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Park M, Song H. Examining Factors Associated with E-Cigarette Use among Current Smokers. Healthcare (Basel) 2023; 11:2526. [PMID: 37761722 PMCID: PMC10530552 DOI: 10.3390/healthcare11182526] [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: 07/31/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
We present a secondary data analysis of the raw data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES). A total of 827 current smokers who responded that they had smoked >5 packs (100 cigarettes) of cigarettes in their lifetime and were currently smoking traditional cigarettes were selected. This study was conducted to identify sociodemographic, smoking-related, and health-related characteristics that influence the use of e-cigarettes in adult smokers. To examine these factors, general characteristics such as age, marital status, education level, and occupation were included in Model 1, while health-related characteristics such as the level of smoking and depression were included in Model 2. In Model 1, age, a high level of education, and working in an office were found to be significantly correlated with e-cigarette use among smokers, while age and working in the office were found to be significantly correlated with e-cigarette use in Model 2. Therefore, e-cigarette use was high among adult smokers of young ages who were office workers. Although evidence is lacking regarding its safety and use as smoking cessation aids, many smokers have been reported to use e-cigarettes as smoking cessation aids, making it necessary to provide accurate information on e-cigarettes.
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Affiliation(s)
- MinHee Park
- Department of Nursing, Wonkwang University, 460 Iksanda-ro, Iksan-si 54538, Jeollabuk-do, Republic of Korea;
| | - HyeYoung Song
- Department of Nursing, Woosuk University, Samrye-eup, Wanju-gun 55338, Jeonbuk, Republic of Korea
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2
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Ashour AM. Use of Vaping as a Smoking Cessation Aid: A Review of Clinical Trials. J Multidiscip Healthc 2023; 16:2137-2144. [PMID: 37529148 PMCID: PMC10389080 DOI: 10.2147/jmdh.s419945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose Smoking is a global public health concern, with a significant negative impact on human health and healthcare spending. Vaping, or the use of electronic cigarettes (e-cigarettes), has emerged as a popular alternative to traditional nicotine replacement therapies (NRTs) for smoking cessation. While considered less harmful than combustible cigarettes, the long-term health effects of e-cigarettes (vaping) are unknown. Therefore, this study aimed to identify and provide a comprehensive overview of the performance of vaping in clinical trials. Patients and Methods A search was conducted in the ClinicalTrials.gov database on April 14th, 2023, using the search term "smoking cessation, e-cigarettes, NRTs, and vaping". Inclusion and exclusion criteria were defined to identify relevant clinical trials. Randomized controlled trials (RCTs) and non-randomized clinical trials that evaluated vaping as a therapeutic approach to smoking cessation were included. Results A total of 87 clinical trials were identified, of which only seven were related to smoking cessation through vaping as a form of treatment. The primary endpoint was the effect of vaping as smoking cessation, and the secondary endpoints were patients' abstinence rate, withdrawal symptoms, and adverse events of e-cigarettes. Most of the trials used e-cigarettes as an intervention, with some trials including a combination of e-cigarettes and other NRTs. The trials lasted from 4 weeks to 12 months. The overall results of the trials indicated that vaping was effective in helping smokers to quit. It was also associated with a lower risk of adverse events than combustible cigarettes. Conclusion Vaping appears to be an effective method for smoking cessation, and it is associated with a lower risk of adverse events than combustible cigarettes.
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Affiliation(s)
- Ahmed M Ashour
- Pharmacology and Toxicology Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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3
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Ali N, Xavier J, Engur M, Pv M, Bernardino de la Serna J. The impact of e-cigarette exposure on different organ systems: A review of recent evidence and future perspectives. JOURNAL OF HAZARDOUS MATERIALS 2023; 457:131828. [PMID: 37320902 DOI: 10.1016/j.jhazmat.2023.131828] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
The use of electronic cigarettes (e-cigs) is rapidly increasing worldwide and is promoted as a smoking cessation tool. The impact of traditional cigs on human health has been well-defined in both animal and human studies. In contrast, little is known about the adverse effects of e-cigs exposure on human health. This review summarizes the impact of e-cigs exposure on different organ systems based on the rapidly expanding recent evidence from experimental and human studies. A number of growing studies have shown the adverse effects of e-cigs exposure on various organ systems. The summarized data in this review indicate that while e-cigs use causes less adverse effects on different organs compared to traditional cigs, its long-term exposure may lead to serious health effects. Data on short-term organ effects are limited and there is no sufficient evidence on long-term organ effects. Moreover, the adverse effects of secondhand and third hand e-cigs vapour exposure have not been thoroughly investigated in previous studies. Although some studies demonstrated e-cigs used as a smoking cessation tool, there is a lack of strong evidence to support it. While some researchers suggested e-cigs as a safer alternative to tobacco smoking, their long-term exposure health effects remain largely unknown. Therefore, more epidemiological and prospective studies including mechanistic studies are needed to address the potential adverse health effects of e-cigs to draw a firm conclusion about their safe use. A wide variation in e-cigs products and the lack of standardized testing methods are the major barriers to evaluating the existing data. Specific regulatory guidelines for both e-cigs components and the manufacturing process may be effective to protect consumer health.
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Affiliation(s)
- Nurshad Ali
- National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, London SW7 2AZ, UK; Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh.
| | - Joseph Xavier
- National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, London SW7 2AZ, UK; Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695012, Kerala, India.
| | - Melih Engur
- National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, London SW7 2AZ, UK
| | - Mohanan Pv
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695012, Kerala, India.
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4
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Opinions and Practices Regarding Electronic Cigarette Use among Middle School Students from Rural Areas of Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127372. [PMID: 35742620 PMCID: PMC9223877 DOI: 10.3390/ijerph19127372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
Background: The objectives of the study were to assess awareness, opinions, and practices regarding electronic cigarette (e-cigarette) use, as well as factors associated with their use, among middle-school aged students from rural areas of Romania. Methods: The study sample included 748 middle-school students aged 13–14 years from 24 schools from rural areas situated in two counties from Romania, after receiving parental consent. A cross-sectional study using confidential questionnaires which assessed smoking-related behaviors, and also opinions and practices related to e-cigarettes use, was performed in 2019 among the participating middle-schoolers. Results: 96.3% of the middle schoolers have heard about e-cigarettes. A percentage of 72.7% of the smokers, 50.8% of the ex-smokers, and 15.4% of the non-smokers had tried e-cigarettes at least once in their life; 20.3% of the smokers, 4.8% of the ex-smokers, and 4.5% of the non-smokers reported using e-cigarettes in the last month. The results of multivariate logistic regression analysis pointed out that e-cigarette use at least once during lifetime was associated with having friends who tried e-cigarettes, having stronger beliefs that they can help quit smoking and that they are less dangerous than traditional cigarettes. The intention to use e-cigarettes in the next year and smoking behavior were also correlated with e-cigarettes experimentation, while no gender differences were found. Conclusions: The results underline the importance of having prevention programs and interventions concerning e-cigarettes consumption, since e-cigarettes consumption is spread among Romanian adolescents from rural areas.
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Aqeeli AA, Makeen AM, Al Bahhawi T, Ryani MA, Bahri AA, Alqassim AY, El-Setouhy M. Awareness, knowledge and perception of electronic cigarettes among undergraduate students in Jazan Region, Saudi Arabia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:706-713. [PMID: 32974976 DOI: 10.1111/hsc.13184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
The use of electronic cigarettes (e-cigarettes) has steadily grown over the past few years, rising in popularity amongst young adults, especially. Owing to the perception that e-cigarettes are less harmful than conventional cigarettes, some people have resorted to using them as a means of quitting cigarette smoking. This study aimed to assess the awareness, knowledge, perception and use of e-cigarettes among Jazan University students in Saudi Arabia. An observational cross-sectional study was conducted with 775 students. Using stratified random sampling to recruit study participants, the dataset tabling the use of e-cigarettes, as well as knowledge, perception and awareness was collected using a translated and culturally adapted structured Arabic questionnaire. Our results showed that 21.0% of the participants used e-cigarettes and 35.1% of them used them to quit smoking. E-cigarette use was mostly reported by students from the College of Medical Applied Sciences (31.7%). The overall knowledge score was 3.9, with a standard deviation of 1.3 for the score range from zero to seven. About half of the participants correctly identified e-cigarettes as not less addictive' than cigarettes. However, 70.2% of students failed to identify e-cigarettes as a source of second-hand exposure to nicotine. About two-thirds of the sample believed that e-cigarettes could adversely affect health. The perception of using e-cigarettes for smoking cessation was not significantly associated with e-cigarette use. In conclusion, the prevalence of e-cigarette use was similar to that reported in the literature. However, Jazan University students failed to identify the health risks associated with e-cigarette use. Therefore, a strategy to enhance students' awareness of the benefits and harms of e-cigarettes is needed.
