scholarly journals Biomarkers of Exposure for Dual Use of Electronic Cigarettes and Combustible Cigarettes: Nicotelline, NNAL, and Total Nicotine Equivalents

2019 ◽  
Vol 22 (7) ◽  
pp. 1107-1113
Author(s):  
Peyton Jacob ◽  
Gideon St. Helen ◽  
Lisa Yu ◽  
Natalie Nardone ◽  
Christopher Havel ◽  
...  
Keyword(s):  
Public Health ◽  
Half Life ◽  
Electronic Cigarettes ◽  
Public Health Issue ◽  
Cigarette Use ◽  
Tobacco Exposure ◽  
Sample Collection ◽  
Dual Use ◽  
Biomarkers Of Exposure ◽  
Urine Concentrations

Abstract Introduction Dual use of electronic cigarettes (e-cigarettes) and combustible cigarettes is a major public health issue. It is generally accepted that exclusive e-cigarette use is less harmful than exclusive combustible cigarette use, but most e-cigarette users continue to smoke combustible cigarettes as well. To what extent the use of e-cigarettes reduces harm in people who continue to smoke combustible cigarettes has been debated. The aim of this study was to explore the utility of biomarkers as measures of dual use. Methods In two human studies of participants who used e-cigarettes only or both combustible cigarettes and e-cigarettes, we measured urine concentrations of the metabolites of nicotine (total nicotine equivalents) as well as two biomarkers of tobacco exposure: 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a tobacco-specific carcinogen metabolite, and nicotelline, a tobacco alkaloid not found in significant concentrations in e-cigarette products. Results The presence of nicotine metabolites indicates either e-cigarette or combustible cigarette use. Nicotelline (half-life of 2–3 hours) indicates recent combustible cigarette use and NNAL (half-life of 10 days or more), indicates combustible cigarette use occurring within several weeks prior to sample collection. Conclusions Nicotelline and NNAL are useful biomarkers for combustible tobacco use in users e-cigarettes. The application of these biomarkers provides a tool to help assess whether, or to what extent, dual use of e-cigarettes and combustible cigarettes reduces harm compared to sole use of combustible cigarettes. These biomarkers can also verify exclusive use of e-cigarettes over short (24 hour) or long (several week) time periods. Implications:  To what extent dual use of e-cigarettes and combustible cigarettes reduce harm compared to smoking combustible cigarettes only is of considerable public health interest. We show that the levels of the minor tobacco alkaloid nicotelline and the nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) are extremely low in electronic cigarette fluids. The urine biomarkers nicotelline and the NNK metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) are indicative of cigarette smoking and can be used to assess recent and past smoking in dual users.

scholarly journals Biomarkers of Exposure Among “Dual Users” of Tobacco Cigarettes and Electronic Cigarettes in Canada

2018 ◽  
Vol 21 (9) ◽  
pp. 1259-1266 ◽  
Author(s):  
Christine D Czoli ◽  
Geoffrey T Fong ◽  
Maciej L Goniewicz ◽  
David Hammond
Keyword(s):  
Repeated Measures ◽  
Electronic Cigarettes ◽  
Cigarette Use ◽  
Dual Use ◽  
Potential Health ◽  
Product Use ◽  
Biomarkers Of Exposure ◽  
Health Authorities ◽  
Concurrent Use ◽  
Public Health Authorities

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.

scholarly journals Analyzing the Effect of Vaping Use in Teens: A Literature Review and Proposed Solutions

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Damilola Ajayi ◽  
Bruce Fuchs ◽  
Dana Reiss
Keyword(s):  
Public Health ◽  
Electronic Cigarettes ◽  
Review Article ◽  
Health Issue ◽  
Public Health Issue ◽  
Cigarette Use ◽  
Common Component ◽  
Major Public Health Issue ◽  
Brand Marketing ◽  
Negative Health Outcomes

Teenage vaping is a major public health issue that is emerging globally. This review article examines what influences teens to use electronic cigarettes (e-cigarettes) and vapes, including families, communities, social media, and brand marketing. Nicotine, a common component of e-cigarettes and vapes, is addictive, and teens who are using these products are starting to report negative health outcomes. After a review of the current literature, three recommendations/solutions are proposed to combat this public health issue. As teen e-cigarette use is on the rise, it is clear that the FDA and the federal government need to enforce tougher regulations on e-cigarette and vaping brands, teens need to be properly educated about these products that are on the market, and advertisements for these products need to be regulated.

Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking

2018 ◽  
Vol 21 (10) ◽  
pp. 1363-1370 ◽  
Author(s):  
Abigail S Friedman ◽  
Samantha J L Horn
Keyword(s):  
Household Income ◽  
Electronic Cigarettes ◽  
Electronic Cigarette ◽  
Socioeconomic Disparities ◽  
Morbidity And Mortality ◽  
Cigarette Use ◽  
Dual Use ◽  
Representative Data ◽  
Percentage Points ◽  
Nationally Representative

Abstract Introduction Socioeconomic disparities have been established for conventional cigarette use, but not for electronic cigarettes. This study estimates socioeconomic gradients in exclusive use of conventional cigarettes, electronic cigarettes, and dual use (ie, use of both products) among adults in the United States. Methods Analyses consider nationally representative data on 25- to 54-year-old respondents to the 2014–2016 National Health Interview Surveys (N = 50306). Demographically adjusted seemingly unrelated regression models estimate how two socioeconomic status measures—respondent education and household income—relate to current exclusive use of conventional cigarettes, electronic cigarettes, and dual use. Results Conventional cigarette use exhibits negative education and income gradients, consistent with existing research: −12.9 percentage points (confidence interval [CI]: −14.0, −11.8) if college educated, and −9.5 percentage points (CI: −10.9, −8.1) if household income exceeds 400% of the federal poverty level. These gradients are flatter for dual use (−1.4 [CI: −1.8, −0.9] and −1.9 [CI: −2.5, −1.2]), and statistically insignificant for electronic cigarette use (−0.03 [CI: −0.5, 0.4] and −0.3 [CI: −0.8, −0.2]). Limiting the sample to ever-smokers, higher education is associated with a 0.9 percentage point increase in likelihood of exclusive electronic cigarette use at interview (CI: 0.0, 1.9). Conclusions Education and income gradients in exclusive electronic cigarette use are small and statistically insignificant, contrasting with strong negative gradients in exclusive conventional cigarette use. Furthermore, more educated smokers are more likely to switch to exclusive e-cigarette use than less educated smokers. Such differential switching may exacerbate socioeconomic disparities in smoking-related morbidity and mortality, but lower the burden of tobacco-related disease. Implications Research has not yet established whether socioeconomic disparities in electronic cigarette (e-cigarette) use resemble those observed for conventional cigarettes. This article uses nationally representative data on US adults aged 25–54 to estimate income and education gradients in exclusive use of conventional cigarettes, e-cigarettes, and dual use. Both gradients are steep and negative for conventional cigarette use, but flat and statistically insignificant for e-cigarette use. Repeating the analysis among ever-smokers indicates that more educated smokers are more likely to transition toward exclusive e-cigarette use than less educated smokers. Such differential substitution may exacerbate disparities in smoking-related morbidity and mortality.

scholarly journals Electronic Cigarette–Related Contents on Instagram: Observational Study and Exploratory Analysis

10.2196/21963 ◽  
2020 ◽  
Vol 6 (4) ◽  
pp. e21963
Author(s):  
Yankun Gao ◽  
Zidian Xie ◽  
Li Sun ◽  
Chenliang Xu ◽  
Dongmei Li
Keyword(s):  
Public Health ◽  
Social Networking ◽  
Electronic Cigarettes ◽  
User Engagement ◽  
Cigarette Use ◽  
Message Delivery ◽  
Delivery Methods ◽  
The Public ◽  
Popular Image ◽  
Image Type

