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Etter JF. An 8-year longitudinal study of long-term, continuous users of electronic cigarettes. Addict Behav 2024; 149:107891. [PMID: 37866230 DOI: 10.1016/j.addbeh.2023.107891] [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: 05/23/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND AIMS E-cigarettes have been available for over 15 years, but relatively little is known about long-term users. Our aim was to describe change over time in behaviours, attitudes and dependence in long-term users. DESIGN AND PARTICIPANTS A longitudinal study of 375 e-cigarette users enrolled on the Internet in 2012-2016 and surveyed again in 2021 (8 years later on average), who continuously used e-cigarettes in the interval. FINDINGS Fewer people in 2021 (11 %) than at baseline (33 %) had smoked tobacco in the past 31 days. Participants switched from second-generation models at baseline (e.g. Ego) to box mods in 2021 (e.g. iStick), they used larger refill bottles, they used home-made e-liquids twice as often, they used tobacco flavours less often and the nicotine concentration in e-liquids decreased from 12 to 6 mg/mL. There was no change over time in the time to the first e-cigarette puff of the day, but an e-cigarette dependence score of 0-100 decreased from 75 to 60, the frequency and strength of urges to vape decreased (from 31 % to 18 % of "strong" urges) and the proportion of people who said they would be likely to succeed if they tried to stop vaping increased. Compared to baseline, fewer people in 2021 reported vaping to cope with cravings or other smoking cessation symptoms, and fewer people reported vaping to quit smoking, to avoid relapse into smoking, or to reduce their tobacco consumption (p < 0.001 for all differences). CONCLUSIONS In long-term, continuous users, over a period of 8 years, substantial changes were observed in the models of e-cigarettes used, in the flavours and strength of e-liquids, and in the reasons for vaping. Their level of nicotine dependence tended to decrease over time. These users were satisfied with e-cigarettes and vaped mostly because they felt that vaping was less dangerous than smoking, and for enjoyment.
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Affiliation(s)
- Jean-François Etter
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland.
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Cho GH, Jang YS, Shin J, Nam CM, Park EC. Association between having a meal together with family and smoking: a cross-sectional nationwide survey. BMC Public Health 2023; 23:2261. [PMID: 37974130 PMCID: PMC10655278 DOI: 10.1186/s12889-023-17155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Smoking is a major risk factor that significantly affects public health. Although the South Korean government spends significant money on smoking cessation services, the smoking rate remains stagnant. Families influence health-conscious decisions, and family meals can positively affect smoking suppression and health behaviors. Therefore, this study investigated whether family meals are correlated with adults' smoking behaviors. METHODS This study used data from the 2019-2021 Korean National Health and Nutrition Examination Survey. Having a meal together with family was defined as "yes" for those who have at least one meal with their family each day and "no" for those who do not. Current smoking status was classified as having smoked at least 5 packs of cigarettes (100 cigarettes) in one's lifetime and having used either conventional cigarettes or e-cigarettes in the last 30 days. Multiple logistic regression analyses were used to examine the association between eating together, smoking, and weight application. RESULTS When comparing the group that ate with their family compared to the group that did not, the odds ratio for current smoking status was 1.27 (95% confidence interval [CI]: 1.05-1.54) for male participants and 1.90 (95% CI: 1.33-2.71) for female participants. This showed a dose-dependent effect according to the frequency of family meals. Those who smoked conventional cigarettes had a strong association (men: OR 1.28, 95% CI 1.00-1.67; women: OR 2.22, 95% CI 1.42-3.46). However, those who only vaped e-cigarettes or used both conventional cigarettes and e-cigarettes had no statistically significant correlations. CONCLUSION This study provides evidence suggesting that eating meals as a family is related to smoking behavior and can positively affect smoking cessation intentions in adults. Consequently, a smoking cessation program can be developed that uses social support, such as encouraging family meals.
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Affiliation(s)
- Gun Hee Cho
- Department of Social Policy Desk, Dong-A Ilbo, Seoul, Republic of Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Chung-Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Alaamri S, Naser AY. Knowledge and Attitudes Toward E-cigarette Use: A Cross-Sectional Study From Saudi Arabia. Cureus 2023; 15:e49583. [PMID: 38156125 PMCID: PMC10754474 DOI: 10.7759/cureus.49583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Background In light of the fact that electronic cigarette (e-cigarette) use is a newly emerging behavior in the Middle Eastern region, where tobacco consumption is widespread, it is imperative to examine the present state of e-cigarette awareness and attitudes toward e-cigarettes. The aim of this research is to investigate the level of knowledge and attitudes pertaining to the utilization of e-cigarettes within the context of Saudi Arabia. Methodology A cross-sectional online survey study was conducted between May and September 2023 to assess public knowledge and attitudes toward e-cigarettes in Saudi Arabia. This study utilized a previously validated questionnaire to assess the knowledge and attitudes of participants regarding e-cigarettes. Binary logistic regression analysis was used to identify predictors of being knowledgeable of and having a positive attitude toward e-cigarettes. Results A total of 422 participants were involved in this study. Around one-third of the study participants were current smokers (37.2%). The median knowledge score for the study participants was 13.00 (11.00-14.00), which reflects a high level of e-cigarette knowledge. The median knowledge score for the study participants ranged between 3.00 and 15.00. The median attitude score for the study participants was 3.00 (1.00-5.00), which reflects a negative attitude toward the use of e-cigarettes. The median attitude score for the study participants ranged between 0.00 and 12.00. Participants with a monthly income of 5,001 SAR and above were more likely to be knowledgeable about e-cigarette use (p < 0.05). However, binary logistic regression analysis did not identify any statistically significant predictor of positive attitude toward the use of e-cigarettes (p > 0.05). Conclusions The study population exhibited a significant level of knowledge regarding e-cigarettes, which was coupled with a prevailing negative attitude toward their use. The income level of individuals emerged as a significant predictor of e-cigarette knowledge. To obtain a comprehensive knowledge of the factors that contribute to negative attitudes toward e-cigarette usage, particularly among specific demographic groups, it is imperative to employ a qualitative research methodology.
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Affiliation(s)
- Shalan Alaamri
- Department of Medicine, College of Medicine, University of Jeddah, Jeddah, SAU
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Isra University, Faculty of Pharmacoepidemiology, Amman, JOR
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Wang J, Wang Y, Zhou W, Huang Y, Yang J. Impacts of cigarette smoking on blood circulation: do we need a new approach to blood donor selection? JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:62. [PMID: 37408051 DOI: 10.1186/s41043-023-00405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
Smoking is a major public health problem and is considered the leading cause of preventable death worldwide. Gas-phase smoke carries bioactive substances and toxic compounds, affecting human health and reducing life spans. The negative effects of smoking on red blood cell (RBC) quality include destroying RBCs and increasing carboxy hemoglobin (COHb). Smoking increases the concentrations of heavy metals such as cadmium (Cd) and lead (Pb) in the blood. Moreover, tobacco smoking has been found to be associated with heightened platelet (PLT)-dependent thrombin level which will induce a prothrombotic state. Smoking may affect the blood circulation of donors, and subsequently the blood components, and ultimately the recipients of transfusion. Nevertheless, there are no restrictions on smoking for volunteer blood donor screenings currently. We reviewed the articles about the influence of smoking on smokers' blood circulation as well as the impact of donated blood products on transfusion when these smokers act as blood donors. We aim to attract blood collection centers' attention to strengthen the management of blood donors who smoke, avoiding their use in massive transfusion protocol and susceptible recipients, especially pediatric ones.
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Affiliation(s)
- Jie Wang
- Department of Transfusion, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Yuhan Wang
- Department of Laboratory Medicine, Luzhou Longmatan District People's Hospital, Luzhou, 625000, Sichuan Province, People's Republic of China
| | - Weixin Zhou
- Department of Transfusion, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Yuanshuai Huang
- Department of Transfusion, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Jianbo Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, People's Republic of China.
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Temourian AA, Song AV, Halliday DM, Gonzalez M, Epperson AE. Why do smokers use e-cigarettes? A study on reasons among dual users. Prev Med Rep 2022; 29:101924. [PMID: 35911573 PMCID: PMC9334340 DOI: 10.1016/j.pmedr.2022.101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
Objective There is minimal research that has measured motivations behind e-cigarette use and the relationship to cigarette and e-cigarette use. The aim of this study was to (1) examine extent to which motivations to use e-cigarettes varies among dual users and (2) examine whether e-cigarette motivations are related to e-cigarette and cigarette consumption among dual users. Methods Adults residing in California were recruited through social media (n = 1762, 68.9 % males, 62.9 % White) to complete an online survey. Participants self-identified as using combustible cigarettes and e-cigarettes (dual users) and reported their motivations for using an e-cigarette device, nicotine consumption, and nicotine dependence with both combustible cigarettes and e-cigarettes. Results A greater proportion of people reported using e-cigarettes for enjoyment purposes than other motivations (34.2 %). Motivations to use e-cigarettes to quit were positively related to monthly cigarette consumption (IRR = 1.17, 95 % CI [1.08, 1.26]). Motivations to use e-cigarettes to quit smoking were also related to smoking the first cigarette within 30 min (IRR = 1.46, 95 % CI [1.05, 2.02]) and first e-cigarette within 30 min (b = 0.28, 95 % CI [0.19, 0.37]). Conclusions Compared to those who use e-cigarettes for enjoyment, smokers who are motivated to use e-cigarettes for cessation purposes are more likely to have greater nicotine dependence, cigarette consumption, and e-cigarette consumption. Future research needs to acknowledge that not all e-cigarette users are the same; motivations and use differ and are related to both consumption and dependence.
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Affiliation(s)
- Allison A Temourian
- Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, USA
| | - Anna V Song
- Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, USA.,Nicotine and Cannabis Policy Center, University of California, Merced, USA
| | - Deanna M Halliday
- Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, USA.,Nicotine and Cannabis Policy Center, University of California, Merced, USA
| | - Mariaelena Gonzalez
- Nicotine and Cannabis Policy Center, University of California, Merced, USA.,Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced, USA
| | - Anna E Epperson
- Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, USA.,Nicotine and Cannabis Policy Center, University of California, Merced, USA
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Participant Experiences of a Quit Smoking Attempt Through Either Nicotine Replacement Therapy (NRT) Methods or the Use of an E-cigarette. J Addict Med 2022; 16:272-277. [PMID: 34128486 DOI: 10.1097/adm.0000000000000881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There is a lack of evidence exploring experiences of using e-cigarettes for smoking cessation. The study's main aim was to explore participant experiences of e-cigarettes compared to nicotine replacement therapy (NRT) delivered through stop smoking services. METHODS Semi-structured, face-to-face, and telephone interviews at 3-month post-quit follow-up in a randomized controlled trial comparing nicotine-containing e-cigarettes, nicotine-free e-cigarettes, and NRT for smoking cessation. N = 17 participants, 9 were male, mean age 44 years, 5 using nicotine-containing e-cigarettes, 7 nicotine-free e-cigarettes, and 5 NRT. Interviews were transcribed and analyzed using thematic analysis. RESULTS Two global themes and 5 organizing themes were identified. Global themes included: (1) experiences of e-cigarette and NRT quit aids (e-cigarette positive impact and dilemmas, NRT perceptions and experiences), and (2) key mechanisms to support quit attempt (physical aids, advice and support, feedback and structure). E-cigarettes were viewed with caution, however, generally evaluated positively alongside NRT methods, finding e-cigarettes useful during a quit attempt due to their versatility in application. Nicotinecontaining e-cigarettes were favored due to their support with nicotine cravings. Participants were, however, wary of replacing smoking addiction with vaping habit. CONCLUSIONS Participant e-cigarette experience were generally positive; however, concerns over long-term application were noted. There was a noticeable preference for nicotine-containing e-cigarettes, but further research is required to better understand how nicotine is used in conjunction with e-cigarettes long-term as a quit aid alongside other NRT.
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Osibogun O, Bursac Z, Maziak W. Longitudinal transition outcomes among adult dual users of e-cigarettes and cigarettes with the intention to quit in the United States: PATH Study (2013-2018). Prev Med Rep 2022; 26:101750. [PMID: 35256929 PMCID: PMC8897625 DOI: 10.1016/j.pmedr.2022.101750] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Many dual users of e-cigarettes/cigarettes report using e-cigarettes with the ITQ. Data was from 3,542 adults (≥18 years) from the PATH cohort (2013–2018). Dual users with ITQ were compared with mono cigarette smokers with ITQ. Dual users with ITQ were less likely to transition to cessation. This needs to be considered when assessing the population impact of e-cigarettes.