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Affiliation(s)
- Abdulwahab A Aqeeli
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Anwar M Makeen
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Tariq Al Bahhawi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Majed A Ryani
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmed A Bahri
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmad Y Alqassim
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Maged El-Setouhy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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6
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Cao Y, Wu D, Ma Y, Ma X, Wang S, Li F, Li M, Zhang T. Toxicity of electronic cigarettes: A general review of the origins, health hazards, and toxicity mechanisms. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 772:145475. [PMID: 33770885 DOI: 10.1016/j.scitotenv.2021.145475] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/24/2021] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
Electronic cigarettes (E-cigarette) are an alternative for traditional cigarette smokers to quit smoking. Based on the current understanding, electronic cigarettes have rapidly become popular among existing smokers and former non-smokers. However, increasing research at different levels reveals that e-cigarettes are unsafe. This review provides an overview of the toxicology of e-cigarettes based on existing in vivo and in vitro studies and compares their toxicity with that of traditional cigarettes. Moreover, we describe the associated toxicity components in e-cigarettes, as well as the potential mechanism by which e-cigarettes exert toxic effects. As is known to all, the nicotine in traditional cigarettes and e-cigarettes has certain toxicity. Besides, a few studies have shown that propylene glycol and vegetable glycerin mixture and flavoring agents in e-cigarettes also are the key components causing adverse effects in animals or cells. There is insufficient scientific evidence on the toxicity of e-cigarettes due to the lack of standardized research methods, prompting the need to conduct a comprehensive toxicity assessment of e-cigarette toxicity to elucidate the safety issues of e-cigarettes. Eventually, a basis for decision-making on whether people use e-cigarettes will be obtained.
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Affiliation(s)
- Yuna Cao
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Daming Wu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Ying Ma
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Xinmo Ma
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Shile Wang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Fuxian Li
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Menghan Li
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Ting Zhang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China.
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Sapru S, Vardhan M, Li Q, Guo Y, Li X, Saxena D. E-cigarettes use in the United States: reasons for use, perceptions, and effects on health. BMC Public Health 2020; 20:1518. [PMID: 33032554 PMCID: PMC7545933 DOI: 10.1186/s12889-020-09572-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/20/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Many researchers claim electronic cigarettes (e-cigarettes) to be a breakthrough invention for tobacco users that aspires to curb their addiction to conventional cigarettes. Claimed to be safer by their promoters, these smokeless devices have become increasingly popular since their arrival on the market among users of all ages, especially adolescents. This paper investigated the trends in e-cigarette usage since the time it arrived in the United States, highlighting the highest surge that has occurred in adolescent e-cigarette use. It also aimed to understand the reasons and perceptions behind the ever-increasing use of e-cigarettes by adolescents. MAIN BODY With the advent of e-cigarettes and common positive perceptions regarding their use, we are at risk of reversing the years of efforts regarding tobacco control and instead advance towards a new addiction with currently unknown long-term health hazards. There is substantial data showing a significant increase of e-cigarette users in the United States, especially among adolescents. The aim of this review was to explore the reasons behind this widespread increase in the use of e-cigarettes among the teenage population in the US and also to uncover the common perceptions about these new electronic delivery systems. In addition, this review attempted to summarize health benefits and hazards associated with e-cigarette use as it crucial to have the right information among its users regarding the health effects of e-cigarette use. CONCLUSION E-cigarettes are more appealing than c-cigarettes for a variety of reasons, including cost, choice of different flavors, ease of accessibility, and use and impact of social media. There are also different perceptions among e-cigarette users, including both adolescents and adults. The former group may use them because of the sense of fashion associated with this novel device, and the latter might intend to quit conventional/combustible cigarettes (c-cigarettes) by switching to e-cigarettes. However, it is important to note that e-cigarettes are a recent phenomenon; therefore, there is a lack of many long-term studies that can identify future health risks associated with e-cigarette use. We need more detailed studies that focus on the long-term health effects of e-cigarette use. Moreover, with the ever-increasing usage of e-cigarettes by adolescents (10 and 19 years), it is very important that e-cigarettes be incorporated into the current tobacco-free laws and ordinances. We conclude by stating that e-cigarettes need stronger regulations to prevent youth access and use.
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Affiliation(s)
- Sakshi Sapru
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
| | - Mridula Vardhan
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
| | - Qianhao Li
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
| | - Yuqi Guo
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
| | - Xin Li
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
- Departments of Urology, New York University School of Medicine, New York, NY, 10016, USA
| | - Deepak Saxena
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA.
- Departments of Surgery, New York University School of Medicine, New York, NY, 10016, USA.
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8
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Fallin-Bennett A, Aleshire M, Scott T, Lee YO. Marketing of e-cigarettes to vulnerable populations: An emerging social justice issue. Perspect Psychiatr Care 2019; 55:584-591. [PMID: 30746718 DOI: 10.1111/ppc.12366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To describe the practice of e-cigarette marketing to vulnerable populations and to suggest strategies to help reduce e-cigarette use. CONCLUSIONS E-cigarette companies target vulnerable populations through civil rights, freedom marketing, and advertising strategies, which may perpetuate continued tobacco disparities in these populations. PRACTICE IMPLICATIONS Health care providers have the responsibility as social justice advocates to engage in efforts to reduce e-cigarette use among vulnerable populations. We must increase knowledge, education, and training specific to e-cigarettes. Awareness of marketing strategies related to vulnerable populations is necessary to develop and implement counter strategies.
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Affiliation(s)
| | - Mollie Aleshire
- University of North Carolina at Greensboro, School of Nursing, Greensboro, North Carolina
| | - Traci Scott
- University of Kentucky College of Nursing, Lexington, Kentucky
| | - Youn Ok Lee
- RTI International, Research Triangle Park, Durham, North Carolina
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9
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Larcombe AN. Early-life exposure to electronic cigarettes: cause for concern. THE LANCET RESPIRATORY MEDICINE 2019; 7:985-992. [PMID: 31160239 DOI: 10.1016/s2213-2600(19)30189-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 01/29/2023]
Abstract
Electronic nicotine delivery systems, or ENDS, are devices that heat and aerosolise a solution of propylene glycol, glycerine, nicotine, and flavourings. They have only achieved widespread use in the past 5 years or so, and therefore evidence around their potential to effect health is scarce. Importantly, they are often viewed as safer than tobacco cigarettes, meaning that at-risk populations, including pregnant women, might be more inclined to use them. No human studies, however, have assessed the potential for maternal ENDS use to effect the health of a developing baby. Experimental research suggests that nicotine alone is likely to adversely affect the fetus. Further, there is a misconception that ENDS do not produce second-hand aerosols. This misconception might put infants and young children at risk because their parents are more likely to use ENDS around them than they are to use tobacco cigarettes. Emerging evidence also proposes that nicotine and other substances produced by ENDS can deposit onto surfaces, and subsequently be exposed to infants and children; a process known as third-hand exposure. Finally, ENDS are often refillable, and instances of accidental poisonings of children who drink nicotine-containing refills have occurred. Thus, there are a multitude of ways that, with respect to early-life exposures and health, ENDS are a cause for concern.
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Affiliation(s)
- Alexander N Larcombe
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia; School of Public Health, Curtin University, Bentley, WA, Australia.
