID: PMC10996441 DOI: 10.3389/fpubh.2024.1348389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Many smokers who use e-cigarettes (ECs) to quit continue smoking alongside vaping. The impact on health among individuals who simultaneously smoke conventional cigarettes (CCs) and use ECs remains unclear. The varying patterns of dual use present differing levels of overall toxin exposure and relative risks concerning smoking-related diseases. Understanding these complexities is vital to assessing the implications for human health. Objective Herein we describe a protocol designed to analyze the impact of different level of substituting CCs with ECs on exposure to toxicants. We'll use biomarkers to measure this exposure and assess harm reduction in dual users through clinical endpoints, harm-related biomarkers, and behavioral correlations. We expect to observe progressive changes with varying patterns of dual use. Methods and analyses For this purpose, we planned to recruit a group of 250 smokers who will be asked to reduce their CC consumption by adopting ECs (intervention group). A separate group of 50 smokers will continue to smoke CC (reference group). Study groups will be followed up for 6 months during which biospecimens will be collected for biomarker analyses, and clinical endpoints will be assessed. The trial is structured to characterize subjects' usage patterns over time using robust biomarkers of exposure and a standardized mobile phone application to facilitate the precise categorization of dual users along the risk continuum based on their usage behaviors. Subject recruitment will start in February 2024 and enrolment is expected to be completed by August 2024. Results will be reported early in 2025. Study findings may provide valuable insights into health benefits or risks associated with varying patterns of dual use. Ethics and dissemination The study protocol and informed consent forms will be approved by the local Ethical Review Boards. Study results will be disseminated through articles published in reputable, peer-reviewed, open access, scientific journals, presentations at conferences, and the University website.
Collapse
Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital "Policlinico-S.Marco", University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy
| | - Nikola Pluym
- ABF Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany
| | - Max Scherer
- ABF Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany
| | | | | | - Pasquale Caponnetto
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Science of Education, Section of Psychology, University of Catania, Catania, Italy
| | - Jakub Weglarz
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Davide Campagna
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- UOC MCAU, University Teaching Hospital "Policlinico-S.Marco", University of Catania, Catania, Italy
| |
Collapse
|
19
|
Lin HX, Liu Z, Hajek P, Zhang WT, Wu Y, Zhu BC, Liu HH, Xiang Q, Zhang Y, Li SB, Pesola F, Wang YY. Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:291-299. [PMID: 38285562 PMCID: PMC10825782 DOI: 10.1001/jamainternmed.2023.7846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 01/31/2024]
Abstract
Importance Electronic cigarettes (ECs) are often used by smokers as an aid to stopping smoking, but evidence is limited regarding their efficacy compared with nicotine replacement therapy (NRT), and no evidence is available on how their efficacy compares with that of varenicline. Objective To evaluate whether ECs are superior to NRT and noninferior to varenicline in helping smokers quit. Design, Setting, and Participants This was a randomized clinical trial conducted at 7 sites in China and including participants who were smoking at least 10 cigarettes per day and motivated to quit, not using stop-smoking medications or EC, and willing to use any of the study products. Participants were first recruited in May 2021, and data analysis was conducted in December 2022. Interventions A cartridge-based EC (30 mg/mL nicotine salt for 2 weeks and 50 mg/mL after that), varenicline (0.5 mg, once a day for 3 days; 0.5 mg, twice a day for 4 days; and 1 mg, twice a day, after that), and 2 mg (for smokers of ≤20 cigarettes per day) or 4 mg (>20 cigarettes per day) nicotine chewing gum, all provided for 12 weeks and accompanied by minimal behavioral support (an invitation to join a self-help internet forum). Main Outcomes and Measures The primary outcome was sustained abstinence from smoking at 6 months as validated by an expired-air carbon monoxide reading (<8 parts per million). Participants lost to follow-up were included as nonabstainers. Results Of 1068 participants, 357 (33.5%) were female, and the mean (SD) age was 33.9 (3.1) years. A total of 409 (38.3%), 409 (38.3%), and 250 (23.4%) participants were randomized to the EC, varenicline, and NRT arms, respectively. The 6-month biochemically validated abstinence rates were 15.7% (n = 64), 14.2% (n = 58), and 8.8% (n = 22) in the EC, varenicline, and NRT study arms, respectively. The quit rate in the EC arm was noninferior to the varenicline arm (absolute risk reduction, 1.47%; 95% CI, -1.41% to 4.34%) and higher than in the NRT arm (odds ratio, 1.92; 95% CI, 1.15-3.21). Treatment adherence was similar in all study arms during the initial 3 months, but 257 participants (62.8%) in the EC arm were still using ECs at 6 months, with no further use in the 2 other study arms. The most common adverse reactions were throat irritation (32 [7.8%]) and mouth irritation (28 [6.9%]) in the EC arm, nausea (36 [8.8%]) in the varenicline arm, and throat irritation (20 [8.0%]) and mouth irritation (22 [8.8%]) in the NRT arm. No serious adverse events were recorded. Conclusions and Relevance The results of this randomized clinical trial found that when all treatments were provided with minimal behavior support, the efficacy of EC was noninferior to varenicline and superior to nicotine chewing gum. Trial Registration Chinese Clinical Trial Registry: ChiCTR2100048156.
Collapse
Affiliation(s)
- Hao-Xiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Wan-Tong Zhang
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuan Wu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Chen Zhu
- Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Hua Liu
- Department of Traditional Chinese Medicine, Beijing Geriatric Hospital, Beijing, China
| | - Qiu Xiang
- Respiratory Intensive Care Unit, Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- Office of China Journal of Traditional Chinese Medicine and Pharmacy, Beijing, China
| | - Shu-Bin Li
- Beijing PL Technology Co, Ltd, Beijing, China
| | - Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Ying-Ying Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
20
|
Lund KE, Saebo G. Challenges in legitimizing further measures against smoking in jurisdictions with robust infrastructure for tobacco control: how far can the authorities allow themselves to go? Harm Reduct J 2024; 21:33. [PMID: 38321438 PMCID: PMC10848560 DOI: 10.1186/s12954-024-00951-w] [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: 06/02/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND According to a recently published study, approximately half of those who currently smoke in Norway have little or no desire to quit despite a hostile regulatory and socio-cultural climate for smoking. On this background, we discuss some challenges that regulators will face in a further tightening of structural measures to curb smoking. MAIN BODY Central to our discussion is the research literature concerned with the concept of state-paternalism in tobacco control-the line between an ethically justified interference with the freedom of those who smoke and an exaggerated infringement disproportionate to the same people's right to live as they choose. In countries with an already advanced infrastructure for tobacco control, this dilemma might become quite intrusive for regulators. We ask that if people, who smoke are aware of and have accepted the risks, are willing to pay the price, smoke exclusively in designated areas, and make decisions uninfluenced by persuasive messages from manufacturers-is a further tightening of anti-smoking measures still legitimate? Strengthening of the infrastructure for tobacco control can be seen as a "help" to people who-due to some sort of "decision failure"-continue to smoke against their own will. However, for those who want to continue smoking for reasons that for them appear rational, such measures may appear unwanted, punitive, and coercive. Is it within the rights of regulators to ignore peoples' self-determination for the sake of their own good? We problematize the "help" argument and discuss the authorities' right to elevate the zero-vision of smoking as universally applicable while at the same time setting up barriers to switching to alternative nicotine products with reduced risk. CONCLUSION We recommend that a further intensification of smoking control in countries that already have a well-developed policy in this area requires that regulators start to exploit the opportunity that lies in the ongoing diversification of the recreational nicotine market.
Collapse
Affiliation(s)
- Karl Erik Lund
- Department for Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health (NIPH), Folkehelseinstituttet, Postboks 222, 0213, Skøyen, Oslo, Norway.
| | - Gunnar Saebo
- Department for Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health (NIPH), Folkehelseinstituttet, Postboks 222, 0213, Skøyen, Oslo, Norway
| |
Collapse
|
21
|
Hendlin YH, Han EL, Ling PM. Pharmaceuticalisation as the tobacco industry's endgame. BMJ Glob Health 2024; 9:e013866. [PMID: 38316465 PMCID: PMC10859997 DOI: 10.1136/bmjgh-2023-013866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024] Open
Abstract
CONTEXT Declining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they planned to shift their business to socially acceptable reduced-harm products. We describe the internal motivations and strategies to achieve this goal. METHODS We analysed previously secret tobacco industry documents available through the Truth Tobacco Documents Library. These documents were triangulated with TTCs' investor and other professional reports, websites and public statements. FINDINGS Mimicking pharmaceutical business models, tobacco companies sought to refurbish their image and ensure long-term profitability by creating and selling pharmaceutical-like products as smoking declined. These products included snus, heated tobacco products, e-cigarettes, nicotine gums and inhalers. Tobacco companies created separate divisions to develop and roll out these products, and the majority developed medical research programmes to steer these products through regulatory agencies, seeking certification as reduced-harm or pharmaceutical products. These products were regarded as key to the survival of the tobacco industry in an unfriendly political and social climate. CONCLUSIONS Pharmaceuticalisation was pursued to perpetuate the profitability of tobacco and nicotine for tobacco companies, not as a sincere search to mitigate the harms of smoking in society. Promotion of new pharmaceuticalised products has split the tobacco control community, with some public health professionals and institutions advocating for the use of 'clean' reduced-harm nicotine and tobacco products, essentially carrying out tobacco industry objectives.
