scholarly journals Fluctuation between cigarette smoking and use of electronic nicotine delivery systems: Impact on clozapine concentrations and clinical effect

2021 ◽  
Vol 11 (6) ◽  
pp. 365-368
Author(s):  
Daniel J. Montville ◽  
Jaclyn M. Lindsey ◽  
Jonathan G. Leung
Keyword(s):  
Delivery System ◽  
Health Care Professionals ◽  
Psychiatric Symptoms ◽  
Delivery Systems ◽  
Serum Concentrations ◽  
Hydrocarbon Production ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery ◽  
Polycyclic Aromatic ◽  
The Impact

Abstract Unlike with smoking cigarettes, electronic nicotine delivery systems do not cause CYP450 1A2 induction as there is a lack of combustion and polycyclic aromatic hydrocarbon production. Changing to the use of an electronic nicotine delivery system from cigarettes can result in the deinduction of CYP450 1A2 and the increase of certain medication serum concentrations, including clozapine. A case is reported in which the switch from smoking to an electronic nicotine delivery system resulted in increased clozapine serum concentration and constipation, necessitating pharmacologic management. The patient ultimately transitioned back to cigarettes, which resulted in the emergence of psychiatric symptoms. An evaluation of longitudinal serum concentrations and clinical correlation is provided. It is important that patients and health care professionals have knowledge not only about the impact of smoking cigarettes on clozapine metabolism, but also the effects of switching to or from an electronic nicotine delivery system.

Government intervention in the market for electronic nicotine delivery systems (ENDS). The known, the unknown and challenges

2020 ◽  
Vol 20 (3) ◽  
pp. 283-294
Author(s):  
Ayda A. Yurekli ◽  
Patricia Kovacevic ◽  
Emil Sunley ◽  
Karthik Ranganathan
Keyword(s):  
Simulation Analysis ◽  
Health Impact ◽  
Delivery Systems ◽  
Economic Research ◽  
Electronic Nicotine Delivery Systems ◽  
Content Type ◽  
The Public ◽  
Premature Deaths ◽  
Nicotine Delivery ◽  
The Impact

Purpose This paper aims to describe the various government measures that regulate the market for novel tobacco harm reduction products (THRPs), with an emphasis on e-cigarettes [electronic nicotine delivery systems (“ENDS”)], and evaluates the public health impact of excise taxes levied on these products. Design/methodology/approach The paper reviews the economic research on the impact ENDS. Using cited evidence, the paper compares the tax treatment of ENDS and cigarettes and provides a simulation of potential lives that can be saved under alternative tax treatment of ENDS. Findings ENDS are considerably less harmful than cigarettes. Imposing the same tax burden on them (per unit of “harm”) as on cigarettes leads to poorer health outcomes. Differential tax treatment of ENDS will encourage more cigarette smokers to switch to ENDS and could save millions of lives worldwide. Research limitations/implications Country experiences with regulatory measures on ENDS are limited to those with high THRP penetration. The paper’s simulation analysis used evidence from a limited number of studies. Rigorous economic analysis is needed to understand how ENDS could save lives and could prevent expected one billion premature deaths by the end of this century. Originality/value The paper uses research evidence in its analysis of the impact that the differential taxation of cigarettes and ENDS would have. It also provides a rough estimate of the number of lives that could be saved if more smokers who are trying to quit can make the switch to ENDS.

scholarly journals Applying the Population Health Standard to the Regulation of Electronic Nicotine Delivery Systems

2020 ◽  
Author(s):  
Zachary Cahn ◽  
Jeffrey Drope ◽  
Clifford E Douglas ◽  
Rosemarie Henson ◽  
Carla J Berg ◽  
...  
Keyword(s):  
Population Health ◽  
Indirect Effects ◽  
Delivery Systems ◽  
Status Quo ◽  
The State ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery ◽  
The Status ◽  
The Impact ◽  
The U.S

Abstract Regulatory authorities have devoted increasing attention and resources to a range of issues surrounding the regulation of novel nicotine and tobacco products. This review highlights the inherent complexity of evaluating prospective policies that pertain to products that heat solutions containing nicotine but not tobacco leaf, sometimes referred to as electronic nicotine delivery systems (ENDS). The U.S. Food and Drug Administration (FDA) is compelled to incorporate a set of public health criteria in their decision-making, collectively referred to as the Population Health Standard. Adherence to this standard is necessary to estimate the impact of prospective ENDS policy decisions on net population harm associated with non-therapeutic nicotine products. For policies that are expected to decrease or increase ENDS use, application of the Population Health Standard requires a comprehensive assessment of the status quo impact of ENDS use on population health. Accordingly, this review first assesses the state of the evidence on the direct harms of ENDS and the indirect effects of ENDS use on smoking, particularly rates of initiation and cessation. After that, the example of flavor restrictions is used to demonstrate the further considerations that are involved in applying the Population Health Standard to a prospective ENDS policy. Implications This narrative review aims to inform regulatory considerations about ends through the prism of the population health standard. More specifically, this review: 1) describes and explains the importance of this approach; 2) provides guidance on evaluating the state of the evidence linking ends to the net population harm associated with non-therapeutic nicotine products; and 3) illustrates how this framework can inform policymaking using the example of flavor restrictions.