Many adult dual users of e-cigarettes and cigarettes in the United States report using e-cigarettes with the intention to quit (ITQ) smoking. This study examined transition outcomes among adult dual users of e-cigarettes and cigarettes with the ITQ compared to mono cigarette smokers with ITQ. We conducted a longitudinal analysis of 3,542 adults aged ≥ 18 years with data from Waves 1 and 4 of the United States Population Assessment of Tobacco and Health study (2013–2018) between May 2021 and January 2022. Current dual users (e-cigarettes and cigarettes use on ≥ 20 days in the past month) with the ITQ were compared to current mono cigarette smokers with the ITQ for transition outcomes (cessation, mono e-cigarette, mono cigarette and dual use) three years later. We conducted multinomial logistic regression modeling adjusting for potential confounders and reported the adjusted relative risk ratios (aRRR) with 95% confidence intervals (CI) for the transition outcomes. Approximately 10.7% (7.8–14.3) of dual users with the ITQ (in 2013) reported cessation (no past-month use of any tobacco) three years later, compared to 16.1% (14.6–17.7) of mono cigarette smokers. Dual users were 83% and 79% less likely to transition to cessation (aRRR: 0.17, 95% CI:0.09–0.32) or mono cigarette use (0.21, 0.14–0.32), respectively, compared to mono cigarette smokers. Our findings show that in a real-world scenario, dual e-cigarette and cigarette use may hinder rather than facilitate smoking cessation among those interested in quitting. This needs consideration when assessing the population impact of e-cigarettes and their role in harm reduction.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
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Shin YM, Hunt DP, Akwe J. An Epidemic Supplanted by a Pandemic: Vaping-Related Illness and COVID-19. South Med J 2021; 115:8-12. [PMID: 34964053 PMCID: PMC8719436 DOI: 10.14423/smj.0000000000001344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Before the coronavirus disease 2019 (COVID-19) pandemic, vaping-related illness was the prevailing public health concern. The incidence of vaping-related illnesses from vaping product use–associated lung injury declined with the arrival of COVID-19, but e-cigarette, or vaping, product use–associated lung injury should still be considered as a differential diagnosis for people with COVID-19 for reasons outlined in this review. This narrative review describes vaping devices, summarizes the adverse health effects of vaping on the lungs and other systems, considers the potential interplay between vaping and COVID-19, and highlights gaps in knowledge about vaping that warrant further research. Before the coronavirus disease 2019 (COVID-19) pandemic, vaping-related illness was the prevailing public health concern. The incidence of vaping-related illnesses—mainly e-cigarette, or vaping, product use–associated lung injury (EVALI)—went from a peak in September 2019 to a low in February 2020, and the Centers for Disease Control and Prevention decided to discontinue the collection of EVALI case reports. Despite the decrease in EVALI with the arrival of COVID-19, EVALI should still be considered a differential diagnosis for people with COVID-19 for reasons outlined in this review. This narrative review describes vaping devices, summarizes the adverse health effects of vaping on the lungs and other systems, considers the potential interplay between vaping and COVID-19, and highlights gaps in knowledge about vaping that warrant further research.
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Affiliation(s)
- Yoo Mee Shin
- From the Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel P Hunt
- From the Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Joyce Akwe
- From the Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia
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Kaplan B, Galiatsatos P, Breland A, Eissenberg T, Cohen JE. Effectiveness of ENDS, NRT and medication for smoking cessation among cigarette-only users: a longitudinal analysis of PATH Study wave 3 (2015-2016) and 4 (2016-2017), adult data. Tob Control 2021; 32:302-307. [PMID: 34526410 PMCID: PMC10176346 DOI: 10.1136/tobaccocontrol-2020-056448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/20/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Research is inconclusive on the effectiveness of electronic nicotine delivery systems (ENDS) as cigarette cessation aids compared with nicotine replacement therapy (NRT) or non-NRT medication. This study compared the cigarette cessation rates for ENDS, NRT and non-NRT medication. METHOD Population Assessment of Tobacco and Health Study wave 3 cigarette-only users who used ENDS, NRT or non-NRT medication (varenicline and bupropion) to quit smoking between wave 3 and 4 were included. 'Cessation' was defined as being a former cigarette smoker in wave 4. χ2, logistic regression, and a sensitivity analysis with Bayes factor assessed the association between quitting smoking and method used. RESULTS Among 6794 cigarette-only users, 532 used ENDS (n=75), NRT (n=289), non-NRT medication (n=68), or a combination of NRT and non-NRT medication (n=100) to quit smoking between wave 3 and 4. The percentages of quitting smoking among those who used ENDS, NRT, non-NRT medication, and a combination of NRT and non-NRT medication were 16.2% (n=14), 16.1% (n=47), 17.7% (n=13), and 14.8% (n=12), respectively (p=0.97). None of the cigarette-only users who used ENDS to quit smoking became ENDS-only users in wave 4; 37.6% became dual users of ENDS and cigarettes. CONCLUSION No differences were found when cessation rates of ENDS, NRT or non-NRT medication were compared. Given uncertainty about the long-term health effect of ENDS and the likelihood of becoming dual users, people who smoke and need assistance quitting should be encouraged to use current Food and Drug Administration-approved cessation methods until more effective methods are developed.
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Affiliation(s)
- Bekir Kaplan
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Panagis Galiatsatos
- Division of Pulmonary & Critical Care Medicine, Tobacco Treatment Clinic, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
| | - Alison Breland
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kang HS, Jung JW, Park HJ, Park DI, Park JS, Park JH, Lee SH, Chun EM, Kim JY, Choi HS. A pilot investigation of e-cigarette use and smoking behaviour among patients with chronic airway disease or respiratory symptoms. CLINICAL RESPIRATORY JOURNAL 2021; 16:17-26. [PMID: 34486226 PMCID: PMC9060118 DOI: 10.1111/crj.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
Background This pilot study aimed to investigate the current status of e‐cigarettes (ECs) use patterns among patients with chronic airway disease or chronic respiratory symptoms and the effects of ECs use on respiratory and mental health. Methods A cross‐sectional survey was conducted at the outpatient clinic of eight teaching hospitals in South Korea between November 2019 and December 2019. All adult ECs users (19 years and above) who visited the outpatient clinic as a patient with chronic airway disease or chronic respiratory symptoms were eligible to participate in this study. Results A total of 51 subjects responded to the survey. Most of the participants were male (92.2%) and the mean age was 41.8 years. Dominant airway diseases were asthma and chronic obstructive pulmonary disease. Most of the subjects had a history of cigarette smoking, and 19 subjects were dual users of current cigarettes and ECs. Most of the subjects started ECs use due to health‐related reasons. When comparing exclusive ECs users and dual users, St. George's respiratory questionnaire (SGRQ) scores, the proportion of cases with moderate to severe depressive symptoms, and average Fagerstrom test for nicotine dependence scores for ECs were higher in dual users than exclusive ECs users (mean 4.64 vs. 2.38, p = 0.006), respectively. Conclusion Most of the subjects started ECs use due to health concerns, but dual users have more respiratory symptoms and higher nicotine dependence in this pilot study. One hypothesis that comes from these results is that greater nicotine dependence may influence behaviours, habits, and views about ECs. These preliminary observations need confirmation in a large cohort.
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Affiliation(s)
- Hye Seon Kang
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Woo Jung
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hye Jung Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Dong Il Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jong Sook Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea
| | - Joo Hun Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ajou University, Suwon, Republic of Korea
| | - Sang Haak Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Mi Chun
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jae Yeol Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hye Sook Choi
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
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AL-Qaysi WW, Abdulla FH. Analytical methods for the identification of micro/nano metals in e-cigarette emission samples: a review. CHEMICKE ZVESTI 2021; 75:6169-6180. [PMID: 34421189 PMCID: PMC8370834 DOI: 10.1007/s11696-021-01779-5] [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: 02/05/2021] [Accepted: 07/04/2021] [Indexed: 12/04/2022]
Abstract
In this review, numerous analytical methods to quantify the heavy and trace elements emitted from electronic cigarettes, cigarettes liquid and atomizer. The selection of a method was dependent upon the purpose, e.g., quantification or identification of elements only. The introductory part of this review focuses on describing the importance of setting up an electronic cigarettes- associated safety profile. The review dealt with studies that assessed elements in sizes ranging from nano to micro. The formation of different degradation chemical substances as well as impurity trends can be indicated through chemical investigation of metals in electronic cigarettes. Some studies have been covered that show the uses and benefits of. It is noticeable from all the collected sources that the minerals emitted from the smoke of e- cigs do not constitute any significant damage, as the percentage is very small, with the exception of minerals that may be emitted from the components of the device after heating it if the components of the e- cig are of poor specifications, except in the case of long-term accumulation. For this reason, an electronic cigarette can help smokers to quit smoking tobacco and replace it with electronic cigarettes smoke with distinctive flavors.
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Affiliation(s)
- Wafaa Waleed AL-Qaysi
- Institute of Analytical Chemistry, Chemo and Biosensors, University of Regensburg, Universitätsstraße 31, 93040 Regensburg, Germany
- Department of Chemistry, College of Science, University of Baghdad, Al-Jadriya campus, 10071 Baghdad, Iraq
| | - Fatma H. Abdulla
- Department of Chemistry, College of Science, University of Baghdad, Al-Jadriya campus, 10071 Baghdad, Iraq
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Conner TS, Zeng J, Blank ML, He V, Hoek J. A Descriptive Analysis of Transitions from Smoking to Electronic Nicotine Delivery System (ENDS) Use: A Daily Diary Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126301. [PMID: 34200773 PMCID: PMC8296109 DOI: 10.3390/ijerph18126301] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We aimed to examine patterns in smoking and electronic nicotine delivery system (ENDS) use over an extended period of time (up to 20 weeks) in people who smoked and who had never previously made a successful quit attempt using an ENDS. DESIGN AND SETTING We conducted a longitudinal mixed-methods study in Dunedin, New Zealand, during 2018 and 2019. PARTICIPANTS Purposively selected participants (N = 45; age (≥18 years), gender, ethnicities, cigarettes/day) who wished to quit smoking. INTERVENTIONS Participants were provided with a second-generation ENDS device (vape pen or starter "tank" device) at the start of their quit attempt, and asked to complete smartphone-based daily diary surveys assessing smoking and ENDS use. OUTCOME MEASURES Sunburst plots and a sequence plot were used to describe weekly and daily patterns of smoking and ENDS use (smoking only, ENDS use only, dual use, abstinent). RESULTS The most frequently reported movements among participants, classified according to their study week behaviour, occurred between dual use and exclusive ENDS use (and vice versa). A smaller group reported moving from dual use to exclusive smoking (and often back to dual use), and a small number reported moving between abstinence and different ENDS and smoked tobacco usage behaviours. Data visualisations focussing on those participants who had provided data during each of weeks 9-12 indicate that only a minority reported sustained dual use; instead, most participants indicated varied smoked tobacco and ENDS use, which included periods of dual use. CONCLUSIONS The considerable variety observed within and between study participants suggests that high variability is typical rather than exceptional. Transitions from smoking to ENDS use may involve considerable periods of dual use, which is likely to be dynamic and potentially sustained over several months.
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Affiliation(s)
- Tamlin S. Conner
- Department of Psychology, University of Otago, Dunedin 9054, New Zealand
- Correspondence:
| | - Jiaxu Zeng
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9054, New Zealand; (J.Z.); (M.-L.B.); (V.H.)
| | - Mei-Ling Blank
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9054, New Zealand; (J.Z.); (M.-L.B.); (V.H.)
| | - Vicky He
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9054, New Zealand; (J.Z.); (M.-L.B.); (V.H.)
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington 6242, New Zealand;
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13
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Mayorga NA, Rogers AH, Smit T, Garey L, Zvolensky MJ. Evaluating the psychometric properties of the e-cigarette barriers to cessation scale. Cogn Behav Ther 2021; 50:492-508. [PMID: 33910485 DOI: 10.1080/16506073.2021.1901773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Evidence suggests that electronic cigarette (e-cigarette) users have difficulty quitting e-cigarettes. The Electronic Cigarette Barriers to Cessation Scale (E-BCS) was developed to assess barriers to cessation among e-cigarette users. Yet, no work has evaluated the psychometric properties of the E-BCS. The current study utilized data from two independent samples of adult e-cigarette users to evaluate the psychometric properties and structure of the E-BCS. In Study 1, competing models of the E-BCS were evaluated, and initial construct validity and reliability were explored using data from 599 adult e-cigarettes users (52.3% female, Mage = 35.16 years, SD = 10.30). Results supported a unidimensional structure for the E-BCS comprised of 18 items. In Study 2, the unidimensional structure of the 18-item E-BCS and construct validity were evaluated among a sample of 516 current e-cigarette using adults (52.3% female; Mage = 34.74, SD = 11.37). Results confirmed the unidimensional structure, measurement invariance across sex, and construct validity across related e-cigarette behavior constructs and psychopathology for the E-BCS. These findings suggest that the E-BCS is a potentially useful clinical instrument for measuring barriers that may interfere with e-cigarette cessation.