Collapse
Affiliation(s)
- Yogi Hale Hendlin
- Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elieen Le Han
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| |
Collapse
|
22
|
Lipperman-Kreda S, Sanders E, Annechino R, Peterkin E, Antin TMJ. Harm perceptions of vaping nicotine relative to cigarette smoking among sexual and gender minority young adults. Drug Alcohol Rev 2024; 43:371-380. [PMID: 38258463 DOI: 10.1111/dar.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION To address gaps in existing research, the current study used a mixed-methods approach to describe, contextualise and understand harm perceptions of vaping nicotine relative to cigarette smoking and associations with nicotine and tobacco (NT) use among young adults who identify their genders and sexualities in ways that classify them as sexual and gender minorities (SGM). METHODS Results are based on cross-sectional surveys and online qualitative interviews with 98 SGM young adults (18-25 years old) in California's San Francisco Bay Area who currently or formerly used combustible tobacco. We generated a measure assessing participants' relative harm perceptions of e-cigarette use versus cigarette smoking and identified those who perceived cigarette smoking as more harmful than e-cigarette use compared to those who perceived it to be equally or less harmful. RESULTS We found that relative harm perceptions of cigarette smoking versus e-cigarette use are likely related to much uncertainty and confusion about the harms of e-cigarette use. Moreover, findings illustrate that public health messages regarding the risks of e-cigarette use may have unintended consequences of increasing cigarette use to replace e-cigarette use for some SGM young adults, a practice that is incongruent with scientific evidence demonstrating that cigarettes and other combustible tobacco products are riskier than e-cigarettes and other forms of NT use. DISCUSSION AND CONCLUSIONS Results suggest the need for evidence-based, clear, and direct messaging about the relative harms of cigarettes versus e-cigarettes to reduce NT-related inequities in SGM populations.
Collapse
Affiliation(s)
- Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, USA
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, USA
| | - Emile Sanders
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, USA
| | - Rachelle Annechino
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, USA
| | - Elaina Peterkin
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, USA
| | - Tamar M J Antin
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, USA
| |
Collapse
|
23
|
Li L, Borland R, Le Grande M, Gartner C. Future nicotine use preferences of current cigarette smokers: Findings from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey. Drug Alcohol Rev 2024; 43:359-370. [PMID: 38113310 PMCID: PMC10922120 DOI: 10.1111/dar.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/21/2023] [Accepted: 11/12/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Consumer preferences should be important factors that are considered when developing health policies and interventions. This paper examines the prevalence of, and factors associated with, consumer preferences regarding smoking behaviour 1 to 2 years in the future. METHODS At least weekly cigarette smokers in the 2020 wave of the International Tobacco Control Four Country Smoking and Vaping Survey (USA, Canada, England and Australia) (N = 8642) were asked if they preferred to continue to smoke or to quit with or without an alternative nicotine product (ANP) over the next 1-2 years. RESULTS Country-specific weighted data showed 21.5% preferred to continue smoking and 8.0% were uncertain, leaving 70.6% preferring to quit: 13.7% using an ANP and 56.9% completely quitting nicotine. Apart from interest in quitting, the main predictors of preferring to quit were history of vaping, being aged 55 and over, smoking weekly, worrying about smoking harms, regretting starting and believing vaping is less harmful relative to smoking. Among those preferring to quit, preferring to use ANPs in future was very strongly associated with current vaping (especially daily), being younger, living in England, reporting strong urges to smoke, believing vaping is much less harmful than smoking, and not strongly regretting starting to smoke, and not wanting to quit. DISCUSSION AND CONCLUSIONS A significant minority of smokers preferred not to quit, at least in the next year or two. Both interest in quitting and preference for ANPs over complete cessation were associated with similar covariates, including interest in vaping.
Collapse
Affiliation(s)
- Lin Li
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Michael Le Grande
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Coral Gartner
- School of Public Heath, The University of Queensland, Brisbane, Australia
| |
Collapse
|
24
|
Leavens ELS, Wagener TL. E-Cigarettes and FDA Nicotine Cap. JAMA 2024; 331:358-359. [PMID: 38261053 PMCID: PMC11201304 DOI: 10.1001/jama.2023.24521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Theodore L Wagener
- Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, Columbus
| |
Collapse
|
25
|
He Y, Yang Q, Lu B, Shang C. The Association Between the License Fee Increase and the Density of Tobacco Retailers in California-A Segmented Interrupted Time-Series Analysis by Income and Race/Ethnicity. Nicotine Tob Res 2024; 26:177-184. [PMID: 37702761 DOI: 10.1093/ntr/ntad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/04/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION On May 9, 2016, the State of California passed a law to increase the licensing fee for tobacco retailers from a one-time-only fee of $100 to an annual fee of $265, effective on June 9, 2016. This study investigates the association between this fee increase and retailer densities by neighborhood income and race/ethnicity characteristics. METHODS We obtained quarterly data on the number of active tobacco retailer licenses from 2011 to 2020 in every zip code in California from the California Department of Tax and Fee Administration. These data were then linked to zip code-level income, race/ethnicity, and population measures. We used a single-group segmented interrupted time-series analysis to assess the association between the increase in licensing fees and retailer densities by neighborhood income and race/ethnicity. RESULTS After the implementation of the annual licensing fees, the retailer density decreased both immediately and gradually. Specifically, the retailer density dropped by 0.47 in the first quarter following the intervention. Compared to the pre-intervention time trend, the retailer density decreased quarterly by 0.05. Furthermore, the impacts of increasing licensing fees were more pronounced in low-income and the majority Black zip codes. CONCLUSIONS Given that higher smoking prevalence is associated with greater tobacco outlet density, the licensing fee increase could be an effective policy tool to reduce tobacco use among economically disadvantaged and minority Black communities, thereby addressing tobacco-use disparities. IMPLICATIONS This study used the single-group segmented interrupted time-series analysis to assess the association between the licensing fee increase and tobacco retailer densities by neighborhood income and race/ethnicity. We found that this licensing fee increase was associated with reduced retailer densities and the total number of active retailers right after the implementation. We further found that the annual licensing fee policy had a continuous effect in reducing tobacco retailer densities in all zip codes. The impacts of increasing licensing fees were more pronounced in low-income and majority of Black zip codes.
Collapse
Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Qian Yang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bo Lu
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Internal Medicine, Medical Oncology Division, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
26
|
Wilhelm AK, Evans MD, Xiong Z, Ortega L, Vock DM, Maruyama G, Allen ML. School Connectedness and Adolescent E-cigarette Susceptibility in an Urban Sample of Middle and High School Students. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01643-4. [PMID: 38244166 DOI: 10.1007/s11121-024-01643-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
Adolescent school connectedness generally protects from risk behaviors such as tobacco use; however, its relationship to e-cigarette use is unclear. This study examines the relationship between adolescent school connectedness and e-cigarette susceptibility in a diverse longitudinal sample. This secondary analysis of a school-based intervention surveyed 608 middle (66%) and high school (34%) students from 10 schools at 3 time points over 1 year. At baseline, respondents had a mean age of 14 years, 54% were female, and 71% were BIPOC (Black, Indigenous, People of Color). Logistic regression models examined unadjusted and adjusted associations between school connectedness (both baseline and concurrent) and e-cigarette susceptibility over time. E-cigarettes represented the most prevalent form of current nicotine-containing product use in spring 2019 (2.3%), and most respondents reported no e-cigarette susceptibility (69%). E-cigarette susceptibility remained relatively stable during the study. Higher baseline school connectedness levels were associated with lower odds of e-cigarette susceptibility over time. Similarly, higher concurrent school connectedness scores were associated with lower odds of e-cigarette susceptibility over time: spring 2019 (OR, 0.39; 95% CI, 0.32, 0.47), fall 2019 (OR, 0.49; 95% CI, 0.34, 0.72), and spring 2020 (OR, 0.64; 95% CI, 0.47, 0.87). Findings were similar for middle and high school students and did not differ significantly after adjusting for other covariates. Adolescents' school connectedness appears to protect from e-cigarette susceptibility over time, underscoring the importance of promoting positive school experiences to reduce adolescent risk e-cigarette use.
