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Zhang X, Zhang X, Zhang S, Ge L, Xu Y, Yao D, Hu X, Huang Z, Zhu T, Wang Z, Chen C. The association between health literacy and e-cigarette use: evidence from Zhejiang, China. Front Public Health 2024; 11:1321457. [PMID: 38239787 PMCID: PMC10794489 DOI: 10.3389/fpubh.2023.1321457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
Objectives The worldwide popularity of electronic cigarettes (ECIG) is becoming a public health concern. Compared to conventional cigarettes (CIG), the harm caused by ECIG is more insidious. Studies have shown that lower health literacy (HL) is associated with CIG use; however, the relationship between HL and ECIG use remains controversial. Because ECIG emerged more recently than CIG, there are fewer relevant studies, and the sample populations and evaluation methods of HL in existing studies differ. This study conducted a large-sample survey to examine the relationship between HL and ECIG use. Methods As part of the 2022 China Health Literacy Survey, a total of 60,998 valid questionnaires were collected from September to November in 2022 using a stratified multistage probability proportional to the population size sampling frame. Chi-square tests and multinomial logistic regression was used to analyze the relationship between HL and ECIG use. Some demographic variables were included as covariates in the analysis. Results The study showed that the average HL score and the HL level of Zhejiang residents in 2022 were 42.8 and 30.8%, respectively. The prevalence of CIG and ECIG was 19.7 and 1.0%, respectively; 19% of participants exclusively used CIG, while only 0.3% of participants used ECIG exclusively; dual users accounted for 0.6%. After adjusting for covariates, adequate HL was associated with lower odds of ECIG-exclusive use (odds ratio [OR] = 0.452, p < 0.001), CIG-exclusive use (OR = 0.833, p < 0.001), and dual use (OR = 0.632, p < 0.001). Young age, male sex, unmarried status, high-income status, and absence of chronic disease were also associated with ECIG use. Conclusion HL was a protective factor against both patterns of ECIG use, especially ECIG-exclusive use. Health policymakers and public health practitioners should consider HL as a potential measure for ECIG control.
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Affiliation(s)
- Xuehai Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xinxin Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Songjia Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Lizheng Ge
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Yue Xu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Dingning Yao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiujing Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zishuo Huang
- School of Innovation and Entrepreneurship, Wenzhou Medical University, Wenzhou, China
| | - Tingting Zhu
- Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine, Hangzhou, China
| | - Zixia Wang
- School of Business, Macau University of Science and Technology, Macau, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
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Wang Y, Xu S, Zhang X, Zhang Y, Feng Y, Wang Y, Chen R. Effects of Tobacco Versus Electronic Cigarette Usage on Nonsuicidal Self-Injury and Suicidality Among Chinese Youth: Cross-Sectional Self-Report Survey Study. JMIR Public Health Surveill 2023; 9:e47058. [PMID: 37418293 PMCID: PMC10362422 DOI: 10.2196/47058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The increase in tobacco/conventional cigarette (CC) and electronic cigarette (EC) usage among Chinese youth has become a growing public health concern. This is the first large-scale study to compare the impact of CC and EC usage on risk for nonsuicidal self-injury (NSSI) and suicidality in cis-heterosexual and sexual and gender minority (SGM) youth populations in China. OBJECTIVE This study examines the CC and EC risks for NSSI and suicidality among Chinese youth and compares the extent to which SGM and cis-heterosexual youth's risks for NSSI and suicidality are influenced by their CC and EC usage and dependence. METHODS A total of 89,342 Chinese participants completed a cross-sectional self-report survey in 2021. Sociodemographic information, sexual orientations, gender identities, CC and EC usage, CC and EC dependence, and risks for suicidality and NSSI were assessed. The Mann-Whitney U test and chi-square test were performed for nonnormally distributed continuous variables and categorical variables, respectively. The multivariable linear regression model was used to examine both the influence of CC and EC usage and CC and EC dependence on NSSI and suicidality as well as the interaction effects of CC and EC usage and CC and EC dependence on NSSI and suicidality by group. RESULTS The prevalence of CC usage (P<.001) and dependence (P<.001) among SGM participants was lower than that among their cis-heterosexual counterparts. However, the prevalence of EC usage (P=.03) and EC dependence (P<.001) among SGM participants was higher than that among their cis-heterosexual counterparts. The multivariable linear regression model showed that CC dependence and EC dependence had a unique effect on NSSI and suicidality (CCs: B=0.02, P<.001; B=0.09, P<.001; ECs: B=0.05, P<.001; B=0.14, P<.001, respectively). The interaction effects of (1) CC usage and group type on NSSI and suicidality (B=0.34, P<.001; B=0.24, P=.03, respectively) and dual usage and group type on NSSI and suicidality (B=0.54, P<.001; B=0.84, P<.001, respectively) were significant, (2) CC dependence and group type on NSSI were significant (B=0.07, P<.001), and (3) EC dependence and group type on NSSI and suicidality were significant (B=0.04, P<.001; B=0.09, P<.001, respectively). No significant interaction effect was observed between EC usage and group type on NSSI and suicidality (B=0.15, P=.12; B=0.33, P=.32, respectively) and between CC dependence and group type on suicidality (B=-0.01, P=.72). CONCLUSIONS Our study shows evidence of intergroup differences in NSSI and suicidality risks between SGM and cis-heterosexual youth related to CC and EC usage. These findings contribute to the growing literature on CC and EC in cis-heterosexual and SGM populations. Concerted efforts are necessary at a societal level to curb the aggressive marketing strategies of the EC industry and media coverage and to maximize the impact of educational campaigns on EC prevention and intervention among the youth population.