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Affiliation(s)
- Nubia A Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,HEALTH Institute, University of Houston, Houston, TX, USA
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14
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McCaffrey SA, Zdinak JP, Plunkett S, Becker E, Lewis JN, Black RA. Development and validation of behavioral intention measures of an E-vapor product: intention to try, use, dual use, and switch. Health Qual Life Outcomes 2021; 19:123. [PMID: 33858450 PMCID: PMC8048046 DOI: 10.1186/s12955-021-01764-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The harm caused by tobacco use is primarily attributable to cigarette smoking. Switching completely to non-combustible products may reduce disease risks in adult cigarette smokers who are unable or unwilling to quit. Before a new tobacco product can enter the market or can be marketed as a modified risk tobacco product, the manufacturer must determine the impact that the product will have on the likelihood of changes in tobacco use behavior among both tobacco users and nonusers. One way to estimate change in tobacco use behavior is to assess tobacco users' and nonusers' behavioral intentions toward the product and its marketing, including intentions to try, use, dual use, and switch to the product from cigarettes. The purpose of this study was to develop and validate behavioral intention metrics appropriate for use with current, former, and never adult tobacco users. METHODS Preliminary items were subjected to cognitive testing with adult (1) smokers planning to quit cigarettes in the next 30 days, (2) smokers not planning to quit cigarettes in the next 30 days, (3) e-vapor users, (4) former tobacco users, and (5) never tobacco users. Items were iteratively revised based on feedback during cognitive testing, and surviving items were administered to a large sample of adults (N = 2943) representing the aforementioned sub-groups. Rating scale functioning, reliability, validity, bias, and ability to detect change were evaluated. RESULTS Examination of the response category thresholds generated by the Rasch model provided evidence that the rating scales were functioning appropriately. Results revealed good stability and excellent internal consistency and person reliability and provided evidence of unidimensionality and convergent validity. Estimates of reliability and validity were similar across sub-groups. A cross-validation sample generally confirmed findings from the validation sample. No items were discarded due to differential item function. Exploratory analyses provided support for ability to detect change. CONCLUSIONS Results from this rigorous, empirical evaluation using large validation and cross-validation samples provide strong support for the psychometric properties of the Intention to Try, Use, Dual Use, and Switch scales with current, former, and never adult tobacco users.
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Affiliation(s)
- Stacey A McCaffrey
- JUUL Labs, Inc., 1000 F Street NW, Suite 800, Washington, DC, 20004, USA
| | | | - Stephanie Plunkett
- Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Elizabeth Becker
- Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA.
| | - Jennifer N Lewis
- Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Ryan A Black
- JUUL Labs, Inc., 1000 F Street NW, Suite 800, Washington, DC, 20004, USA
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15
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El-Mahdy MA, Mahgoup EM, Ewees MG, Eid MS, Abdelghany TM, Zweier JL. Long-term electronic cigarette exposure induces cardiovascular dysfunction similar to tobacco cigarettes: role of nicotine and exposure duration. Am J Physiol Heart Circ Physiol 2021; 320:H2112-H2129. [PMID: 33606584 DOI: 10.1152/ajpheart.00997.2020] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Electronic cigarette (e-cig) vaping (ECV) has been proposed as a safer alternative to tobacco cigarette smoking (TCS); however, this remains controversial due to a lack of long-term comparative studies. Therefore, we developed a chronic mouse exposure model that mimics human vaping and allows comparison with TCS. Longitudinal studies were performed to evaluate alterations in cardiovascular function with TCS and ECV exposure durations of up to 60 wk. For ECV, e-cig liquid with box-mod were used and for TCS, 3R4F-cigarettes. C57/BL6 male mice were exposed 2 h/day, 5 days/wk to TCS, ECV, or air control. The role of vape nicotine levels was evaluated using e-cig-liquids with 0, 6, or 24 mg/mL nicotine. Following 16-wk exposure, increased constriction to phenylephrine and impaired endothelium-dependent and endothelium-independent vasodilation were observed in aortic segents, paralleling the onset of systemic hypertension, with elevations in systemic vascular resistance. Following 32 wk, TCS and ECV induced cardiac hypertrophy. All of these abnormalities further increased out to 60 wk of exposure, with elevated heart weight and aortic thickness along with increased superoxide production in vessels and cardiac tissues of both ECV and TCS mice. While ECV-induced abnormalities were seen in the absence of nicotine, these occurred earlier and were more severe with higher nicotine exposure. Thus, long-term vaping of e-cig can induce cardiovascular disease similar to TCS, and the severity of this toxicity increases with exposure duration and vape nicotine content.NEW & NOTEWORTHY A chronic mouse exposure model that mimics human e-cigarette vaping and allows comparison with tobacco cigarette smoking was developed and utilized to perform longitudinal studies of alterations in cardiovascular function. E-cigarette exposure led to the onset of cardiovascular disease similar to that with tobacco cigarette smoking. Impaired endothelium-dependent and endothelium-independent vasodilation with increased adrenergic vasoconstriction were observed, paralleling the onset of systemic hypertension and subsequent cardiac hypertrophy. This cardiovascular toxicity was dependent on exposure duration and nicotine dose.
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Affiliation(s)
- Mohamed A El-Mahdy
- Center for Environmental and Smoking Induced Disease and Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Elsayed M Mahgoup
- Center for Environmental and Smoking Induced Disease and Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Pharmacology and Toxicology, College of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Mohamed G Ewees
- Center for Environmental and Smoking Induced Disease and Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mahmoud S Eid
- Center for Environmental and Smoking Induced Disease and Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Tamer M Abdelghany
- Center for Environmental and Smoking Induced Disease and Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jay L Zweier
- Center for Environmental and Smoking Induced Disease and Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, Ohio
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16
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Mayorga NA, Chavez J, Garey L, Otto MW, Zvolensky MJ. Affective Vulnerability Across Non-Daily and Daily Electronic Cigarette Users. Behav Med 2021; 47:51-59. [PMID: 31361573 DOI: 10.1080/08964289.2019.1644282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Electronic cigarette (e-cigarette) use has risen exponentially since its initial introduction. The widespread and growing use of these novel products has prompted increased research to evaluate use from a nuanced perspective that considers patterns and antecedents of use. Specifically, research has identified sociodemographic characteristics related to varying levels of e-cigarette use frequency. Yet, limited research has investigated broad-based psychological factors related to frequent and infrequent e-cigarette use. The current study sought to address this clinically relevant research gap within a cross sectional design. Several affective vulnerability states were evaluated, including anxiety sensitivity, anxious arousal, general distress, and anhedonia across 566 (51.1% female, Mage = 35.3 years, SD = 10.1) non-daily and daily past month, adult e-cigarette users. Results demonstrated that in comparison to non-daily e-cigarette users, daily users evinced significantly higher levels of anxiety sensitivity, anxiety sensitivity cognitive concerns, anxiety sensitivity social concerns, anxiety sensitivity physical concerns, anxious arousal, and general distress. No significant differences were found for anhedonic depression. Overall, the current study provides initial and novel empirical evidence that certain affective vulnerability constructs related to anxiety may be more strongly endorsed by daily e-cigarette users. Importantly, this work adds to evolving, but underdeveloped, e-cigarette models by highlighting the need to consider anxiety-related constructs when evaluating e-cigarette use patterns and behavior.
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Affiliation(s)
| | | | - Lorra Garey
- Department of Psychology, University of Houston
| | - Michael W Otto
- Department of Psychology & Brain Sciences, Boston University
| | - Michael J Zvolensky
- Department of Psychology, University of Houston.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center.,HEALTH Institute, University of Houston
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17
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Chavez J, Smit T, Olofsson H, Mayorga NA, Garey L, Zvolensky MJ. Substance Use among Exclusive Electronic Cigarette Users and Dual Combustible Cigarette Users: Extending Work to Adult Users. Subst Use Misuse 2021; 56:888-896. [PMID: 33726615 PMCID: PMC10032028 DOI: 10.1080/10826084.2021.1899234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have become increasingly popular in recent years. Existing evidence indicates e-cigarettes used in isolation are less harmful than combustible cigarettes, yet emerging work has demonstrated that adults use e-cigarettes largely in combination with combustible cigarettes (i.e. dual use). Despite this data, little is understood about how exclusive and dual e-cigarette users may differ across behavioral outcomes, such as substance use dependence and behaviors among adults. OBJECTIVES Thus, the current project examined differences in e-cigarette dependence, problematic alcohol use, cannabis use, and nonmedical prescription opioid use (e.g. methadone and oxycodone) across both exclusive and dual e-cigarette adult users. RESULTS Participants included 531 (53.6% female; Mage = 35.29 years, SD = 10.44) adults with past-month e-cigarette use. Dual users reported greater e-cigarette dependence, alcohol use, current cannabis use, and endorsement of nonprescription opioid use. Conclusions/Importance: Importantly, this work suggests that adults who use both combustible and e-cigarettes may constitute a group more vulnerable to experiencing problematic substance use and more severe e-cigarette dependence than exclusive e-cigarette users.
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Affiliation(s)
- JeanFelix Chavez
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Hannah Olofsson
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
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18
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Piper ME, Baker TB, Benowitz NL, Smith SS, Jorenby DE. E-cigarette Dependence Measures in Dual Users: Reliability and Relations With Dependence Criteria and E-cigarette Cessation. Nicotine Tob Res 2020; 22:756-763. [PMID: 30874804 DOI: 10.1093/ntr/ntz040] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have drastically changed the nicotine and tobacco product landscape. However, their potential public health impact is still unclear. A reliable and valid measure of e-cigarette dependence would likely advance assessment and prognostication of the public health impact of e-cigarettes. The aim of this research was to examine the internal consistency, structure, and validity of three e-cigarette dependence scales. METHODS Adult dual users (smokers who also vape, N = 256) enrolled in an observational cohort study (45.1% women, 70.7% white). At baseline, participants completed the e-cigarette Fagerström Test of Cigarette Dependence (e-FTCD), the e-cigarette Wisconsin Inventory of Smoking Dependence Motives (e-WISDM), and the Penn State Electronic Cigarette Dependence Index (PS-ECDI). All participants provided a urine sample for cotinine analysis and reported e-cigarette use at 1 year. RESULTS The e-WISDM subscales had the highest internal consistency (α = .81-.96), then the PS-ECDI (α = .74) and e-FTCD (α = .51). A single-factor structure for the e-FTCD and an 11-factor structure for the e-WISDM were supported, but the PS-ECDI did not have a single-factor structure. All three e-cigarette dependence scales were highly correlated with validation criteria including continued e-cigarette use at 1 year, but not with e-liquid nicotine concentration or cotinine. CONCLUSIONS The e-WISDM and PS-ECDI had stronger internal consistency than did the e-FTCD, despite the e-FTCD's single-factor structure, but all 3 measures appear to be valid measures of e-cigarette dependence as suggested by their significant relations with self-perceived addiction, heavy use, early use after overnight deprivation, and continued use over time. IMPLICATIONS This research provides empirical support for three e-cigarette dependence measures: the e-FTCD, the PS-ECDI, and the e-WISDM among dual users of e-cigarettes and combustible cigarettes. The PS-ECDI and e-WISDM are more reliable, but all three measures were strongly correlated with key dependence constructs such as heavy use and continued use over time.
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Affiliation(s)
- Megan E Piper
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Timothy B Baker
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Neal L Benowitz
- Department of Medicine and Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Stevens S Smith
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Douglas E Jorenby
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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19
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DiPiazza J, Caponnetto P, Askin G, Christos P, Maglia MLP, Gautam R, Roche S, Polosa R. Sensory experiences and cues among E-cigarette users. Harm Reduct J 2020; 17:75. [PMID: 33059666 PMCID: PMC7559939 DOI: 10.1186/s12954-020-00420-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS We characterized the extent and quality of respiratory sensations and sensory-related smoking cues associated with e-cigarette use among those who failed to quit combustible tobacco cigarette (CTC) use with traditional FDA approved medications but succeeded in doing so with e-cigarettes. Further, we sought to understand former smokers' perceptions about the influence of sensory experience with e-cigarette use on CTC cessation outcomes. METHODS A nonrandom purposive sample of 156 participants recruited in the USA through the Consumer Advocates for Smoke Free Alternatives Association Facebook page completed an online cross-sectional survey to assess sensory experiences and smoking cues associated with e-cigarette use. Descriptive statistics were calculated, and the ANOVA/Kruskal-Wallis test with post hoc testing and the two-sample t test/Wilcoxon rank-sum test, as appropriate based on distribution, were used to assess the association between sample characteristics and sensory experiences and cues using investigator constructed questions, the Modified Cigarette Evaluation Questionnaire (mCEQ) and the Smoking Cue Appeal Survey (SCAS). RESULTS With e-cigarette use, participants reported feeling the vapor in their throats, windpipes, noses, lungs, and on their tongues; reductions in nicotine craving; and enjoyment of their e-cigarette, including tasting, smelling, and seeing the vapor and touching the device. Women had greater craving reduction than men (p = 0.023). Those who began smoking at 13 years of age or younger had more satisfaction and had greater sensory enjoyment than those who began smoking at 16-17 years of age (p = 0.015 and p = 0.026, respectively), as well as greater sensory enjoyment than those who began smoking at 14-15 years of age (p = 0.047). There was a significant overall association between the number of years a respondent smoked and e-cigarette sensory enjoyment (p = 0.038). Participants 18-34 years old rated e-cigarettes as being more pleasant compared to 45 + years olds, (p = 0.012). Eighty-four percent of participants reported the sensation of the vapor as important in quitting CTCs, and 91% believed the sensations accompanying e-cigarette use contributed to their smoking cessation success. CONCLUSIONS For those who failed to quit previously using approved cessation medications to stop smoking cigarettes, sensory experiences associated with e-cigarette use may help smokers quit smoking.
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Affiliation(s)
- J DiPiazza
- Hunter Bellevue School of Nursing, Hunter College-City University of New York, New York, NY, USA
| | - P Caponnetto
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "V.Emanuele-Policlinico", Università di Catania, Catania, Italy.