Collapse
Affiliation(s)
- April K Wilhelm
- Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota Health, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Michael D Evans
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota Health, Minneapolis, USA
| | - Zong Xiong
- Department of Biochemistry, Molecular Biology, and Biophysics, College of Biological Sciences, University of Minnesota Twin Cities, Minneapolis, USA
| | - Luis Ortega
- SoLaHmo Partnership for Health and Wellness, Inc, Community University Health Care Center, Minneapolis, USA
| | - David M Vock
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota Health, Minneapolis, USA
- Division of Biostatistics, School of Public Health, University of Minnesota Health, Minneapolis, USA
| | - Geoffrey Maruyama
- Department of Educational Psychology, College of Education and Human Development, University of Minnesota Twin Cities, Minneapolis, USA
| | - Michele L Allen
- Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota Health, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| |
Collapse
|
27
|
Kim S, Shiffman S, Goldenson NI. Adult smokers' Complete Switching Away from Cigarettes at 6, 9, and 12 Months after Initially Purchasing a JUUL e-Cigarette. Subst Use Misuse 2024; 59:805-815. [PMID: 38238646 DOI: 10.1080/10826084.2024.2303990] [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: 03/01/2024]
Abstract
Background: Electronic nicotine delivery systems (ENDS) have the potential to benefit public health if smokers completely switch from cigarettes to ENDS. Methods: A cohort of adult smokers (age ≥ 21) who purchased a JUUL Starter Kit was followed for 12 months after the initial purchase. We defined "switching" as past-30-day abstinence from smoking (even if JUUL use had stopped), and analyzed factors associated with achievement and maintenance of self-reported repeated point-prevalence switching (RPPS) at three follow-ups, i.e., no past-30-day smoking at months 6, 9, and 12. Results: RPPS was reported by 21.6% of the 12,537 evaluable smokers. Smokers with lighter smoking history and lower cigarette dependence at baseline were more likely to report RPPS. RPPS was also associated with daily use of JUUL (Month-3: OR = 2.32, 95% CI = 2.02-2.68; Month-6: OR = 1.73, 95% CI = 1.42-2.10), and with greater subjective reinforcing effects from JUUL use (assessed by the mCEQ, Month-3: OR = 1.46, 95% CI = 1.38-1.56; Month-6: OR = 1.11; 95% CI = 1.02-1.20). Even among smokers who did not meet the criteria of RPPS (i.e., who smoked at least once), 35.5% reported past 30-day point-prevalence switching on at least one follow-up, and their cigarette consumption was substantially reduced compared to baseline. Conclusions: Approximately one-fifth of adult smokers reported 30-day point-prevalence abstinence at 6, 9, and 12 months after purchasing JUUL. Greater use of JUUL and stronger subjective reinforcing effects were associated with nonsmoking, validating the potential for ENDS to substitute for smoking, with potential for positive impacts on individual and population health.
Collapse
Affiliation(s)
- Sooyong Kim
- PinneyAssociates, Inc., Pittsburgh, Pennsylvania, USA
| | - Saul Shiffman
- PinneyAssociates, Inc., Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
28
|
Pienkowski M, Chaiton M, Bondy SJ, Cohen JE, Dubray J, Eissenberg T, Kaufman P, Stanbrook MB, O'Loughlin J, Dos Santos J, Schwartz R. Milestones in the natural course of the onset of e-cigarette dependence among adolescents and young adults: Retrospective study. Addict Behav 2024; 148:107846. [PMID: 37678007 DOI: 10.1016/j.addbeh.2023.107846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION There is considerable controversy about the development of dependence among e-cigarette users. This study describes the average amount of time using e-cigarettes before dependence milestones emerge and the differences in developing dependence between e-cigarette users who smoke cigarettes compared to those who do not. METHODS Adolescents and young adults aged 16-25 living in Canada were recruited into an online survey in 2021. Current (past-month) e-cigarette users completed 15 items assessing dependence from the Penn-State Electronic Cigarette Dependence Index and the E-cigarette Dependence Scale for a total of 12 behavioural (e.g., difficulty refraining from vaping) and 3 frequency (e.g., using e-cigarette daily, weekly, or monthly) indicators of dependence milestones. Number of years after e-cigarette onset at which the cumulative probability of attaining each milestone was 25 % was computed. RESULTS Among 1205 participants, most (80.6 %) were female, 73.7 % were Caucasian, and 49.7 % resided in Ontario. Ten of the 12 e-cigarette use milestones were attained by 25 % of respondents 2 years after starting vaping except for daily cigarette use (2.5 years after onset) and waking at night to vape (5.6 years after onset). Within the entire study population, frequency milestones (weekly, monthly, daily e-cigarette use) were attained faster by ever-smokers (hazard ratio compared to attainment by never-smokers: 1.12, 1.21, and 1.28 respectively), whereas for at least monthly users, behavioural milestones were attained faster by never-smokers. DISCUSSION Many current e-cigarette users developed symptoms of e-cigarette dependence between two and five years since onset. Never smokers may be at higher risk of becoming e-cigarette dependent since they attained e-cigarette dependence milestones faster than smokers.
Collapse
Affiliation(s)
- M Pienkowski
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - M Chaiton
- Dalla Lana School of Public Health, University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada.
| | - S J Bondy
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - J E Cohen
- Dalla Lana School of Public Health, University of Toronto, Canada; Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Dubray
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - T Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - P Kaufman
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - M B Stanbrook
- Division of Respirology, Department of Medicine, University of Toronto, Canada
| | - J O'Loughlin
- School of Public Health, University of Montreal, Montreal, QC, Canada
| | - J Dos Santos
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - R Schwartz
- Dalla Lana School of Public Health, University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| |
Collapse
|
29
|
Ebrahimi Kalan M, Lazard AJ, Sheldon JM, Whitesell C, Hall MG, Ribisl KM, Brewer NT. Terms tobacco users employ to describe e-cigarette aerosol. Tob Control 2023; 33:15-20. [PMID: 35728932 PMCID: PMC9768092 DOI: 10.1136/tobaccocontrol-2021-057233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The scientific term for the substance people inhale and exhale from a vaping device is 'aerosol', but whether the public uses this term is unclear. To inform tobacco control communication efforts, we sought to understand what tobacco users call e-cigarette aerosols. METHODS Participants were a national convenience sample of 1628 US adults who used e-cigarettes, cigarettes or both (dual users). In an online survey, conducted in spring 2021, participants described what 'people inhale and exhale when they vape', using an open-ended and then a closed-ended response scale. Participants then evaluated warning statements, randomly assigned to contain the term 'aerosol' or 'vapor' (eg, 'E-cigarette aerosol/vapor contains nicotine, which can lead to seizures'). RESULTS In open-ended responses, tobacco users most commonly provided the terms 'vapor' (31%) and 'smoke' (23%) but rarely 'aerosol' (<1%). In closed-ended responses, the most commonly endorsed terms were again 'vapor' (57%) and 'smoke' (22%) but again infrequently 'aerosol' (2%). In closed-ended responses, use of the term 'vapor' was more common than other terms among people who were older; white; gay, lesbian or bisexual; college educated; or vape users only (all p<0.05). In the experiment, warnings using the terms 'aerosol' and 'vapor' were equally effective (all p>0.05). CONCLUSIONS The public rarely uses the term 'aerosol' to describe e-cigarette output, potentially complicating educational efforts that use the term. Future studies should explore public knowledge and understanding of the terms 'aerosol' and the more popular 'vapor' to better inform vaping risk communication.
Collapse
Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- School of Media and Journalism, University of North Carolina, Chapel Hill, NC, USA
| | | | - Callie Whitesell
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
30
|
Prieger JE. Optimal Taxation of Cigarettes and E-Cigarettes: Principles for Taxing Reduced-Harm Tobacco Products. Forum Health Econ Policy 2023; 26:41-64. [PMID: 38101803 DOI: 10.1515/fhep-2022-0025] [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: 08/26/2022] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
As the tax base for traditional tobacco excise taxes continues to erode, policymakers have growing interest to expand taxation to novel and reduced-risk tobacco products. Chief among the latter are electronic nicotine delivery systems (ENDS; commonly known as e-cigarettes), although other reduced-risk tobacco products such as heated tobacco and smokeless tobacco products are also being considered for taxation. There are many possible rationales for taxing such products: to raise revenue, to correct for health externalities, to improve public health, to correct for internalities caused by irrationality or misinformation, and to redistribute income. Although each rationale leads to a different objective function, the conclusions regarding relative tax rates are largely the same. The relatively higher price elasticity of demand for e-cigarettes (compared to cigarettes) and the lower marginal harms from use imply in each case that taxes on e-cigarettes and other harm-reduced products should be relatively lower, and likely much lower, than those on cigarettes. Additional considerations concerning the policy goal of discouraging use of any tobacco product by youth are discussed as well.