Background Instagram is a popular social networking platform for users to upload pictures sharing their experiences. Instagram has been widely used by vaping companies and stores to promote electronic cigarettes (e-cigarettes), as well as by public health entities to communicate the risks of e-cigarette use (vaping) to the public. Objective We aimed to characterize current vaping-related content on Instagram through descriptive analyses. Methods From Instagram, 42,951 posts were collected using vaping-related hashtags in November 2019. The posts were grouped as (1) pro-vaping, (2) vaping warning, (3) neutral to vaping, and (4) not related to vaping based on the attitudes to vaping expressed within the posts. From these Instagram posts and the corresponding 18,786 unique Instagram user accounts, 200 pro-vaping and 200 vaping-warning posts as well as 200 pro-vaping and 200 vaping-warning user accounts were randomly selected for hand coding. Furthermore, follower counts and media counts of the Instagram user accounts as well as the “like” counts and hashtags of the posts were compared between pro-vaping and vaping-warning groups. Results There were more posts in the pro-vaping group (41,412 posts) than there were in the vaping-warning group (1539 posts). The majority of pro-vaping images were product display images (163/200, 81.5%), and the most popular image type in vaping-warning posts was educational (95/200, 47.5%). The highest proportion of pro-vaping user account type was vaping store (110/189, 58.1%), and the store account type had the highest mean number of posts (10.33 posts/account). The top 3 vaping-warning user account types were personal (79/155, 51%), vaping-warning community (37/155, 23.9%), and community (35/155, 22.6%), of which the vaping-warning community had the highest mean number of posts (3.68 posts/account). Pro-vaping user accounts had more followers (median 850) and media (median 232) than vaping-warning user accounts had (follower count: median 191; media count: 92). Pro-vaping posts had more “likes” (median 22) and hashtags (mean 20.39) than vaping-warning posts had (“like” count: median 12; hashtags: mean 7.16). Conclusions Instagram is dominated by pro-vaping content, and pro-vaping posts and user accounts seem to have more user engagement than vaping-warning accounts have. These results highlight the importance of regulating e-cigarette posts on social media and the urgency of identifying effective communication content and message delivery methods with the public about the health effects of e-cigarettes to ameliorate the epidemic of vaping in youth.

scholarly journals Electronic Cigarette–Related Contents on Instagram: Observational Study and Exploratory Analysis (Preprint)

2020 ◽  
Author(s):  
Yankun Gao ◽  
Zidian Xie ◽  
Li Sun ◽  
Chenliang Xu ◽  
Dongmei Li
Keyword(s):  
Public Health ◽  
Social Networking ◽  
Electronic Cigarettes ◽  
User Engagement ◽  
Cigarette Use ◽  
Message Delivery ◽  
Delivery Methods ◽  
The Public ◽  
Popular Image ◽  
Image Type

BACKGROUND Instagram is a popular social networking platform for users to upload pictures sharing their experiences. Instagram has been widely used by vaping companies and stores to promote electronic cigarettes (e-cigarettes), as well as by public health entities to communicate the risks of e-cigarette use (vaping) to the public. OBJECTIVE We aimed to characterize current vaping-related content on Instagram through descriptive analyses. METHODS From Instagram, 42,951 posts were collected using vaping-related hashtags in November 2019. The posts were grouped as (1) pro-vaping, (2) vaping warning, (3) neutral to vaping, and (4) not related to vaping based on the attitudes to vaping expressed within the posts. From these Instagram posts and the corresponding 18,786 unique Instagram user accounts, 200 pro-vaping and 200 vaping-warning posts as well as 200 pro-vaping and 200 vaping-warning user accounts were randomly selected for hand coding. Furthermore, follower counts and media counts of the Instagram user accounts as well as the “like” counts and hashtags of the posts were compared between pro-vaping and vaping-warning groups. RESULTS There were more posts in the pro-vaping group (41,412 posts) than there were in the vaping-warning group (1539 posts). The majority of pro-vaping images were product display images (163/200, 81.5%), and the most popular image type in vaping-warning posts was educational (95/200, 47.5%). The highest proportion of pro-vaping user account type was vaping store (110/189, 58.1%), and the store account type had the highest mean number of posts (10.33 posts/account). The top 3 vaping-warning user account types were personal (79/155, 51%), vaping-warning community (37/155, 23.9%), and community (35/155, 22.6%), of which the vaping-warning community had the highest mean number of posts (3.68 posts/account). Pro-vaping user accounts had more followers (median 850) and media (median 232) than vaping-warning user accounts had (follower count: median 191; media count: 92). Pro-vaping posts had more “likes” (median 22) and hashtags (mean 20.39) than vaping-warning posts had (“like” count: median 12; hashtags: mean 7.16). CONCLUSIONS Instagram is dominated by pro-vaping content, and pro-vaping posts and user accounts seem to have more user engagement than vaping-warning accounts have. These results highlight the importance of regulating e-cigarette posts on social media and the urgency of identifying effective communication content and message delivery methods with the public about the health effects of e-cigarettes to ameliorate the epidemic of vaping in youth.

