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Sun Y, Prabhu P, Rahman R, Li D, McIntosh S, Rahman I. e-Cigarette Tobacco Flavors, Public Health, and Toxicity: Narrative Review. Online J Public Health Inform 2024; 16:e51991. [PMID: 38801769 PMCID: PMC11165290 DOI: 10.2196/51991] [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: 08/19/2023] [Revised: 11/08/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Recently, the US Food and Drug Administration implemented enforcement priorities against all flavored, cartridge-based e-cigarettes other than menthol and tobacco flavors. This ban undermined the products' appeal to vapers, so e-cigarette manufacturers added flavorants of other attractive flavors into tobacco-flavored e-cigarettes and reestablished appeal. OBJECTIVE This review aims to analyze the impact of the addition of other flavorants in tobacco-flavored e-cigarettes on both human and public health issues and to propose further research as well as potential interventions. METHODS Searches for relevant literature published between 2018 and 2023 were performed. Cited articles about the toxicity of e-cigarette chemicals included those published before 2018, and governmental websites and documents were also included for crucial information. RESULTS Both the sales of e-cigarettes and posts on social media suggested that the manufacturers' strategy was successful. The reestablished appeal causes not only a public health issue but also threats to the health of individual vapers. Research has shown an increase in toxicity associated with the flavorants commonly used in flavored e-cigarettes, which are likely added to tobacco-flavored e-cigarettes based on tobacco-derived and synthetic tobacco-free nicotine, and these other flavors are associated with higher clinical symptoms not often induced solely by natural, traditional tobacco flavors. CONCLUSIONS The additional health risks posed by the flavorants are pronounced even without considering the toxicological interactions of the different tobacco flavorants, and more research should be done to understand the health risks thoroughly and to take proper actions accordingly for the regulation of these emerging products.
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Affiliation(s)
- Yehao Sun
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Prital Prabhu
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Ryan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical & Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
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Ma H, Daisy Dai H. Factors associated with intentions to quit vaping and quit attempts among Adolescents: A structural equation modeling approach. Addict Behav 2024; 157:108074. [PMID: 38852380 DOI: 10.1016/j.addbeh.2024.108074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/05/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Previous youth tobacco research has identified multiple factors relating to intentions to quit vaping and quit attempts among current e-cigarette users in adolescents. The pathways in the complex associations with vaping cessation behaviors remain unclear. METHODS Using data from the 2022 National Youth Tobacco Survey (NYTS) (grades 6-12), structural equation models (SEMs) are developed to examine the associations of social environment, vaping risk perceptions, e-cigarette marketing, vaping characteristics, and demographics with two outcome measures - intentions to quit vaping and past year quit attempts among current e-cigarette users. RESULTS The national sample of current e-cigarette users (n = 2,701) consisted of 52.7 % females, 47.0 % non-Hispanic Whites, 80.1 % high school students, and 56.2 % heterosexual individuals. Among them, 70.2 % reported intentions to quit vaping and 66.3 % reported past year quit attempts. The protective factor for quit intentions was vaping risk perceptions (p < 0.001). Risk factors included e-cigarette marketing (p = 0.04), dual use of e-cigarettes and other tobacco products (p = 0.003), vaping due to feeling anxious or stressed (p = 0.01), vaping for nicotine buzz (p = 0.002), nicotine dependence (p = 0.02), identifying as Gay or Lesbian (p < 0.001), bisexual (p = 0.03), or Hispanic (p = 0.04). Similar associations were observed with quit attempts except that e-cigarette marketing, vaping due to feeling anxious or stressed, vaping dependence, and identifying as Hispanic were not significant. Besides, high vaping frequency (p < 0.001), grade level (p < 0.001) and not sure about sexual orientation (p = 0.01) were also negatively associated with quit attempts. CONCLUSIONS This study provided insights into factors influencing vaping cessation outcomes among adolescent current e-cigarette users. Developing tailored vaping cessation programs based on these findings could enhance quit success.