Collapse
Affiliation(s)
- James E Prieger
- School of Public Policy, Pepperdine University, Malibu, CA, USA
| |
Collapse
|
31
|
Hair EC, Do EK, Liu SM, Tulsiani S, Vallone DM, Pierce JP. Patterns of Daily Cigarette and E-cigarette Use among United States Youth and Young Adults: Insights from the Truth Longitudinal Cohort between 2018 and 2019. Prev Med Rep 2023; 36:102416. [PMID: 37753384 PMCID: PMC10518703 DOI: 10.1016/j.pmedr.2023.102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose Temporal patterns of daily tobacco product use among ever users from the Truth Longitudinal Cohort (TLC) between 2018 and 2019 were explored. Methods The sample (N = 5274) includes individuals (15-36 years), residing in the United States, who had ever used any tobacco product at Wave 7 (February - May 2018) and provided tobacco use information at Wave 9 (September - December 2019). Results There was a nonsignificant 1.1 percentage point increase in daily tobacco use (on at least 25 of the past 30 days), from 14.6% (95% CI: 12.8, 16.6) to 15.7% (95% CI: 13.8, 17.7). Tobacco product use remained stable over time, as 65.3% (95% CI: 56.4, 73.3) of daily cigarette smokers, 57.0% (95% CI: 43.6, 69.4) of daily e-cigarette vapers, and 8.5% (95% CI: 2.0, 29.3) of daily dual users stayed with their primary tobacco product. There was also some evidence of switching, as 7.5% (95% CI: 3.7, 14.8) of daily cigarette smokers became daily e-cigarette vapers and 2.3% (95% CI: 0.7, 6.8) of daily e-cigarette vapers became daily cigarette smokers. Discussion Although most daily tobacco users were likely to continue using their primary product, some daily users transitioned to daily use of other products - suggesting that policies and public education focused on reducing overall nicotine use are essential for addressing the nicotine epidemic among young people.
Collapse
Affiliation(s)
- Elizabeth C. Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth K. Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Donna M. Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego Cancer, La Jolla, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
32
|
Meza R, Cao P, Jeon J, Warner KE, Levy DT. Trends in US Adult Smoking Prevalence, 2011 to 2022. JAMA HEALTH FORUM 2023; 4:e234213. [PMID: 38038988 PMCID: PMC10692849 DOI: 10.1001/jamahealthforum.2023.4213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/02/2023] [Indexed: 12/02/2023] Open
Abstract
Importance President Biden recently prioritized the fight against smoking as key to reducing cancer mortality. Objective To assess trends in smoking and illuminate the association between smoking and reducing deaths due to cancer. Design, Setting, and Participants This cross-sectional study used responses to National Health Interview Surveys from January 1, 2011, to December 31, 2022, to characterize trends in current smoking for key sociodemographic groups among US adults. Exposures Age (18-24, 25-39, 40-64, and ≥65 years), family income (<200%, 200%-399%, and ≥400% of the federal poverty level [FPL]), educational level (less than high school, high school degree or General Educational Development, some college, and college degree or above), and race and ethnicity (Black, Hispanic, White, and other). Main Outcomes and Measures Weighted current smoking prevalence with 95% CIs by analysis group from 2011 to 2022. Average annual percentage change (AAPC) in smoking prevalence by analysis group is calculated using Joinpoint regression. Results Data from 353 555 adults surveyed by the National Health Interview Surveys from 2011 to 2022 were included (12.6% Black, 15.0% Hispanic, 65.2% White, and 7.3% other race or ethnicity). Overall, smoking prevalence decreased among adults aged 18 to 24 years from 19.2% (95% CI, 17.5%-20.9%) in 2011 to 4.9% (95% CI, 3.7%-6.0%) in 2022 at an AAPC of -11.3% (95% CI, -13.2% to -9.4%), while it remained roughly constant among adults 65 years or older at 8.7% (95% CI, 7.9%-9.5%) in 2011 and 9.4% (95% CI, 8.7%-10.2%) in 2022 (AAPC, -0.1% [95% CI, -0.8% to 0.7%]). Among adults 65 years or older, smoking prevalence increased from 13.0% (95% CI, 11.2%-14.7%) in 2011 to 15.8% (95% CI, 14.1%-17.6%) for those with income less than 200% FPL (AAPC, 1.1% [95% CI, 0.1%-2.1%]) and remained roughly constant with no significant change for those of higher income. Similar age patterns are seen across educational level and racial and ethnic groups. Conclusions and Relevance This cross-sectional study found that smoking prevalence decreased from 2011 to 2022 in all age groups except adults 65 years or older, with faster decreases among younger than older adults. These findings suggest that the greatest gains in terms of reducing smoking-attributable morbidity and mortality could be achieved by focusing on individuals with low socioeconomic status, as this population has the highest smoking rates and the worst health prospects.
Collapse
Affiliation(s)
- Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor
| | - Kenneth E. Warner
- Department of Health Management and Policy, University of Michigan, Ann Arbor
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| |
Collapse
|
33
|
Pinho-Gomes AC, Santos JA, Jones A, Thout SR, Pettigrew S. E-cigarette attitudes and behaviours amongst 15-30-year-olds in the UK. J Public Health (Oxf) 2023; 45:e763-e775. [PMID: 37525566 PMCID: PMC10687603 DOI: 10.1093/pubmed/fdad138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/08/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The use of e-cigarettes has been rising in the UK, particularly by young people. This study investigated behaviours, attitudes and beliefs about e-cigarettes amongst 15-30-year-olds in the UK. METHODS An online survey was administered to a sample of 1009 15-30-year-olds in the UK. RESULTS About one in five participants currently used e-cigarettes at least monthly, with 1 in 10 using them daily. Amongst those using e-cigarettes at least monthly, 90% had used e-cigarettes containing nicotine. E-cigarettes were mainly obtained from vape shops and used at home. Having friends who used e-cigarettes and using them to help quit/reduce smoking were the most common reasons for vaping. About half of participants had been exposed to e-cigarette advertising, especially online, and warning labels on e-cigarettes. Most participants agreed that e-cigarettes are addictive (75%), help people quitting smoking (64%) and are bad for health (63%). Previous or current tobacco smokers were 9 and 22 times more likely to use e-cigarettes than never smokers, respectively. Perceiving e-cigarettes as harmful was associated with a 40% lower likelihood of use. CONCLUSION Raising awareness on the uncertain long-term consequences of vaping and regulation of marketing and sales are crucial to protect young people in the UK.
Collapse
Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, School of Public Health, Imperial College London, 58 Wood Lane London, W12 7RZ, UK
- Institute of Health Informatics, University College London, 222 Euston Road London, NW1 2DA, UK
| | - Joseph A Santos
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown 2042, Sydney, NSW, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown 2042, Sydney, NSW, Australia
| | - Sudhir Raj Thout
- The George Institute for Global Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre New Delhi 110025, India
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown 2042, Sydney, NSW, Australia
| |
Collapse
|
34
|
Starr R, Murray K, Chaiton M. The Compassion Club: A New Proposal for Transformation of Tobacco Retail. Nicotine Tob Res 2023; 25:1822-1828. [PMID: 36591922 DOI: 10.1093/ntr/ntac295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/03/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION One major assumption in the current tobacco industry is the distribution of tobacco products through a system of commercial for-profit retail. However, other models of distribution that do not rely on this mechanism exist. AIMS AND METHODS In this review, we examine the potential of a nonprofit Compassion Club model and discuss how the current existence of independent vape stores might provide the infrastructure to allow the transformation of tobacco distribution. RESULTS Compassion Clubs exist internationally with different levels of regulation and legality and have generally been focused on the distribution of illegal drugs or hard-to-access pharmaceuticals. They provide access to drugs for existing users, limit access by novices, limit negative impacts from illicit markets, and provide social support focused on reducing harms associated with drug use. CONCLUSIONS With decreasing prevalence of tobacco use in many countries and growing interest in a tobacco endgame, a Compassion Club model of distribution could help transition tobacco away from the model of commercial widely available distribution. More work is needed to develop the regulations and policies that might guide a compassion club model. IMPLICATIONS Compassion clubs are a model for the distribution of psychoactive substances that are focused on harm reduction and social support rather than profit. There has been little discussion about the possibility that this promising model could be applied to help transform the tobacco industry. Many independent vape stores already demonstrate aspects of the compassion club model that could be used to support a transition.