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

2020 ◽  
Vol 17 (9) ◽  
pp. 3128 ◽  
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.

scholarly journals Pulmonary Health Effects of Electronic Cigarettes: A Scoping Review

2021 ◽  
pp. 152483992098550
Author(s):  
Emma Gugala ◽  
Chinyere M. Okoh ◽  
Somraj Ghosh ◽  
Leticia R. Moczygemba
Keyword(s):  
Public Health ◽  
Health Effects ◽  
Scoping Review ◽  
Electronic Cigarettes ◽  
The United States ◽  
Disease Diagnosis ◽  
Adverse Outcomes ◽  
Chronic Obstructive ◽  
Original Research ◽  
Dual Use

Background There is global concern regarding the public health impact of electronic cigarettes (ECs). ECs are commonly promoted as safer than conventional cigarettes (CCs), however there is limited knowledge of the long-term health effects. This scoping review examined the pulmonary health effects of ECs reported in the literature from 2009 to 2019. Method PubMed, CINAHL, and Science Direct databases were used. Search terms included “vaping, electronic nicotine delivery systems, electronic cigarettes, lung diseases, respiratory diseases, and pulmonary.” Original research articles in English that used human subjects between January 1, 2009 and January 31, 2020 and reported pulmonary outcomes were included. Results Forty-five studies met the inclusion criteria. There were 14 (31.1%) randomized experimental, 7 (15.6%) nonrandomized experimental, 6 (13.3%) cohort, and 18 (40.0%) cross-sectional studies. Sixteen (35.6%) studies were conducted in the United States; the rest were conducted across 11 other countries. The total number of subjects was 1,465,292 and ages ranged from 12 to 99 years across studies. Eligible studies demonstrated an association between EC use and pulmonary symptoms, asthma and chronic obstructive pulmonary disease diagnosis and exacerbations. The degree of this association varied based on the use of additional tobacco products. EC use resulted in worse outcomes than nonsmoking, but resulted in improved outcomes when compared with CC use or dual use of CC and EC. Conclusion Evidence indicates that EC use, especially dual use, leads to negative pulmonary effects and adverse outcomes. Education on the potential risks and publishing of EC ingredients on labels could help improve public health safety communication and reduce EC use.

Use of Electronic Cigarettes and Other Tobacco Products Among Active Component Services Members

2021 ◽  
Author(s):  
Sierra Smucker ◽  
Sarah O Meadows ◽  
Robin Beckman
Keyword(s):  
Health Behaviors ◽  
Active Component ◽  
Electronic Cigarettes ◽  
Service Members ◽  
Cigarette Use ◽  
Physical And Mental Health ◽  
Dual Use ◽  
Tobacco Products ◽  
Health Related Behaviors ◽  
Health Related

ABSTRACT Introduction e-cigarettes have been touted as a safer alternative to classic cigarettes and other combustible tobacco products. However, a growing body of evidence finds that any risk reduction associated with e-cigarette use is eliminated when individuals use “both” e-cigarettes and other tobacco products. Recent analyses from the Health Related Behaviors Survey suggest that rates of e-cigarette use are higher among active component service members than in the general population. However, little is known about the frequency and health behaviors associated with the dual use of e-cigarettes and other tobacco products among service members. Data and Method Using data from the 2018 Health Related Behaviors Survey, this paper investigates whether active component service members who use both e-cigarettes and other tobacco products are more likely to engage in other types of substance use or negative health behaviors. Results We find that the dual use of e-cigarettes and other tobacco products is associated with poorer physical and mental health, higher rates of alcohol misuse, and higher rates of insufficient sleep. Conclusion The association between the dual use of e-cigarettes and tobacco products suggests that these individuals represent an important target group for health-related resources and attention in DoD.