- Institute of Internal Medicine, Azienda Ospedaliero-Universitaria "Policlinico V. Emanuele", Università di Catania, Catania, Italy.
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, UK.
| | - G Askin
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - P Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - M Lyc Psych Maglia
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "V.Emanuele-Policlinico", Università di Catania, Catania, Italy
| | - R Gautam
- Clinical and Translational Science Center, Weill Cornell Medicine, New York, NY, USA
| | - S Roche
- Hunter Bellevue School of Nursing, Hunter College-City University of New York, New York, NY, USA
| | - R Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "V.Emanuele-Policlinico", Università di Catania, Catania, Italy
- Institute of Internal Medicine, Azienda Ospedaliero-Universitaria "Policlinico V. Emanuele", Università di Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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20
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Struik LL, Dow-Fleisner S, Belliveau M, Thompson D, Janke R. Tactics for Drawing Youth to Vaping: Content Analysis of Electronic Cigarette Advertisements. J Med Internet Res 2020; 22:e18943. [PMID: 32663163 PMCID: PMC7455879 DOI: 10.2196/18943] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences. Objective The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television. Methods In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC). Results In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively. Conclusions The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages.
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Affiliation(s)
- Laura L Struik
- School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Sarah Dow-Fleisner
- School of Social Work, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Michelle Belliveau
- School of Social Work, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Desiree Thompson
- School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Robert Janke
- Library, University of British Columbia Okanagan, Kelowna, BC, Canada
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21
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Abstract
IMPORTANCE Several states have banned sales of flavored e-cigarettes, but evidence on the association between vaping flavors and subsequent smoking initiation and cessation is limited. OBJECTIVE To evaluate whether new uptake of flavored e-cigarettes is more strongly associated with subsequent smoking initiation and cessation than uptake of unflavored e-cigarettes, separately for youths (12-17 years), emerging adults (18-24 years), and prime-age adults (25-54 years). DESIGN, SETTING, AND PARTICIPANTS This cohort study conducted secondary data analyses of longitudinal survey data from waves 1 to 4 of the Population Assessment of Tobacco and Health Study (collected from 2013 to 2018). The analytic sample was limited to 17 929 respondents aged 12 to 54 years at wave 1 who completed at least 3 consecutive waves of the survey and did not use e-cigarettes at baseline. Data were collected from 2013 to 2018 and analyzed in February 2020. EXPOSURES Flavored vs unflavored e-cigarette use reported in wave 2 of the Population Assessment of Tobacco and Health Study. MAIN OUTCOMES AND MEASURES Binary indicators captured wave 3 smoking among 7311 youths and 4634 emerging adults who did not smoke at baseline (ie, initiation) and not smoking at wave 3 among 1503 emerging adults and 4481 prime-age adults who smoked at baseline (ie, cessation). Smoking status was based on having smoked in the past 30 days for youths and established smoking (ie, current smoking among those who smoked at least 100 cigarettes in their lifetime) for emerging and prime-age adults. RESULTS The youths who did not smoke at baseline, emerging adults who smoked at baseline, and prime-age adults who smoked at baseline consisted of 51.4% to 58.0% male participants and 66.9% to 77.0% white individuals. Vaping uptake was positively associated with smoking initiation in youth (adjusted odds ratio [AOR], 6.75; 95% CI, 3.93-11.57; P < .001) and in emerging adults (AOR, 3.20; 95% CI, 1.70-6.02; P < .001). Vaping uptake was associated with cessation in adults (AOR, 1.34; 95% CI, 1.02-1.75; P = .03). Vaping nontobacco flavors was no more associated with youth smoking initiation than vaping tobacco-flavors (AOR in youth, 0.66; 95% CI, 0.16-2.76; P = .56) but was associated with increased adult smoking cessation (AOR in adults, 2.28; 95% CI, 1.04-5.01; P = .04). CONCLUSIONS AND RELEVANCE In this study, adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors. More research is needed to establish the relationship between e-cigarette flavors and smoking and to guide related policy.
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Affiliation(s)
- Abigail S. Friedman
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - SiQing Xu
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Zvolensky MJ, Mayorga NA, Garey L. Positive Expectancies for E-Cigarette Use and Anxiety Sensitivity Among Adults. Nicotine Tob Res 2020; 21:1355-1362. [PMID: 29800464 DOI: 10.1093/ntr/nty106] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/22/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Although e-cigarette use is on the rise among youth and adults, there is little understanding of the individual difference factors at a cognitive level of analysis for e-cigarette beliefs and quit behavior. METHOD The present investigation sought to test a theoretically driven interactive model of positive expectancies for e-cigarettes and anxiety sensitivity (fear of the consequences of anxiety) among 551 adult e-cigarette users (50.6% female, Mage = 35.2 years, SD = 10.1). RESULTS Results indicated a significant interaction between positive expectancies for e-cigarette use and AS was significantly related to greater perceived benefits of e-cigarette use, greater perceived risk of e-cigarette use, and more serious attempts for trying to quit e-cigarettes. The significant interaction effect for each dependent variable was evident over and above the main effects as well as the covariates of sex, income, education, and concurrent combustible cigarette use. The form of this interaction indicated that e-cigarette users higher in AS who also maintained more positive outcome expectancies for e-cigarette use reported more perceived benefits as well as more perceived risk of e-cigarette use and engaged in more (failed) attempts to quit e-cigarettes. CONCLUSIONS Overall, the current data suggest that individual differences in AS and positive expectancies may represent two important factors to consider in e-cigarette beliefs and quit attempts. IMPLICATIONS This study provides the first empirical evidence of a transdiagnostic construct (anxiety sensitivity) in relation to e-cigarette use and how it interplays with positive expectancies for e-cigarette use beliefs and behavior. These novel data suggest that future clinical research may benefit by understanding the potential therapeutic role of anxiety sensitivity and expectancies for e-cigarette use behavior.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX.,Health Institute, University of Houston, Houston, TX
| | - Nubia A Mayorga
- Department of Psychology, University of Houston, Houston, TX
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX
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23
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Yingst J, Foulds J, Veldheer S, Cobb CO, Yen MS, Hrabovsky S, Allen SI, Bullen C, Eissenberg T. Measurement of Electronic Cigarette Frequency of Use Among Smokers Participating in a Randomized Controlled Trial. Nicotine Tob Res 2020; 22:699-704. [PMID: 30365024 PMCID: PMC7171268 DOI: 10.1093/ntr/nty233] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/24/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The United States Food and Drug Administration has prioritized understanding the dependence potential of electronic cigarettes (e-cigs). Dependence is often estimated in part by examining frequency of use; however measures of e-cig use are not well developed because of varying product types. This study used an e-cig automatic puff counter to evaluate the value of self-reported e-cig use measures in predicting actual use (puffs). METHODS Data were collected from a two-site randomized placebo-controlled trial evaluating the effects of e-cigs on toxicant exposure in smokers attempting to reduce their cigarette consumption. Participants randomized to an e-cig condition self-reported their e-cig frequency of use (times per day-one "time" consists of around 15 puffs or lasts around 10 minutes) on the Penn State Electronic Cigarette Dependence Index (PSECDI) and kept daily diary records of the number of puffs per day from the e-cig automatic puff counter. A linear mixed-effects model was used to determine the predictive value of the times per day measure. Correlations were used to further investigate the relationship. RESULTS A total of 259 participants with 1165 observations of e-cig use were analyzed. Self-reported e-cig use in times per day was a significant predictor of e-cig puffs per day (p < .01). The Spearman correlation between measures was r equal to .58. Examination of individual participant responses revealed some potential difficulties reporting and interpreting times per day because of the difference in use patterns between cigarettes and e-cigs. CONCLUSION This study provides evidence that the self-reported PSECDI measure of times per day is a significant predictor of actual frequency of e-cig puffs taken. IMPLICATIONS Self-reported measures of e-cig frequency of use are predictive of actual use, but quantifying e-cig use in patterns similar to cigarettes is problematic.
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Affiliation(s)
- Jessica Yingst
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | - Jonathan Foulds
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | - Susan Veldheer
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Miao-Shan Yen
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
| | - Shari Hrabovsky
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | - Sophia I Allen
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | | | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
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24
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E-Cigarette Quality Control: Impurity and Nicotine Level Analysis in Electronic Cigarette Refill Liquids. ScientificWorldJournal 2020; 2020:3050189. [PMID: 32327940 PMCID: PMC7174940 DOI: 10.1155/2020/3050189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022] Open
Abstract
This work targets mainly the quality control of electronic cigarette liquids. It relies on an analytical control of a “32-product” sample made of several types of e-cigarette liquids taken from various supermarkets and tobacconist's offices in Morocco. All along this study, we made sure to check both the conformity of the nicotine level indicated in the packaging of each product and the existence of any other components inside the product, especially toxic or unknown impurities. The method used for this study is known under the name of high-performance liquid chromatography. For statistical analysis, we used Student's t-test for a single sample in order to analyze the relative differences between nicotine quantity reported in the product and the one measured during our experiment. Finally, we used linear regression test to determine the relationship between the nicotine level accuracy on the packaging and the level of toxic impurities in the products. The differences between the nicotine concentrations reported in the packages and the measured ones varied from −100% to +3.3%. The study showed that 31% of analyzed products have an accurate indication of the level of nicotine on the packaging. However, 47% of the studied products showed more than 20% difference between measure and packaging indication. In all analyzed samples, the level of impurities altered from 0 to 32.6%. Furthermore, the level of the nicotine breakdown products did not exceed 2% of the nicotine content in pretty much all of the samples. The actual nicotine content of electronic cigarette refill liquids is not always as precise as what is stated on the packaging; in addition to the level of impurities detected in several brands and that exceeds the European Pharmacopoeia standards, some may even present a risk of causing toxicological damage.
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25
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Briganti M, Wackowski OA, Delnevo CD, Brown L, Hastings SE, Singh B, Steinberg MB. Content Analysis of Electronic Nicotine Delivery System Publications in Core Clinical Journals from 2012 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2201. [PMID: 32218306 PMCID: PMC7177383 DOI: 10.3390/ijerph17072201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 02/07/2023]
Abstract
There is no consensus if electronic nicotine delivery systems (ENDS) should be used to reduce harm among the smoking population. Physicians, who represent a trusted source of health communication, are exposed to a range of often conflicting ENDS information and this information may be relayed to patients looking to quit smoking. Previous studies have examined ENDS content of various sources of media but there is a lack of knowledge about ENDS content in medical journals. We analyzed 421 ENDS publications printed between 2012 and 2018 from PubMed's Core Clinical Journal list. Publications were analyzed based on publication type, journal type, study design, geographic focus, theme, terminology, outcomes, and positive/negative statements. The number of ENDS publications grew since 2012, and peaked in 2015. Across all years, negative statements about ENDS outnumbered positive statements, though this difference decreased over time. Over time, negative statements about "toxins and carcinogens" were made less frequently, while negative statements about "gateway effects" and "youth appeal" became more prevalent. UK journals had fewer negative statements relative to US journals. Only 12.6% of publications included guidance for healthcare professionals about ENDS. As published ENDS topics change over time, physicians' communications with patients may be impacted.
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Affiliation(s)
- Michael Briganti
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Leanne Brown
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
| | - Shirin E. Hastings
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
| | - Binu Singh
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Michael B. Steinberg
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
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26
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Mayorga NA, Garey L, Nizio P, Buckner JD, Zvolensky MJ. The Effects of Cannabis Use: A Test Among Dual Electronic and Combustible Cigarette Users. Am J Addict 2020; 29:287-294. [DOI: 10.1111/ajad.13021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - Lorra Garey
- Department of PsychologyUniversity of HoustonHouston Texas
| | - Pamella Nizio
- Department of PsychologyUniversity of HoustonHouston Texas
| | - Julia D. Buckner
- Department of PsychologyLouisiana State UniversityBaton Rouge Louisiana
| | - Michael J. Zvolensky
- Department of PsychologyUniversity of HoustonHouston Texas
- Department of Behavioral ScienceThe University of Texas MD Anderson Cancer CenterHouston Texas
- HEALTH InstituteUniversity of HoustonHouston Texas
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27
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Aghar H, El-Khoury N, Reda M, Hamadeh W, Krayem H, Mansour M, Raouf H, Jaffa MA. Knowledge and attitudes towards E-cigarette use in Lebanon and their associated factors. BMC Public Health 2020; 20:278. [PMID: 32111186 PMCID: PMC7049178 DOI: 10.1186/s12889-020-8381-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 02/20/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite the misconceptions regarding E-cigarettes (ECs), only a few studies have been conducted in the Middle East that focused on this topic. This study assesses the knowledge of and attitudes towards ECs in Lebanon, determines how these two measures are associated, and identifies the variables that explain each of these measures. METHODS A cross sectional study was conducted on a convenience sample of Lebanese pedestrians aged between 18 and 64 inclusive. A structured self-administered questionnaire comprising of knowledge and attitude scales, and questions on demographical, health and smoking characteristics was used. RESULTS Scores for attitudes and knowledge of ECs were summed and dichotomized using a 75% cutoff, above which the participant was considered to have a positive attitude and good knowledge. Among the 352 participants (56.6% males, 43.3% females, mean age 30.3, 46.2% smokers), 63.3% exhibited a lower level of EC knowledge. More than 50% erroneously thought that ECs are not associated with lung and bladder cancer or impair lung and heart function. 65% falsely thought that it is harmless and not addictive. As for attitude, 43.3, 53.9, and 44.3% thought that it is socially acceptable, helps in smoking cessation, and is a good replacement for cigarettes and an enjoyable recreational device respectively. Our results revealed an inverse correlation between attitude and knowledge scores (Spearman's correlation = -.30, p < .001). Predictors of knowledge included health-related occupation (p = .010), regular exercise (p = .016), healthy diet (p = .026), EC use (p = .026), perception that ECs are not harmful (p = .001), and help in smoking cessation (p = .017). Predictors of attitude included EC use (p = .008), sex (p = .010), and knowledge that most ECs are addictive (p = .006), harmful (p = .014), and impair heart and lung function (p = .047). CONCLUSIONS Our study revealed a gap in EC knowledge, especially among participants who displayed a positive attitude towards ECs. Hence, measures should be undertaken to regulate its use by instituting more stringent laws and holding nationwide awareness campaigns.
