scholarly journals E-cigarettes: no smoke without fire?

2020 ◽  
Vol 25 ◽  
Author(s):  
N. Daniels ◽  
C. Cosma ◽  
A. Llewellyn ◽  
D. Banks ◽  
H. Morris ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
National Health ◽  
Working Party ◽  
Cigarette Use ◽  
Dual Use ◽  
Common View ◽  
Potential Impact ◽  
The Impact ◽  
Relapse Rates

Abstract Smoking was one of the biggest preventable killers of the 20th century, and it continues to cause the death of millions across the globe. The rapid growth of the e-cigarette market in the last 10 years and the claims that it is a safer form of smoking, and can help with smoking cessation, have led to questions being raised on their possible impact to society, the health of the population and the insurance industry. Recent media attention around the possible health implications of e-cigarette use has also ensured that this topic remains in the public eye. The e-cigarette working party was initiated by the Institute and Faculty of Actuaries’ Health and Care Research Sub-Committee in July 2016, with the primary objective of understanding the impact of e-cigarettes on life and health insurance. In this paper, we have looked at all areas of e-cigarette usage and how it relates to insurance in the UK market. In particular, we have covered the potential risks and benefits of switching to e-cigarettes, the results of studies that have been published, the potential impact on underwriting and claims processes and the potential impact on pricing (based on what modelling is possible with the data available). Research in this area is still in its infancy and data are not yet mature, which makes predicting the long-term impact of e-cigarette smoking extremely challenging, for example, there are no studies that directly measure the mortality or morbidity impact of long-term e-cigarette use and so we have had to consider studies that consider more immediate health impacts or look more simply at the constituents of the output of an e-cigarette and compare them to that of a cigarette. The data issue is further compounded by the findings of studies and the advice of national health authorities often being conflicting. For example, while National Health Service England has publicly stated that it supports the growth of e-cigarette usage as an aid to reduce traditional smoking behaviour, the US Food and Drug Administration has been much more vocal in highlighting the perceived dangers of this new form of smoking. Users’ behaviour also adds complexity, as dual use (using both e-cigarettes and cigarettes) is seen in a high percentage of users and relapse rates back to cigarette smoking are currently unknown. Having talked to a number of experts in the field, we have discovered that there is certainly not a common view on risk. We have heard from experts who have significant concerns but also to experts who do believe that e-cigarettes are far safer than tobacco. We have purposefully considered conflicting evidence and have consulted with various parties so we can present differing points of view, thereby ensuring a balanced, unbiased and fair picture of our findings is presented. The evidence we have reviewed does suggest that e-cigarettes are a safer alternative to traditional smoking, but not as safe as non-smoking. There are no large, peer-reviewed, long-term studies yet available to understand the true impact of a switch to e-cigarette use, so currently we are unable to say where on the risk spectrum between cigarette smoking and life-time non-smoking it lies. We do not yet understand if the benefits seen in the studies completed so far will reduce the risk in the long term or whether other health risks will come to light following more prolonged use and study. This, coupled with concerns with the high proportion of dual use of cigarettes and e-cigarettes, relapse rates and the recent growth in medical problems linked with e-cigarette use, means that we need to wait for experience to emerge fully before firm conclusions can be drawn. Although we have presented a view, it is vitally important that our industry continues to monitor developments in this area and fully considers what next steps and future actions may be required to ensure our position reflects the potential benefits and risks that e-cigarette use may bring. We feel that the time is right for a body such as the IFoA to analyse the feasibility of collecting the necessary data through the Continuous Mortality Investigation that would allow us to better analyse the experience that is emerging.

scholarly journals Cigarette smoking and e-cigarette use among university students in Queensland, Australia and New Zealand: results of two cross-sectional surveys

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041705
Author(s):  
Ben Wamamili ◽  
Sheleigh Lawler ◽  
Mark Wallace-Bell ◽  
Coral Gartner ◽  
David Sellars ◽  
...  
Keyword(s):  
New Zealand ◽  
Cigarette Smoking ◽  
University Students ◽  
Multinomial Logistic Regression ◽  
Smoking Status ◽  
Cigarette Use ◽  
Dual Use ◽  
Cross Sectional ◽  
Free Spaces ◽  
And Gender

