scholarly journals Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Arielle S. Selya
Keyword(s):  
Harm Reduction ◽  
Tobacco Smoking ◽  
Lower Risk ◽  
Time Delays ◽  
Electronic Cigarettes ◽  
Dynamics Simulation ◽  
Political Resistance ◽  
Cigarette Use ◽  
Implementation Challenges ◽  
The Usa

Abstract Background Electronic cigarettes (“e-cigarettes”) have altered tobacco smoking trends, and their impacts are controversial. Given their lower risk relative to combustible tobacco, e-cigarettes have potential for harm reduction. This study presents a simulation-based analysis of an e-cigarette harm reduction policy set in the USA. Methods A system dynamics simulation model was constructed, with separate aging chains representing people in different stages of use (both of combustible cigarettes and e-cigarettes). These structures interact with a policy module to close the gap between actual (simulated) and goal numbers of individuals who smoke, chosen to reduce the tobacco-attributable death rate (i.e., mostly combustible cigarette-attributable, but conservatively allowing e-cigarette-attributable deaths) to that due to all accidents in the general population. The policy is two-fold, removing existing e-liquid flavor bans and providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on tobacco smoking occur through three mechanisms: (1) diversion from ever initiating smoking; (2) reducing progression to established smoking; and (3) increasing smoking cessation. An important unintended effect of possible death from e-cigarettes was conservatively included. Results The base-case model replicated the historical exponential decline in smoking and the exponential increase in e-cigarette use since 2010. Simulations suggest tobacco smoking could be reduced to the goal level approximately 40 years after implementation. Implementation obstacles (time delays, political resistance, and budgetary constraints) could delay and weaken the effect of the policy by up to 62% in the worst case, relative to the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations as negative feedback loops stabilize the system after the one-time “shock” introduced by policy changes. Conclusions The simulation suggests that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current evidence that e-cigarettes offset or divert from smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles can usefully inform policy design. Ongoing research is needed, given continuing changes in e-cigarette use prevalence, new policies being enacted for e-cigarettes, and emerging evidence for substitution effects between combustible cigarettes and e-cigarettes.

scholarly journals Reducing the Smoking-Related Health Burden in the US through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

2020 ◽  
Author(s):  
Arielle Selya
Keyword(s):  
Harm Reduction ◽  
Time Delays ◽  
Electronic Cigarettes ◽  
Dynamics Simulation ◽  
Political Resistance ◽  
Cigarette Use ◽  
Ideal Case ◽  
Implementation Challenges ◽  
The Us ◽  
The Ideal

Abstract Background: Electronic cigarettes (“e-cigarettes”) have altered tobacco use trends, and their impacts are controversial. Given their lower risk relative to conventional cigarettes, e-cigarettes have potential for harm reduction. This study presents a simulation-based analysis of an e-cigarette harm reduction policy set in the US. Methods: A system dynamics simulation model was constructed, with separate aging chains representing different stages of use for both cigarette smokers and e-cigarette users. These structures interact with a policy module to close the gap between actual (simulated) and goal numbers of cigarette smokers, chosen to reduce the tobacco-attributable death rate to that due to all accidents in the general population. The policy is two-fold, removing existing flavor bans and providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on conventional smoking occurs through three mechanisms: 1) diversion from ever initiating conventional smoking; 2) reducing progression to established smoking; and 3) increasing smoking cessation. An important unintended effect was included, which increases the tobacco-related mortality accordingly with an increase in nicotine users due to e-cigarettes. Results: The base-case model replicated the historical exponential decline in smoking and the exponential increase in e-cigarette use since 2010. The ideal-case policy was able to reduce conventional smoking to the goal level approximately 40 years after implementation. Implementation obstacles (time delays, political resistance, and budgetary constraints) delayed and weakened the effect of the policy by up to 95% in the worst case, relative to the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations as negative feedback loops stabilize the system after the one-time “shock” introduced by policy changes. Conclusions: Current findings demonstrate that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current knowledge of e-cigarettes’ effects on conventional smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles is essential in policy design. Ongoing research is needed with forthcoming data on e-cigarette use prevalence and possible effects on cigarette smoking.

scholarly journals Reducing the Smoking-Related Health Burden through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

2020 ◽  
Author(s):  
Arielle Selya
Keyword(s):  
Cigarette Smoking ◽  
Harm Reduction ◽  
Death Rate ◽  
Electronic Cigarettes ◽  
Dynamics Simulation ◽  
Cigarette Use ◽  
Ideal Case ◽  
Cigarette Smokers ◽  
Implementation Challenges ◽  
The Ideal