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Affiliation(s)
- Hanan Aghar
- Faculty of Medicine, American University of Beirut, P.O.Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Nathalie El-Khoury
- Faculty of Medicine, American University of Beirut, P.O.Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Mahasen Reda
- Faculty of Medicine, American University of Beirut, P.O.Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Wissam Hamadeh
- Faculty of Medicine, American University of Beirut, P.O.Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Hussein Krayem
- Faculty of Medicine, American University of Beirut, P.O.Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Mohammad Mansour
- Faculty of Medicine, American University of Beirut, P.O.Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Hawraa Raouf
- Faculty of Medicine, American University of Beirut, P.O.Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Miran A Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
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28
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Dunbar ZR, Giovino G, Wei B, O’Connor RJ, Goniewicz ML, Travers MJ. Use of Electronic Cigarettes in Smoke-Free Spaces by Smokers: Results from the 2014-2015 Population Assessment on Tobacco and Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E978. [PMID: 32033239 PMCID: PMC7038091 DOI: 10.3390/ijerph17030978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 01/04/2023]
Abstract
Background: Smoke-free air policies exist to protect users and nonusers from exposure to tobacco smoke. Although electronic nicotine delivery systems (ENDS) may expose passerby to nicotine and particulate matter, few US states regulate indoor use of ENDS. The purpose of this study was to investigate reported rationales for ENDS use and reported ENDS use in public smoke-free places by dual cigarette/ENDS users. Methods: A population of ENDS/cigarette co-users (n = 2051) was drawn from Wave 2 of the Population Assessment of Tobacco and Health (PATH) dataset (2014-2015). Harm reduction beliefs and cessation behavior of co-users were investigated as predictors of ENDS use in public smoke-free places using logistic regression. Results: Fifty-eight percent of dual users reported past 30-day ENDS use in public smoke-free places. Reported use of ENDS to cut down on cigarette smoking (OR: 2.38, 95% CI: 1.86, 3.05), as an alternative to quitting tobacco (OR: 1.71, 95% CI: 1.37, 2.13), or because of belief that ENDS help people to quit cigarettes (OR: 1.52, 95% CI: 1.20, 1.92) were significantly associated with increased odds of ENDS use in smoke-free places. Conclusions: Beliefs that ENDS were useful as cessation tools or posed modified risk to users and nonusers were associated with elevated odds of use ENDS in locations where conventional tobacco is prohibited. Due to limitations in the survey instrument, in-home ENDS use could not be directly assessed in this analysis. However, these self-reported findings suggest that use of ENDS in public places where cigarette use is prohibited is prevalent enough to be of concern for future regulation and enforcement efforts.
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Affiliation(s)
- Zachary R. Dunbar
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Gary Giovino
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY 14214-8028, USA;
| | - Binnian Wei
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Richard J. O’Connor
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Maciej L. Goniewicz
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Mark J. Travers
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA
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29
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Hua M, Sadah S, Hristidis V, Talbot P. Health Effects Associated With Electronic Cigarette Use: Automated Mining of Online Forums. J Med Internet Res 2020; 22:e15684. [PMID: 31899452 PMCID: PMC6969389 DOI: 10.2196/15684] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/11/2019] [Accepted: 10/20/2019] [Indexed: 12/22/2022] Open
Abstract
Background Our previous infodemiological study was performed by manually mining health-effect data associated with electronic cigarettes (ECs) from online forums. Manual mining is time consuming and limits the number of posts that can be retrieved. Objective Our goal in this study was to automatically extract and analyze a large number (>41,000) of online forum posts related to the health effects associated with EC use between 2008 and 2015. Methods Data were annotated with medical concepts from the Unified Medical Language System using a modified version of the MetaMap tool. Of over 1.4 million posts, 41,216 were used to analyze symptoms (undiagnosed conditions) and disorders (physician-diagnosed terminology) associated with EC use. For each post, sentiment (positive, negative, and neutral) was also assigned. Results Symptom and disorder data were categorized into 12 organ systems or anatomical regions. Most posts on symptoms and disorders contained negative sentiment, and affected systems were similar across all years. Health effects were reported most often in the neurological, mouth and throat, and respiratory systems. The most frequently reported symptoms and disorders were headache (n=939), coughing (n=852), malaise (n=468), asthma (n=916), dehydration (n=803), and pharyngitis (n=565). In addition, users often reported linked symptoms (eg, coughing and headache). Conclusions Online forums are a valuable repository of data that can be used to identify positive and negative health effects associated with EC use. By automating extraction of online information, we obtained more data than in our prior study, identified new symptoms and disorders associated with EC use, determined which systems are most frequently adversely affected, identified specific symptoms and disorders most commonly reported, and tracked health effects over 7 years.
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Affiliation(s)
- My Hua
- University of California, Riverside, Riverside, CA, United States
| | - Shouq Sadah
- University of California, Riverside, Riverside, CA, United States
| | | | - Prue Talbot
- University of California, Riverside, Riverside, CA, United States
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30
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Begh R, Coleman T, Yardley L, Barnes R, Naughton F, Gilbert H, Ferrey A, Madigan C, Williams N, Hamilton L, Warren Y, Grabey J, Clark M, Dickinson A, Aveyard P. Examining the effectiveness of general practitioner and nurse promotion of electronic cigarettes versus standard care for smoking reduction and abstinence in hardcore smokers with smoking-related chronic disease: protocol for a randomised controlled trial. Trials 2019; 20:659. [PMID: 31779689 PMCID: PMC6883522 DOI: 10.1186/s13063-019-3850-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/25/2019] [Indexed: 02/05/2023] Open
Abstract
Background Despite the clear harm associated with smoking tobacco, many people with smoking-related chronic diseases or serious mental illnesses (SMI) are unwilling or unable to stop smoking. In many cases, these smokers have tried and exhausted all methods to stop smoking and yet clinicians are repeatedly mandated to offer them during routine consultations. Providing nicotine through electronic cigarettes (e-cigarettes) may reduce the adverse health consequences associated with tobacco smoking, but these are not currently offered. The aim of this study is to examine the feasibility, acceptability and effectiveness of general practitioners (GPs) and nurses delivering a brief advice intervention on e-cigarettes and offering an e-cigarette starter pack and patient support resources compared with standard care in smokers with smoking-related chronic diseases or SMI who are unwilling to stop smoking. Methods/design This is an individually randomised, blinded, two-arm trial. Smokers with a smoking-related chronic condition or SMI with no intention of stopping smoking will be recruited through primary care registers. Eligible participants will be randomised to one of two groups if they decline standard care for stopping smoking: a control group who will receive no additional support beyond standard care; or an intervention group who will receive GP or nurse-led brief advice about e-cigarettes, an e-cigarette starter pack with accompanying practical support booklet, and telephone support from experienced vapers and online video tutorials. The primary outcome measures will be smoking reduction, measured through changes in cigarettes per day and 7-day point-prevalence abstinence at 2 months. Secondary outcomes include smoking reduction, 7-day point-prevalence abstinence and prolonged abstinence at 8 months. Other outcomes include patient recruitment and follow-up, patient uptake and use of e-cigarettes, nicotine intake, contamination of randomisation and practitioner adherence to the delivery of the intervention. Qualitative interviews will be conducted in a subsample of practitioners, patients and the vape team to garner their reactions to the programme. Discussion This is the first randomised controlled trial to investigate whether e-cigarette provision alongside a brief intervention delivered by practitioners leads to reduced smoking and abstinence among smokers with smoking-related chronic diseases or SMI. Trial registration ISRCTN registry, ISRCTN59404712. Registered 28/11/17.
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Affiliation(s)
- Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Lucy Yardley
- Academic Unit of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, SO17 1BJ, UK.,School of Experimental Psychology, University of Bristol, Bristol, BS8 1TU, UK
| | - Rebecca Barnes
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, NR4 7UL, UK
| | - Hazel Gilbert
- Research Department of Primary Care and Population Health, University College London, Royal Free and University College Medical School, London, NW3 2PF, UK
| | - Anne Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Claire Madigan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Louisa Hamilton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Yolanda Warren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Jenna Grabey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Miranda Clark
- Division of Primary Care, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Anne Dickinson
- Division of Primary Care, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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Tucker MR, Laugesen M, Bullen C, Grace RC. Predicting Short-Term Uptake of Electronic Cigarettes: Effects of Nicotine, Subjective Effects, and Simulated Demand. Nicotine Tob Res 2019; 20:1265-1271. [PMID: 29272446 DOI: 10.1093/ntr/ntx269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/07/2017] [Indexed: 11/14/2022]
Abstract
Introduction E-cigarettes have potential to support tobacco cessation or reduction, but how nicotine content affects smokers' subjective perceptions and use of e-cigarettes, rather than tobacco, is unclear. Method Thirty-five adult daily smokers who had not previously tried e-cigarettes were recruited from two cities in New Zealand in 2016-2017. Smokers were given four e-cigarette cartridges (0, 6, 12, and 18 mg nicotine) in a randomized, blinded order over four 2-week periods. Daily cigarette smoking and e-cigarette use was monitored using ecological momentary analysis and participants completed the modified Cigarette Evaluation Questionnaire after each 2-week period. Results Mean cigarettes per day decreased by 37% (9.69 to 6.09) when e-cigarettes were available relative to baseline (p = .008). Nicotine-containing cartridges (>0 mg) were associated with greater use (p = .023) and craving reduction (p = .026) than 0 mg. Alleviation of withdrawal symptoms (p = .048) and taste and enjoyment factors (p = .039) predicted e-cigarette use. Conclusion Availability of e-cigarettes reduced cigarette smoking behavior regardless of nicotine content, and e-cigarette use was greater with nicotine-containing cartridges. First-time users' e-cigarette use can be predicted using subjective ratings and more research is required to clarify the effect of nicotine content on subjective perceptions and use. Implications For low-moderate dependence smokers, availability of e-cigarettes may reduce cigarette smoking behavior regardless of nicotine content, but the availability of nicotine-containing cartridges may promote greater e-cigarette use. First response to trialing e-cigarettes is an important factor in determining subsequent experimental and possibly longer-term use.
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Affiliation(s)
- Megan R Tucker
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Randolph C Grace
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
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32
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McCabe SE, West BT, McCabe VV. Associations Between Early Onset of E-cigarette Use and Cigarette Smoking and Other Substance Use Among US Adolescents: A National Study. Nicotine Tob Res 2019; 20:923-930. [PMID: 29986103 DOI: 10.1093/ntr/ntx231] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 09/29/2017] [Indexed: 12/23/2022]
Abstract
Introduction This study examines the associations between early onset of e-cigarette use and cigarette smoking and other substance use behaviors among US adolescents. Methods Data were collected via self-administered questionnaires from a nationally representative sample of 2299 US high school seniors attending public and private high schools during the spring of their senior year in 2015 as part of the Monitoring the Future study. Results A higher percentage of adolescents who began using e-cigarettes in ninth grade or earlier (early onset) were found to report current and lifetime cigarette smoking and other substance use relative to those individuals who never used e-cigarettes or those who began using e-cigarettes later in the 12th grade. Multivariate logistic regression analyses indicated that the adjusted odds of alcohol use, cigarette smoking, marijuana use, nonmedical prescription drug use, and other illicit drug use among early onset e-cigarette users were significantly greater than those for individuals never having used e-cigarettes (adjusted odds ratios [AORs] ranged 9.5-70.6, p < .001). While these associations were significant for both experimental and frequent e-cigarette users, the effects of early onset were stronger among frequent e-cigarette users. Similarly, the odds of these substance use behaviors (except alcohol) among early onset e-cigarette users were also significantly greater than the odds for later onset e-cigarette users (AORs ranged 2.8-4.1, p < .05). Conclusions Early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. E-cigarette use is often preceded by alcohol use, cigarette smoking, and marijuana use, suggesting that more long-term prospective studies are warranted. Implications To date, no studies have examined the probability of cigarette smoking and other substance use behaviors as a function of age at onset of e-cigarette use. In the present study, early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. The findings reinforce the importance of addressing a wide range of substances including alcohol, traditional cigarettes, and marijuana when developing early primary prevention efforts to reduce e-cigarette use among youth.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, Substance Abuse Research Center, University of Michigan, Ann Arbor, MI
| | - Brady T West
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Vita V McCabe
- Lung Care and Smoking Cessation Program, St. Joseph Mercy Ann Arbor, Ann Arbor, MI
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Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health 2019; 19:1211. [PMID: 31477072 PMCID: PMC6721166 DOI: 10.1186/s12889-019-7523-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/21/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The American Cancer Society discourages the dual use of electronic cigarettes (ECs) and cigarettes because such use has not resulted in reduced exposures to the harmful effects of smoking. American Indian (AI) people have the highest prevalence of smoking and of EC use in the United States, but very little is known about dual EC and cigarette use in AI communities. METHODS In 2016, 375 adult AI in Oklahoma who smoked cigarettes completed a survey about EC use (vaping). We describe vaping patterns, nicotine dependence, and reasons for EC use among the subset of 44 (12%) current dual EC users. To differentiate habitual EC users from occasional or merely curious users, we defined dual use as using ECs on some days or every day in the past 30 days. RESULTS About one-third of dual users vaped ten or more times daily. About two-thirds used a tank product. Eleven percent used ECs without nicotine and another 9% were unsure of the nicotine content. A minority (40%) enjoyed vaping more than smoking, and most (76%) would smoke first on days they did both. Thirty-one percent vaped within 5 min of waking and another 24% within 30 min. Although the two-item heaviness of use index did not differ significantly between smoking and vaping, the ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping (11.02 vs. 6.42, respectively; p < .0001). The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them. CONCLUSIONS Nearly 20% of dual users used ECs either without nicotine or without knowing if the product contained nicotine. The PSDI indicated greater dependence on smoking than vaping. Reasons for vaping were nearly equal between smoking reduction and enjoying flavors. Understanding patterns of dual use will inform future efforts to address nicotine dependence for AI communities with high prevalence of smoking.