scholarly journals The impact of flavour, device type and warning messages on youth preferences for electronic nicotine delivery systems: evidence from an online discrete choice experiment

2017 ◽  
Vol 27 (e2) ◽  
pp. e152-e159 ◽  
Author(s):  
Ce Shang ◽  
Jidong Huang ◽  
Frank J Chaloupka ◽  
Sherry L Emery
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Delivery Systems ◽  
Electronic Nicotine Delivery Systems ◽  
Health Warning ◽  
Warning Messages ◽  
Nicotine Delivery ◽  
Device Type ◽  
The Impact

ObjectiveTo examine the impact of flavour, device type and health warning messages on youth preference for electronic nicotine delivery systems (ENDS), and to provide evidence and data to inform the Food and Drug Administration’s potential regulatory actions on ENDS.DesignAn online discrete choice experiment was conducted in September 2015. Each participant was given nine choice sets and asked to choose one out of two alternative ENDS products, with varying characteristics in three attributes (flavour, device type and warning message). The impact of the attributes on the probability of choosing ENDS was analysed using conditional and nested logit regressions, controlling for individual sociodemographic characteristics and current smoking status.Setting and participantsA general population sample of 515 participants (50 ever-users and 465 never-users of ENDS) aged 14–17 years were recruited to complete the experiment using an online panel.ResultsFruit/sweets/beverage flavours significantly increase the probability of choosing ENDS among youth (p<0.01 for never-users and <0.1 for ever-users) and flavour has the most pronounced impact among three attributes. Among never-users, menthol flavour also increases (p<0.05) the probability of choosing ENDS compared with tobacco flavour. Vaping devices that are modifiable, compared with cigarette-like e-cigarettes, increase (p<0.05) the probability of choosing ENDS among adolescent never-users. Warning messages reduce (p<0.01) the probability of choosing ENDS among never-users.Conclusions and relevanceRestricting fruit/sweets/beverage flavours in ENDS, regulating modifiable vaping devices and adopting strong health warning messages may reduce the uptake of ENDS among youth.

scholarly journals Impact of Nicotine Replacement and Electronic Nicotine Delivery Systems on Fetal Brain Development

2019 ◽  
Vol 16 (24) ◽  
pp. 5113 ◽  
Author(s):  
Sebastian Sailer ◽  
Giorgia Sebastiani ◽  
Vicente Andreu-Férnández ◽  
Oscar García-Algar
Keyword(s):  
Brain Development ◽  
Pregnant Women ◽  
Tobacco Smoking ◽  
Fetal Brain ◽  
Delivery Systems ◽  
Nicotine Replacement ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery ◽  
Fetal Brain Development ◽  
The Impact

Maternal tobacco smoking during pregnancy remains a major public health issue. The neurotoxic properties of nicotine are associated with fetal neurodevelopmental disorders and perinatal morbimortality. Recent research has demonstrated the effects of nicotine toxicity on genetic and epigenetic alterations. Smoking cessation strategies including nicotine replacement therapy (NRT) and electronic nicotine delivery systems (ENDS) show lack of clear evidence of effectiveness and safety in pregnant women. Limited trials using randomized controls concluded that the intermittent use formulation of NRT (gum, sprays, inhaler) in pregnant women is safe because the total dose of nicotine delivered to the fetus is less than continuous-use formulations (transdermal patch). Electronic nicotine delivery systems (ENDS) were hyped as a safer alternative during pregnancy. However, refill liquids of ENDS are suspected to be cytotoxic for the fetus. Animal studies revealed the impact of ENDS on neural stem cells, showing a similar risk of pre- and postnatal neurobiological and neurobehavioral disorders to that associated with the exposure to traditional tobacco smoking during early life. There is currently no clear evidence of impact on fetal brain development, but recent research suggests that the current guidelines should be reconsidered. The safety of NRT and ENDS is increasingly being called into question. In this review, we discuss the special features (pharmacodynamics, pharmacokinetics, and metabolism) of nicotine, NRT, and ENDS during pregnancy and postnatal environmental exposure. Further, we assess their impact on pre- and postnatal neurodevelopment.

scholarly journals Flavors Enhance Nicotine Vapor Self-administration in Male Mice