ObjectivesExamine the patterns of cigarette smoking and e-cigarette use (vaping), the perceived harm of e-cigarettes compared with tobacco cigarettes, and associations between smoking and vaping with student characteristics.DesignCross-sectional studies.SettingThe University of Queensland (UQ), Australia and eight New Zealand (NZ) universities.ParticipantsStudents at UQ: 4957 (70.8% aged <25 years, 63.0% women) and NZ: 1854 (82.5% aged <25 years, 60.1% women).MethodsΧ2 tests compared smoking by age and gender, and vaping by age, gender and smoking status. Two-sided p<0.05 was considered significant and 95% CIs reported where appropriate. Multinomial logistic regression examined associations between smoking and vaping (exclusive smoking, exclusive vaping, dual use and non-use) with age, gender and student type (domestic vs international).ResultsSmoking (UQ vs NZ, 95% CI): ever 45.2% (43.8% to 46.6%) vs 50.0% (47.7% to 52.3%), current 8.9% (8.1% to 9.7%) vs 10.4% (9.1% to 11.9%) and daily 5.2% (4.6% to 5.8%) vs 5.6% (4.6% to 6.7%), and not smoking in indoor 98.3% vs 87.7% or outdoor smoke-free spaces 83.8% vs 65.3%.Vaping (UQ vs NZ, 95% CI): ever 20.9% (19.8% to 22.1%) vs 37.6% (35.4% to 39.9%), current 1.8% (1.5% to 2.2%) vs 6.5% (5.4% to 7.7%) and daily 0.7% (0.5% to 1.0%) vs 2.5% (1.9% to 3.4%), and not vaping in indoor 91.4% vs 79.6% or outdoor smoke-free spaces 84.4% vs 71.3%. Of respondents, 71.7% (70.3% to 73.2%) vs 75.3% (72.9% to 77.6%) perceived e-cigarettes as less harmful than tobacco cigarettes.Men were more likely than women to smoke and vape, and to believe that e-cigarettes are less harmful. Regression models containing all predictors for smoking and vaping were significant and the effect of gender was significant for dual use, exclusive smoking and exclusive vaping (all p<0.01). Men had higher odds for smoking, vaping or dual use.ConclusionsResults suggest significant differences in patterns of smoking and vaping of university students in Australia and NZ, and a strong influence of gender on smoking and vaping.

scholarly journals The Implications of HIV Treatment on the HIV-Malaria Coinfection Dynamics: A Modeling Perspective

2015 ◽  
Vol 2015 ◽  
pp. 1-14 ◽  
Author(s):  
F. Nyabadza ◽  
B. T. Bekele ◽  
M. A. Rúa ◽  
D. M. Malonza ◽  
N. Chiduku ◽  
...  
Keyword(s):  
Hiv Treatment ◽  
Pathogen Transmission ◽  
Disease Epidemiology ◽  
Qualitative Dynamics ◽  
Potential Impact ◽  
Negative Impacts ◽  
Long Term Behavior ◽  
The Impact ◽  
Multiple Pathogens

Most hosts harbor multiple pathogens at the same time in disease epidemiology. Multiple pathogens have the potential for interaction resulting in negative impacts on host fitness or alterations in pathogen transmission dynamics. In this paper we develop a mathematical model describing the dynamics of HIV-malaria coinfection. Additionally, we extended our model to examine the role treatment (of malaria and HIV) plays in altering populations’ dynamics. Our model consists of 13 interlinked equations which allow us to explore multiple aspects of HIV-malaria transmission and treatment. We perform qualitative analysis of the model that includes positivity and boundedness of solutions. Furthermore, we evaluate the reproductive numbers corresponding to the submodels and investigate the long term behavior of the submodels. We also consider the qualitative dynamics of the full model. Sensitivity analysis is done to determine the impact of some chosen parameters on the dynamics of malaria. Finally, numerical simulations illustrate the potential impact of the treatment scenarios and confirm our analytical results.

scholarly journals Vaping and subsequent comorbidities potentially associated with increased mortality and more severe illness in COVID-19: a narrative review

2021 ◽  
Keyword(s):  
Risk Factors ◽  
Cigarette Smoking ◽  
Health Risks ◽  
Older Patients ◽  
Significant Risk ◽  
Self Report ◽  
Severe Illness ◽  
Protective Effects ◽  
Cigarette Use