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Affiliation(s)
- Dorothy A Rhoades
- Department of Medicine, University of Oklahoma Health Sciences Center, and Stephenson Cancer Center, 655 Research Parkway, Room 449, Oklahoma City, OK, 73104, USA.
| | | | - Justin D Dvorak
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kai Ding
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michelle Hopkins
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul Spicer
- Center for Applied Social Research, University of Oklahoma, Norman, OK, USA
| | - Theodore L Wagener
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mark P Doescher
- Department of Family Medicine, University of Oklahoma Health Sciences Center, and Stephenson Cancer Center, Oklahoma City, OK, USA
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Rhoades DA, Comiford AL, Dvorak JD, Ding K, Driskill LM, Hopkins AM, Spicer P, Wagener TL, Doescher MP. Dual Versus Never Use of E-Cigarettes Among American Indians Who Smoke. Am J Prev Med 2019; 57:e59-e68. [PMID: 31377092 PMCID: PMC6702079 DOI: 10.1016/j.amepre.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Many American Indian communities have a high prevalence of smoking and e-cigarette use, but factors associated with their dual use are rarely studied. METHODS In 2016, a total of 375 American Indian adults who smoke completed paper surveys regarding cigarette and e-cigarette use and provided saliva for cotinine levels. In 2018, cross-sectional analyses were performed, comparing dual users (12%), defined as using e-cigarettes on some or every day for the past 30 days, with never users of e-cigarettes (37%). RESULTS Compared with never users, dual users were younger, more often reported history of depression (56% and 29%, respectively; p<0.01) and family history of smoking-related disease (77% and 59%, respectively; p<0.05), had lower harm perceptions of e-cigarettes (27% and 47%, respectively; p<0.01) or vapor (14% and 35%, respectively; p<0.01), and more often perceived e-cigarettes as cessation aids (75% and 16%, respectively; p<0.01) and as less harmful than cigarettes (70% and 17%, respectively; p<0.01). Dual users were less often uncertain/unknowing about e-cigarette benefits or harms (p<0.01) and more often reported likelihood to quit smoking (49% and 24%, respectively; p<0.01) and prior attempt to quit smoking, ever (89% and 67%, respectively; p<0.01) or in the past year (55% and 32%, respectively; p=0.01). Cigarette consumption and cotinine levels did not differ between groups. Dual users more often tried other nicotine products (p<0.02) and more often lived with a vaping partner/spouse (45% and 6%, respectively; p<0.01). CONCLUSIONS Dual users perceived e-cigarettes as less harmful than cigarettes and more as cessation aids than cigarette-only users did, but cigarette consumption did not differ between groups. Whether e-cigarettes will reduce smoking-related disparities among American Indian people remains undetermined.
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Affiliation(s)
- Dorothy A Rhoades
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma City, Oklahoma.
| | | | - Justin D Dvorak
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kai Ding
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Leslie M Driskill
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Audrea M Hopkins
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Paul Spicer
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
| | - Theodore L Wagener
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mark P Doescher
- Stephenson Cancer Center, Oklahoma City, Oklahoma; Department of Family Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Czoli CD, Fong GT, Goniewicz ML, Hammond D. Biomarkers of Exposure Among "Dual Users" of Tobacco Cigarettes and Electronic Cigarettes in Canada. Nicotine Tob Res 2019; 21:1259-1266. [PMID: 30203076 PMCID: PMC6698946 DOI: 10.1093/ntr/nty174] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/05/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION "Dual use" refers to the concurrent use of tobacco cigarettes (smoking) and electronic cigarettes (e-cigarettes; vaping). Although dual use is common among e-cigarette users, there is little evidence regarding biomarkers of exposure among dual users and how these change under different conditions of product use. METHODS A nonblinded within-subjects crossover experiment was conducted with adult daily dual users (n = 48) in Ontario, Canada. Participants completed three consecutive 7-day periods in which the use of tobacco cigarettes and e-cigarettes was experimentally manipulated, resulting in four study conditions: Dual use, Tobacco cigarette use, E-cigarette use, and No product use. Repeated measures models were used to examine changes in product use and biomarkers of exposure. RESULTS Compared to dual use, cotinine remained stable when participants exclusively smoked (p = .524), but significantly decreased when they exclusively vaped (p = .027), despite significant increases in e-cigarette consumption (p = .001). Levels of biomarkers of exposure to toxicants, including carbon monoxide (CO), 1-hydroxypyrene (1-HOP), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), were significantly lower when participants exclusively vaped than when they engaged in dual use (CO = -41%, p < .001; 1-HOP = -31%, p = .025; NNAL = -30%, p = .017). Similar findings were observed among participants abstaining from both products as compared to dual use (CO: -26%, p < .001; 1-HOP = -14% [ns]; NNAL = -35%, p = .016). In contrast, levels of biomarkers of exposure increased when participants exclusively smoked as compared to dual use (CO = +21%, p = .029; 1-HOP = +23%, p = .048; NNAL = +8% [ns]). CONCLUSIONS Although dual use may reduce exposure to tobacco smoke constituents to some extent, abstaining from smoking is the most effective way to reduce such exposure. IMPLICATIONS Public health authorities should clearly communicate the relative risk of e-cigarettes and tobacco cigarettes to the general public, focusing on two salient points: (1) e-cigarettes are not harmless, but they are less harmful than tobacco cigarettes; and (2) using e-cigarettes while smoking may not necessarily reduce health risks; therefore, consumers should stop smoking completely to maximize potential health benefits.
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Affiliation(s)
- Christine D Czoli
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Geoffrey T Fong
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Goldenson NI, Leventhal AM, Simpson KA, Barrington-Trimis JL. A Review of the Use and Appeal of Flavored Electronic Cigarettes. CURRENT ADDICTION REPORTS 2019; 6:98-113. [PMID: 31453046 PMCID: PMC6709993 DOI: 10.1007/s40429-019-00244-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW E-cigarettes are available in a variety of flavors not found in traditional tobacco products (i.e., "nontraditional flavors"), which is a commonly-cited reason for e-cigarette use. This review examines the prevalence of nontraditional-flavored e-cigarette use, mechanisms through which flavorings enhance product appeal, use of nontraditional-flavored e-cigarettes for smoking cessation, and differences in these findings between youth and adults. RECENT FINDINGS Nontraditional-flavored e-cigarettes are used at e-cigarette initiation by the majority of youth. These flavors enhance the appeal of e-cigarettes by creating sensory perceptions of sweetness and coolness and masking the aversive taste of nicotine. Use of nontraditional-flavored e-cigarettes is higher among youth and young adults (vs. older adults) and among nonsmokers (vs. combustible cigarette smokers). SUMMARY Nontraditional-flavored e-cigarettes are popular among youth, but may be less common among older adults and combustible cigarette smokers. Further research is needed to determine whether use of e-cigarettes in nontraditional flavors affects smoking cessation.
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Affiliation(s)
- Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Kelsey A. Simpson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
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Javadi-Paydar M, Kerr TM, Harvey EL, Cole M, Taffe MA. Effects of nicotine and THC vapor inhalation administered by an electronic nicotine delivery system (ENDS) in male rats. Drug Alcohol Depend 2019; 198:54-62. [PMID: 30878767 PMCID: PMC6467722 DOI: 10.1016/j.drugalcdep.2019.01.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/23/2019] [Accepted: 01/26/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS, e-cigarettes) are increasingly used for the self-administration of nicotine by various human populations, including previously nonsmoking adolescents. Studies in preclinical models are necessary to evaluate health impacts of ENDS including the development of nicotine addiction, effects of ENDS vehicles, flavorants and co-administered psychoactive substances such as Δ9-tetrahydrocannabinol (THC). This study was conducted to validate a rat model useful for the study of nicotine effects delivered by inhalation of vapor created by ENDS. METHODS Male Sprague-Dawley rats (N = 8) were prepared with radio telemetry devices for the reporting of temperature and activity. Experiments subjected rats to inhalation of vapor generated by an electronic nicotine delivery system (ENDS) adapted for rodents. Inhalation conditions included vapor generated by the propylene glycol (PG) vehicle, Nicotine (1, 10, 30 mg/mL in the PG) and THC (12.5, 25 mg/mL). RESULTS Nicotine inhalation increased spontaneous locomotion and decreased body temperature of rats. Pretreatment with the nicotinic cholinergic receptor antagonist mecamylamine (2 mg/kg, i.p.) prevented stimulant effects of nicotine vapor inhalation and attenuated the hypothermic response. Combined inhalation of nicotine and THC resulted in apparently independent effects which were either additive (hypothermia) or opposed (activity). CONCLUSIONS These studies provide evidence that ENDS delivery of nicotine via inhalation results in nicotine-typical effects on spontaneous locomotion and thermoregulation in male rats. Effects were blocked by a nicotinic antagonist, demonstrating mechanistic specificity. This system will therefore support additional studies of the contribution of atomizer/wick design, vehicle constituents and/or flavorants to the effects of nicotine administered by ENDS.
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Affiliation(s)
| | - Tony M. Kerr
- Department of Neuroscience, The Scripps Research Institute, La Jolla, CA, USA
| | - Eric L. Harvey
- Department of Neuroscience, The Scripps Research Institute, La Jolla, CA, USA
| | - Maury Cole
- La Jolla Alcohol Research, Inc., La Jolla, CA, USA
| | - Michael A. Taffe
- Department of Neuroscience, The Scripps Research Institute, La Jolla, CA, USA,Correspondence: Michael A. Taffe, Department of Neuroscience, The Scripps Research Institute, SP30-2400 10550 North Torrey Pines Road, La Jolla, CA 92037, Phone: +1.858.784.7228 Fax: +1.858.784.7405
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Cooper MR, Case KR, Hébert ET, Vandewater EA, Raese KA, Perry CL, Businelle MS. Characterizing ENDS use in young adults with ecological momentary assessment: Results from a pilot study. Addict Behav 2019; 91:30-36. [PMID: 30471788 PMCID: PMC6364672 DOI: 10.1016/j.addbeh.2018.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ecological Momentary Assessment (EMA) allows for assessment of electronic nicotine delivery systems (ENDS) use in real-time. This EMA study aimed to 1) describe study participation rates; 2) evaluate the concordance of EMA and survey items measuring frequency and quantity of ENDS use; and 3) assess the relationships between EMA items measuring frequency and quantity of ENDS use with ENDS dependence, measured at baseline and with saliva cotinine collected at follow-up. METHODS Fifty young adult ENDS users completed baseline surveys, EMAs (i.e., random, event-based, daily diaries), and follow-up questionnaires over a 14-day period. Spearman correlations were conducted to determine concordance of survey items. Linear regression models assessed the relationships between EMA ENDS use characteristics (e.g., puffs, number of days used, quantity of e-liquid) with dependence items at baseline and saliva cotinine at follow-up. RESULTS Overall completion for the prompted EMAs (random and daily diaries) was 68%. Correlations between EMA measures assessing ENDS use ranged from weak (ρ = -0.02; NS) to strong (ρ = 0.69, p < .001); EMA to follow-up items ranged from weak (ρ = 0.16; p < .05) to moderate (ρ = 0.54; p < .001). Significant associations were found between ENDS use measured via random and daily diary EMAs and saliva cotinine at follow-up after controlling for cigarette smoking (B = 0.70-1.76; p < .01), but not for event-based EMAs. Items measuring frequency/quantity of use from random EMAs were consistently associated with ENDS dependence at baseline (B = 0.74-1.58; p < .01). CONCLUSION EMA represents a promising methodology to capture real-time ENDS use behaviors, primarily through daily diary and random EMAs.
