Comparison of Urinary Biomarkers of Exposure in Humans Using Electronic Cigarettes, Combustible Cigarettes, and Smokeless Tobacco

Abstract Background Cigarette smoking is associated with an increase in cardiovascular disease risk, attributable in part to reactive volatile organic chemicals (VOCs). However, little is known about the extent of VOC exposure due to the use of other tobacco products. Methods We recruited 48 healthy, tobacco users in four groups: cigarette, smokeless tobacco, occasional users of first generation e-cigarette and e-cigarette menthol and 12 healthy nontobacco users. After abstaining for 48 h, tobacco users used an assigned product. Urine was collected at baseline followed by five collections over a 3-h period to measure urinary metabolites of VOCs, nicotine, and tobacco alkaloids. Results Urinary levels of nicotine were ≃2-fold lower in occasional e-cigarette and smokeless tobacco users than in the cigarette smokers; cotinine and 3-hydroxycotinine levels were similar in all groups. Compared with nontobacco users, e-cigarette users had higher levels of urinary metabolites of xylene, cyanide, styrene, ethylbenzene, and benzene at baseline and elevated urinary levels of metabolites of xylene, N,N-dimethylformamide, and acrylonitrile after e-cigarette use. Metabolites of acrolein, crotonaldehyde, and 1,3-butadiene were significantly higher in smokers than in users of other products or nontobacco users. VOC metabolite levels in smokeless tobacco group were comparable to those found in nonusers with the exception of xylene metabolite—2-methylhippuric acid (2MHA), which was almost three fold higher than in nontobacco users. Conclusions Smoking results in exposure to a range of VOCs at concentrations higher than those observed with other products, and first generation e-cigarette use is associated with elevated levels of N,N-dimethylformamide and xylene metabolites. Implications This study shows that occasional users of first generation e-cigarettes have lower levels of nicotine exposure than the users of combustible cigarettes. Compared with combustible cigarettes, e-cigarettes, and smokeless tobacco products deliver lower levels of most VOCs, with the exception of xylene, N,N-dimethylformamide, and acrylonitrile, whose metabolite levels were higher in the urine of e-cigarette users than nontobacco users. Absence of anatabine in the urine of e-cigarette users suggests that measuring urinary levels of this alkaloid may be useful in distinguishing between users of e-cigarettes and combustible cigarettes. However, these results have to be validated in a larger cohortcomprised of users of e-cigarettes of multiple brands.

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Workplace smoke-free policies that allow heated tobacco products and electronic cigarettes use are associated with use of both these products and conventional tobacco smoking: the 2018 JASTIS study

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055465 ◽

2020 ◽

pp. tobaccocontrol-2019-055465

Author(s):

Yanakawee Siripongvutikorn ◽

Takahiro Tabuchi ◽

Sumiyo Okawa

Keyword(s):

Regression Models ◽

Electronic Cigarettes ◽

Internet Survey ◽

Survey Study ◽

Cigarette Use ◽

Cigarette Smokers ◽

Tobacco Products ◽

National Legislation ◽

Adjusted Rate ◽

Rate Ratios

ObjectivesHeated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) are rapidly gaining popularity, especially in Japan. However, at the time of the survey (2018), there was no national legislation banning HTPs or e-cigarette use in the workplace. The objective is to examine the current situation for workplace smoke-free policies which ban the use of HTPs/e-cigarettes and the associations of such rules with the use of HTP and e-cigarette as well as conventional cigarette smoking.MethodsAn internet-based self-reported questionnaire survey was conducted in 2018 as a part of the Japan Society and New Tobacco Internet Survey study. 5646 eligible employees aged 15–72 years were analysed. Proportions and adjusted rate ratios for HTP and e-cigarette use were calculated according to covariates, using Poisson regression models. Those who reported HTP or e-cigarette use within 30 days were defined as current user of the products.ResultsIn workplaces which prohibited smoking indoors but permitted the use of HTPs/e-cigarettes, the rate ratios of HTP use was 2.19 (95% CI 1.57 to 3.06), e-cigarette use was 3.86 (95% CI 1.97 to 7.57) and combustible cigarette use was 1.67 (95% CI 1.19 to 2.34) when using workplaces which also prohibited HTPs/e-cigarettes as a reference category.ConclusionsWorkplaces that allow HTP/e-cigarette use indoors were associated with higher rate for HTP and e-cigarette users, and for combustible cigarette smokers. National legislation banning tobacco should be enforced and also cover HTPs and e-cigarettes in order to avoid renormalisation of smoking and nicotine addiction.