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Affiliation(s)
- Yinzhe Wang
- Department of Human Development & Quantitative Methods, Graduate School of Education, University of Pennsylvania, Philadelphia, PA, United States
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, Jilin, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, Jilin, China
| | - Xiaoqian Zhang
- Department of Psychiatry, Tsinghua University Yuquan Hospital, Beijing, China
| | - Yanwen Zhang
- Department of Human Development & Quantitative Methods, Graduate School of Education, University of Pennsylvania, Philadelphia, PA, United States
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
- Psychology Application Center for Enterprise and Society, School of Sociology and Psychology, Central University of Finance and Economics, Beijing, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Beijing, China
| | - Runsen Chen
- Department of Human Development & Quantitative Methods, Graduate School of Education, University of Pennsylvania, Philadelphia, PA, United States
- Institute for Healthy China, Tsinghua University, Beijing, China
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Chen G, Rahman S, Lutfy K. E-cigarettes may serve as a gateway to conventional cigarettes and other addictive drugs. Adv Drug Alcohol Res 2023; 3:11345. [PMID: 38389821 PMCID: PMC10880776 DOI: 10.3389/adar.2023.11345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/14/2023] [Indexed: 02/24/2024]
Abstract
Electronic cigarettes (e-cigarettes) are devices that allow the user to inhale nicotine in a vapor, and are primarily marketed as a means of quitting smoking and a less harmful replacement for traditional cigarette smoking. However, further research is needed to determine if vaping nicotine via e-cigarettes can be effective. Conversely, nicotine has been considered a gateway drug to alcohol and other addictive drugs and e-cigarettes containing nicotine may have the same effects. Previous reports have shown that e-cigarette use may open the gate for the use of other drugs including conventional cigarettes, cannabis, opioids, etc. The increasing prevalence of e-cigarettes, particularly among youth and adolescents in the last decade have led to an increase in the dual use of e-cigarettes with alcohol, cannabis, and other illicit drug use like heroin and 3-4-methylenedioxymethamphetamine (MDMA). The advent of e-cigarettes as a device to self-administer addictive agents such as cocaine and synthetic cathinones may bring about additional adverse health effects associated with their concurrent use. This review aims to briefly describe e-cigarettes and their different generations, and their co-use with other addictive drugs as well as the use of the device as a tool to self-administer addictive drugs, such as cocaine, etc.