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Affiliation(s)
- Maria R Cooper
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA.
| | - Kathleen R Case
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Emily T Hébert
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA
| | - Elizabeth A Vandewater
- University of Texas at Austin, Population Research Center, 305 E. 23rd Street, Stop G1800, Austin, TX 78712, USA
| | - Kristen A Raese
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Michael S Businelle
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA
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Herbeć AA, Chang Y, Tindle HA, Rigotti NA. Smokers' use of electronic cigarettes before, during, and in the month after hospitalization. Findings from the Helping HAND 2 Study. Addict Behav 2019; 91:5-11. [PMID: 30502929 DOI: 10.1016/j.addbeh.2018.10.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hospitalization can motivate smokers to attempt cessation, and some smokers might use e-cigarettes to aid quitting after discharge. Little is known about the patterns and predictors of smokers' e-cigarette use immediately before, during, and after hospitalization. METHODS Secondary data analysis of a multi-site randomized controlled trial that enrolled 1357 hospitalized smokers planning to quit offered two intensities of post-discharge cessation treatment and reached 1100 participants at 1-month follow-up. We assessed reasons for and patterns of e-cigarette use before, during and immediately after hospitalization. Multivariable logistic regression models identified independent predictors of e-cigarette use. RESULTS E-cigarettes were used, primarily to aid quitting, by 21.4% of smokers in the month before admission, 3.1% during hospitalization, and 18.3% in the month after discharge. At 1 month, 10.6% were past 7-day (current) e-cigarette users, but few used e-cigarettes regularly and 57.3% also smoked tobacco. New e-cigarette use in the month after discharge was rare. The adjusted odds ratio (AOR;95%CI) for current e-cigarette use was higher among smokers who used e-cigarettes before hospitalization (5.08;3.31-7.81), consumed more alcohol (1.80;1.16-2.80) and had less confidence to quit (1.66;1.05-2.61). The AOR was lower among non-Hispanic blacks (0.25;0.09-0.71), Medicaid-insured (0.56;0.33-0.93), and those randomly assigned to receive free cessation medication and counseling at discharge (0.58;0.38-0.90). CONCLUSIONS Following hospitalization, some smokers who plan to quit use e-cigarettes, particularly if they used them before admission, are less confident to quit, or have less easy access to conventional treatment. Clinicians should document and be prepared to address e-cigarette use among hospitalized smokers.
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Affiliation(s)
- Aleksandra A Herbeć
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Department of Behavioral Science and Health, University College London, London, UK.
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hilary A Tindle
- Vanderbilt Center for Tobacco, Addiction, and Lifestyle (ViTAL), Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center and Vanderbilt Medical School, Nashville, TN, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Mayorga NA, Garey L, Zvolensky MJ. Differences in perceptions of e-cigarettes across daily and non-daily users. Addict Behav 2019; 90:415-420. [PMID: 30537655 DOI: 10.1016/j.addbeh.2018.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/18/2018] [Accepted: 12/04/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE E-cigarette use has increased significantly over the past decade. Among the growing population of e-cigarette users, several pattern-based subgroups have emerged, including daily and non-daily users. Daily users are at greater risk for experiencing negative health consequences from use. Yet, little is understood about underlying e-cigarette processes that may be related to daily use relative to non-daily use. METHOD The present study sought to investigate differences in three clinically-relevant e-cigarette processes, including perceived risks (including both absolute and comparable risks to combustible cigarettes), benefits, and innovation of e-cigarettes between daily and non-daily users. The study included 564 adult current e-cigarette users (51.1% female, Mage = 35.1 years, SD = 10.2). RESULTS Results indicated a significant difference in levels of perception for all three dependent variables, such that daily users reported a higher level of perceived risks, benefits, and innovation for e-cigarettes. CONCLUSIONS Overall, the current study provides empirical evidence that perceived risks, benefits and innovations may be more strongly endorsed by more daily e-cigarette uses. Importantly, this study adds to evolving, but thus far limited, knowledge of e-cigarettes by highlighting how frequency of e-cigarette use relates to beliefs about e-cigarette use.
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Gentzke AS, Homa DM, Kenemer JB, Gomez Y, King BA. Rules to prohibit the use of electronic vapor products inside homes and personal vehicles among adults in the U.S., 2017. Prev Med 2018; 114:47-53. [PMID: 29857024 PMCID: PMC6082704 DOI: 10.1016/j.ypmed.2018.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
Most U.S. adults have voluntary rules prohibiting the use of smoked tobacco products in their homes and vehicles. However, the prevalence of similar rules for electronic vapor products (EVPs) is uncertain. This study assessed the prevalence and correlates of rules prohibiting EVP use inside homes and vehicles. Data from a 2017 Internet-based panel survey of U.S. adults aged ≥18 years (n = 4107) were analyzed. For homes and vehicles, prevalence of reporting that EVP use was not allowed, partially allowed, fully allowed, or unknown was assessed overall and by covariates. Correlates of prohibiting EVP use was assessed by multivariable logistic regression. In homes, 58.6% of adults did not allow EVP use, 7.7% partially allowed use, 10.1% fully allowed use, and 23.6% were unsure of the rules. In vehicles, 63.8% of respondents did not allow EVP use, 6.0% partially allowed use, 8.9% fully allowed use, and 21.4% were unsure of the rules. Following multivariable adjustment, prohibiting EVP use inside homes and vehicles was more likely among respondents with higher income and education, and with a child aged <18 years. Users of EVPs and other tobacco products, and respondents living with users of EVPs and other tobacco products, were less likely to prohibit EVP use in these locations. These findings show that about 6 in 10 U.S. adults have rules prohibiting EVP use inside homes and vehicles, but variations exist by population subgroups. Voluntary smoke-free rules in homes and vehicles that include EVPs can help protect children and non-users from secondhand EVP aerosol exposure.
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Affiliation(s)
- Andrea S Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-79, Atlanta, GA 30341, USA.
| | - David M Homa
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-79, Atlanta, GA 30341, USA
| | - J Brandon Kenemer
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-79, Atlanta, GA 30341, USA
| | - Yessica Gomez
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-79, Atlanta, GA 30341, USA
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-79, Atlanta, GA 30341, USA
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Case KR, Lazard AJ, Mackert MS, Perry CL. Source Credibility and E-Cigarette Attitudes: Implications for Tobacco Communication. HEALTH COMMUNICATION 2018; 33:1059-1067. [PMID: 28622021 PMCID: PMC5732895 DOI: 10.1080/10410236.2017.1331190] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As there are many conflicting sources of e-cigarette information, research is needed to determine the impact of these sources on e-cigarette attitudes to inform future communication campaigns. Source credibility is important in shaping attitudes toward other health topics; however, no study has examined its role in influencing e-cigarette attitudes. Data from the 2015 Health Information National Trends Survey-FDA (HINTS-FDA) were utilized to assess differences in trust in different sources by e-cigarette user status and to investigate the associations between trust in sources and e-cigarette attitudes (n = 3,738). Differences in trust in sources were examined using weighted linear regression. Associations between trust in sources of e-cigarette health effects and attitudes toward e-cigarettes were assessed using weighted logistic regression. Overall, e-cigarette ever users reported significantly lower trust in governmental agencies as compared to never users. Trust in e-cigarette companies was negatively associated with perceived addictiveness of e-cigarettes (AOR = 0.76, 95% CI = 0.58, 1.00), while trust in doctors/pharmacists/healthcare providers was negatively associated with harm perceptions of e-cigarettes relative to conventional cigarettes (AOR = 0.72, 95% CI = 0.55, 0.95). Trust in tobacco companies and trust in e-cigarette companies were negatively associated with absolute perceived harm of e-cigarettes (AOR = 0.70, 95% CI = 0.51, 0.95; AOR = 0.60, 95% CI = 0.46, 0.79, respectively). Results from this study indicate that the associations between trust in sources of e-cigarette health effects and e-cigarette attitudes differ both by source and specific attitude assessed. Ultimately, future campaigns should incorporate messaging to discredit industry sources of information and utilize non-governmental sources to effectively influence e-cigarette attitudes.
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Affiliation(s)
- Kathleen R. Case
- School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth)
| | - Allison J. Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill
| | - Michael S. Mackert
- School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth)
- Stan Richards School of Advertising and Public Relations, University of Texas at Austin
- University of Texas at Austin, University of Texas at Austin Center for Health Communication
| | - Cheryl L. Perry
- School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth)
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Stroup AM, Branstetter SA. Effect of e-cigarette advertisement exposure on intention to use e-cigarettes in adolescents. Addict Behav 2018; 82:1-6. [PMID: 29471130 DOI: 10.1016/j.addbeh.2018.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/26/2018] [Accepted: 02/13/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With the growth of electronic cigarettes use, curiosity about and experimentation with these products has increased among adolescents. The purpose of the present study was to evaluate the moderating effect of e-cigarette advertisement (ad) exposure on the relation between perceptions of use and intentions to use in youth. METHODS Multiple regression analyses utilizing data from the 2014 National Youth Tobacco Survey (N = 17,286) were used to evaluate the effect of ad exposure, perceived harmfulness, barriers, and benefits of e-cigarette use on intentions to use among youth who had never used e-cigarettes. RESULTS Models for non-smokers accounted for 15.5% of the variance in intention to use (R2 = 0.155, F (15) = 187.0, p < 0.001). Results demonstrate that an increase in the number of exposures to e-cigarette ads was associated with an increase in intent to use (b = 0.039, t = 7.4, p < 0.001). Models also demonstrated significant interactions between ad exposure and perceptions of use on future intention to use. For smokers, models explained 11.1% of the variance in intention to use (R2 = 0.111, F (15) = 3.1, p < 0.001). Ad exposure had a non-significant effect on intention to use e-cigarettes (b = -0.010, t = -0.2, p = 0.859). In smokers, ad exposure did not significantly affect the association between perceptions of use and intention to use. CONCLUSIONS Ads are most effective at attracting non-smoking youth as new users rather than promoting product switching in young cigarette smokers.
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Affiliation(s)
- Andrea M Stroup
- Pennsylvania State University, Department of Biobehavioral Health, 219 Biobehavioral Health Building, University Park, PA 16802, USA.
| | - Steven A Branstetter
- Pennsylvania State University, Department of Biobehavioral Health, 219 Biobehavioral Health Building, University Park, PA 16802, USA.
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Getachew B, Payne JB, Vu M, Pillai D, Shah J, Levine H, Berg CJ. Perceptions of Alternative Tobacco Products, Anti-tobacco Media, and Tobacco Regulation among Young Adults: A Qualitative Study. Am J Health Behav 2018; 42:118-130. [PMID: 29973316 PMCID: PMC6818245 DOI: 10.5993/ajhb.42.4.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives With increased alternative tobacco product (ATP) use and lagging public health action, we explored perceptions of ATPs, anti-tobacco messaging, and tobacco regulation among young adults. Methods Semi-structured interviews were conducted with 60 Georgia college students aged 18-25 using: (1) cigarettes, little cigars/cigarillos (LCCs), smokeless tobacco, or e-cigarettes ≥15 days of the past 30; or (2) hookah ≥10 of the past 30 days (due to lower frequency of use). Of 99 participants recruited, 80 consented, and 60 participated. Results Participants were on average 21.01 years old (SD = 2.07), 56.7% women, and 65.0% black; 56.7% reported current use of cigarettes, 43.3% LCCs, 26.7% smokeless tobacco, 45.0% e-cigarettes, and 41.7% hookah. Cigarettes were perceived as most harmful to health and most addictive. E-cigarettes and hookah were generally regarded as lowest risk. Many indicated that ATP risk information was limited or inaccessible and that most anti-tobacco campaigns were irrelevant to ATPs. Participants requested more research and dissemination of evidence regarding ATP risks and need for ATP regulation. Conclusions In light of low risk perceptions regarding ATPs among young adults, research, anti-tobacco campaigns, and regulation must address their known and potential risks.
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Tan ASL, Rees VW, Rodgers J, Agudile E, Sokol NA, Yie K, Sanders-Jackson A. Effects of exposure to anti-vaping public service announcements among current smokers and dual users of cigarettes and electronic nicotine delivery systems. Drug Alcohol Depend 2018; 188:251-258. [PMID: 29793189 PMCID: PMC6825509 DOI: 10.1016/j.drugalcdep.2018.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/28/2018] [Accepted: 04/01/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Anti-vaping public service announcements (PSAs) are intended to discourage vaping or use of electronic nicotine delivery systems (ENDS). However, vaping portrayals in PSAs may have unintended effects if they increase smoking or vaping urges. This study examined benefits and unintended effects of anti-vaping PSAs with vapor portrayals on smoking and vaping-related outcomes. METHODS Young adult smokers (N = 171) and dual users (N = 122) aged 21-30 years were randomly assigned to view: 1) anti-vaping PSAs with vapor; 2) anti-vaping PSAs without vapor; 3) physical activity PSAs; or 4) anti-smoking PSAs with smoking cues. Outcomes were changes in vaping and smoking urges before and after viewing PSAs, post-test vaping and smoking intentions in the next hour, and post-test intention to purchase ENDS and traditional cigarettes. RESULTS Smokers only: Exposure to anti-vaping PSAs with vapor (vs. physical activity) was associated with lower intention to vape and to purchase ENDS (ps < 0.001) and lower intention to smoke and purchase cigarettes (ps < 0.05). Exposure to anti-vaping PSAs with vapor (vs. PSAs without vapor and vs. anti-smoking PSAs with smoking cues) was associated with lower intention to vape in the next hour (ps < 0.05). Exposure to anti-vaping PSAs without vapor (vs. physical activity) was associated with lower change in vaping urge (p < 0.05) and intention to purchase ENDS (p < 0.001). Dual users: Exposure to anti-vaping PSAs without vapor (vs. anti-smoking PSAs) was associated with lower intention to purchase ENDS (p < 0.05). CONCLUSION Viewing anti-vaping PSAs with vapor was not associated with unintended effects and may have benefits on reducing smoking and vaping-related outcomes.