Collapse
Affiliation(s)
- Raven Starr
- Department of Social Work, University of Toronto, Toronto, Canada
| | - Kim Murray
- Former Vape Store owner, Brainerd, MN, United States
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Ontario Tobacco Research Unit, Toronto, Canada
| |
Collapse
|
35
|
Tildy BE, McNeill A, Robins J, Dregan A, Richardson S, Brose LS. How is nicotine vaping product (e-cigarette) use monitored in primary care electronic health records in the United Kingdom? An exploratory analysis of Clinical Practice Research Datalink (CPRD). BMC Public Health 2023; 23:2263. [PMID: 37974094 PMCID: PMC10655457 DOI: 10.1186/s12889-023-17200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) could identify long-term health effects of nicotine vaping. We characterised the extent to which vaping is recorded in primary care EHRs in the UK, on a population level. METHODS We performed descriptive analysis of Clinical Practice Research Datalink (CPRD), primary care electronic health records of 25% of the UK population (~ 16 million patients). Patients aged ≥ 18 years whose vaping status was recorded using medical codes between 2006 and 2022 were identified. We reported the frequency of vaping codes; their distribution by patient age, gender, and ethnicity; trends in vaping recording over time (including interrupted time series analyses); and transitions in patient smoking status. RESULTS Seven medical codes indicated current or former vaping, from 150,114 patients. When their vaping status was first recorded, mean patient age was 50.2 years (standard deviation: 15.0), 52.4% were female, and 82.1% were White. Of those recorded as currently vaping, almost all (98.9%) had records of their prior smoking status: 55.0% had been smoking, 38.3% had stopped smoking, 5.6% had never smoked. Of those who were smoking prior to being recorded as vaping, more than a year after the vaping record, over a third (34.2%) were still smoking, under a quarter (23.7%) quit smoking, 1.7% received a 'never smoked' status, and there was no smoking status for 40.4%. The 'e-cigarette or vaping product use-associated lung injury' (EVALI) outbreak was significantly associated with a declining trend in new records of current vaping between September 2019 and March 2020; and an immediate significant increase in new records of former vaping, followed by a declining trend. CONCLUSIONS Few patients are being asked about vaping. Most who vape had smoked, and many quit smoking after starting vaping. To enable electronic health records to provide stronger evidence on health effects, we recommend improved completeness, accuracy and consistency.
Collapse
Affiliation(s)
- Bernadett E Tildy
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK.
- SPECTRUM Consortium, London, UK.
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- SPECTRUM Consortium, London, UK
- NIHR Applied Research Collaboration South London, London, UK
| | - John Robins
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- NIHR Applied Research Collaboration South London, London, UK
| | - Alexandru Dregan
- Psychological Medicine Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Mingli Building, Haidian District, Beijing, 100083, China
| | - Leonie S Brose
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- SPECTRUM Consortium, London, UK
| |
Collapse
|
36
|
Timberlake DS, Bruckner TA, Pechmann C, Soroosh AJ, Simard BJ, Padon AA, Silver LD. Cannabis Vape Product Sales in California Following CDC's Initial Advisory About Lung Injuries. Cannabis Cannabinoid Res 2023. [PMID: 37939267 DOI: 10.1089/can.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
Introduction: The 2019 outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) is believed to have been caused by vitamin E acetate, an additive used in some cannabis vaporizer products. Previous studies have primarily focused on changes in sales of electronic nicotine delivery systems following the initial advisory issued by the Centers for Disease Control (CDC) on August 17, 2019. The present study is intended to examine variation by age groups in sales of regulated cannabis vape products in the state of California before, during, and after the outbreak. Methods: Weekly sales revenue of cannabis vape products (from January 1, 2018, to December 31, 2020) was obtained from a sample of recreational cannabis retailers licensed in California. An interrupted time series analysis, using AutoRegressive, Integrated, Moving Average methods, was employed to estimate changes in the sales and market share of cannabis vape products in the weeks following the CDC advisory. Results: The total volume of regulated cannabis vape product sales increased substantially over the 3-year study period (2018-2020). Sales and market share of cannabis vape products, however, declined in both young and older adults immediately following the advisory, rebounding to pre-EVALI levels only for the young adults. For sales, the potential EVALI effect following the CDC's advisory equates to an 8.0% and 2.2% decline below expected levels in the older and young adults, respectively. Conclusions: The differential age effect on sales may reflect concerns regarding health effects of cannabis vaping products and greater awareness of the outbreak among older adults. Findings highlight the importance of informing consumers about health risks associated with using cannabis vape products acquired from regulated versus illicit sources.
Collapse
Affiliation(s)
- David S Timberlake
- Department of Population Health and Disease Prevention, Society and Behavior, Program in Public Health, College of Health Sciences, University of California, Irvine, California, USA
| | - Tim A Bruckner
- Department of Health, Society and Behavior, Program in Public Health, College of Health Sciences, University of California, Irvine, California, USA
| | - Cornelia Pechmann
- The Paul Merage School of Business, University of California, Irvine, California, USA
| | | | | | | | | |
Collapse
|
37
|
Campbell C, Jin T, Round EK, Nelson PR, Baxter S. Abuse liability of two electronic nicotine delivery systems compared with combustible cigarettes and nicotine gum from an open-label randomized crossover study. Sci Rep 2023; 13:18951. [PMID: 37919490 PMCID: PMC10622442 DOI: 10.1038/s41598-023-45894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
An assessment of the likelihood of use and abuse potential for new tobacco products is an important part of tobacco product regulation in the United States and abroad. This paper reports the results of a randomized, open-label, crossover clinical study that assessed factors related to product adoption and abuse liability (AL), comparing two closed electronic nicotine delivery system (ENDS) products to combustible cigarettes and nicotine gum, high- and low-AL comparator products, respectively. During an 11-day confinement period that included multiple product familiarization sessions, healthy adult smokers participated in AL test sessions to evaluate the abuse liability of each product. During these test sessions, changes in subjective measures; speed and amount of nicotine uptake; and maximum changes in physiological effects before, during, and after use of each assigned product were assessed over 4 h. Positive subjective effects measures scores such as product-liking and overall intent to use again were highest for cigarettes, followed by the Vuse ENDS, with nicotine gum consistently having the lowest scores. The PK results (Cmax and Tmax) of the Vuse ENDS products are between UB cigarettes and nicotine gum, which correlates with the subjective effects. All nicotine uptake measures for the Vuse ENDS products were lower than that of usual brand (UB) cigarettes, including peak nicotine uptake and overall nicotine uptake, and were either similar to or lower than nicotine gum. The time course of nicotine uptake after use of the ENDS was more similar to that of combustible cigarettes than nicotine gum. The results indicate that the AL of each ENDS product is lower than that of UB cigarettes and similar to that of nicotine gum.
Collapse
Affiliation(s)
| | - Tao Jin
- RAI Services Company, 401 N. Main Street, Winston‑Salem, NC, 27101, USA.
| | - Elaine K Round
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK
| | | | - Sarah Baxter
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK
| |
Collapse
|
38
|
Selya A, Shiffman S. Comparative risk perceptions of switching to JUUL vs. continued smoking and subsequent switching away from cigarettes: a longitudinal observational study. BMC Psychol 2023; 11:305. [PMID: 37798775 PMCID: PMC10552465 DOI: 10.1186/s40359-023-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Evidence indicates that electronic nicotine delivery systems (ENDS) pose lower risk than cigarettes; however, many smokers harbor misperceptions that ENDS are equally or more harmful, possibly deterring them from switching. This study examines whether comparative risk perceptions of JUUL vs. smoking are associated with subsequent switching, among smokers who recently purchased JUUL. METHODS N = 16,996 current established smokers who recently purchased a JUUL Starter Kit were followed 6 times over 12 months. Comparative risk perceptions were assessed using both direct and indirect measures (i.e., contrasting JUUL and smoking directly in questions, and deriving from separate absolute scales). Repeated-measures logistic regression examined switching across follow-up (no smoking in past 30 days) as a function of baseline risk perceptions, adjusting for demographics and baseline smoking behavior. RESULTS Perceiving JUUL as less harmful than smoking was associated with higher switching rates, using both direct (e.g., adjusted odds ratio [AOR] = 1.48 for "JUUL much less" vs. "more/much more harmful") and indirect (AOR = 1.07, for each 10-unit increase in fraction; AOR = 1.51 for highest (6-100) vs. lowest (0 to < 1) fraction categories) comparative risk measures (all p < 0.0001). Among the subset smoking 10 + cigarettes per day, associations between risk perceptions and switching were more pronounced (AOR = 2.51 for "JUUL much less" vs. "more/much more harmful"; AOR = 1.81 for 6-100 vs. 0 to < 1 fraction, both p < 0.0001). CONCLUSIONS Smokers who perceive JUUL as less harmful than cigarettes have higher odds of switching. Future research should examine whether messaging which aligns comparative risk perceptions with current evidence can facilitate switching, especially among heavier smokers.
Collapse
Affiliation(s)
- Arielle Selya
- Pinney Associates, Inc, 201 N Craig St., Suite 320, Pittsburgh, PA, 15213, USA.
| | - Saul Shiffman
- Pinney Associates, Inc, 201 N Craig St., Suite 320, Pittsburgh, PA, 15213, USA
| |
Collapse
|
39
|
Yach D, Scherer G. Applications of biomarkers of exposure and biological effects in users of new generation tobacco and nicotine products: Tentative proposals. Drug Test Anal 2023; 15:1127-1132. [PMID: 37653566 DOI: 10.1002/dta.3567] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
Despite efforts to eliminate smoking, more than 1 billion people worldwide continue to use combustible cigarettes through choice or inability to quit. With an associated 8 million deaths, the provision of noncombustible tobacco and nicotine products that smokers will accept to replace combustible cigarettes can lessen harm. However, most of these products have entered the market only in the past 20 years. Therefore, particularly for some smoking-related diseases, epidemiological studies to test harm reduction potential are only now becoming feasible. For cancer and chronic obstructive pulmonary disease, around two decades of data might be required. In this article, we discuss how the use of biomarkers might be applied to supplement epidemiological research for regulators. We further discuss how health providers and insurers can keep up with the rapid changes in biomarker research and recognize these reduced risks.
