Use of electronic cigarettes and heated tobacco products during the Covid-19 pandemic

Only a few studies investigated changes in electronic cigarette (e-cigarette) and heated tobacco product (HTP) use during pandemic restrictions. We conducted a web-based cross-sectional study of a representative sample of 6,003 Italian adults during the strictest phase of the Covid-19 lockdown (April–May 2020). Participants were asked to report changes in e-cigarette and HTP use compared to before the pandemic. E-cigarette users increased from 8.1% to 9.1% and HTP users from 4.0% to 4.5%. Among e-cigarette non-users before lockdown, 1.8% started using e-cigarettes during lockdown. New users were more frequently younger (p for trend 0.001), men (odds ratio, OR 1.56; 95% confidence interval, CI: 1.03–2.34), cannabis users (OR 2.35; 95% CI: 1.33–4.13), gamblers (OR 3.34; 95% CI: 2.18–5.11) and individuals with anxiety symptoms (OR 1.58; 95% CI: 1.00–2.52). 1.0% of HTP non-users started using it during lockdown. New users were less frequently current than never cigarette smokers (OR 0.19; 95% CI: 0.06–0.61) and more frequently gamblers (OR 2.23; 95% CI: 1.22–4.07). E-cigarettes and HTPs played little role as smoking cessation tools for hardcore smokers but rather provided opportunities for young never smokers to engage in socially acceptable activities, perhaps reflecting the obstacles they faced in obtaining other addictive substances during confinement.

Influence of Nicotine from Diverse Delivery Tools on the Autonomic Nervous and Hormonal Systems

Background: Through measurements of the heart rate variability (HRV) accompanied by the pertinent biomarker assays, the effects of nicotine and byproducts derived from alternative nicotine delivery systems (ANDS) on the autonomic nervous system (ANS) and hormonal system have been investigated. Methods: HRV was studied in a group of volunteers (17 people), involving non-smokers, i.e., who never smoked before (11), ex-smokers (4) and active smokers (2). ANDS and smoking simulators, including regular, nicotine-free and electronic cigarettes; tobacco heating systems; chewing gums and nicotine packs of oral fixation (nic-packs), were used. Blood pressure, levels of stress hormones in saliva and catecholamines in the blood were also monitored. Results: HRV analysis showed relatively small changes in HRV and in the other studied parameters with the systemic use of nic-packs with low and moderate nicotine contents (up to 6 mg) compared to other ANDS. Conclusions: The HRV method is proven to be a promising technique for evaluation of the risks associated with smoking, dual use of various ANDS and studying the biomedical aspects of smoking cessation. Nic-packs are shown to be leaders in biological safety among the studied ANDS. A sharp surge in the activity of the sympathetic division of the ANS within the first minutes of the use of nicotine packs implies that nicotine begins to act already at very low doses (before entering the blood physically in any significant amount) through fast signal transmission to the brain from the nicotinic and taste buds located in the mouth area.

Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trial

Background Smoking cessation is the most effective means of slowing the decline of lung function associated with chronic obstructive pulmonary disease (COPD). While effective smoking cessation treatments are available, they are underutilized and nearly half of people with COPD continue to smoke. By addressing both nicotine and behavioral dependence, electronic cigarettes (EC) could help people with COPD reduce the harm of combustible cigarettes (CC) through reductions in number of Cigarettes per Day (CPD) or quitting CC completely. The purpose of this pilot study is to identify barriers and facilitators to the use of and assess the preliminary effectiveness of EC as a harm reduction strategy among people with COPD. Methods In an open-label two-arm randomized controlled trial pilot study, 60 patients identified as smokers with a COPD diagnosis via electronic health records from a large urban health center are randomized in a 1:1 ratio to either standard care [counseling + nicotine replacement therapy (NRT)] or counseling + EC. The NRT arm will receive nicotine patches and nicotine lozenges for 12 weeks. The EC arm will receive EC for 12 weeks. Both cohorts will receive counseling from a licensed mental health counselor. Using ecological momentary assessment, participants will report their use of CC in both arms and EC use in the EC arm daily via text message. Primary outcomes will be feasibility and acceptability of intervention, and secondary outcomes will be reduction in CPD and change in COPD symptoms as measured by COPD Assessment Tool (CAT) score at 12-weeks. EC displacement of CC. To explore attitudes towards the use of EC as a harm-reduction strategy for patients with COPD, interviews will be performed with a sample of participants from both study arms. Discussion Despite decades of availability of smoking cessation medications, nearly half of people with COPD still smoke. This study aims to address the unmet need for feasible and effective strategies for reducing CC use among those with COPD, which has the potential to significantly improve the health of people with COPD who smoke. Trial Registration ClinicalTrials.gov Identifier: NCT04465318.