Abstract Background: Electronic cigarettes (“e-cigarettes”) have altered nicotine use trends, and their impacts are controversial. Given their reduced risk profile relative to conventional cigarettes, e-cigarettes have potential for harm reduction. The current study presents a simulation-based analysis of an e-cigarette harm reduction policy. Methods: A system dynamics simulation model was constructed, with separate aging chains for cigarette smokers and e-cigarette users. These structures work together with a policy module to close the gap between actual (simulated) and a goal number of cigarette smokers, chosen to reduce the nicotine-attributable death rate to the accidental death rate. The policy is two-fold, first removing existing regulations on e-cigarettes (e.g. flavor bans) and second providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on conventional smoking occurs through three mechanisms: 1) diversion from ever initiating conventional smoking; 2) reducing smoking behavior and thus progression to established smoking; and 3) increasing smoking cessation. An important unintended effect was included, which increases the nicotine-related mortality accordingly with an increase in nicotine users due to e-cigarettes.Results: The base-case model replicated the historical exponential decline in conventional cigarette smoking and the exponential increase in e-cigarette use since their introduction circa 2010. The ideal-case policy was able to reduce conventional smoking to the goal level approximately 40 years after implementation. Policy scenarios that included realistic, practical obstacles to implementation delayed and weakened the effect of the policy by up to 95% in the worst case, relative to the same time point in the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations. Conclusions: Current findings demonstrate that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current knowledge of e-cigarettes’ effects on conventional smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles is essential in policy design. Ongoing research is needed with forthcoming data on e-cigarette use prevalence and possible effects on cigarette smoking.

scholarly journals Maxillofacial injury related to an exploding e-cigarette

2021 ◽  
Vol 14 (1) ◽  
pp. e239677
Author(s):  
Angelo La Valle ◽  
Rory O'Connor ◽  
A Brooks ◽  
Ramzi Freij
Keyword(s):  
Harm Reduction ◽  
Tobacco Smoking ◽  
Electronic Cigarettes ◽  
Cigarette Use ◽  
Maxillofacial Injury ◽  
Dramatic Effect ◽  
The Public ◽  
The Media ◽  
Psychological Impairment ◽  
The Uk

Electronic cigarettes (also known as e-cigarettes or electronic nicotine delivery systems) were invented in China in 2003 then introduced to the British market in 2007. They remain popular among the public and are deemed to be effective in reducing tobacco smoking (the UK being one of the first countries to embrace them in a harm reduction policy). However, reports in the media of e-cigarettes exploding are of concern, considering the potential functional and psychological impairment that lifelong disfigurement will cause, especially given their uptake among people of any age. We present a case of this rare, but dramatic, effect of e-cigarette use as a warning to the public.

Should psychiatrists support the availability of nicotine e-cigarettes in Australia?

2019 ◽  
Vol 27 (4) ◽  
pp. 392-395 ◽  
Author(s):  
James G Scott ◽  
Sarah Jhetam ◽  
Renee Chen ◽  
Mark Daglish
Keyword(s):  
Harm Reduction ◽  
Electronic Cigarettes ◽  
Position Statement ◽  
Cigarette Use ◽  
Physical And Mental Health ◽  
Limited Evidence ◽  
Tobacco Harm Reduction ◽  
People With Mental Illness ◽  
Potential Risks ◽  
Zealand College

Objective: To examine the position statement of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) regarding the availability of electronic cigarettes in Australia. Conclusion: There is limited evidence supporting the efficacy of nicotine e-cigarettes as an effective tobacco harm-reduction or cessation strategy for people with mental illness. The recommendations to increase their availability under regulation must be balanced with the physical and mental health risks of vapour inhalation and nicotine use, particularly for youth. Future recommendations by the RANZCP in relation to e-cigarettes must consider both the available evidence for harm reduction and the potential risks associated with youth e-cigarette use.

Secondhand smoke from electronic cigarette resulting in hypersensitivity pneumonitis

2020 ◽  
Vol 13 (3) ◽  
pp. e233381 ◽  
Author(s):  
Panagis Galiatsatos ◽  
Erin Gomez ◽  
Cheng Ting Lin ◽  
Peter B Illei ◽  
Pali Shah ◽  
...  
Keyword(s):  
Lung Injury ◽  
Secondhand Smoke ◽  
Hypersensitivity Pneumonitis ◽  
Electronic Cigarettes ◽  
Electronic Cigarette ◽  
Cigarette Use ◽  
Diagnostic Investigation ◽  
Health Related ◽  
The Usa ◽  
Exposure To Secondhand Smoke

Cases of vaping-induced lung injury have increased in the USA, resulting in a heterogeneous collection of pneumonitis patterns in persons who used electronic cigarettes. Hypersensitivity pneumonitis has been documented in several cases of first-hand electronic cigarette use; however, secondhand smoke health-related consequences have not been fully understood. We present a case of the patient who developed hypersensitivity pneumonitis secondary to exposure to secondhand smoke from electronic cigarette. We summarise the presentation and diagnostic investigation, as well as the management of this case.