Introduction: COVID-19 (or COVID) is a highly virulent viral disease which more frequently presents severe infection in specific populations, such as the elderly, patients with hypertension, patients with respiratory disease, and patients who smoke. The effects vaping (i.e., an electronic cigarette or JUUL device) has on COVID progression remains unclear, because there is an information paucity correlating e-cigarette use and COVID. This review sought to identify links between vape use and COVID severity via literature review. Additionally, because there is more widespread information about cigarette smoking than about vaping, this review sought to illustrate commonalities between smoking and vaping. If smoking and vaping are deemed near-identical practices, then it is possible the effects of smoking on human health and on COVID disease could be comparable in vaping. Methods: Several searches were performed on PubMed with MeSH headings and JSTOR between 17 December 2020 and 22 December 2020. Search results were excluded if they were not trials or controlled clinical trials, if the articles were not about COVID, if the articles were about smoking behaviors or habits, or if the articles were not related to vaping or smoking. Key findings were summarized and tabled based on relevance, substantiability, and applicability to COVID. Results: Multiple sources viewed smoking and vaping as equal risk factors for COVID disease, whereas other sources viewed the two as unique risk factors. Because of this controversy, it is challenging to view the two practices as similar enough to pose equivalent risks for COVID. Both practices pose significant health risks to its users, but these health risks are unique to each practice. Discussion: There are several limitations which exacerbate ambiguity—(1) it is unclear how harmful smoking is for COVID patients, because several publications found smoking may have protective effects; (2) few older patients vape, but yet most severe COVID cases occur in older populations; (3) older patients and impoverished patients show a statistically significant risk for severe COVID disease independent of other factors; (4) vaping is a relatively new practice, and there are few patients who self-report long-term e-cigarette use or long-term adverse effects as a result thereof. Conclusion: Although vaping may present serious health risks, clinically, it is uncertain how significantly vaping affects COVID disease, especially when compared against cigarette smoking. More research is needed on both the effects of vaping on COVID and the likeness of vaping versus smoking.

The lost worlds of royal commissions in the NHS: The unaccountable in pursuit of the unanswerable?

2019 ◽  
Vol 37 (2) ◽  
pp. 199-217
Author(s):  
Martin Powell
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Royal Commission ◽  
Select Committee ◽  
House Of Lords ◽  
The Impact ◽  
British National Health ◽  
Advisory Bodies

There have been recent calls for a royal commission (RC) on the British National Health Service (NHS). This article focuses on the impact of RCs and similar advisory bodies, particularly on finance recommendations, of three inquiries with broad remits across the whole of the NHS from very different periods: Guillebaud (1956); Royal Commission on the National Health Service (1979); and House of Lords Select Committee on the Long-term Sustainability of the NHS (2017). These inquiries appear to have had rather limited impacts, especially on NHS funding. First, there appears to be some hesitancy in suggesting precise figures for NHS expenditure. Second, the reports are advisory, and governments can ignore their conclusions. Third, governments have ignored their conclusions. In the 1950s and the 1980s, contrary to the recommendations of the inquiries, NHS expenditure subsequently grew only slowly, and charges were increased. In short, asking an independent RC to provide answers on NHS expenditure is perhaps the unaccountable in pursuit of the unanswerable.

scholarly journals Associations Between Peer Use, Costs and Benefits, Self-Efficacy, and Adolescent E-cigarette Use

2020 ◽  
Author(s):  
Kristine Durkin ◽  
Desireé N Williford ◽  
Nicholas A Turiano ◽  
Melissa D Blank ◽  
Paul T Enlow ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
Self Efficacy ◽  
Adolescent Medicine ◽  
Public High Schools ◽  
Cigarette Use ◽  
Costs And Benefits ◽  
Tailored Interventions ◽  
The Individual ◽  
Peer Use