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Affiliation(s)
- Grace Chen
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA, United States
| | - Shafiqur Rahman
- Department of Pharmaceutical Sciences, College of Pharmacy, South Dakota State University, Brookings, SD, United States
| | - Kabirullah Lutfy
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, United States
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Cammalleri V, Marotta D, Protano C, Vitali M, Villari P, Cattaruzza MS, On Behalf Of The Smoke-Free Department Working Group. How Do Combustion and Non-Combustion Products Used Outdoors Affect Outdoor and Indoor Particulate Matter Levels? A Field Evaluation Near the Entrance of an Italian University Library. Int J Environ Res Public Health 2020; 17:E5200. [PMID: 32708489 DOI: 10.3390/ijerph17145200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022]
Abstract
Particulate Matter (PM) is a well-known health risk factor and pollutes both outdoor and indoor air. Using PM as an air pollution indicator, the aims were to assess outdoor and indoor air pollution due to combustion and/or non-combustion products used outdoors and to compare the PM levels emitted by different products. PM with an aerodynamic diameter ≤10, 4, 2.5 and 1 µm (PM10, PM4, PM2.5, PM1) was simultaneously measured in two areas, respectively, indoors (with smoking ban) and outdoors (where people commonly smoke) of a university library during the morning and the afternoon of two weekdays. Both combustion and non-combustion products determined a relevant worsening of outdoor air quality, with the highest PM1 levels achieved when a single traditional cigarette (9920 µg m-3), a single e-cigarette (9810 µg m-3) and three simultaneous traditional cigarettes (8700 µg m-3) were smoked. An increase of indoor PM1 levels was found during outdoor smoking/vaping sessions, persisting also after the end of sessions. The results highlighted the need for a revision of smoke-free laws, especially for outdoor areas, to include non-combustion products. In addition, it is essential to make society aware of the dangers of smoking outdoors by implementing health promotion interventions.
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Nga JDL, Hakim SL, Bilal S. Comparison of End Tidal Carbon Monoxide Levels between Conventional Cigarette, Electronic Cigarette and Heated Tobacco Product among Asiatic Smokers. Subst Use Misuse 2020; 55:1943-1948. [PMID: 32552152 DOI: 10.1080/10826084.2020.1781180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs) are noncombustible tobacco products which have been found to generate aerosols containing lower levels of Harmful and Potentially Harmful Constituents (HPHCs) in comparison to conventional cigarettes. Objective: This quasi experimental study measured and compared the end tidal carbon monoxide (eCO) levels of participants after use of ENDS, HTPs and conventional cigarettes. Methods: In total 45 smokers, each smoking at least 10 conventional cigarettes per day for 5 years participated in the study. Based on their preference, participants used only one of the tobacco products (ENDS, HTPs, or conventional cigarette) and were briefed about the product use based on manufacturer's instructions. The eCO levels were obtained at baseline, followed by 5, 10, 15, 30 and 45 min respectively after the product use. Results: There was significant increase in eCO levels for conventional cigarettes as compared to other modes. Peak eCO levels of 20.2 ± 0.86 ppm, 8.8 ± 1.56 ppm and 6.0 ± 1.36 ppm was achieved at 30 min, 15 min and 10 min for conventional cigarettes, ENDS and HTPs respectively. However, the levels were significantly lower in ENDS and HTPs. Conclusion: Even though ENDS and HTPs may have produced significantly lower eCO than conventional cigarettes, the significantly increasing levels over time from baseline which was not shown before is a cause of concern. As of now, their use as an alternate to cigarettes needs to be considered under regulatory framework.
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Affiliation(s)
- Janice Diong Li Nga
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - S Lokman Hakim
- Institute for Research, Development and Innovation and Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur
| | - Sobia Bilal
- Department of Children and Community Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Lampos S, Kostenidou E, Farsalinos K, Zagoriti Z, Ntoukas A, Dalamarinis K, Savranakis P, Lagoumintzis G, Poulas K. Real-Time Assessment of E-Cigarettes and Conventional Cigarettes Emissions: Aerosol Size Distributions, Mass and Number Concentrations. Toxics 2019; 7:E45. [PMID: 31480224 DOI: 10.3390/toxics7030045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022]
Abstract
Cigarette smoke is a complex mixture of chemical compounds which are emitted during the processes of tobacco combustion. Electronic cigarettes (e-cigs) are expected to produce less harmful compounds due to the absence of tobacco leaf combustion. However, potential risks of the passive exposure to the aerosol exhaled by e-cig users have been raised in the last decade. In this study, the aerosols with diameter less than 1 μm (PM1) produced by vaping of various e-cig liquids were compared to those generated by smoking conventional cigarettes in real time. The mass and number concentration along with the number size distribution were measured in a closed room of 35 m3 volume. Our results showed that aerosols emitted from e-cig liquids had a different profile compared to those from conventional cigarettes. Although e-cigs initially produced higher particle mass and number concentrations, their emissions had much shorter lifetime of approximately 10–20 s, in comparison with the conventional and hand-rolling cigarette particulate emissions which had a dissipation time of approximately 1.4 h in a 35 m3 room. E-cigs emitted aerosols which volatilized rapidly, as they probably consisted almost only of propylene glycol and/or vegetable glycerin.