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A Comparison of Dependence across Different Types of Nicotine Containing Products and Coffee

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15081609 ◽

2018 ◽

Vol 15 (8) ◽

pp. 1609

Author(s):

Karl Fagerstrom

Keyword(s):

Data Collection ◽

Random Sample ◽

Electronic Cigarettes ◽

Coffee Consumption ◽

Cigarette Use ◽

Tobacco Products ◽

Nicotine Replacement ◽

Heavy Smoking ◽

Different Types ◽

Smoking Index

Introduction: Few studies have compared the dependence to different tobacco and nicotine products. Even less is known about how it relates to dependence on other common drugs, e.g., caffeine. In this study degree of dependence was compared between snus, cigarettes, nicotine replacement (NR), electronic cigarettes and coffee. Methods: A random sample of Swedish citizens belonging to an internet panel were contacted from September to October 2017. The responders were asked among other related things about their use of snus, NR, traditional cigarette or e-cigarette use and coffee consumption. The indicators of dependence used were: (A) the Heavy Smoking Index, (B) The proportions that used within 30 min after raising in the morning, (C) rating the first use in the morning as the most important and (D) Stating that it would be very hard to give up entirely. Results: Significantly fewer coffee drinkers started use within 30 min of awakening compared with all other products. The first use of the day was found to be more important for snus users compared with other products. On HSI there was no difference between snus and cigarettes. Snus and cigarettes were rated as being more difficult to give up than NR and coffee. Conclusion: Dependence to traditional cigarettes and snus seem to be relatively similar while NR was rated lower and coffee lowest. Since the prevalence of caffeine use in all forms is so much more prevalent than nicotine there might be more persons in the society heavily dependent on caffeine. Implication: Tobacco products are likely more dependence forming than NR products and coffee although there might be more people dependent on caffeine. The addiction to coffee or caffeine is seldom discussed in the society probably because of the little or no harm it causes. Funding: The Snus Commission in Sweden (snuskommissionen) funded the data collection. No funding used for the analysis and writing of manuscript.

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Uptake and Perceptions of E-cigarette use in Vascular Patients

The Journal of Smoking Cessation ◽

10.1017/jsc.2018.17 ◽

2018 ◽

Vol 14 (2) ◽

pp. 83-87

Author(s):

Rachael Taylor ◽

David Sidloff ◽

Robert D. Sayers ◽

Matthew J. Bown ◽

Athanasios Saratzis

Keyword(s):

Smoking Cessation ◽

Risk Group ◽

Electronic Cigarettes ◽

High Risk Group ◽

Cigarette Use ◽

Structured Interviews ◽

Tobacco Products ◽

Patterns Of Use ◽

Initial Interviews

Introduction: Smoking is one of the most important risk factors for cardiovascular disease (CVD). Electronic cigarettes (e-cigarettes) are becoming increasingly popular. However, little is known regarding their patterns of use in patients with established CVD.Aims: We aimed to assess the perceptions and patterns of use of e-cigarettes in patients presenting to a vascular clinic.Methods: We performed a qualitative study to identify perceptions and beliefs about e-cigarettes. Semi-structured interviews of consecutive patients consenting to participate were performed over five-months. Individuals were recruited from a vascular surgery outpatient clinic. Initial interviews were based on a questionnaire. Further structured interviews were conducted with patients currently using e-cigarettes, which were transcribed and analysed to assess perceptions and patterns of use.Results/Findings: Four overarching themes emerged: attraction to e-cigarettes as a harm reduction/smoking cessation strategy; uncertainty regarding the risks of e-cigarettes; use of various types of smoking cessation strategies; dual use and often complete relapse to tobacco products.Conclusions: Patients with established CVD view e-cigarettes as a means of smoking cessation; however, many relapse to tobacco products or use both simultaneously. Further research is necessary regarding the role of e-cigarettes in smoking cessation in this high-risk group.