Collapse
Affiliation(s)
- Derek Yach
- Global Health Strategies LLC, Southport, Connecticut, USA
| | - Gerhard Scherer
- ABF Analytisch-Biologisches Forschunglabor GmbH, Planegg, Germany
| |
Collapse
|
40
|
Wackowski OA, Bover Manderski MT, Gratale SK, Weiger CV, O’Connor RJ. Perceptions about levels of harmful chemicals in e-cigarettes relative to cigarettes, and associations with relative e-cigarette harm perceptions, e-cigarette use and interest. Addiction 2023; 118:1881-1891. [PMID: 37218410 PMCID: PMC10640892 DOI: 10.1111/add.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Exposure to chemicals contributes to harm from nicotine products, and e-cigarette communications often refer to chemicals. However, while e-cigarette studies commonly measure perceived harmfulness of e-cigarettes relative to cigarettes, few have assessed comparative perceptions about chemicals. This study measured perceived levels of harmful chemicals in e-cigarettes compared with cigarettes and associations with e-cigarette/cigarette relative harm perceptions, e-cigarette use and interest. DESIGN, SETTING AND PARTICIPANTS This was an on-line cross-sectional survey of adults/young adults from a nationally representative research panel in the United States conducted in January 2021. Participants were independent samples of 1018 adults who smoked cigarettes and 1051 young adult non-smokers (aged 18-29 years). MEASUREMENTS Participants were asked their perceptions of the level of harmful chemicals in e-cigarettes versus cigarettes (fewer/about the same/more/do not know), perceived harmfulness of using e-cigarette versus cigarettes (less/about the same/more/do not know) and their current e-cigarette use and use interest. FINDINGS Approximately 20% of all participants (18.1% of adult smokers, and 21.0% of young adult non-smokers) believed e-cigarettes contain fewer harmful chemicals than cigarettes, while 35.6% of adult smokers and 24.9% of young adult non-smokers responded 'do not know'. Participants more frequently reported 'do not know' to the chemicals item than the harm item. Approximately half (51.0-55.7%) of those who believed e-cigarettes contain fewer harmful chemicals also believed e-cigarettes are less harmful than cigarettes. Both beliefs were associated with higher odds of interest in using e-cigarettes [less harmful belief, odds ratio (OR) = 5.53, 95% confidence interval (CI = 2.93-10.43); fewer chemicals belief, OR = 2.45, 95% CI = 1.40-4.29] and past 30-day e-cigarette use (less harmful belief, OR = 2.53, 95% CI = 1.17-5.44; fewer chemicals belief, OR = 5.09, 95% CI = 2.31-11.19) for adults who smoke, but not young adult non-smokers. CONCLUSIONS In the United States, most adults who smoke cigarettes and young adult non-smokers do not appear to think that e-cigarettes have fewer harmful chemicals than cigarettes, and many are uncertain about how these levels compare.
Collapse
Affiliation(s)
- Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ
| | - Michelle T. Bover Manderski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | | | - Caitlin V. Weiger
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY
| |
Collapse
|
41
|
Do EK, Aarvig K, Muller-Tabanera H, Mills S, Sumibcay JR, Koh HK, Vallone DM, Hair EC. E-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander youth in the contiguous United States: Insights from the Monitoring the Future Study (2018-2019). Prev Med Rep 2023; 35:102376. [PMID: 37662868 PMCID: PMC10472302 DOI: 10.1016/j.pmedr.2023.102376] [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: 01/26/2023] [Revised: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
This study examines e-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) youth, in relation to other racial/ethnic groups in the United States. Data were obtained from the 2018 and 2019 Monitoring the Future surveys, which include a random, probability-based sample of youth in 8th, 10th, and 12th grades surveyed annually across the contiguous United States. Respondents provided information on race/ethnicity and e-cigarette use (n = 42,980). Measures of e-cigarette use included current (1 + of past 30 days) and regular use (10 + of past 30 days). Chi-square tests were used to determine differences in e-cigarette use by race/ethnicity. Associations between race/ethnicity, other sociodemographic factors, and e-cigarette use were explored using logistic regression analyses. Approximately 5.1% (n = 2,410) of the sample identified as AANHPI. A greater proportion of Native Hawaiian and Pacific Islanders reported current e-cigarette use (NHPI, 28.0%), relative to Asian American (AA, 10.3%), Black (9.5%), Hispanic or Latino (15.0%), American Indian or Alaskan Native (AIAN, 16.5%), multiracial (22.3%), and non-Hispanic White (25.2%) youth. Regular e-cigarette use was highest among non-Hispanic White (12.3%), followed by multiracial (10.7%), AIAN (7.8%), Hispanic or Latino (5.0%), AA (4.3%), and Black (3.0%) youth. Associations between race/ethnicity and e-cigarette use remained significant, after controlling for other sociodemographic factors. Continued monitoring of e-cigarette use is needed among AANHPI, a historically underrepresented population in tobacco research. Special attention should be paid to NHPI, who reported the highest rates of e-cigarette use.
Collapse
Affiliation(s)
- Elizabeth K. Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Sarah Mills
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Howard K. Koh
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Donna M. Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth C. Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
42
|
Graham-DeMello A, Hoek J, Drew J. How do underage youth access e-cigarettes in settings with minimum age sales restriction laws? A scoping review. BMC Public Health 2023; 23:1809. [PMID: 37723457 PMCID: PMC10506222 DOI: 10.1186/s12889-023-16755-9] [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: 06/07/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Despite measures to reduce young people's access to electronic cigarettes (ECs), or "vapes", many countries have recorded rising youth vaping prevalence. We summarised studies documenting how underage youth in countries with minimum age sales restrictions (or where sales are banned) report accessing ECs, and outline research and policy implications. METHODS We undertook a focused literature search across multiple databases to identify relevant English-language studies reporting on primary research (quantitative and qualitative) and EC access sources among underage youth. RESULTS Social sourcing was the most prevalent EC access route, relative to commercial or other avenues; however, social sourcing dynamics (i.e., who is involved in supplying product and why) remain poorly understood, especially with regard to proxy purchasing. While less prevalent, in-person retail purchasing (mainly from vape shops) persists among this age group, and appears far more common than online purchasing. CONCLUSIONS Further research examining how social supply routes operate, including interaction and power dynamics, is crucial to reducing youth vaping. Given widespread access via schools and during social activities and events, exploring how supply routes operate and evolve in these settings should be prioritized. Inadequate compliance with existing sales regulations suggest greater national and local policy enforcement, including fines and licence confiscation for selling to minors, is required at the retailer level.
Collapse
Affiliation(s)
- Anna Graham-DeMello
- Department of Public Health, University of Otago, 23 Mein Street, Newtown, Wellington, 6021, New Zealand.
| | - Janet Hoek
- Department of Public Health, University of Otago, 23 Mein Street, Newtown, Wellington, 6021, New Zealand
| | - Jonathan Drew
- Te Whatu Ora Southern, Health New Zealand, Dunedin Hospital, Dunedin, New Zealand
| |
Collapse
|
43
|
Harlow AF, Xie W, Goghari AR, Lundberg DJ, Raquib RV, Berlowitz JB, Stokes AC. Sociodemographic Differences in E-Cigarette Uptake and Perceptions of Harm. Am J Prev Med 2023; 65:356-365. [PMID: 36924804 PMCID: PMC10440280 DOI: 10.1016/j.amepre.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION This study aimed to evaluate socioeconomic and racial/ethnic differences in e-cigarette uptake and harm perceptions about e-cigarettes among adults who smoke cigarettes in the U.S. METHODS Five waves of the U.S. Population Assessment of Tobacco and Health Study (2013-2019) were used to assess transitions from exclusive cigarette smoking to (1) exclusive e-cigarette use, (2) dual use, and (3) nonuse of either product (N=7,172). Analyses (conducted in 2022) estimated differences in transitions and e-cigarette harm perceptions by race/ethnicity, income, and education. RESULTS Hispanic (OR=0.32; 95% CI=0.18, 0.54) and Black (OR=0.38; 95% CI=0.22, 0.65) adults were less likely than White adults to transition from exclusive cigarette to exclusive e-cigarette use after 1 year. Adults with a bachelor's degree (versus those with less than high school) (OR=2.57; 95% CI=1.49, 4.45) and adults making ≥$100,000/year (versus those making <$10,000) (OR=3.61; 95% CI=2.10, 6.22) were more likely to transition from exclusive cigarette to exclusive e-cigarette use. Hispanic and Black adults and those with lower income and education were more likely to perceive e-cigarettes as equally or more harmful than cigarettes, which in turn was associated with lower odds of transitioning from exclusive cigarette smoking to exclusive e-cigarette use (OR=0.62; 95% CI=0.47, 0.81). CONCLUSIONS Adults who were Hispanic, were Black, and/or had lower SES were less likely to use e-cigarettes to quit cigarettes. Findings provide preliminary evidence that differences in harm perceptions may contribute to disparities in e-cigarette transitions.