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Wu SYD, Wang MP, Li WH, Kwong AC, Lai VW, Lam TH. Does Electronic Cigarette Use Predict Abstinence from Conventional Cigarettes among Smokers in Hong Kong? Int J Environ Res Public Health 2018; 15:E400. [PMID: 29495388 PMCID: PMC5876945 DOI: 10.3390/ijerph15030400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate the effects of ever use of electronic cigarettes (ECs), many of which lack nicotine, on abstinence from convention cigarettes among Hong Kong adult smokers. METHODS We collected data from 956 daily smokers in 2014-2015 regarding ever EC use and smoking behaviors at baseline, any and past 30-day EC use at the 3-month follow-up. Outcomes measured at 6 months included past 7-day point prevalence abstinence (PPA), biochemically validated quitting, smoking reduction (≥50% from baseline) and cessation attempt. Logistic regression yielded adjusted odds ratios (AOR) for quitting in relation to EC use, adjusting for socio-demographic characteristics and smoking profile. Complete case, missing observation as smoking and propensity score analyses were conducted. RESULTS By complete case, ever EC use at baseline did not predict self-reported PPA (AOR 0.99, 95% CI 0.57-1.73), biochemically validated quitting (AOR 1.22, 95% CI 0.64-2.34), cessation attempt (AOR 0.74, 95% CI 0.48-1.14), or smoking reduction (AOR 0.89, 95% CI 0.54-1.47). EC use during the first 3 months did not predict quitting (AOR 1.02, 95% CI 0.22-4.71). Similar results were observed for missing observations as smoking and propensity score analyses. CONCLUSIONS Any use of ECs, many of which lack nicotine, did not predict smoking abstinence among Hong Kong adult smokers.
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Affiliation(s)
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China.
| | - William H Li
- School of Nursing, University of Hong Kong, Hong Kong, China.
| | | | - Vienna W Lai
- Hong Kong Council on Smoking and Health, Hong Kong, China.
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China.
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Liu J, Liang Q, Oldham MJ, Rostami AA, Wagner KA, Gillman IG, Patel P, Savioz R, Sarkar M. Determination of Selected Chemical Levels in Room Air and on Surfaces after the Use of Cartridge- and Tank-Based E-Vapor Products or Conventional Cigarettes. Int J Environ Res Public Health 2017; 14:ijerph14090969. [PMID: 28846634 PMCID: PMC5615506 DOI: 10.3390/ijerph14090969] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/07/2017] [Accepted: 08/16/2017] [Indexed: 02/08/2023]
Abstract
There is an ongoing debate regarding the potential of secondhand exposure of non-users to various chemicals from use of e-vapor products (EVPs). Room air levels of 34 chemicals (nicotine, propylene glycol (PG), glycerol, 15 carbonyl chemicals, 12 volatile organic chemicals (VOCs), and four selected trace elements) were measured where EVPs and cigarettes were used by n = 37 healthy adult tobacco users in an exposure chamber. The products used were MarkTen® 2.5% Classic (Group I), a Prototype GreenSmoke® 2.4% (Group II), Ego-T® Tank with subjects' own e-liquids (Group III) and subjects' own conventional cigarettes (Group IV). Products were used under controlled conditions and 4-h ad libitum use. Background (without subjects) and baseline levels (with subjects) were measured. Cumulative 4-h. levels of nicotine, PG and glycerol measured were several-fold below the time-weighted average limits used in workplace exposure evaluation. Most the other chemicals (>75%) were at or below the limit of quantification during EVP use. Significant levels of chemicals (17 out of 34) were observed in Group IV. Overall, our results indicate that under the study conditions with the products tested, cumulative room air levels of the selected chemicals measured over 4-h were relatively small and were several-fold below the current occupational regulatory and consensus limits.
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Affiliation(s)
- Jianmin Liu
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - Qiwei Liang
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - Michael J Oldham
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - Ali A Rostami
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - Karl A Wagner
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
| | - I Gene Gillman
- Enthalpy Analytical Inc., 800 Capitola Drive, Durham, NC 27713, USA.
| | - Piyush Patel
- Inflamax Research Inc., 1310 Fewster Drive, Mississauga, ON L4W 1A4, Canada.
| | - Rebecca Savioz
- Clinopsis SA, Chemin des Jardins 6, 1426 Concise, Switzerland.
| | - Mohamadi Sarkar
- Center for Research and Technology, Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA 23219, USA.
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