Abstract Objective Prior research identified peer use as a salient risk factor of adolescent electronic cigarette (e-cigarette) use, but has not expanded on the mechanisms of this association. Methods Participants were 562 adolescents recruited from rural and suburban public high schools and an adolescent medicine clinic in the mid-Atlantic United States. Participants completed a packet of questionnaires that assessed demographics, substance use, expectations about the consequences of e-cigarette use, and perceptions of their own self-efficacy to resist using e-cigarettes. We estimated a series of mediation models using the MODEL INDIRECT command in MPLUS statistical software. In all models, significance of indirect effects from peer e-cigarette use to self-reported e-cigarette use were tested via two variables: (a) expected costs, (b) benefits of e-cigarette use, and (c) the perceived self-efficacy of the individual to refrain from e-cigarette use. Results Adolescents with more peers using e-cigarettes were more likely to have ever used an e-cigarette and perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 1). Those with more peers using e-cigarettes were more likely to be currently using e-cigarettes themselves because they perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 2). Conclusion Peer use, self-efficacy to resist use, and expectations of cost and benefits of e-cigarette use should be considered as possible targets when devising tailored interventions and policies to prevent or reduce negative health consequences of long-term e-cigarette use.

scholarly journals Quantifying the impact of delayed delivery of cardiac rehabilitation on patients’ health

2020 ◽  
Vol 27 (16) ◽  
pp. 1775-1781
Author(s):  
Sebastian Hinde ◽  
Alexander Harrison ◽  
Laura Bojke ◽  
Patrick Doherty
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Life Expectancy ◽  
Cardiac Rehabilitation ◽  
National Health ◽  
Average Lifetime ◽  
National Guidelines ◽  
Patient Health ◽  
The Impact

Background Despite its role as an effective intervention to improve the long-term health of patients with cardiovascular disease and existence of national guidelines on timeliness, many health services still fail to offer cardiac rehabilitation in a timely manner after referral. The impact of this failure on patient health and the additional burden on healthcare providers in an English setting is quantified in this article. Methods Two logistic regressions are conducted, using the British Heart Foundation National Audit of Cardiac Rehabilitation dataset, to estimate the impact of delayed cardiac rehabilitation initiation on the level of uptake and completion. The results of these regressions are applied to a decision model to estimate the long-term implications of these factors on patient health and National Health Service expenditure. Results We demonstrate that the failure of 43.6% of patients in England to start cardiac rehabilitation within the recommended timeframe results in a 15.3% reduction in uptake, and 7.4% in completion. These combine to cause an average lifetime loss of 0.08 years of life expectancy per person. Scaled up to an annual cohort this implies 10,753 patients not taking up cardiac rehabilitation due to the delay, equating to a loss of 3936 years of life expectancy. We estimate that an additional £12.3 million of National Health Service funding could be invested to alleviate the current delay. Conclusions The current delay in many patients starting cardiac rehabilitation is causing quantifiable and avoidable harm to their long-term health; policy and research must now look at both supply and demand solutions in tackling this issue.

scholarly journals Patterns of E-cigarette Use and Subsequent Cigarette Smoking Cessation Over 2 Years (2013/2014–2015/2016) in the Population Assessment of Tobacco and Health Study

2020 ◽  
Author(s):  
Allison M Glasser ◽  
Mahathi Vojjala ◽  
Jennifer Cantrell ◽  
David T Levy ◽  
Daniel P Giovenco ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Cigarette Smoking ◽  
The United States ◽  
Adjusted Relative Risk ◽  
Cigarette Use ◽  
Short Term ◽  
Population Assessment ◽  
Quit Attempt ◽  
Quit Smoking

Abstract Introduction Understanding the population impact of e-cigarettes requires determining their effect on cigarette smoking cessation. Methods Using the US Population Assessment of Tobacco and Health cohort, we examined smoking cessation among adult current cigarette smokers at Wave 1 with follow-up data at Waves 2 and 3 (n = 9724). Results By Wave 3 (2015/2016), 17.3% of smokers had quit smoking. Smokers using e-cigarettes daily or who increased to daily use over the three waves were two to four times more likely to have quit in the short term (&lt;1 year) and long term (1+ years) compared with never e-cigarette users (p &lt; .001). E-cigarette use in the last quit attempt was associated with a higher likelihood of short-term (&lt;1 year) quitting at Wave 3 (adjusted relative risk ratio: 1.33; 95% confidence interval: 1.04, 1.71) compared with smokers who did not use an e-cigarette in their last quit attempt. Noncurrent (no use in any wave) e-cigarette users and users who were unstable in use frequency were 33% and 47% less likely to quit in the short-term, respectively (p &lt; .001). Flavored (vs nonflavored) and using a rechargeable (vs disposable) e-cigarette device was associated with an increased likelihood of both short- and long-term quitting. Conclusion Smoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices. Less frequent, unstable, past, or never e-cigarette users were less likely to quit smoking. Monitoring the relationship between patterns of e-cigarette and cigarette use is complex but critical for gauging the potential of e-cigarettes as a harm reduction tool. Implications This study suggests that consistent and frequent e-cigarette use over time is associated with cigarette smoking cessation among adults in the United States. In addition, findings suggest that flavored e-cigarette use and use of rechargeable e-cigarette devices can facilitate smoking cessation. These results underscore the importance of carefully defining and characterizing e-cigarette exposure patterns, potential confounders, and use of e-cigarettes to quit smoking, as well as variations in length of the smoking cessation.