scholarly journals E-Cigarette Use and Future Cigarette Initiation Among Never Smokers and Relapse Among Former Smokers in the PATH Study

2019 ◽  
Vol 134 (5) ◽  
pp. 528-536 ◽  
Author(s):  
Robert McMillen ◽  
Jonathan D. Klein ◽  
Karen Wilson ◽  
Jonathan P. Winickoff ◽  
Susanne Tanski
Keyword(s):  
Cigarette Smoking ◽  
Harm Reduction ◽  
Electronic Cigarettes ◽  
Computer Assisted ◽  
Cigarette Use ◽  
Cigarette Smokers ◽  
Potential Harm ◽  
Increased Risk ◽  
Never Smokers

Objectives: Any potential harm-reduction benefit of electronic cigarettes (e-cigarettes) could be offset by nonsmokers who initiate e-cigarette use and then smoke combustible cigarettes. We examined correlates of e-cigarette use at baseline with combustible cigarette smoking at 1-year follow-up among adult distant former combustible cigarette smokers (ie, quit smoking ≥5 years ago) and never smokers. Methods: The Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal study, surveyed 26 446 US adults during 2 waves: 2013-2014 (baseline) and 2014-2015 (1-year follow-up). Participants completed an audio computer-assisted interview in English or Spanish. We compared combustible cigarette smoking at 1-year follow-up by e-cigarette use at baseline among distant former combustible cigarette smokers and never smokers. Results: Distant former combustible cigarette smokers who reported e-cigarette past 30-day use (9.3%) and ever use (6.7%) were significantly more likely than those who had never used e-cigarettes (1.3%) to have relapsed to current combustible cigarette smoking at follow-up ( P < .001). Never smokers who reported e-cigarette past 30-day use (25.6%) and ever use (13.9%) were significantly more likely than those who had never used e-cigarettes (2.1%) to have initiated combustible cigarette smoking ( P < .001). Adults who reported past 30-day e-cigarette use (7.0%) and ever e-cigarette use (1.7%) were more likely than those who had never used e-cigarettes (0.3%) to have transitioned from never smokers to current combustible cigarette smokers ( P < .001). E-cigarette use predicted combustible cigarette smoking in multivariable analyses controlling for covariates. Conclusions: Policies and counseling should consider the increased risk for nonsmokers of future combustible cigarette smoking use as a result of using e-cigarettes and any potential harm-reduction benefits e-cigarettes might bring to current combustible cigarette smokers.

scholarly journals Cardiovascular autonomic effects of electronic cigarette use: a systematic review

2020 ◽  
Vol 30 (6) ◽  
pp. 507-519 ◽  
Author(s):  
Phoebe D. Garcia ◽  
Jeffrey A. Gornbein ◽  
Holly R. Middlekauff
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
Electronic Cigarettes ◽  
Meta Analysis ◽  
Cardiovascular Effects ◽  
Tobacco Product ◽  
Cigarette Use ◽  
Prisma Statement ◽  
The Usa ◽  
Acute And Chronic Effects

Abstract Purpose Electronic cigarettes (ECs) are the fastest growing tobacco product in the USA, and ECs, like tobacco cigarettes (TCs), have effects on the cardiovascular autonomic nervous system, with clinical implications. The purpose of this review was to collect and synthesize available studies that have investigated the autonomic cardiovascular effects of EC use in humans. Special attention is paid to the acute and chronic effects of ECs, the relative contributions of the nicotine versus non-nicotine constituents in EC emissions and the relative effects of ECs compared to TCs. Methods Using the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, we conducted a literature search of the Ovid PubMed and Embase databases on 6 December 2019 using keywords in titles and abstracts of published literature. Acute (minutes to hours) and chronic (days or longer) changes in heart rate variability (HRV), heart rate (HR) and blood pressure (BP) were used as estimates of cardiovascular autonomic effects. Results Nineteen studies were included in this systematic review, all of which used earlier generation EC devices. Acute EC vaping increased HR and BP less than acute TC smoking. Nicotine but not non-nicotine constituents in EC aerosol were responsible for the sympathoexcitatory effects. The results of chronic EC vaping studies were consistent with a chronic sympathoexcitatory effect as estimated by HRV, but this did not translate into chronic increases in HR or BP. Conclusions Electronic cigarettes are sympathoexcitatory. Cardiac sympathoexcitatory effects are less when vaping using the earlier generation ECs than when smoking TCs. Additional studies of the latest pod-like EC devices, which deliver nicotine similarly to a TC, are necessary.