2020 ◽  
Author(s):  
Skylar Y Cooper ◽  
Austin T Akers ◽  
Brandon J Henderson
Keyword(s):  
Mouse Model ◽  
Electronic Cigarettes ◽  
Fixed Ratio ◽  
Progressive Ratio ◽  
Delivery Systems ◽  
Male Mice ◽  
Self Administration ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery ◽  
The Impact

Abstract Introduction Although the use of combustible cigarettes has decreased in many urban regions of America, the use of electronic nicotine delivery systems (ENDS) has dramatically increased. ENDS, or electronic cigarettes (e-cigarettes), differ from combustible cigarettes given that there are no restrictions on flavorant additives in e-liquids. With 95% of ENDS users vaping flavored e-liquids, it is critical to understand how flavors alter vaping-related behaviors. We have previously shown that menthol and green apple flavors enhance nicotine reward-related behavior in a mouse model and in the present study have investigated how menthol and green apple flavors alter e-Vape self-administration behavior in male mice. Methods Adult C57/BL6J male mice were used in vapor-inhalation self-administration assays. Mice were assigned vaping e-liquids (6 mg/mL nicotine with or without menthol or green apple flavor) to escalate on a fixed-ratio 1 (FR1) schedule in daily 3-hour sessions to examine initiation-related behaviors. Following escalation, mice were transitioned to a FR3 and progressive ratio schedules in 3-hour sessions to examine reinforcement-related behaviors. Results Here we observed that male mice exhibited increased rates of self-administration escalation on a FR1 schedule when assigned to flavored e-liquids. Upon transition to FR3, mice continued to exhibit enhanced levels of reinforcement with flavored e-liquids. We also observed that mice self-administer zero-nicotine green apple flavored e-liquids. Conclusions These data provide additional evidence that ENDS flavors enhance vaping-related initiation and reinforcement-related behavior and promote the need to continue investigating the role ENDS flavors play in vaping-related behaviors. Implications There has been much discussion recently regarding the impact of flavors on vaping-related behavior. Our study here shows that flavors significantly enhance the acquisition and reinforcement of vaping-related behavior. This suggests that flavors in electronic nicotine delivery systems significantly increase the risk of addiction-related behaviors among users of vaping products.

scholarly journals Beliefs and Self-reported Practices of Health Care Professionals Regarding Electronic Nicotine Delivery Systems: A Mixed-Methods Systematic Review and Synthesis

2019 ◽  
Vol 22 (5) ◽  
pp. 619-629 ◽  
Author(s):  
Daniel A Erku ◽  
Coral E Gartner ◽  
Kylie Morphett ◽  
Kathryn J Steadman
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Care Professionals ◽  
Delivery Systems ◽  
Potential Health ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery ◽  
Patient Health ◽  
Training And Support

Abstract Aims This review explores the (1) beliefs and attitudes of health care professionals (HCPs) toward electronic nicotine delivery systems (ENDS) including use as a smoking cessation aid and/or harm reduction, safety and regulation, and (2) the extent and content of patient–HCP communication about ENDS. Methods PubMed, Embase, CINAHL, and PsycINFO were searched to identify articles published since 2003. The Mixed Methods Appraisal Tool and Strengthening the Reporting of Observational Studies in Epidemiology checklists were used to assess the quality of studies. Thematic synthesis was used to analyze qualitative data. Results A total of 45 articles (32 quantitative, 12 qualitative, and 1 mixed) were included. There was wide variation regarding beliefs about the efficacy of ENDS as a cessation aid. Although the majority of HCPs believes that ENDS are safer than combustible cigarettes, they also have concern about the short and long-term safety of ENDS, uptake by adolescents, and the potential for ENDS to act as a “gateway” to smoking cigarettes. Beliefs about ENDS are influenced by media stories and experiences provided by patients. Although most HCPs do not proactively recommend ENDS, they are more likely to support ENDS use among patients with smoking related comorbidities, heavy smokers with previous unsuccessful quit attempts, or patients who express interest in trying them. Conclusions Overall, HCPs hold diverse views about the efficacy of ENDS and expressed wariness over their potential health effects. HCP endorsement of ENDS use seems to depend largely on patient health status, the presence of other competing risk factors and patient preferences. Implication Although evidence on safety and efficacy of ENDS is emerging, HCPs should be honest with their clients, stating that the long-term safety is not yet established but what is known is that they appear to be a lower risk alternative to cigarettes. Our review highlights a need for further training and support for HCPs regarding ENDS use, which would enable them to guide their clients in making evidence-based decisions.