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Tobacco price and use following California Proposition 56 tobacco tax increase

PLoS ONE ◽

10.1371/journal.pone.0257553 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257553

Author(s):

Christian Gunadi ◽

Tarik Benmarhnia ◽

Martha White ◽

John P. Pierce ◽

Sara B. McMenamin ◽

...

Keyword(s):

Smokeless Tobacco ◽

Control Method ◽

Cigarette Consumption ◽

Sensitivity Analyses ◽

Synthetic Control ◽

Cigarette Use ◽

Cigarette Price ◽

Cigarette Tobacco ◽

Tobacco Products ◽

Tobacco Tax

Background California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017. Methods Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011–2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a “synthetic” California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted. Results The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products. Conclusion Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco.

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Instruments to Measure E-Cigarette Related Constructs: A Systematic Review

10.21203/rs.3.rs-496491/v1 ◽

2021 ◽

Author(s):

Eunhee Park ◽

Misol Kwon ◽

Thomas Chacko ◽

Maciej Goniewicz ◽

Chin-Shang Li ◽

...

Keyword(s):

Systematic Review ◽

Content Validity ◽

Web Of Science ◽

Electronic Cigarettes ◽

Cigarette Use ◽

Public Attention ◽

Validation Process ◽

Cronbach’S Alpha ◽

Tobacco Products ◽

Cronbach's Alpha

Abstract Background Electronic cigarettes (e-cigarettes) are relatively new tobacco products that are attracting public attention due to their unique features, especially their many flavor options and their potential as an alternative to cigarettes. However, uncertainties remain regarding the determinants and consequences of e-cigarette use because current research on e-cigarettes is made more difficult due to the lack of valid and reliable instruments that measure e-cigarette related constructs. This systematic review therefore seeks to identify the instruments proposed by researchers in the field that are designed to assess various aspects of e-cigarette use or its related constructs and analyze the evidence presented regarding the psychometric properties of the identified instruments.Methods This systematic review utilized six search engines: PubMed, Medline, CINAHL, PsycINFO, Web of Science, and EMBASE, to identify articles published in the peer-reviewed journals from inception to June 2018 that contained development or validation processes for these instruments.Results Eighteen articles describing the development or validation of 20 unique instruments were identified. Beliefs, perception, motive, e-cigarette use, and dependence, were the most commonly assessed e-cigarette related constructs. The included studies reported either construct or criterion validity, with 14 studies reporting both. Most studies did not report the content validity; for reliability, most reported internal consistencies using Cronbach’s alpha, with 15 instruments reporting Cronbach’s alpha > 0.70 for the scale or its subscales.Conclusions Twenty instruments with a reported development or validation process to measure e-cigarette related constructs are currently available for practitioners and researchers.

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Global Study on Tobacco Use among Youth in the Kyrgyz Republic Republic (GYTS, 2019)

Russian Pulmonology ◽

10.18093/0869-0189-2020-30-3-270-277 ◽

2020 ◽

Vol 30 (3) ◽

pp. 270-277

Author(s):

A. G. Polupanov ◽

A. A. Tolebaeva ◽

I. S. Sabirov ◽

A. T. Altymysheva ◽

A. I. Sabirova ◽

...