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Affiliation(s)
- Haijing Ma
- College of Liberal Arts and Social Sciences, University of Houston-Victoria, Victoria, TX 77901, USA.
| | - Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
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McKay F, Chan L, Cerio R, Rickards S, Hastings P, Reakes K, O'Brien T, Dunn M. Assessing the Quality and Behavior Change Potential of Vaping Cessation Apps: Systematic Search and Assessment. JMIR Mhealth Uhealth 2024; 12:e55177. [PMID: 38532616 PMCID: PMC11004626 DOI: 10.2196/55177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Background An increasing number of people are using vapes (e-cigarettes), and with growing evidence of associated harms, there is a need for acceptable cessation support and interventions. Smartphone apps for health and well-being have increased in popularity and use. Limited published literature assesses the potential of apps to support vaping cessation. Objective A systematic search of vaping cessation apps currently available in Australia for iOS and Android platforms was conducted. Apps were assessed against established health app assessment tools for quality and behavior change potential. Methods A systematic search through the Australian Apple iTunes and Google Play stores was conducted using the search terms "vape"; "vaping"; "e-cigarette"; and "cessation," "quit," or "quitting" in May 2023. Only apps that encouraged the cessation of vaping were included. App descriptions were reviewed to determine if they were relevant for inclusion in this study, and relevant apps were downloaded onto the appropriate mobile device for review. The Mobile App Rating Scale (MARS) was used to rate the quality (engagement, functionality, aesthetics, and information) of the apps using an overall score out of 5. The App Behavior Change Scale (ABACUS) was used to assess the behavior change potential of each app using a score out of 21. Results An initial search of the app stores yielded 220 Android apps and 124 iOS apps. Screening against the inclusion criteria left 20 iOS apps and 10 Android apps for review. Six apps were available on both operating systems, and these were downloaded, reviewed, and reported separately for each operating system. The average MARS score for all apps assessed in this review was 3.1 (SD 0.41) out of 5. The reviewed apps overall performed well for the MARS elements relating to functionality, such as ease of use and navigation, but had the lowest scores for information-related elements, such as credibility. The number of ABACUS behavior change features per app ranged from 0 to 19 out of 21, with a mean of 8.9 (SD 4.51). The apps commonly included information-related features, such as requesting baseline information. The least common behavior change features were those relating to goal-setting, such as asking about the user's willingness for behavior change and providing feedback on current actions in comparison to future goals. Conclusions The identified vaping cessation apps had moderate levels of quality and some behavior change components. Future vaping cessation apps could benefit from including more features that are known to support behavior change, such as goal-setting, to improve the potential benefit of these apps to support people to stop vaping. As guidelines for vaping cessation continue to be established, future apps need to reference these in their development.
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Affiliation(s)
- Fiona McKay
- Instutite for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- The School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Lilian Chan
- Cancer Institute of New South Wales, St. Leonards, New South Wales, Australia
| | - Rebecca Cerio
- Cancer Institute of New South Wales, St. Leonards, New South Wales, Australia
| | - Sandra Rickards
- Cancer Institute of New South Wales, St. Leonards, New South Wales, Australia
| | - Phillipa Hastings
- Cancer Institute of New South Wales, St. Leonards, New South Wales, Australia
| | - Kate Reakes
- Cancer Institute of New South Wales, St. Leonards, New South Wales, Australia
| | - Tracey O'Brien
- Cancer Institute of New South Wales, St. Leonards, New South Wales, Australia
| | - Matthew Dunn
- Instutite for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- The School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Holt LJ, Latimer LJ. Emerging Adults' Experiences with E-Cigarette Cessation. Subst Use Misuse 2024; 59:405-410. [PMID: 37932876 DOI: 10.1080/10826084.2023.2275563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Background: The use of electronic nicotine delivery systems (ENDS) is one of the most common substance use behaviors in college students, yet most individuals show some interest in quitting. The current study added to the limited literature on ENDS cessation by examining readiness to quit and the use and perceived efficacy of ENDS cessation methods in a heterogeneous sample of college students. Methods: Students 18-24 years in Psychology courses (N = 1563; 73% female) from six US universities completed an online survey between September 2021-April 2022. Results: Nearly half the sample (n = 738, 47%) reported lifetime ENDS use and nearly half of lifetime users (n = 356, 48%) reported a quit attempt. Most ENDS users reported some readiness to quit (n = 251, 67%). Quitting "cold turkey", using willpower, and replacing ENDS use with another activity were endorsed most frequently; strategies were perceived as more helpful if students had direct experience with them. Social support (e.g., counseling, groups, family/friend support) and nicotine replacement products were perceived as effective but were utilized infrequently. Digital tools (i.e., apps, text messaging) were perceived to be least helpful and were utilized infrequently. Conclusion: Most college students who use ENDS are interested in quitting and have relied on unassisted methods for cessation. Our data suggest a significant opportunity for college personnel and public health officials to further enhance awareness and uptake of ENDS cessation resources for this demographic. Digital tools that integrate social support may be especially effective given their low cost, demonstrated efficacy, and alignment with students' preferences for social support.