Collapse
Affiliation(s)
- Alyssa F Harlow
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California.
| | - Wubin Xie
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Aboli R Goghari
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Dielle J Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Rafeya V Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Jonathan B Berlowitz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| |
Collapse
|
44
|
Cai J, Bidulescu A. Associations between e-cigarette use or dual use of e-cigarette and combustible cigarette and metabolic syndrome: results from the National Health and Nutrition Examination Survey (NHANES). Ann Epidemiol 2023; 85:93-99.e2. [PMID: 37201667 DOI: 10.1016/j.annepidem.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/30/2023] [Accepted: 05/14/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Examine associations between e-cigarette use or dual use of e-cigarette and combustible cigarette and metabolic syndrome (MetS). METHODS Cross-sectional data of 5121 U.S. adults from the National Health and Nutrition Examination Survey were analyzed. Weighted multivariable Poisson regression models were used to examine associations between e-cigarette use or dual use and MetS and its components. Prevalence ratios (PRs) with 95% confidence intervals (95% CI) were estimated. RESULTS Current and former e-cigarette users were 30% (95% CI: 1.13, 1.50) and 15% (95% CI: 1.03, 1.28) more likely to have MetS than never e-cigarette users. Current or former e-cigarette use was also associated with elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, and elevated blood pressure (AOR ranged from 1.15 to 1.42, all P < 0.05). The prevalence of MetS for dual users was 1.35-fold (95% CI: 1.15, 1.58) higher than that for never smokers and 1.21-fold (95% CI: 1.00, 1.46) higher than that for combustible cigarette-only users. Dual users were also more likely to report elevated triglycerides and reduced HDL cholesterol than never smokers or combustible cigarette-only users (all P < 0.05). CONCLUSIONS E-cigarette use or dual use is associated with MetS. Our findings may inform tobacco control policies regarding regulations of e-cigarette use.
Collapse
Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington.
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington
| |
Collapse
|
45
|
Carpenter MJ, Wahlquist AE, Dahne J, Gray KM, Cummings KM, Warren G, Wagener TL, Goniewicz ML, Smith TT. Effect of unguided e-cigarette provision on uptake, use, and smoking cessation among adults who smoke in the USA: a naturalistic, randomised, controlled clinical trial. EClinicalMedicine 2023; 63:102142. [PMID: 37753443 PMCID: PMC10518503 DOI: 10.1016/j.eclinm.2023.102142] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 09/28/2023] Open
Abstract
Background As summarised in the most recent Cochrane review, the few clinical trials on e-cigarettes are largely focused on smoking cessation. We aimed to determine the naturalistic uptake, use, and impact of e-cigarettes among adults who may or may not want to stop smoking. Methods In this naturalistic, randomised, controlled clinical trial, adult smokers, across the motivational spectrum and with minimal history of e-cigarette use, were recruited online from the general community within 11 cities across the USA. Participants were randomly assigned (2:1) to either receive either a free 4-week supply of flavoured, tank-style e-cigarette, or not. E-cigarette group participants received a battery and device with up to 30 pre-filled tanks, offered among five flavours, with minimal instructions on use. The study's primary purpose was to descriptively assess naturalistic uptake and usage of the e-cigarette, and to secondarily assess its impact on smoking behavior. The latter, assessed through six months of follow-up, included: a) self-reported 7-day point prevalence abstinence, b) incidence of quit attempts, and c) smoking reduction. This trial is registered at ClinicalTrials.gov, NCT03453385. Findings Between 5/2018 and 3/2022, 638 adult smokers were enrolled and randomly assigned (427 in the e-cigarette group and 211 in the no-product control group). Uptake of e-cigarettes was robust: approximately 70% of participants used the product, with average usage exceeding 4 days per week during the initial 30 days. Based on an intent-to-treat approach where missing data is imputed as smoking, almost all behavioral outcomes favored the e-cigarette group relative to no-product control, including point prevalence abstinence at six months (Odds Ratio [OR] = 1.8; 95% Confidence Interval [CI] = 1.0-3.1), cumulative incidence of 24-hr quit attempts (OR = 1.5; 95% CI = 1.0-2.2), and having reduced smoking by at least 50% since baseline (OR = 1.8; 95% CI = 1.2-2.7). Results were similar under an alternative imputation. Interpretation Complementing cessation-focused trials, results suggest that unguided e-cigarette use also leads to smoking cessation, allaying the notion that causal effects of e-cigarettes on cessation are not reflective of real-world scenario of self-determined use. For smokers who may not be able to quit using existing pharmacologic approaches, e-cigarettes may be considered to achive that purpose. Funding National Cancer Institute.
Collapse
Affiliation(s)
- Matthew J. Carpenter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Department of Public Health Sciences, MUSC, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Amy E. Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
| | - Jennifer Dahne
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Kevin M. Gray
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Department of Public Health Sciences, MUSC, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Graham Warren
- Hollings Cancer Center, MUSC, Charleston, SC, USA
- Department of Radiation Oncology, MUSC, Charleston, SC, USA
| | - Theodore L. Wagener
- Department of Internal Medicine, Ohio State University (OSU), Columbus, OH, USA
- Center for Tobacco Research, OSU Comprehensive Cancer Center, Columbus, OH, USA
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - Tracy T. Smith
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| |
Collapse
|
46
|
Yan D, Wang Z, Laestadius L, Mosalpuria K, Wilson FA, Yan A, Lv X, Zhang X, Bhuyan SS, Wang Y. A systematic review for the impacts of global approaches to regulating electronic nicotine products. J Glob Health 2023; 13:04076. [PMID: 37622721 PMCID: PMC10451104 DOI: 10.7189/jogh.13.04076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Background The rapid increase in electronic nicotine product (ENP) use among young people has been a global public health challenge, given the potential harm of ENPs and nicotine dependence. Many countries have recently introduced legislations to regulate ENPs, but the impacts of these policies are poorly understood. This systematic review aims to critically synthesise empirical studies on the effects of global regulations regarding ENPs on the prevalence of use, health outcomes and their determinants, using the 4A marketing mix framework (acceptability, affordability, accessibility and awareness). Methods Following the PRISMA guideline, we searched PubMed, Embase, Scopus, Web of Science, Academic Search Complete, Business Source Complete, and APA PsycINFO databases from inception until June 14, 2022 and performed citation searches on the included studies. Reviewed literature was restricted to peer-reviewed, English-language articles. We included all pre-post and quasi-experimental studies that evaluated the impacts of e-cigarette policies on the prevalence of ENP use and other health outcomes. A modified Joanna Briggs Institute (JBI) Critical Appraisal checklist for quasi-experimental studies was used for quality assessment. Due to heterogeneity of the included studies, we conducted a narrative synthesis of evidence. Results Of 3991 unduplicated records screened, 48 (1.2%) met the inclusion criteria, most were from high-income countries in North America and Europe and 26 studies measured self-reported ENPs use. Flavour restrictions significantly decreased youth ENP use and taxation reduced adult use; mixed results were found for the impacts of age restrictions. Indoor vaping restrictions and the European Tobacco Products Directive (TPD) did not seem to reduce ENP use based on existing studies. Changes in determinants such as sales and perceptions corroborated our conclusions. Few studies assessed the impacts of other regulations such as advertising restrictions and retail licensing requirements. Conclusions Flavour restrictions and taxes have the strongest evidence to support effective control of ENPs, while others need powerful enforcement and meaningful penalties to ensure their effectiveness. Future research should focus on under-examined policies and differential impacts across sociodemographic characteristics and countries. Registration PROSPERO CRD42022337361.