Keyword(s):

Tobacco Use ◽

Smokeless Tobacco ◽

Electronic Cigarettes ◽

Statistical Processing ◽

Tobacco Consumption ◽

Kyrgyz Republic ◽

Street Vendor ◽

Global Youth Tobacco Survey ◽

Tobacco Products ◽

Passive Smoker

The aim of the study was to assess the situation related to tobacco consumption among adolescents aged 13 – 15 in the Kyrgyz Republic.Materials and Methods. The study used a two-stage selection of schoolchildren in grades 7 – 9 (teenagers 13 – 15 years old) to conduct the survey. At the 1st stage, information was collected about all schools of the republic, where children of the target group study. the schools in which the survey was subsequently conducted were selected by the statistical sampling method according to the number of students in grades 7 – 9. The grades whose students participated in the questionnaire were set at stage 2 by random sampling in each school The survey includes 43 questions from the Standard main Questionnaire of the Global Youth Tobacco Survey (GYTS) and 30 supplementary questions (73 in total) with multiple choice of answers. The statistical processing was performed using the SUDAAN software package (US Centers for Disease Control and Prevention); a 95% confidence interval was calculated to calculate weighted prevalence estimates and standard errors (SE).Results. The survey found that 6.0% of schoolchildren (9.5% of boys and 2.4% of girls) currently use various types of tobacco; 4.4% of schoolchildren currently use tobacco (6.8% of boys and 2.0% of girls); 2.4% of schoolchildren smoke cigarettes; 2.4% use smokeless tobacco, 2.8% use other tobacco products (hookah); 2.8% of schoolchildren smoke electronic cigarettes (3.9% of boys and 1.7% of girls). Tobacco use most often begins before age 7 or after age 12. 16.8% of schoolchildren are exposed to tobacco smoke at home, of which 14.2% are in closed places and 14.8% in open public places. 87.2% of schoolchildren purchase cigarettes in a shop, kiosk, from a street vendor, and in the market. During the visit to the point of sale 26.7% noticed tobacco advertising and promotions; 49.7% saw anti-tobacco messages in the mass media. Definitely think that smoking tobacco by other people is bad for them, 71.2% of schoolchildren.Conclusion. A high percentage of teenagers consuming e-cigarettes, hookah, and smokeless tobacco products has been noted, although > 50% of them are aware of the dangers of tobacco use. Every 6th student is a passive smoker. The vast majority of schoolchildren aged 13 – 15 who try to quit smoking do not receive professional help in quitting tobacco use, and are exposed to protobacco media marketing campaigns.

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Comparing Factors Related to Any Conventional Cigarette Smokers, Exclusive New Alternative Product Users, and Non-Users among Japanese Youth: A Nationwide Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093128 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3128 ◽

Cited By ~ 1

Author(s):

Yuki Kuwabara ◽

Aya Kinjo ◽

Maya Fujii ◽

Aya Imamoto ◽

Yoneatsu Osaki ◽

...

Keyword(s):

Electronic Cigarettes ◽

Multivariable Analysis ◽

Nationwide Survey ◽

Public Health Issue ◽

Cigarette Use ◽

Cigarette Smokers ◽

Tobacco Products ◽

Alternative Product ◽

Japanese Youth ◽

The Impact

The impact of heated-tobacco-products (HTPs) and electronic cigarettes (e-cigarettes) on youth is a controversial public health issue, as it is unknown whether alternative products result in more youth using such products or smoking. In Japan, e-cigarettes with nicotine are prohibited, but e-cigarettes without nicotine are available. HTPs are marketed as tobacco products. Within this unique context, we aimed to compare any conventional cigarette smokers (including those who also used alternative products) with exclusive users of alternative products and examine factors relating to their use in Japan. In 2017, 22,275 students in grades 7–9 (age 12–15) and 42,142 in grades 10–12 (age 15–18) nationwide were surveyed. Overall, 1.8% were current users of any of the three products over the last month. Multivariable analysis revealed that risk factors for alternative product use were the same as those for cigarette use. Among all users, exclusive new product users were more likely to participate in club activities and intend to continue to higher education; any conventional cigarette users (including those who also used alternative products) were more likely to be exposed to secondhand smoke at home and to drink alcohol. Reducing adult smoking and disseminating health education remain relevant as strategies for preventing adolescents’ future tobacco use.