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10
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Visser WF, Klerx WN, Cremers HWJM, Ramlal R, Schwillens PL, Talhout R. The Health Risks of Electronic Cigarette Use to Bystanders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091525. [PMID: 31052162 PMCID: PMC6539638 DOI: 10.3390/ijerph16091525] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 12/01/2022]
Abstract
This works aimed to assess the health risks of e-cigarette use to bystanders. The exhaled breath of 17 volunteers was collected while they were vaping, and the levels of nicotine, propylene glycol, glycerol, formaldehyde, acetaldehyde, acrolein, tobacco-specific nitrosamines (TSNAs), and heavy metals were analyzed. Increased levels of nicotine, propylene glycol, TSNAs and copper were found in the exhaled breath of the volunteers. From these measurements, bystander exposure was estimated for two different scenarios: (1) A non-ventilated car with two e-cigarette users and (2) a ventilated office with one e-cigarette user. Our results show that bystanders may experience irritation of the respiratory tract as a result of exposure to propylene glycol and glycerol. Systemic effects of nicotine should also be expected if nicotine-containing e-liquid is used, including palpitations, and an increase of the systolic blood pressure. Furthermore, due to the presence of TSNAs in some e-liquids, an increased risk of tumors could not be excluded for the ‘car’ scenario. While e-cigarette use can clearly have effects on the health of bystanders, the risks depend on the rate of ventilation, dimensions of the room, and vaping behavior of the e-cigarette user. The presence of TSNAs in e-liquids can be avoided, which will prevent the most serious effect identified (increased risk of tumors).
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Affiliation(s)
- Wouter F Visser
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Anthonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.
| | - Walther N Klerx
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Anthonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.
| | - Hans W J M Cremers
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Anthonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.
| | - Ramon Ramlal
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Anthonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.
| | - Paul L Schwillens
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Anthonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.
| | - Reinskje Talhout
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Anthonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.
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11
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Drehmer JE, Nabi-Burza E, Hipple Walters B, Ossip DJ, Levy DE, Rigotti NA, Klein JD, Winickoff JP. Parental Smoking and E-cigarette Use in Homes and Cars. Pediatrics 2019; 143:peds.2018-3249. [PMID: 30858346 PMCID: PMC6564069 DOI: 10.1542/peds.2018-3249] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine how smoke-free and vape-free home and car policies differ for parents who are dual users of cigarettes and electronic cigarettes (e-cigarettes), who only smoke cigarettes, or who only use e-cigarettes. To identify factors associated with not having smoke-free or vape-free policies and how often smoke-free advice is offered at pediatric offices. METHODS Secondary analysis of 2017 parental interview data collected after their children's visit in 5 control practices participating in the Clinical Effort Against Secondhand Smoke Exposure trial. RESULTS Most dual users had smoke-free home policies, yet fewer had a vape-free home policies (63.8% vs 26.3%; P < .01). Dual users were less likely than cigarette users to have smoke-free car (P < .01), vape-free home (P < .001), or vape-free car (P < .001) policies. Inside cars, dual users were more likely than cigarette users to report smoking (P < .001), e-cigarette use (P < .001), and e-cigarette use with children present (P < .001). Parental characteristics associated with not having smoke-free or vape-free home and car policies include smoking ≥10 cigarettes per day, using e-cigarettes, and having a youngest child >10 years old. Smoke-free home and car advice was infrequently delivered. CONCLUSIONS Parents may perceive e-cigarette aerosol as safe for children. Dual users more often had smoke-free policies than vape-free policies for the home. Dual users were less likely than cigarette-only smokers to report various child-protective measures inside homes and cars. These findings reveal important opportunities for intervention with parents about smoking and vaping in homes and cars.
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Affiliation(s)
- Jeremy E. Drehmer
- Division of General Academic Pediatrics,
Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center and
| | - Emara Nabi-Burza
- Division of General Academic Pediatrics,
Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center and
| | - Bethany Hipple Walters
- Division of General Academic Pediatrics,
Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center and
| | - Deborah J. Ossip
- Department of Public Health Sciences, University of
Rochester Medical Center, Rochester, New York
| | - Douglas E. Levy
- Tobacco Research and Treatment Center and,Mongan Institute Health Policy Center, Massachusetts
General Hospital, Boston, Massachusetts;,Harvard Medical School, Harvard University, Boston,
Massachusetts
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center and,Mongan Institute Health Policy Center, Massachusetts
General Hospital, Boston, Massachusetts;,Harvard Medical School, Harvard University, Boston,
Massachusetts
| | - Jonathan D. Klein
- Department of Pediatrics, College of Medicine,
University of Illinois at Chicago, Chicago, Illinois; and,Julius B. Richmond Center of Excellence, American
Academy of Pediatrics, Itasca, Illinois
| | - Jonathan P. Winickoff
- Division of General Academic Pediatrics,
Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center and,Harvard Medical School, Harvard University, Boston,
Massachusetts;,Julius B. Richmond Center of Excellence, American
Academy of Pediatrics, Itasca, Illinois
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12
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Passive exposure to pollutants from conventional cigarettes and new electronic smoking devices (IQOS, e-cigarette) in passenger cars. Int J Hyg Environ Health 2019; 222:486-493. [PMID: 30685192 DOI: 10.1016/j.ijheh.2019.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/20/2018] [Accepted: 01/11/2019] [Indexed: 12/22/2022]
Abstract
Smoking in car interiors is of particular concern because concentrations of potentially harmful substances can be expected to be high in such small spaces. To assess the potential exposure for occupants, especially children, we performed a comprehensive evaluation of the pollution in 7 passenger cars while tobacco cigarettes and new electronic smoking products (IQOS, e-cigarette) were being smoked. We collected data on the indoor climate and indoor air pollution with fine and ultrafine particles and volatile organic compounds while the cars were being driven. Smoking of an IQOS had almost no effect on the mean number concentration (NC) of fine particles (>300 nm) or on the PM2.5 concentration in the interior. In contrast, the NC of particles with a diameter of 25-300 nm markedly increased in all vehicles (1.6-12.3 × 104/cm3). When an e-cigarette was vaped in the interior, 5 of the 7 tested cars showed a strong increase in the PM2.5 concentration to 75-490 μg/m3. The highest PM2.5 levels (64-1988 μg/m3) were measured while tobacco cigarettes were being smoked. With the e-cigarette, the concentration of propylene glycol increased in 5 car interiors to 50-762 μg/m3, whereby the German indoor health precaution guide value for propylene glycol was exceeded in 3 vehicles and the health hazard guide value in one. In 4 vehicles, the nicotine concentration also increased to 4-10 μg/m3 while the e-cigarette was being used. The nicotine concentrations associated with the IQOS and e-cigarette were comparable, whereas the highest nicotine levels (8-140 μg/m3) were reached with tobacco cigarettes. Cigarette use also led to pollution of the room air with formaldehyde (18.5-56.5 μg/m3), acetaldehyde (26.5-141.5 μg/m3), and acetone (27.8-75.8 μg/m3). Tobacco cigarettes, e-cigarettes, and the IQOS are all avoidable sources of indoor pollutants. To protect the health of other non-smoking passengers, especially that of sensitive individuals such as children and pregnant women, these products should not be used in cars.