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.

scholarly journals “It is the One Thing that has Worked”: facilitators and barriers to switching to nicotine salt pod system e-cigarettes among African American and Latinx people who smoke: a content analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Kim Pulvers ◽  
Myra Rice ◽  
Jasjit S. Ahluwalia ◽  
Michael J. Arnold ◽  
Crystal Marez ◽  
...  
Keyword(s):  
African American ◽  
Health Disparities ◽  
Harm Reduction ◽  
Ethnic Minority ◽  
Kansas City ◽  
Electronic Cigarettes ◽  
Cigarette Use ◽  
Smoking Reduction ◽  
Facilitators And Barriers ◽  
Racial Ethnic

Abstract Background Electronic cigarettes are a harm reduction strategy for individuals who smoke cigarettes who cannot or do not want to quit using FDA-approved cessation methods. Identifying perceived facilitators and barriers to switching among people who smoke cigarettes is critical to optimizing health impact. This is particularly important for the most dominant e-cigarette device, nicotine salt pod electronic cigarettes. We investigate the experience using pod electronic cigarettes among African American and Latinx individuals who smoke, the two largest racial/ethnic minority groups who experience significant health disparities. Methods From July 2018 to May 2019, adults who smoked cigarettes, age 21 + (N = 114; M age = 44.6, 59.6% male, 52.6% African American from Kansas City, 47.4% Latinx from San Diego) received JUUL-brand electronic cigarettes (referred to hereafter as JUUL) for 6 weeks and answered interview questions at week six. We inquired what they liked and disliked about using JUUL, what helped with switching and made switching difficult, future intentions for continued JUUL use, and how JUUL compared to past smoking reduction methods. Responses were coded into themes by independent raters. Theme frequencies were analyzed separately by race/ethnicity and week 6 use trajectory (exclusive JUUL use, dual JUUL and cigarette use, exclusive cigarette use). Results Clean/smell was the aspect of using JUUL most commonly liked (23%), followed by convenience (19%). Coughing/harshness was a more common barrier to switching for African American (44%) than Latinx (9%), and for continuing cigarette use (56%) than for those who exclusively switched or dually used JUUL and combustible cigarettes (15–21%). Most (78% African American; 90% Latinx) reported that the benefits of using JUUL outweighed barriers, and this varied by JUUL use trajectory: 94% exclusive switch, 86% dual use, and 42% continued cigarette use. The majority said they would continue using JUUL to replace cigarettes (83% African American; 94% Latinx) and that JUUL worked better than other methods to reduce cigarettes (72%). Conclusion African American and Latinx individuals who smoked experience using pod electronic cigarettes was generally positive. Understanding facilitators and impediments to switching to electronic cigarettes among racial/ethnic minority people who smoke can inform harm reduction interventions and reduce tobacco-related health disparities. Trial Registration ClinicalTrials.gov Identifier: NCT03511001 posted April 27, 2018.

Knowledge, attitudes and beliefs towards waterpipe tobacco smoking and electronic shisha (e-shisha) among young adults in London: a qualitative analysis

2015 ◽  
Vol 17 (02) ◽  
pp. 166-174 ◽  
Author(s):  
Shrinal Kotecha ◽  
Mohammed Jawad ◽  
Steve Iliffe
Keyword(s):  
Young Adults ◽  
United Kingdom ◽  
Harm Reduction ◽  
Peer Influence ◽  
Tobacco Smoking ◽  
Electronic Cigarettes ◽  
Educational Interventions ◽  
Snowball Sampling ◽  
The United Kingdom ◽  
Waterpipe Tobacco Smoking

IntroductionWaterpipe tobacco smoking (WTS), known in the United Kingdom as shisha, is popular among adolescents worldwide. Some electronic cigarettes are marketed in the United Kingdom as ‘electronic shisha’ (e-shisha). This study aimed to understand how WTS users view e-shisha and whether it could be used as a harm-reduction or cessation aid.MethodIn-depth face-to-face interviews were conducted with 16 young adults recruited by snowball sampling in London, UK. Recurrent themes were derived iteratively through thematic analysis.ResultsWTS is a socially acceptable activity, carried out at home or in a café. Peer influence and flavour play a key role in its use. Participants were aware of some health risks of WTS, although many accepted this risk and reported a need for more health-related WTS information. Although participants were familiar with e-shisha, there was no evidence of its use as a harm-reduction or cessation product. E-shisha tasted different to flavoured waterpipe tobacco and removed the positive social attributes typically ascribed to WTS. Waterpipe users felt e-shisha may encourage non-users to initiate cigarettes or WTS.ConclusionOpinions of reduced risk in using WTS may be due to the lack of available information, misconceptions and its easy accessibility. E-shisha does not appear to play a role in WTS harm reduction or cessation. On-going research efforts should test educational interventions addressing the adverse health impacts of WTS in this population group.

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