scholarly journals Electronic cigarettes and health with special focus on cardiovascular effects: position paper of the European Association of Preventive Cardiology (EAPC)

2020 ◽  
pp. 204748732094199
Author(s):  
Maryam Kavousi ◽  
Charlotta Pisinger ◽  
Jean-Claude Barthelemy ◽  
Delphine De Smedt ◽  
Konstantinos Koskinas ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Tobacco Smoking ◽  
European Association ◽  
Electronic Cigarettes ◽  
Cardiovascular Effects ◽  
Position Paper ◽  
Cigarette Use ◽  
Preventive Cardiology ◽  
The Impact

Background Tobacco use is the single largest preventable risk factor for premature death of non-communicable diseases and the second leading cause of cardiovascular disease. In response to the harmful effects of tobacco smoking, the use of electronic cigarettes (e-cigarettes) has emerged and gained significant popularity over the past 15 years. E-cigarettes are promoted as safe alternatives for traditional tobacco smoking and are often suggested as a way to reduce or quit smoking. However, evidence suggests they are not harmless. Discussion The rapid evolution of the e-cigarette market has outpaced the legislator’s regulatory capacity, leading to mixed regulations. The increasing use of e-cigarettes in adolescents and young individuals is of concern. While the long-term direct cardiovascular effects of e-cigarettes remain largely unknown, the existing evidence suggests that the e-cigarette should not be regarded as a cardiovascular safe product. The contribution of e-cigarette use to reducing conventional cigarette use and smoking cessation is complex, and the impact of e-cigarette use on long-term cessation lacks sufficient evidence. Conclusion This position paper describes the evidence regarding the prevalence of e-cigarette smoking, uptake of e-cigarettes in the young, related legislations, cardiovascular effects of e-cigarettes and the impact of e-cigarettes on smoking cessation. Knowledge gaps in the field are also highlighted. The recommendations from the population science and public health section of the European Association of Preventive Cardiology are presented.

A systematic review of the impact of cigarettes and electronic cigarettes in otology

2020 ◽  
pp. 1-6 ◽  
Author(s):  
S Patel ◽  
N Wooles ◽  
T Martin
Keyword(s):  
Systematic Review ◽  
Hearing Loss ◽  
Cigarette Smoking ◽  
Sensorineural Hearing Loss ◽  
Otitis Media ◽  
Electronic Cigarettes ◽  
Sensorineural Hearing ◽  
Suppurative Otitis Media ◽  
The Impact

Abstract Background The detrimental systemic effects of cigarette smoking are well established. Though less pronounced in the field of otology, they are proposed to contribute to the global burden of unaddressed hearing loss. Recently, in efforts to stop smoking, individuals have used electronic cigarettes of which the long-term safety data are largely unknown. This study aimed to conduct a systematic review of cigarette smoking and electronic cigarette effects in the field of otology. Method Relevant articles were identified by a National Institute for Health and Care Excellence healthcare database literature search and by scanning the references of relevant articles and reviews. Results A total of 473 articles were identified, with 43 articles included in the review after trials were excluded. Conclusion Cigarette smoking is associated with recurrent otitis media, otitis media with effusion and sensorineural hearing loss in children exposed to second-hand smoke. In adults, it is associated with active and aggressive chronic suppurative otitis media, worse tympanoplasty success rates, increased post-operative complications and sensorineural hearing loss that is more pronounced in the long term and at high frequencies. The effects of e-cigarettes in otology are largely unknown.

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