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Yu M, Mukai K, Tsai M, Galli SJ. Thirdhand smoke component can exacerbate a mouse asthma model through mast cells. J Allergy Clin Immunol 2018; 142:1618-1627.e9. [PMID: 29678746 DOI: 10.1016/j.jaci.2018.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thirdhand smoke (THS) represents the accumulation of secondhand smoke on indoor surfaces and in dust, which, over time, can become more toxic than secondhand smoke. Although it is well known that children of smokers are at increased risk for asthma or asthma exacerbation if the disease is already present, how exposure to THS can influence the development or exacerbation of asthma remains unknown. OBJECTIVE We investigated whether epicutaneous exposure to an important component of THS, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), can influence asthma pathology in a mouse model elicited by means of repeated intranasal challenge with cockroach antigen (CRA). METHODS Wild-type mice, α7 nicotinic acetylcholine receptor (nAChR)- or mast cell (MC)-deficient mice, and mice with MCs that lacked α7 nAChRs or were the host's sole source of α7 nAChRs were subjected to epicutaneous NNK exposure, intranasal CRA challenge, or both, and the severity of features of asthma pathology, including airway hyperreactivity, airway inflammation, and airway remodeling, was assessed. RESULTS We found that α7 nAChRs were required to observe adverse effects of epicutaneous NNK exposure on multiple features of CRA-induced asthma pathology. Moreover, MC expression of α7 nAChRs contributed significantly to the ability of epicutaneous NNK exposure to exacerbate airway hyperreactivity to methacholine, airway inflammation, and airway remodeling in this model. CONCLUSION Our results show that skin exposure to NNK, a component of THS, can exacerbate multiple features of a CRA-induced model of asthma in mice and define MCs as key contributors to these adverse effects of NNK.
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Affiliation(s)
- Mang Yu
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif.
| | - Kaori Mukai
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Stephen J Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, Calif.
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Liu J, Liang Q, Oldham MJ, Rostami AA, Wagner KA, Gillman IG, Patel P, Savioz R, Sarkar M. Determination of Selected Chemical Levels in Room Air and on Surfaces after the Use of Cartridge- and Tank-Based E-Vapor Products or Conventional Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14090969. [PMID: 28846634 PMCID: PMC5615506 DOI: 10.3390/ijerph14090969] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/07/2017] [Accepted: 08/16/2017] [Indexed: 02/08/2023]
Abstract
There is an ongoing debate regarding the potential of secondhand exposure of non-users to various chemicals from use of e-vapor products (EVPs). Room air levels of 34 chemicals (nicotine, propylene glycol (PG), glycerol, 15 carbonyl chemicals, 12 volatile organic chemicals (VOCs), and four selected trace elements) were measured where EVPs and cigarettes were used by n = 37 healthy adult tobacco users in an exposure chamber. The products used were MarkTen® 2.5% Classic (Group I), a Prototype GreenSmoke® 2.4% (Group II), Ego-T® Tank with subjects' own e-liquids (Group III) and subjects' own conventional cigarettes (Group IV). Products were used under controlled conditions and 4-h ad libitum use. Background (without subjects) and baseline levels (with subjects) were measured. Cumulative 4-h. levels of nicotine, PG and glycerol measured were several-fold below the time-weighted average limits used in workplace exposure evaluation. Most the other chemicals (>75%) were at or below the limit of quantification during EVP use. Significant levels of chemicals (17 out of 34) were observed in Group IV. Overall, our results indicate that under the study conditions with the products tested, cumulative room air levels of the selected chemicals measured over 4-h were relatively small and were several-fold below the current occupational regulatory and consensus limits.
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Affiliation(s)
- Jianmin Liu
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - Qiwei Liang
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - Michael J Oldham
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - Ali A Rostami
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - Karl A Wagner
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - I Gene Gillman
- Enthalpy Analytical Inc., 800 Capitola Drive, Durham, NC 27713, USA.
| | - Piyush Patel
- Inflamax Research Inc., 1310 Fewster Drive, Mississauga, ON L4W 1A4, Canada.
| | - Rebecca Savioz
- Clinopsis SA, Chemin des Jardins 6, 1426 Concise, Switzerland.
| | - Mohamadi Sarkar
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
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Smith VA, McBrearty AR, Watson DG, Mellor DJ, Spence S, Knottenbelt C. Hair nicotine concentration measurement in cats and its relationship to owner-reported environmental tobacco smoke exposure. J Small Anim Pract 2017; 58:3-9. [PMID: 28094859 DOI: 10.1111/jsap.12616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 08/21/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the association between hair nicotine concentration in cats and owner-reported exposure to environmental tobacco smoke. MATERIALS AND METHODS Owner questionnaires documented exposure. Nicotine was extracted from hair by sonification in methanol followed by hydrophilic interaction chromatography with mass spectrometry. Relationships between hair nicotine concentration and owner-reported exposure were examined using hypothesis-testing statistics and receiver operating characteristic curve analysis. RESULTS The hair nicotine concentration of reportedly exposed cats was significantly higher than unexposed cats and groups of cats with different levels of exposure had significantly different median hair nicotine concentrations corresponding to exposure. A hair nicotine concentration of 0·1 ng/mg had a specificity of 98% (95% confidence interval: 83 to 100) and a sensitivity of 69% (95% confidence interval: 54 to 84) for detecting environmental tobacco smoke exposure. Outdoors access, coat colour, urban or rural environment and length of time living with the owner were not obviously associated with hair nicotine concentration. CLINICAL SIGNIFICANCE Feline hair nicotine concentration appears strongly associated with owner-reported environmental tobacco smoke exposure. Feline hair nicotine concentration could therefore be used as a biomarker for tobacco smoke exposure, allowing future studies to assess whether exposed cats have an increased risk of specific diseases.
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Affiliation(s)
- V A Smith
- Small Animal Hospital, Veterinary School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH
| | - A R McBrearty
- Small Animal Hospital, Veterinary School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH
| | - D G Watson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE
| | - D J Mellor
- Small Animal Hospital, Veterinary School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH
| | - S Spence
- Small Animal Hospital, Veterinary School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH
| | - C Knottenbelt
- Small Animal Hospital, Veterinary School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Figueiró LR, Ziulkoski AL, Dantas DCM. Thirdhand smoke: when the danger is more than you can see or smell. CAD SAUDE PUBLICA 2016; 32:e00032216. [PMID: 27925021 DOI: 10.1590/0102-311x00032216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/24/2016] [Indexed: 11/21/2022] Open
Abstract
Recent discussion has focused on another form of exposure to tobacco - thirdhand smoke (THS) - consisting of residual pollutants from cigarette smoke that remain in environments. The main concern with THS is based on the presence and persistence of many toxic compounds, some specific nitrosamines from tobacco that have carcinogenic activity. Little is known about THS, and few people are aware of its existence and potential health repercussions, thus highlighting the need to shed light on the subject and incorporate it into the public health debate, as was done with passive smoking several years ago. THS is a form of passive smoking, together with secondary or involuntary exposure to cigarette smoke. Recentemente, passou a ser discutida mais uma forma de exposição ao tabaco - thirdhand smoke (THS) - que consiste nos poluentes residuais da fumaça de cigarro que permanecem nos ambientes. A principal preocupação com o THS é embasada na presença e longa persistência de muitos compostos tóxicos, algumas nitrosaminas específicas do tabaco que têm atividade carcinogênica. Além de se saber pouco sobre o THS, poucos sabem de sua existência e preocupante repercussão na saúde. Coloca-se em destaque a necessidade de trazê-lo à luz e incluí-lo nas discussões, assim como foi feito com o tabagismo passivo alguns anos atrás, até mesmo porque o THS se caracteriza como uma forma de tabagismo passivo junto à exposição secundária ou involuntária da fumaça de cigarro.
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Kaisar MA, Prasad S, Liles T, Cucullo L. A decade of e-cigarettes: Limited research & unresolved safety concerns. Toxicology 2016; 365:67-75. [PMID: 27477296 DOI: 10.1016/j.tox.2016.07.020] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/07/2016] [Accepted: 07/26/2016] [Indexed: 01/21/2023]
Abstract
It is well known that tobacco consumption is a leading cause of preventable deaths worldwide and has been linked to major diseases ranging from cancer to chronic obstructive pulmonary disease, atherosclerosis, stroke and a host of neurological/neurodegenerative disorders. In the past decade a number of alternative vaping products have hit the market, rapidly gaining consumers especially among the younger population. Electronic nicotine delivery systems or e-cigarettes have become the sought-after product due to the belief that they are much safer than traditional cigarettes. However, inadequate research and lack of regulatory guidelines for both the manufacturing process and the content of the vaping solution of the e-cigarette has become a major concern. Highly debated and unresolved questions such as whether e-cigarettes may help smokers quit and whether e-cigarettes will promote the use of nicotine among non-smokers add to the confusion of the safety of e-cigarettes. In this review article, we summarize the current understanding (and lack thereof) of the potential health impacts of e-cigarettes. We will also highlight the most recent studies (in vivo/in vitro) which seem to conflict with the broad safety claims put forward by the manufacturers. Finally, we provide potential solutions to overcome the research gap of the short and long-term health impact of e-cigarettes.