Collapse
Affiliation(s)
- Duo Yan
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Zicheng Wang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Linnea Laestadius
- Joseph J. Zilber College of Public Health, University of Wisconsin – Milwaukee, Milwaukee, Wisconsin USA
| | - Kavita Mosalpuria
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Department of Economics, University of Utah, Salt Lake City, Utah, USA
| | - Alice Yan
- Department of Research Patient Care Service, Stanford Health Care, Palo Alto, California, USA
| | - Xiaoyang Lv
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaotian Zhang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey, USA
- School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
| | - Yang Wang
- China Center for Health Development Studies, Peking University, Beijing, China
| |
Collapse
|
47
|
Rose JJ, Krishnan-Sarin S, Exil VJ, Hamburg NM, Fetterman JL, Ichinose F, Perez-Pinzon MA, Rezk-Hanna M, Williamson E. Cardiopulmonary Impact of Electronic Cigarettes and Vaping Products: A Scientific Statement From the American Heart Association. Circulation 2023; 148:703-728. [PMID: 37458106 DOI: 10.1161/cir.0000000000001160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Vaping and electronic cigarette (e-cigarette) use have grown exponentially in the past decade, particularly among youth and young adults. Cigarette smoking is a risk factor for both cardiovascular and pulmonary disease. Because of their more limited ingredients and the absence of combustion, e-cigarettes and vaping products are often touted as safer alternative and potential tobacco-cessation products. The outbreak of e-cigarette or vaping product use-associated lung injury in the United States in 2019, which led to >2800 hospitalizations, highlighted the risks of e-cigarettes and vaping products. Currently, all e-cigarettes are regulated as tobacco products and thus do not undergo the premarket animal and human safety studies required of a drug product or medical device. Because youth prevalence of e-cigarette and vaping product use was as high as 27.5% in high school students in 2019 in the United States, it is critical to assess the short-term and long-term health effects of these products, as well as the development of interventional and public health efforts to reduce youth use. The objectives of this scientific statement are (1) to describe and discuss e-cigarettes and vaping products use patterns among youth and adults; (2) to identify harmful and potentially harmful constituents in vaping aerosols; (3) to critically assess the molecular, animal, and clinical evidence on the acute and chronic cardiovascular and pulmonary risks of e-cigarette and vaping products use; (4) to describe the current evidence of e-cigarettes and vaping products as potential tobacco-cessation products; and (5) to summarize current public health and regulatory efforts of e-cigarettes and vaping products. It is timely, therefore, to review the short-term and especially the long-term implications of e-cigarettes and vaping products on cardiopulmonary health. Early molecular and clinical evidence suggests various acute physiological effects from electronic nicotine delivery systems, particularly those containing nicotine. Additional clinical and animal-exposure model research is critically needed as the use of these products continues to grow.
Collapse
|
48
|
O'Leary R, Polosa R. e-Cigarette Use and the Cessation of Tobacco Cigarette Smoking: Protocol for an Umbrella Review. JMIR Res Protoc 2023; 12:e47711. [PMID: 37561572 PMCID: PMC10450527 DOI: 10.2196/47711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been examined in clinical studies for their effects on tobacco smoking cessation. In the past 2 years, a dozen or more systematic reviews on ENDS and cigarette smoking cessation have been published that present differing conclusions and recommendations on the use of ENDS. OBJECTIVE Our umbrella review aims to synthesize the findings from current systematic reviews to investigate the quit rates and the percentage of participants abstinent from cigarette smoking using ENDS. Additionally, we will examine the quit rates with ENDS in comparison to other established cessation treatments. METHODS The search will retrieve systematic reviews that include both clinical trials and experimental studies on the use of ENDS for smoking cessation. We will also include nonrandomized cohort studies that track ENDS use and the subsequent abstinence from smoking. Databases searches will be conducted in Embase, Scopus, PubMed, and 7 additional registries. Secondary searches will include reference checking, citation chasing, and consultations with topic experts. Two reviewers will perform a title and abstract exclusion followed by a full-paper inclusion process. Data extraction will be conducted by 1 reviewer and completely checked by a second reviewer. Each systematic review will be assessed by 2 reviewers for methodological quality using AMSTAR2 (A Measurement Tool to Assess Systematic Reviews, version 2) and for reporting bias using categories from the Centre for Evidence-Based Medicine's Catalogue of Bias. Unreported discrepancies between the protocol and the published review will be identified. RESULTS The umbrella review started on March 1, 2023. At the time of publication, the study selection was being conducted and the pilot testing of the data extraction and bias assessment forms were in progress. The review is expected to be completed by December 31, 2023, followed by the submission of the review for journal publication. A second-order meta-analysis will calculate the range and average of quit rates for ENDS. A vote counting of the direction of effect, based on quit rates, will be used to present the relative effectiveness of ENDS for smoking cessation compared to other cessation treatments (including no treatment). A citation matrix will list primary studies with their bias ratings from all the systematic reviews. The effect of overlapping studies between the systematic reviews will be calculated using the corrected coverage area analysis. A sensitivity analysis will examine the impact of the intensity of cessation treatment on quit rates. Depending on the availability of data, subgroup analyses will be conducted based on participants' gender, age, prior quit attempts, and nicotine dependence. The strength or weakness of the evidence synthesis will be assessed using a stratification of evidence technique. Reporting bias will be presented with a tabulation of bias indicators. Publication bias will be assessed. CONCLUSIONS The use of ENDS for smoking cessation is a highly controversial subject. Through an exhaustive synthesis of the available data, we will present the quit rates of cigarette smoking cessation obtained with ENDS and how they compare to quit rates obtained from other established cessation treatments. The critical quality and bias assessment of the systematic reviews will indicate the most reliable sources to inform treatment considerations and policy development. TRIAL REGISTRATION PROSPERO CRD42023406165; https://tinyurl.com/4ekzpbrj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47711.
Collapse
Affiliation(s)
- Renee O'Leary
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
| |
Collapse
|
49
|
Tildy BE, McNeill A, East K, Gravely S, Fong GT, Cummings KM, Borland R, Chan GCK, Lim CCW, Gartner C, Yong HH, Brose LS. Self-reported depression and anxiety and healthcare professional interactions regarding smoking cessation and nicotine vaping: Findings from 2018 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Survey. Tob Prev Cessat 2023; 9:26. [PMID: 37533461 PMCID: PMC10391919 DOI: 10.18332/tpc/168288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION People with mental health conditions are disproportionately affected by smoking-related diseases and death. The aim of this study was to assess whether health professional (HP) interactions regarding smoking cessation and nicotine vaping products (NVPs) differ by mental health condition. METHODS The cross-sectional 2018 International Tobacco Control Four Country (Australia, Canada, England, United States) Smoking and Vaping Survey data included 11040 adults currently smoking or recently quit. Adjusted weighted logistic regressions examined associations between mental health (self-reported current depression and/or anxiety) and visiting a HP in last 18 months; receiving advice to quit smoking; discussing NVPs with a HP; and receiving a recommendation to use NVPs. RESULTS Overall, 16.1% self-reported depression and anxiety, 7.6% depression only, and 6.6% anxiety only. Compared with respondents with no depression/anxiety, those with depression (84.7%, AOR=2.65; 95% CI: 2.17-3.27), anxiety (82.2%, AOR=2.08; 95% CI: 1.70-2.57), and depression and anxiety (87.6%, AOR=3.74; 95% CI: 3.19-4.40) were more likely to have visited a HP. Among those who had visited a HP, 47.9% received advice to quit smoking, which was more likely among respondents with depression (AOR=1.58; 95% CI: 1.34-1.86), and NVP discussions were more likely among those with depression and anxiety (AOR=1.63; 95% CI: 1.29-2.06). Of the 6.1% who discussed NVPs, 33.5% received a recommendation to use them, with no difference by mental health. CONCLUSIONS People with anxiety and/or depression who smoke were more likely to visit a HP than those without, but only those with depression were more likely to receive cessation advice, and only those with depression and anxiety were more likely to discuss NVPs. There are missed opportunities for HPs to deliver cessation advice. NVP discussions and receiving a positive recommendation to use them were rare overall.
Collapse
Affiliation(s)
- Bernadett E. Tildy
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Ann McNeill
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Katherine East
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Gary C. K. Chan
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
| | - Carmen C. W. Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, Faculty of Medicine, School of Public Health, University of Queensland, Herston, Australia
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Leonie S. Brose
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| |
Collapse
|
50
|
Abstract
As debate persists over regulating electronic nicotine delivery systems (ENDS), those favouring liberal ENDS policies have advanced rights-based arguments privileging harm reduction to people who smoke over harm prevention to children and never-smokers. Recent ethical arguments advocate regulating ENDS to prioritise their harm reduction potential for people who currently smoke over any future harm to young never-smokers. In this article, we critically assess these arguments, in particular, the assumption that ethical arguments for prioritising the interests of young people do not apply to ENDS. We argue that, when the appropriate comparators are used, it is not clear the weight of ethical argument tips in favour of those who currently smoke and against young never-smokers. We also assert that arguments from a resource prioritisation context are not appropriate for analysing ENDS regulation, because ENDS are not a scarce resource. Further, we reject utilitarian arguments regarding maximising net population health benefits, as these do not adequately consider vulnerable groups' rights, or address the population distribution of benefits and harms. Lastly, we argue that one-directional considerations of harm reduction do not recognise that ENDS potentially increase harm to those who do not smoke and who would not otherwise have initiated nicotine use.
Collapse
Affiliation(s)
| | - Lindsay Robertson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|