scholarly journals Co-creating opportunities to incorporate cessation for electronic nicotine delivery systems in family medicine – a qualitative program evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kevin A. Kovach ◽  
Reshana Peterson ◽  
Rajani Bharati ◽  
Kathryn Istas ◽  
Michael Monroe
Keyword(s):  
Family Medicine ◽  
Health Care Professionals ◽  
Research Team ◽  
Technical Assistance ◽  
Clinical Care ◽  
Delivery Systems ◽  
Clinical Expertise ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery ◽  
Electronic Health

Abstract Background The number of Americans who use tobacco has decreased in the twenty-first century, but electronic nicotine delivery systems (ENDS) have increased the complexity of treating tobacco dependence. The experiences of 18 family medicine practices were explored and opportunities to improve ENDS cessation were co-created in this study. Methods Eighteen family medicine practices were enrolled into an implementation project to incorporate ENDS cessation into their practice. The participants’ experiences were explored throughout the project using an iterative qualitative approach. The research team provided technical assistance. Semi-structured group interviews and focus groups were held with participants at the beginning, middle, and end of the project to explore participants’ experiences. The collective knowledge and experiences of participants, expert consultants and the research team were fused together to co-create opportunities to improve ENDS cessation. Results Nine opportunities to improve ENDS cessation were identified in three larger categories. The first category was leading change. This included: creating a vision for change to establish buy-in from key stakeholders and educate health care professionals to improve their confidence to address ENDS. The second category was creating processes. This included: establishing criteria for screening and quality improvement for ENDS cessation; being specific when asking about ENDS; creating electronic health record systems to support incorporating ENDS cessation; using chart audits if electronic health records cannot support incorporating ENDS into tobacco cessation; and assigning roles and responsibilities to members of the clinical care team. The third category was assisting patients who use ENDS. This included: educating patients and their parents/caregivers about ENDS and their potential harms, avoiding dual use, and developing a plan to quit. Conclusions This study highlights challenges and opportunities for incorporating ENDS cessation into family medicine. The opportunities outlined here provide a practical approach which is rooted in the experiences of family physicians and their clinical care teams working to improve how they address ENDS and based on peer reviewed literature and expert input. Improving how ENDS are addressed in family medicine will require more than clinical expertise. It will also require leadership skills and the ability to create process improvements. Trial registration Not applicable

Updated Health and Cost Impacts of Electronic Nicotine Delivery Systems, Using Recent Estimates of Relative Harm for Vaping Compared to Smoking

2021 ◽  
Author(s):  
Jennifer A Summers ◽  
Driss Ait Ouakrim ◽  
Nick Wilson ◽  
Tony Blakely
Keyword(s):  
New Zealand ◽  
Cost Saving ◽  
Health System ◽  
Population Health ◽  
Delivery Systems ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery ◽  
Life Years ◽  
Per Capita ◽  
The Impact

Abstract Background Measuring population health and costs effects of liberalizing access to electronic nicotine delivery systems (ENDS) is an evolving field with high persisting uncertainty. A critical area of uncertainty for policy-makers are estimates of net harms from ENDS relative to cigarettes, therefore, we model these harms using updated estimates incorporating disease specificity. Methods We use updated estimates of relative harm of vaping vs smoking, based upon relevant biomarker studies to model the impact of liberalizing access to ENDS in New Zealand (NZ), relative to a ban (where ENDS are not legally available), in an existing proportional multi-state life-table model of 16 tobacco-related diseases. Results This modeling suggests that ENDS liberalization results in an expected gain of 195 000 quality-adjusted life-years (QALYs) over the remainder of the NZ population’s lifespan. There was wide uncertainty in QALYs gained (95% uncertainty interval [UI] = −8000 to 406 000) with a 3.2% probability of net health loss (based upon the number of simulation runs returning positive QALY gains). The average per capita health gain was 0.044 QALYs (equivalent to an extra 16 days of healthy life). Health system cost-savings were expected to be NZ$2.8 billion (US$2.1 billion in 2020 US$; 95%UI: −0.3 to 6.2 billion [2011 NZ$]), with an estimated 3% chance of a net increase in per capita cost. Conclusions This updated modeling around liberalizing ENDs in NZ, still suggests likely net health and cost-saving benefits—but of lesser magnitude than previous work and with a small possibility of net harm to population health. Implications This study found evidence using updated biomarker studies that ENDS liberalization could result in QALY gains across the New Zealand population lifespan that are also cost-saving to the health system. Governments should include the information from these types of modeling studies in their decision-making around potentially improving access to ENDS for existing smokers, while at the same further reducing access to tobacco.

Electronic Nicotine Delivery Systems Rejection Measure

2020 ◽  
Author(s):  
Scott R. Weaver ◽  
J. Wesley Heath ◽  
David L. Ashley ◽  
Jidong Huang ◽  
Terry F. Pechacek ◽  
...  
Keyword(s):  
Delivery Systems ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery
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