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Affiliation(s)
- Mohammad Abul Kaisar
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Shikha Prasad
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Tylor Liles
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA; Center for Blood Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
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Awan KH. Experimentation and correlates of electronic nicotine delivery system (electronic cigarettes) among university students - A cross sectional study. Saudi Dent J 2016; 28:91-5. [PMID: 27486295 PMCID: PMC4957264 DOI: 10.1016/j.sdentj.2015.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/23/2015] [Accepted: 12/19/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE E-cigarettes are becoming popular among youth as safe nicotine delivery systems. Many have expressed concern, however, that e-cigarettes may serve as a gateway to future smoking, given their low perceived risk, or that their use may prevent regular smokers from quitting by maintaining their nicotine addiction. The aim of this study was to assess experimentation with and correlates of e-cigarette use among university students. MATERIAL AND METHODS A cross-sectional study was carried out among 480 university students from four faculties at a university in Riyadh in August-October 2014. A modified version of the World Health Organization's Global Adult Tobacco Survey was used, and multinomial logistic regression was carried out to assess correlations with e-cigarette variables in the whole study sample and among smokers. RESULTS Almost all students, including the majority of ex-smokers (96.3%) and smokers (94.4%), reported having heard about e-cigarettes. In addition, about one-quarter of the sample (54.2% of smokers, 24.7% of ex-smokers, 6% of never smokers) had experimented with e-cigarettes at least once during their lifetime. Curiosity and peer influence were reported as the main reasons for the use of e-cigarettes. Factors found to be correlated significantly with e-cigarette use were male gender, being a traditional cigarette smoker, having friends who have tried e-cigarettes, and having a strong belief that e-cigarettes could aid smoking cessation. CONCLUSION E-cigarettes are popular among Saudi youth, especially among smokers and ex-smokers. Well-designed health education programs and regulatory interventions are required to address this issue.
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Affiliation(s)
- K H Awan
- Department of Oral Medicine & Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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El-Shahawy O, Brown R, Elston Lafata J. Primary Care Physicians' Beliefs and Practices Regarding E-Cigarette Use by Patients Who Smoke: A Qualitative Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050445. [PMID: 27128928 PMCID: PMC4881070 DOI: 10.3390/ijerph13050445] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/16/2022]
Abstract
We explored primary care physicians’ (PCPs’) beliefs and practices about e-cigarettes. Cross-sectional, semi-structured interviews with PCPs in 2014 were conducted and audio-recorded. Participants were 15 general internal and family medicine physicians practicing in two settings in Virginia, USA. Interview recordings were transcribed, and the content analyzed using the Constant Comparative Method to identify key themes regarding PCPs’ reported current practices and beliefs. Five themes were identified: (1) existing clinic processes do not include mechanisms to screen for noncombustible tobacco products (such as e-cigarettes); (2) e-cigarette discussions are becoming commonplace with patients initiating the discussions and seeking physician guidance regarding e-cigarette use; (3) a lack of knowledge regarding the potential harms and benefits of e-cigarettes, yet a willingness to support their patients’ desire to use e-cigarettes (4) believing e-cigarettes are a safer alternative to smoking combustible tobacco products; and (5) abandoning concerns regarding the potential harms of e-cigarettes in the context of highly addicted patients and those with extensive comorbidities. Despite acknowledging limited knowledge regarding e-cigarettes, findings suggest that some PCPs are currently recommending e-cigarettes to their patients for smoking cessation and relative harm reduction, often personalizing recommendations based on the patient’s perceived addiction level and current health status. Physicians need to be informed about the evolving evidence regarding the risks and benefits of e-cigarettes.
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Affiliation(s)
- Omar El-Shahawy
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi 129188, UAE.
| | - Richard Brown
- Department of Health Behavior and Policy, School of Medicine and Massey Cancer Center, Virginia Commonwealth University; Richmond, VA 23284, USA.
| | - Jennifer Elston Lafata
- Department of Health Behavior and Policy, School of Medicine and Massey Cancer Center, Virginia Commonwealth University; Richmond, VA 23284, USA.
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Cooke A, Fergeson J, Bulkhi A, Casale TB. The Electronic Cigarette: The Good, the Bad, and the Ugly. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:498-505. [PMID: 26164573 DOI: 10.1016/j.jaip.2015.05.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 01/16/2023]
Abstract
Electronic cigarettes (EC) are battery-powered nicotine delivery systems that have increased in popularity since they entered the US market. EC has been reported to contain less carcinogens than traditional cigarettes, cause less acute lung effects in healthy individuals, and may help with smoking cessation. It has also been viewed as a potential safer alternative for asthmatic smokers, but its effects on lung functions are unclear. However, EC do carry some harmful aspects as they contain formaldehyde and formaldehyde-forming hemiacetals as well as potentially toxic particulate matter that deposits on surfaces. EC are an increasingly popular device that could serve as a gateway into traditional cigarette smoking or illicit drugs. The popularity of EC has brought with it money from large tobacco corporations and mass marketing. Lack of regulation has generated product inconsistency and potential health hazards. This review highlights what is known and what still needs to be answered about EC.
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Affiliation(s)
- Andrew Cooke
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Fla
| | - Jennifer Fergeson
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Fla
| | - Adeeb Bulkhi
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Fla; Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Fla.
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Ganjre AP, Sarode GS. Third hand smoke – A hidden demon. Oral Oncol 2016; 54:e3-4. [DOI: 10.1016/j.oraloncology.2016.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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Lazuras L, Muzi M, Grano C, Lucidi F. E-cigarettes as smoking cessation aids: a survey among practitioners in Italy. Int J Public Health 2015; 61:243-8. [PMID: 26687040 PMCID: PMC4819500 DOI: 10.1007/s00038-015-0772-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/26/2015] [Accepted: 11/26/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives To describe experiences with and beliefs about e-cigarettes as safe and useful aids for smoking cessation among healthcare professionals providing smoking cessation services. Methods Using a cross-sectional design, anonymous structured questionnaires were completed by 179 healthcare professionals in public smoking cessation clinics across 20 regions in Italy. Results Service providers reported that considerably more smokers made inquiries about e-cigarettes in 2014 than in 2013. The most frequent inquiries concerned the ingredients, safety and effectiveness of e-cigarettes as smoking cessation aids. Clients used e-cigarettes to quit smoking, cut down the number of conventional cigarettes smoked, have a safe alternative to smoking, and protect their health while continuing to smoke. More than 60 % of service providers reported favourable beliefs about the safety and effectiveness of e-cigarettes, and believed that e-cigarettes are as effective as other smoking cessation aids, including pharmacotherapy. Conclusions Despite limited empirical evidence, service providers in Italy viewed e-cigarettes, as safe and effective smoking cessation aids. More concerted efforts are needed to improve knowledge about e-cigarettes among service providers, to guide their clinical practice and decision-making with respect to e-cigarettes.