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Smoke-Free Ordinances and Policies Protect Youth, but Ordinances Appear to Have Little Impact on Non-Combustible Tobacco Use

Children ◽

10.3390/children6030044 ◽

2019 ◽

Vol 6 (3) ◽

pp. 44

Author(s):

Nell Valentine ◽

Emily McClelland ◽

Robert McMillen

Keyword(s):

High School Students ◽

Cigarette Smoking ◽

Tobacco Use ◽

Smokeless Tobacco ◽

Cigarette Use ◽

Lower Prevalence ◽

Tobacco Products ◽

Shs Exposure ◽

Smokeless Tobacco Use ◽

Cigar Smoking

Smoke-free ordinances and policies protect youth from exposure to secondhand smoke (SHS) and cigarette use. This study investigated whether smoke-free ordinances also protect youth from the use of other tobacco products. We compared the prevalence of SHS exposure, cigarette smoking, cigar smoking, smokeless tobacco use, and e-cigarette use among high school students living in a municipality with or without a smoke-free ordinance and in homes with and without smoke-free policies. Data were analyzed using the 2017 Mississippi Youth Tobacco Survey (n = 1923). Smoke-free ordinances were found to be associated with lower prevalence of SHS exposure (41.9% vs. 51.5%), cigarette smoking (5.1% vs. 11.4%), and cigar smoking (7.2% vs. 10.9%). There were no differences in smokeless tobacco use (6.6% vs. 6.5%) or e-cigarette use (11.2% vs 12.1%). Smoke-free homes were associated with lower prevalence of SHS exposure (38.0% vs 74.6%), cigarette smoking (4.8% vs. 17.6%), cigar smoking (6.4% vs. 16.4%), smokeless tobacco use (4.9% vs. 13.2%), and e-cigarette use (9.6% vs. 19.5%), p < 0.05 for all comparisons. The results suggest that smoke-free ordinances and policies protect against exposure to tobacco smoke and use of combustible tobacco products, but smoke-free ordinances do not protect from smokeless tobacco and e-cigarette use. Tobacco-free, rather than smoke-free, ordinances might offer more protection.

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Electronic Cigarettes: Their Role in the Lives of College Students

Journal of Pharmacy Practice ◽

10.1177/08971900211026841 ◽

2021 ◽

pp. 089719002110268

Author(s):

Carla Daniel ◽

Christa Haddad ◽

Jamie L. McConaha ◽

Philip Lunney

Keyword(s):

United States ◽

College Students ◽

Smoking Cessation ◽

Healthcare Professionals ◽

Electronic Cigarettes ◽

The United States ◽

Descriptive Statistics ◽

Cigarette Use ◽

Tobacco Products ◽

High Prevalence

Background: Electronic cigarettes have increased in popularity amongst college-aged adults. Although often advertised as smoking cessation tools, students have taken to them as their primary exposure to nicotine. For many reasons, e-cigarettes are extremely convenient and have become the most common tobacco products among this generation. Objective: To assess perceptions and reasons for e-cigarette use in college students Methods: A 20 question online Qualtrics® survey was distributed to college students aged 18 and above across the United States. All responses were anonymous and data were analyzed using quantitative and qualitative inferential and descriptive statistics. Results: Of those who used e-cigarettes, 67.7% are not likely to smoke when they are upset or sad, 56.8% disagree that stress is a factor, and 83.5% cited that alcohol was involved when smoking. Most respondents, 74% (n = 467), associated smoking with emotions of happiness, joy or peace. 43.7% who associated e-cigarettes with happiness or peace were more likely to agree that stress was an influence versus 26.5% for those who did not (p = 0.004). Conclusion: Results show a high prevalence of e-cigarette usage among college-aged students. Emotional pleasurable connections with e-cigarettes, similar to traditional cigarettes, play a role in their use. This information will allow healthcare professionals to tailor educational messages surrounding cessation.

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