Electronic cigarettes in Italy: a tool for harm reduction or a gateway to smoking tobacco?

2019 ◽  
pp. tobaccocontrol-2018-054726 ◽  
Author(s):  
Xiaoqiu Liu ◽  
Alessandra Lugo ◽  
Enrico Davoli ◽  
Giuseppe Gorini ◽  
Roberta Pacifici ◽  
...  
Keyword(s):  
Public Health ◽  
General Population ◽  
Tobacco Smoking ◽  
Multivariate Analyses ◽  
Electronic Cigarettes ◽  
Smoking Behaviour ◽  
Point Of View ◽  
Cigarette Use ◽  
Face To Face ◽  
Stop Smoking

IntroductionMore than a decade after electronic cigarettes (e-cigarette) hit the European market, we are still debating whether they may help or hinder tobacco control. It is therefore useful to explore the potential net effect of e-cigarette use in the general population.MethodsWe annually conduct a face-to-face survey on smoking in Italy on a representative sample of the general population aged 15 years or over (52.4 million). A total of 15 406 subjects were interviewed in 2014–2018. We investigated the consequences of using e-cigarettes on tobacco smoking behaviour among ever and regular e-cigarette users.ResultsIn all, 5.7% of our sample reported ever e-cigarette use. Multivariate analyses showed more use by men, ex-smokers and current smokers. E-cigarette use decreased with age and increased with education and calendar year. Only 1.1% of subjects were regular e-cigarette users. This prevalence rose from 0.4% in 2014–2015 to 1.8% in 2016–2017 and was 1.3% in 2018. Among 522 ever users, 13.2% stopped smoking after trying e-cigarettes and 22.2% started smoking or relapsed after using e-cigarettes. The corresponding estimates among regular users were 24.7% and 28.0%, respectively.ConclusionsAmong Italian e-cigarette users, those (re)starting smoking after using e-cigarettes outnumber those who stop smoking after using e-cigarettes. From a public health point of view, e-cigarettes may have an unfavourable net effect. Consequently, if we are not able to prevent sales of e-cigarettes to non-smokers, this product will more likely stimulate smoking tobacco than reduce harm.

scholarly journals Midwives' recommendation of electronic cigarettes as a smoking cessation strategy in pregnancy

2021 ◽  
Vol 29 (1) ◽  
pp. 37-44
Author(s):  
Amy Broadfield ◽  
Keivan Ahmadi ◽  
Helen Ayre
Keyword(s):  
Public Health ◽  
Smoking Cessation ◽  
Current Knowledge ◽  
Electronic Cigarettes ◽  
Cigarette Use ◽  
Health Crisis ◽  
Knowledge And Attitudes ◽  
Stop Smoking Services ◽  
Narrative Literature Review ◽  
In Pregnancy

Introduction Electronic cigarettes have been described as a public health crisis. Approximately 10.6% of pregnant women smoke conventional cigarettes at the time of delivery, but the prevalence of e-cigarette use during pregnancy is unknown. Objectives To assess the extent of midwives' current knowledge and attitudes on electronic cigarettes as a smoking cessation strategy during pregnancy. Methods Electronic databases were searched. These were supplemented by manual searches, which were completed to include reports from Public Health England and the Royal College of Midwives. Results A total of 22 papers were identified, reviewed and are presented as a narrative literature review. Topics such as epidemiology, organisational stances, opinions of smoking cessation in pregnancy and opinions from stop smoking services were explored. There have been conflicting ideas regarding the use of electronic cigarettes in pregnancy and women who have recently given birth. Conclusions Whilst the current literature regarding electronic cigarettes as a smoking cessation strategy during pregnancy is well explored, there is no literature that investigates the attitudes of midwives and how this may affect their recommendation of e-cigarettes. The results of this study could serve as a point of reference for future clinical research, as well as clinical practice, by bringing to light the knowledge and attitudes midwives have regarding electronic cigarette use in pregnancy, and may be able to suggest some changes to improve the current practices.

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