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Affiliation(s)
- Lambros Lazuras
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, S10 2BQ, UK. .,Department of Social and Developmental Psychology, 'La Sapienza' University of Rome, Rome, Italy.
| | - Milena Muzi
- Department of Social and Developmental Psychology, 'La Sapienza' University of Rome, Rome, Italy
| | - Caterina Grano
- Department of Social and Developmental Psychology, 'La Sapienza' University of Rome, Rome, Italy
| | - Fabio Lucidi
- Department of Social and Developmental Psychology, 'La Sapienza' University of Rome, Rome, Italy
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West HW, Gall SL, Juonala M, Magnussen CG. Is Passive Smoking Exposure in Early Life a Risk Factor for Future Cardiovascular Disease? CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0471-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Santos e Silva SI, Bowdler P, Giltrow D, Riddell S, Honeychurch KC. A simple and rapid method for the determination of nicotine in third-hand smoke by liquid chromatography and its application for the assessment of contaminated outdoor communal areas. Drug Test Anal 2015; 8:676-81. [DOI: 10.1002/dta.1822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 04/08/2015] [Accepted: 05/16/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Samira Inácia Santos e Silva
- Universidade Federal de Minas Gerais (UFMG); Avenida Presidente Antônio Carlos, 6627, Pampulha Belo Horizonte MG 31270-901 Brazil
| | - Paul Bowdler
- Centre for Research in Biosciences; Faculty of Health & Life Sciences; University of the West of England; Frenchay Campus, Coldharbour Lane Bristol BS16 1QY UK
| | - Danielle Giltrow
- Centre for Research in Biosciences; Faculty of Health & Life Sciences; University of the West of England; Frenchay Campus, Coldharbour Lane Bristol BS16 1QY UK
| | - Stephanie Riddell
- Centre for Research in Biosciences; Faculty of Health & Life Sciences; University of the West of England; Frenchay Campus, Coldharbour Lane Bristol BS16 1QY UK
| | - Kevin C. Honeychurch
- Centre for Research in Biosciences; Faculty of Health & Life Sciences; University of the West of England; Frenchay Campus, Coldharbour Lane Bristol BS16 1QY UK
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Use of electronic cigarettes among Romanian university students: a cross-sectional study. BMC Public Health 2015; 15:358. [PMID: 25888354 PMCID: PMC4414446 DOI: 10.1186/s12889-015-1713-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Because electronic cigarettes are relatively new, data on usage patterns and factors which influence them are sparse. Hence, this study aims at assessing awareness, beliefs about electronic cigarettes and experimentation with them among university students from Romania- a country where the sales and marketing of these products are widespread. Secondly, correlates of electronic cigarette experimentation will also be investigated. Methods A cross-sectional study was performed by means of anonymous questionnaires among 480 students, aged 19–24, from Cluj-Napoca, Romania, between April-May 2013. Results The results show that 92.5% of the students have heard about e-cigarettes; out of these, one quarter (53.3% of the smokers, 25% of the ex-smokers, 5.5% of the non-smokers) have tried electronic cigarettes at least once during lifetime. The results of the multinomial logistic regression point out that the correlates of electronic cigarette experimentation were: male gender, being a smoker of traditional cigarettes, having friends who experimented with electronic cigarettes, having stronger beliefs that electronic cigarettes could help them quit smoking and being less convinced that they are used only by smokers. The explained variance was 59%. Conclusions The results underline the importance of addressing the issue of e-cigarette use through health education programs and regulatory interventions, since e-cigarettes are a reality faced by the Romanian youth.
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Kong G, Morean ME, Cavallo DA, Camenga DR, Krishnan-Sarin S. Reasons for Electronic Cigarette Experimentation and Discontinuation Among Adolescents and Young Adults. Nicotine Tob Res 2014; 17:847-54. [PMID: 25481917 DOI: 10.1093/ntr/ntu257] [Citation(s) in RCA: 468] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Understanding why young people try and stop electronic cigarette (e-cigarette) use is critical to inform e-cigarette regulatory efforts. METHODS We conducted 18 focus groups (N = 127) in 1 middle school (MS), 2 high schools (HSs), and 2 colleges in Connecticut to assess themes related to e-cigarette experimentation and discontinuation. We then conducted surveys to evaluate these identified themes in 2 MSs, 4 HSs, and 1 college (N = 1,175) to explore whether reasons for e-cigarette experimentation and/or discontinuation differed by school level or cigarette smoking status. RESULTS From the focus groups, we identified experimentation themes (i.e., curiosity, flavors, family/peer influence, easy access, and perceptions of e-cigarettes as "cool" and as a healthier/better alternative to cigarettes) and discontinuation themes (i.e., health concerns, loss of interest, high cost, bad taste, and view of e-cigarettes as less satisfying than cigarettes). The survey data showed that the top reasons for experimentation were curiosity (54.4%), appealing flavors (43.8%), and peer influences (31.6%), and the top reasons for discontinuation were responses related to losing interest (23.6%), perceiving e-cigarettes as "uncool" (16.3%), and health concerns (12.1%). Cigarette smokers tried e-cigarettes because of the perceptions that they can be used anywhere and to quit smoking and discontinued because they were not as satisfying as cigarettes. School level differences were detected. CONCLUSIONS E-cigarette prevention efforts toward youth should include limiting e-cigarette flavors, communicating messages emphasizing the health risks of use, and changing social norms surrounding the use of e-cigarettes. The results should be interpreted in light of the limitations of this study.
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Affiliation(s)
- Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT;
| | - Meghan E Morean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Dana A Cavallo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Deepa R Camenga
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Hamilton HA, Ferrence R, Boak A, Schwartz R, Mann RE, O'Connor S, Adlaf EM. Ever Use of Nicotine and Nonnicotine Electronic Cigarettes Among High School Students in Ontario, Canada. Nicotine Tob Res 2014; 17:1212-8. [PMID: 25358662 DOI: 10.1093/ntr/ntu234] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/22/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION There are limited data on the use of electronic cigarettes (e-cigarettes) among youth, particularly with regard to the use of nicotine versus nonnicotine products. This study investigates ever use of nicotine and nonnicotine e-cigarettes and examines the demographic and behavioral correlates of e-cigarette use in Ontario, Canada. METHODS Data for 2,892 high school students were derived from the 2013 Ontario Student Drug Use and Health Survey. This province-wide school-based survey is based on a 2-stage cluster design. Bivariate and multivariate analyses were used to investigate the factors associated with ever use of e-cigarettes. Ever use of e-cigarettes was derived from the question, "Have you ever smoked at least one puff from an electronic cigarette?" All analyses included appropriate adjustments for the complex study design. RESULTS Fifteen percent of high school students reported using e-cigarettes in their lifetime. Most students who ever used e-cigarettes reported using e-cigarettes without nicotine (72%), but 28% had used e-cigarettes with nicotine. Male, White/Caucasian, and rural students, as well as those with a history of using tobacco cigarettes, were at greater odds of e-cigarette use. Seven percent of students who had never smoked a tobacco cigarette in their lifetime reported using an e-cigarette. Five percent of those who had ever used an e-cigarette had never smoked a tobacco cigarette. CONCLUSION More students reported ever using e-cigarettes without nicotine than with nicotine in Ontario, Canada. This underscores the need for greater knowledge of the contents of both nicotine and nonnicotine e-cigarettes to better guide public health policies.
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Affiliation(s)
- Hayley A Hamilton
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;
| | - Roberta Ferrence
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Ontario Tobacco Research Unit, University of Toronto, Toronto, Ontario, Canada
| | - Angela Boak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robert Schwartz
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Ontario Tobacco Research Unit, University of Toronto, Toronto, Ontario, Canada
| | - Robert E Mann
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shawn O'Connor
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Ontario Tobacco Research Unit, University of Toronto, Toronto, Ontario, Canada
| | - Edward M Adlaf
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Oh AY, Kacker A. Do electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes? Review on E-cigarette vapor versus tobacco smoke. Laryngoscope 2014; 124:2702-6. [PMID: 25302452 DOI: 10.1002/lary.24750] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/01/2014] [Accepted: 05/01/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Development and utilization of electronic cigarettes (ECs) resulted from the search for healthier alternatives to conventional tobacco cigarettes (TCs) and the search for alternative methods for quitting TCs. This review compares the potential disease burden presented by TC smoke to that of EC vapor. METHODS Potential disease burden of EC vapor versus TC smoke was assessed by reviewing clinical studies that measured inhaled components. Chemicals and carcinogens produced by vapor versus smoke were compared. RESULTS Studies show that EC vapors contain far less carcinogenic particles than TC smoke. Whereas ECs have the ability to reach peak serum cotinine/nicotine levels comparable to that of TCs, ECs do not cause an increase in total white blood cell count; thus, ECs have the potential to lower the risk of atherosclerosis and systemic inflammation. Use of ECs has been shown to improve indoor air quality in a home exposed to TC smoke. This reduces secondhand smoke exposure, thus having the potential to decrease respiratory illness/asthma, middle-ear disease, sudden infant death syndrome, and more. However, some studies claim that propylene glycol (PG) vapor can induce respiratory irritation and increase chances for asthma. To minimize risks, EC manufacturers are replacing PG with distilled water and glycerin for vapor production. CONCLUSION Based on the comparison of the chemical analysis of EC and TC carcinogenic profiles and association with health-indicating parameters, ECs impart a lower potential disease burden than conventional TCs.