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Affiliation(s)
- Andy SL Tan
- Dana-Farber Cancer Institute, Population Sciences Division, Center for Community Based Research, Boston, USA,Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, USA
| | - Vaughan W Rees
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, USA
| | - Justin Rodgers
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, USA
| | - Emeka Agudile
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, USA
| | - Natasha A Sokol
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, USA
| | - Kyeungyeun Yie
- Michigan State University, Department of Advertising and Public Relations, College of Communication Arts and Science, 404 Wilson Road, Lansing, MI
| | - Ashley Sanders-Jackson
- Michigan State University, Department of Advertising and Public Relations, College of Communication Arts and Science, 404 Wilson Road, Lansing, MI
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Buckell J, Marti J, Sindelar JL. Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment. Tob Control 2018; 28:tobaccocontrol-2017-054165. [PMID: 29807947 PMCID: PMC6261708 DOI: 10.1136/tobaccocontrol-2017-054165] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To provide the policy-relevant estimates of impacts of alternative flavour bans on preferences and demand for cigarettes and e-cigarettes in adult smokers and recent quitters. METHODS A best-best discrete choice experiment (DCE) is used to elicit smokers' and recent quitters' preferences for flavours, price, health impact and nicotine level in cigarettes and e-cigarettes. Choice of tobacco products and an opt-out option were examined. An efficient design yielded 36 choice sets. Exploded logit choice models were estimated. Flavour bans are modelled by restricting flavour coefficients in the estimated model. SETTING AND PARTICIPANTS A sample of 2031 adult smokers and recent quitters was recruited to complete an online survey and DCE. RESULTS Current smokers and recent quitters, on average, prefer cigarettes and menthol cigarettes over flavoured e-cigarettes. However, there is substantial preference heterogeneity by younger adults (ages 18-25), race/ethnicity and respondents with higher education. Our predictions suggest that a ban on menthol cigarettes would produce the greatest reduction in the choice of cigarettes (-5.2%), but with an accompanying increase in e-cigarettes use (3.8%). In contrast, banning flavours in e-cigarettes, while allowing menthol in cigarettes would result in the greatest increase in the selection of cigarettes (8.3%), and a decline in the use of e-cigarettes (-11.1%). A ban on all flavours, but tobacco in both products would increase 'opting-out' the most (5.2%) but would also increase choice of cigarettes (2.7%) and decrease choice of e-cigarettes (-7.9%). CONCLUSIONS A ban on flavoured e-cigarettes alone would likely increase the choice of cigarettes in smokers, arguably the more harmful way of obtaining nicotine, whereas a ban on menthol cigarettes alone would likely be more effective in reducing the choice of cigarettes. A ban on all flavours in both products would likely reduce the smoking/vaping rates, but the use of cigarettes would be higher than in the status quo. Policy-makers should use these results to guide the choice of flavour bans in light of their stance on the potential health impacts both products.
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Affiliation(s)
- John Buckell
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Joachim Marti
- Institute of Social and Preventive Medicine (IUMSP), CHUV, Université de Lausanne, Lausanne, Switzerland
| | - Jody L Sindelar
- School of Public Health, Yale University, New Haven, Connecticut, USA
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Coleman B, Rostron B, Johnson SE, Persoskie A, Pearson J, Stanton C, Choi K, Anic G, Goniewicz ML, Cummings KM, Kasza KA, Silveira ML, Delnevo C, Niaura R, Abrams DB, Kimmel HL, Borek N, Compton WM, Hyland A. Transitions in electronic cigarette use among adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1 and 2 (2013-2015). Tob Control 2018; 28:50-59. [PMID: 29695458 DOI: 10.1136/tobaccocontrol-2017-054174] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/06/2018] [Accepted: 03/21/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION This study assessed patterns of e-cigarette and cigarette use from Wave 1 to Wave 2 among adult e-cigarette users at Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. METHODS We examined changes in e-cigarette use frequency at Wave 2 among adult e-cigarette users at Wave 1 (unweighted n=2835). Adjusted prevalence ratios (aPR) were calculated using a predicted marginal probability approach to assess correlates of e-cigarette discontinuance and smoking abstinence at Wave 2. RESULTS Half (48.8%) of adult e-cigarette users at Wave 1 discontinued their use of e-cigarettes at Wave 2. Among dual users of e-cigarettes and cigarettes at Wave 1, 44.3% maintained dual use, 43.5% discontinued e-cigarette use and maintained cigarette smoking and 12.1% discontinued cigarette use at Wave 2, either by abstaining from cigarette smoking only (5.1%) or discontinuing both products (7.0%). Among dual users at Wave 1, daily e-cigarette users were more likely than non-daily users to report smoking abstinence at Wave 2 (aPR=1.40, 95% CI 1.02 to 1.91). Using a customisable device (rather than a non-customisable one) was not significantly related to smoking abstinence at Wave 2 (aPR=1.14, 95% CI 0.81 to 1.60). CONCLUSIONS This study suggests that e-cigarette use patterns are highly variable over a 1-year period. This analysis provides the first nationally representative estimates of transitions among US adult e-cigarette users. Future research, including additional waves of the PATH Study, can provide further insight into long-term patterns of e-cigarette use critical to understanding the net population health impact of e-cigarettes in USA.
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Affiliation(s)
- Blair Coleman
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Brian Rostron
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sarah E Johnson
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Alexander Persoskie
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jennifer Pearson
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | | | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Gabriella Anic
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Maciej Lukasz Goniewicz
- Division of Cancer Prevention and Population Sciences, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Kenneth Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Medical University of South Carolina, South Carolina, USA
| | - Karin A Kasza
- Division of Cancer Prevention and Population Sciences, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Marushka L Silveira
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland, USA.,Kelly Government Solutions, Rockville, Maryland, USA
| | - Cristine Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, New Brunswick, New Jersey, USA
| | | | - David B Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York, USA
| | - Heather L Kimmel
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Wilson M Compton
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Andrew Hyland
- Division of Cancer Prevention and Population Sciences, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
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Correa JB, Brandon KO, Meltzer LR, Hoehn HJ, Piñeiro B, Brandon TH, Simmons VN. Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication. Psychooncology 2018; 27:1757-1764. [PMID: 29671928 DOI: 10.1002/pon.4721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 03/24/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Smoking tobacco cigarettes after a cancer diagnosis increases risk for several serious adverse outcomes. Thus, patients can significantly benefit from quitting smoking. Electronic cigarettes are an increasingly popular cessation method. Providers routinely ask about combustible cigarette use, yet little is known about use and communication surrounding e-cigarettes among patients with cancer. This study aims to describe patterns, beliefs, and communication with oncology providers about e-cigarette use of patients with cancer. METHODS Patients with cancer (N = 121) who currently used e-cigarettes were surveyed in a cross-sectional study about their patterns and reasons for use, beliefs, and perceptions of risk for e-cigarettes, combustible cigarettes, and nicotine replacement therapies. Patient perspectives on provider communication regarding e-cigarettes were also assessed. RESULTS Most participants identified smoking cessation as the reason for initiating (81%) and continuing (60%) e-cigarette use. However, 51% of patients reported current dual use of combustible cigarettes and e-cigarettes, and most patients reported never having discussed their use of e-cigarettes with their oncology provider (72%). Patients characterized e-cigarettes as less addictive, less expensive, less stigmatizing, and less likely to impact cancer treatment than combustible cigarettes (Ps < .05), and more satisfying, more useful for quitting smoking, and more effective at reducing cancer-related stress than nicotine replacement therapies (Ps < .05). CONCLUSIONS Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation. This study also highlights the need for improved patient-provider communication on the safety and efficacy of e-cigarettes for smoking cessation.
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Affiliation(s)
- John B Correa
- Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Karen O Brandon
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Lauren R Meltzer
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Hannah J Hoehn
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Bárbara Piñeiro
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Thomas H Brandon
- Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Vani N Simmons
- Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Primack BA, Shensa A, Sidani JE, Hoffman BL, Soneji S, Sargent JD, Hoffman RM, Fine MJ. Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use Among Tobacco-Naïve US Young Adults. Am J Med 2018; 131:443.e1-443.e9. [PMID: 29242110 PMCID: PMC7054856 DOI: 10.1016/j.amjmed.2017.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 04/25/2017] [Accepted: 11/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although electronic cigarettes (e-cigarettes) may help some smokers quit, some young adult never-smokers are now using e-cigarettes recreationally, potentially increasing their risk for initiation of smoking. We aimed to determine the association between baseline e-cigarette use and subsequent initiation of cigarette smoking among initially never-smoking young adults. METHODS We conducted a prospective cohort study with assessments at baseline (March 2013) and follow-up (October 2014). We used sampling frames representing 97% of the US population to recruit a nationally representative sample of never-smoking young adults aged 18 to 30 years. The independent variable was baseline ever use of e-cigarettes. The main outcome measure was initiation of traditional cigarette smoking between baseline and 18-month follow-up. RESULTS Baseline surveys were completed by 1506 never-smoking young adults, of whom 915 (60.8%) completed follow-up. There were no demographic differences between responders and nonresponders. After applying survey weights-which accounted for both nonresponse and overcoverage or undercoverage-2.5% of the represented population of never-smokers (801,010 of 32,040,393) used e-cigarettes at baseline. Cigarette smoking was initiated by 47.7% of e-cigarette users and 10.2% of nonusers (P = .001). In fully adjusted multivariable models, e-cigarette use at baseline was independently associated with initiation of smoking at 18 months (adjusted odds ratio, 6.8; 95% confidence interval, 1.7-28.3). Results remained similar in magnitude and statistically significant in all sensitivity analyses. CONCLUSIONS Baseline e-cigarette use was independently associated with initiation of traditional cigarette smoking at 18 months. This finding supports policy and educational interventions designed to decrease use of e-cigarettes among nonsmokers.
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Affiliation(s)
- Brian A Primack
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa; University of Pittsburgh Honors College, University of Pittsburgh, Pittsburgh, Pa.
| | - Ariel Shensa
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Jaime E Sidani
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Beth L Hoffman
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Samir Soneji
- C. Everett Koop Institute at Dartmouth, Geisel School of Medicine, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - James D Sargent
- C. Everett Koop Institute at Dartmouth, Geisel School of Medicine, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | | | - Michael J Fine
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa; VA Pittsburgh Healthcare System, Pittsburgh, Pa
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Kulik MC, Lisha NE, Glantz SA. E-cigarettes Associated With Depressed Smoking Cessation: A Cross-sectional Study of 28 European Union Countries. Am J Prev Med 2018; 54:603-609. [PMID: 29449132 PMCID: PMC5860982 DOI: 10.1016/j.amepre.2017.12.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/22/2017] [Accepted: 12/13/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) are often promoted to assist with cigarette smoking cessation. In 2016-2017, the relationship between e-cigarette use and having stopped smoking among ever (current and former) smokers was assessed in the European Union and Great Britain by itself. METHODS Cross-sectional logistic regression of the association between being a former smoker and e-cigarette use was applied to the 2014 Eurobarometer survey of 28 European Union countries controlling for demographics. RESULTS Among all ever smokers, any regular ever use of nicotine e-cigarettes was associated with lower odds of being a former smoker (unadjusted OR=0.34, 95% CI=0.26, 0.43, AOR=0.43, 95% CI=0.32, 0.58) compared with smokers who had never used e-cigarettes. In unadjusted models, daily use (OR=0.42, 95% CI=0.31, 0.56); occasional use (OR=0.25, 95% CI=0.18, 0.35); and experimentation (OR=0.24, 95% CI=0.19, 0.30) of nicotine e-cigarettes were associated with lower odds of being a former smoker compared with having never used nicotine-containing e-cigarettes. Comparable results were found in adjusted models. Results were similar in Great Britain alone. Among current smokers, daily cigarette consumption was 15.6 cigarettes/day (95% CI=14.5, 16.7) among those who also used e-cigarettes versus 14.4 cigarettes/day (95% CI=13.4, 15.4) for those who did not use them (p<0.05). CONCLUSIONS These results suggest that e-cigarettes are associated with inhibiting rather than assisting in smoking cessation. On the population level, the net effect of the entry of e-cigarettes into the European Union (and Great Britain) is associated with depressed smoking cessation of conventional cigarettes.
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Affiliation(s)
- Margarete C Kulik
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Nadra E Lisha
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California.
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