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Do EK, Tulsiani S, Edwards G, Cha S, Amato MS, Hair EC. Treatment-seeking young people enrolled in a United States vaping cessation intervention trial report high frequency of use and nicotine dependence. Prev Med Rep 2023; 36:102533. [PMID: 38116264 PMCID: PMC10728452 DOI: 10.1016/j.pmedr.2023.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
Objective This study examines characteristics of participants enrolled in a vaping cessation intervention trial and study generalizability of the treatment-seeking sample to the broader population of young people interested in quitting vaping to evaluate dissemination of an evidence-based treatment program. Methods Data was obtained from 697 treatment-seeking participants (aged 13-24 years) from a vaping cessation intervention trial conducted between February and March 2023 with This is Quitting and 665 participants who expressed intent to quit vaping in the Truth Longitudinal Cohort, a nationally representative longitudinal study of United States youth and young adults (aged 15-24 years), collected October 2022 to February 2023. Comparisons were made using two-sample Pearson Chi-square tests and t-tests. Results Treatment-seeking young people were younger, less racially diverse, more diverse in sexual orientation, and reported higher psychological distress, frequency of e-cigarette use, and nicotine dependence, relative to the nationally representative sample of young people expressing intentions to quit vaping. Conclusions Participants enrolled in treatment reported higher levels of dependence and use frequency than the broader population, suggesting that many young e-cigarette users with lower dependence who want to quit might not be reached by current treatment dissemination efforts. The implication of these findings is that communications for vaping cessation programs may need to be adjusted to have broader appeal among young people.
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Affiliation(s)
| | | | | | - Sarah Cha
- Innovations, Truth Initiative, Washington, DC, USA
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Webb J, Lin YT, Ang A, Michero D, Majeed A, Eisingerich A, Glasner S. Feasibility and Preliminary Outcomes of a Mobile Intervention Combining Cognitive Behavioral Therapy, Virtual Coaching, and Nicotine Replacement Therapy for Nicotine Vaping Cessation. TELEMEDICINE REPORTS 2023; 4:48-52. [PMID: 37102136 PMCID: PMC10125401 DOI: 10.1089/tmr.2023.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Despite research demonstrating that those who use e-cigarettes, also known as vaping, express an interest in quitting, evidence-based vaping cessation interventions are lacking. The purpose of this study was to examine the feasibility and preliminary outcomes of an mHealth vaping cessation intervention. METHODS Adults (N = 51) who were vaping nicotine were recruited online and enrolled in a 6-week mHealth intervention combining nicotine replacement therapy (NRT), self-guided cognitive behavioral therapy (CBT), and coaching support through telephone and asynchronous messaging. Feasibility and self-reported 7- and 30-day abstinence were assessed at baseline and 1-month postquit date. RESULTS The majority of participants completed treatment (45/51) and found the intervention helpful in supporting their vaping behavior change objectives. At 1-month postquit date, 48.9% (22/45) of study completers reported 7-day point prevalence abstinence and 28.8% (13/45) reported continuous 30-day abstinence. CONCLUSIONS Findings provide preliminary support for an mHealth intervention approach to vaping cessation combining remote CBT-based coaching with NRT.
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Affiliation(s)
- Jamie Webb
- Department of Clinical Affairs, Digital Therapeutics, Inc., San Francisco, California, USA
| | - Yu-Ting Lin
- School of Marketing, University of New South Wales, Sydney, Australia
- Imperial College Business School, Imperial College London, London, United Kingdom
| | - Alfonso Ang
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
| | - Darcy Michero
- Department of Clinical Affairs, Digital Therapeutics, Inc., San Francisco, California, USA
| | - Azeem Majeed
- School of Medicine, Imperial College London, London, United Kingdom
| | - Andreas Eisingerich
- Imperial College Business School, Imperial College London, London, United Kingdom
| | - Suzette Glasner
- Department of Clinical Affairs, Digital Therapeutics, Inc., San Francisco, California, USA
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
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