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Affiliation(s)
- Anne Y Oh
- Department of Otolaryngology, Cornell Weill Medical College, New York, New York, U.S.A
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Goniewicz ML, Lee L. Electronic cigarettes are a source of thirdhand exposure to nicotine. Nicotine Tob Res 2014; 17:256-8. [PMID: 25173774 DOI: 10.1093/ntr/ntu152] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Substances remaining on the surfaces in areas where people have smoked contribute to thirdhand exposure. Nicotine from tobacco smoke has been shown to react with oxidizing chemicals in the air to form secondary pollutants, such as carcinogenic nitrosamines. While previous studies have demonstrated thirdhand exposure to nicotine from tobacco smoke, none have investigated whether nicotine from electronic cigarettes (e-cigarettes) can also be deposited on various surfaces. METHODS Three brands of e-cigarettes were refilled with varying nicotine concentrations. We released 100 puffs from each product directly into an exposure chamber. Surface wipe samples were taken from 5 indoor 100 cm(2) surfaces (window, walls, floor, wood, and metal) pre- and post-release of vapors. Nicotine was extracted from the wipes and was analyzed using gas chromatography. RESULTS Three of the 4 experiments showed significant increases in the amount of nicotine on all five surfaces. The floor and glass windows had the greatest increases in nicotine, on average by a factor of 47 and 6, respectively (p < .05). The average amount of nicotine deposited on a floor during each experiment was 205 μg/m(2) and varied from limit of quantitation to 550 μg/m(2). CONCLUSIONS This study indicates that there is a risk for thirdhand exposure to nicotine from e-cigarettes. Thirdhand exposure levels differ depending on the surface and the e-cigarette brand. Future research should explore the potential risks of thirdhand exposure to carcinogens formed from the nicotine that is released from e-cigarettes.
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Affiliation(s)
- Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY
| | - Lily Lee
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY
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Harrell PT, Simmons VN, Correa JB, Padhya TA, Brandon TH. Electronic nicotine delivery systems ("e-cigarettes"): review of safety and smoking cessation efficacy. Otolaryngol Head Neck Surg 2014; 151:381-93. [PMID: 24898072 DOI: 10.1177/0194599814536847] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Cigarette smoking is common among cancer patients and is associated with negative outcomes. Electronic nicotine delivery systems ("e-cigarettes") are rapidly growing in popularity and use, but there is limited information on their safety or effectiveness in helping individuals quit smoking. DATA SOURCES The authors searched PubMed, Web of Science, and additional sources for published empirical data on safety and use of electronic cigarettes as an aid to quit smoking. REVIEW METHODS We conducted a structured search of the current literature up to and including November 2013. RESULTS E-cigarettes currently vary widely in their contents and are sometimes inconsistent with labeling. Compared to tobacco cigarettes, available evidence suggests that e-cigarettes are often substantially lower in toxic content, cytotoxicity, associated adverse effects, and secondhand toxicity exposure. Data on the use of e-cigarettes for quitting smoking are suggestive but ultimately inconclusive. CONCLUSIONS Clinicians are advised to be aware that the use of e-cigarettes, especially among cigarette smokers, is growing rapidly. These devices are unregulated, of unknown safety, and of uncertain benefit in quitting smoking. IMPLICATIONS FOR PRACTICE In the absence of further data or regulation, oncologists are advised to discuss the known and unknown safety and efficacy information on e-cigarettes with interested patients and to encourage patients to first try FDA-approved pharmacotherapies for smoking cessation.
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Affiliation(s)
- Paul Truman Harrell
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Vani Nath Simmons
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - John Bernard Correa
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Tapan Ashvin Padhya
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Thomas Henry Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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Abstract
OBJECTIVE With the rapid increase in use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes (e-cigarettes), users and non-users are exposed to the aerosol and product constituents. This is a review of published data on the human health effects of exposure to e-cigarettes and their components. METHODS Literature searches were conducted through September 2013 using multiple electronic databases. RESULTS Forty-four articles are included in this analysis. E-cigarette aerosols may contain propylene glycol, glycerol, flavourings, other chemicals and, usually, nicotine. Aerosolised propylene glycol and glycerol produce mouth and throat irritation and dry cough. No data on the effects of flavouring inhalation were identified. Data on short-term health effects are limited and there are no adequate data on long-term effects. Aerosol exposure may be associated with respiratory function impairment, and serum cotinine levels are similar to those in traditional cigarette smokers. The high nicotine concentrations of some products increase exposure risks for non-users, particularly children. The dangers of secondhand and thirdhand aerosol exposure have not been thoroughly evaluated. CONCLUSIONS Scientific evidence regarding the human health effects of e-cigarettes is limited. While e-cigarette aerosol may contain fewer toxicants than cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive. Some evidence suggests that e-cigarette use may facilitate smoking cessation, but definitive data are lacking. No e-cigarette has been approved by FDA as a cessation aid. Environmental concerns and issues regarding non-user exposure exist. The health impact of e-cigarettes, for users and the public, cannot be determined with currently available data.
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Lim HB, Kim SH. Inhallation of e-Cigarette Cartridge Solution Aggravates Allergen-induced Airway Inflammation and Hyper-responsiveness in Mice. Toxicol Res 2014; 30:13-8. [PMID: 24795794 PMCID: PMC4007038 DOI: 10.5487/tr.2014.30.1.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/19/2014] [Accepted: 03/22/2014] [Indexed: 11/20/2022] Open
Abstract
Electronic cigarettes (e-cigarettes) are becoming increasingly popular worldwide and their cellular effects warrant further evaluation. In this study, we investigated the effects of an e-cigarette cartridge solution on allergen related asthmatic airway inflammation (AI) and airway hyperresponsiveness (AHR), when it is delivered by intratracheal route in mice. Asthmatic AI and AHR were induced by systemic sensitization to ovalbumin (OVA) followed by intratracheal, intraperitoneal, and aerosol allergen challenges in BALB/c mice. The cartridge solution of e-cigarette (containing 16 mg/ml nicotine) was diluted 50 times and 100 μl of the diluted solution was intratracheally instilled to OVA-sensitized (OVA-S) mice two times a week for 10 weeks. Long-term e-cigarette inhalation elicited no remarkable changes in the activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase enzymes in serum, however, increased infiltration of inflammatory cells including eosinophils, into airways from blood, aggravated the asthmatic AI and AHR, and stimulated the production of cytokines such as interleukin (IL)-4, IL-5 and IL-13, and OVA-specific IgE production. Our data suggest that the inhalation of e-cigarette solutions can function as an important factor to exacerbate the allergy-induced asthma symptoms. Further studies are needed to address the effects of e-cigarette solutions on human health.
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Affiliation(s)
- Heung Bin Lim
- Department of Industrial Crop Science and Technology, Chungbuk National University, Cheongju, Chungbuk, Korea
| | - Seung Hyung Kim
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon, Korea
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Bell K. Science, policy and the rise of ‘thirdhand smoke’ as a public health issue. HEALTH RISK & SOCIETY 2014. [DOI: 10.1080/13698575.2014.884214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Solheim J, Papa A, Lefton C. It’s Electric! J Emerg Nurs 2014; 40:75-7. [DOI: 10.1016/j.jen.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Paek HJ, Kim S, Hove T, Huh JY. Reduced harm or another gateway to smoking? source, message, and information characteristics of E-cigarette videos on YouTube. JOURNAL OF HEALTH COMMUNICATION 2014; 19:545-60. [PMID: 24117370 DOI: 10.1080/10810730.2013.821560] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
E-cigarettes are widely promoted on the Internet, but little is known about what kinds of information about them are available online. This study examines message, source, and health information characteristics of e-cigarette videos on the popular online video-sharing platform YouTube. A content analysis of 365 e-cigarette videos indicates that 85% of the videos were sponsored by marketers. These videos highlight e-cigarettes' economic and social benefits, featuring a low level of fear appeal and negative message valence and a high level of marketing information about e-cigarette products. They also convey certain health claims that have been proscribed by the U.S. Food and Drug Administration, the prevalence of which warrants ongoing monitoring and regulatory guidelines for online e-cigarette marketing.
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Affiliation(s)
- Hye-Jin Paek
- a Department of Advertising and Public Relations , Hanyang University , Ansan , Republic of Korea
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Faletau J, Glover M, Nosa V, Pienaar F. Looks like smoking, is it smoking?: children's perceptions of cigarette-like nicotine delivery systems, smoking and cessation. Harm Reduct J 2013; 10:30. [PMID: 24238406 PMCID: PMC3874641 DOI: 10.1186/1477-7517-10-30] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 11/16/2013] [Indexed: 11/20/2022] Open
Abstract
Background Alternative cigarette-like nicotine delivery systems have been met with diverse opinions. One concern has been for the effect on children. We investigate whether children can differentiate tobacco cigarette smoking from use of a nicotine inhaler and electronic cigarette. Their opinions on these devices was also of interest. Methods Two structured focus groups and twelve individual interviews were conducted with twenty Māori and Pacific children (6–10 years old) in low socioeconomic areas in Auckland, New Zealand. Children viewed short video clips on an iPad that demonstrated an actor smoking a tobacco cigarette, sucking a lollipop or using an electronic cigarette or a nicotine inhaler. Results Children did not recognise the inhaler or electronic cigarette. Some children did however notice anomalies in the ‘smoking’ behaviour. Once told about the products the children were mostly positive about the potential of the inhaler and electronic cigarette to assist smokers to quit. Negative perceptions were expressed, including views about the ill health effects associated with continued nicotine intake and the smoker’s inability to quit. Conclusions In a context unfamiliar with electronic cigarettes or nicotine inhalers, such as New Zealand, children may misperceive use of these products as smoking. Once these products are more common and the purpose of them is known, seeing people use them should normalise quitting behaviour, something the children were very supportive of.
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Affiliation(s)
| | - Marewa Glover
- Centre for Tobacco Control Research, School of Population Health, University of Auckland, Private 92019, Auckland 1142, New Zealand.
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Affiliation(s)
- Jennifer L. Reed
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ont
| | - Alan A. Gervais
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ont
| | - Robert D. Reid
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ont
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Bertholon J, Becquemin M, Annesi-Maesano I, Dautzenberg B. Electronic Cigarettes: A Short Review. Respiration 2013; 86:433-8. [DOI: 10.1159/000353253] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
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Kusel J, Timm B, Lockhart I. The impact of smoking in the home on the health outcomes of non-smoker occupants in the UK. Tob Induc Dis 2013; 11:3. [PMID: 23360643 PMCID: PMC3568010 DOI: 10.1186/1617-9625-11-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/16/2013] [Indexed: 11/10/2022] Open
Abstract
Smoking in the home remains a key source of exposure to secondhand smoke for non-smokers, particularly since the UK public smoking ban in 2007. A systematic literature review was conducted to identify all UK evidence on the impact of secondhand smoke exposure in the home on health and behavioural outcomes in non-smoker occupants. MEDLINE, EMBASE and the Cochrane Library were searched to identify all relevant UK empirical studies from 2000 to June 2011. A qualitative overview of the evidence is presented. Exposure to secondhand smoke in UK homes was found to be associated with serious negative health effects in non-smokers, including significantly increased risk of meningococcal carriage (p < 0.001) and disease (p = 0.05) in children and adolescents, cognitive impairment (p < 0.001) in adults, a higher rate of medically attended accidents in children with smoking mothers (p < 0.01), and for non-smoking women, a significant decrease in infant birth weight (p = 0.007). Living in a smoking household significantly increased the risk of future regular smoking in children (p < 0.001). In conclusion, this systematic review has identified strong evidence of an association between secondhand smoke exposure in the home and several serious health conditions. This finding highlights the importance of educating current smokers on the consequences of non-smoker exposure to smoking in the home.
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Affiliation(s)
- Jeanette Kusel
- Costello Medical Consulting Ltd, St John's Innovation Centre, Cowley Road, Cambridge, CB4 0WS, UK.
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Goniewicz ML, Zielinska-Danch W. Electronic cigarette use among teenagers and young adults in Poland. Pediatrics 2012; 130:e879-85. [PMID: 22987874 DOI: 10.1542/peds.2011-3448] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) are battery-powered devices developed with the goal of mimicking the action of smoking, including nicotine delivery, without the toxic effects of tobacco smoke. Little is known about the uptake of e-cigarettes among young people. METHODS A survey was conducted with a cluster sample of 20240 students enrolled at 176 nationally representative Polish high schools and universities between September 2010 and June 2011. We estimated national e-cigarette prevalence among various demographic groups by using population weights. Multiple logistic regression was used to evaluate which demographic factors were independent predictors of 2 outcomes: ever use of e-cigarettes and use in the previous 30 days. RESULTS Among high school students, aged 15 to 19 years, 23.5% had ever used e-cigarettes and 8.2% had done so within the previous 30 days. Among those in universities, aged 20 to 24 years, 19.0% had ever used an e-cigarette and 5.9% had done so in the previous 30 days. In multivariate analyses that controlled for covariates, smoking cigarettes, male gender, living in an urban area, and having parents who smoke were associated with ever use of e-cigarettes. Overall, 3.2% of never smoking students reported ever use of e-cigarettes. CONCLUSIONS About one-fifth of Polish youth have tried e-cigarettes; most of them had previously smoked cigarettes. It is unclear whether e-cigarettes are just a novelty that young people try only once or whether they have potential to compete in the marketplace with conventional cigarettes.
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Affiliation(s)
- Maciej Lukasz Goniewicz
- Tobacco Dependence Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, 55 Philpot Street, London, E1 2JH, UK.
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Goniewicz ML, Lingas EO, Hajek P. Patterns of electronic cigarette use and user beliefs about their safety and benefits: an internet survey. Drug Alcohol Rev 2012; 32:133-40. [PMID: 22994631 DOI: 10.1111/j.1465-3362.2012.00512.x] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 08/20/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS As the popularity of electronic cigarettes (e-cigarettes) increases, it is becoming important to find out more about the characteristics of e-cigarette users, why and how they use the product and whether e-cigarettes are used exclusively or in combination with conventional cigarettes. The objective of this study was to investigate patterns and effects of e-cigarette use and user beliefs about e-cigarette safety and benefits. DESIGN AND METHODS E-cigarette users in Poland were recruited online and asked to participate in a web-based survey. The participants provided information on their smoking history, patterns of e-cigarette use, beliefs and attitudes regarding the product and information on concurrent use of conventional cigarettes. RESULTS The survey was completed by 179 e-cigarette users. Almost all participants used e-cigarettes daily. E-cigarettes were primarily used to quit smoking or to reduce the harm associated with smoking (both 41%), and were successful in helping the surveyed users to achieve these goals with 66% not smoking conventional cigarettes at all and 25% smoking under five cigarettes a day. Most participants (82%) did not think that e-cigarettes were completely safe, but thought that they were less dangerous than conventional cigarettes. Sixty percent believed that e-cigarettes were addictive, but less so than conventional cigarettes. DISCUSSION AND CONCLUSIONS The participants primarily used e-cigarettes as a stop-smoking aid or as an alternative to conventional cigarettes, and the majority reported that they successfully stopped smoking. More data on e-cigarette safety and its efficacy in harm-reduction and smoking cessation are needed.
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Affiliation(s)
- Maciej L Goniewicz
- UK Centre for Tobacco Control Studies, Tobacco Dependence Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
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