Unintended Side Effects of Electronic Cigarettes in Otolaryngology: A Scoping Review

Objective Electronic cigarettes (E-cigs) are nicotine delivery systems with increasing popularity. The US Food and Drug Administration defines side effects as unwanted or unexpected events or reactions. Our objective was to examine the unintended otolaryngology-related side effects associated with E-cigs. Data Sources Medline, EMBASE, CINAHL, Web of Science, and CENTRAL databases. Review Methods Study selection was independently performed by 2 authors in accordance with the PRISMA-ScR statement (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews); discrepancies were resolved by the senior author. English studies from database inception to May 1, 2020, with a sample size >5 were included. In vitro, animal, and lower respiratory tract studies were excluded. The main outcome was defined as otolaryngology-related side effects following E-cig use. Levels of evidence per the Oxford Centre for Evidence-Based Medicine were used to determine study quality. Results From 1788 articles, 32 studies were included. The most common unintended side effects were throat irritation (n = 16), cough (n = 16), mouth irritation (n = 11), and oral mucosal lesions (n = 8). A large proportion of participants also reported conventional tobacco use in addition to E-cigs. Eight studies investigated the effectiveness of vaping on smoking cessation. The quality of the literature was level 2 to 4. Given the significant heterogeneity in the studies, meta-analysis was not performed. Conclusion The most reported side effects were throat and mouth irritation, followed by cough. The long-term impact of E-cigs is not known given the recent emergence of this technology. Future studies are warranted.

The Orthopedic Effects of Electronic Cigarettes: A Systematic Review and Pediatric Case Series

Electronic cigarette (EC) use is highly prevalent, especially in the adolescent population, where 29% of Canadian adolescents have used an EC in the past thirty days per national surveys. Our pediatric orthopedic referral centre observed a cluster of delayed unions of bone fractures in adolescents using ECs and present the case series here. We then asked whether electronic cigarettes impair bone healing or influence orthopedic outcomes. A PRISMA-compliant systematic review was carried out, which revealed no human clinical studies and a general paucity of evidence around ECs and musculoskeletal health. The existing experimental evidence relevant to orthopedics is summarized. The effect of ECs on the musculoskeletal system is poorly understood and is a target for further research.

Clearing the Haze: How Does Nicotine Affect Hematopoiesis before and after Birth?

Hematopoiesis is a tightly regulated process orchestrated by cell-intrinsic and cell-extrinsic cues. Over the past several decades, much effort has been focused on understanding how these cues regulate hematopoietic stem cell (HSC) function. Many endogenous key regulators of hematopoiesis have been identified and extensively characterized. Less is known about the mechanisms of long-term effects of environmental toxic compounds on hematopoietic stem and progenitor cells (HSPCs) and their mature immune cell progeny. Research over the past several decades has demonstrated that tobacco products are extremely toxic and pose huge risks to human health by causing diseases like cancer, respiratory illnesses, strokes, and more. Recently, electronic cigarettes have been promoted as a safer alternative to traditional tobacco products and have become increasingly popular among younger generations. Nicotine, the highly toxic compound found in many traditional tobacco products, is also found in most electronic cigarettes, calling into question their purported “safety”. Although it is known that nicotine is toxic, the pathophysiology of disease in exposed people remains under investigation. One plausible contributor to altered disease susceptibility is altered hematopoiesis and associated immune dysfunction. In this review, we focus on research that has addressed how HSCs and mature blood cells respond to nicotine, as well as identify remaining questions.

The Emission of VOCs and CO from Heated Tobacco Products, Electronic Cigarettes, and Conventional Cigarettes, and Their Health Risk

The differences in aerosol composition between new tobacco types (heated tobacco products and electronic cigarettes) and conventional cigarettes have not been systematically studied. In this study, the emissions of volatile organic compounds (VOCs), carbon monoxide (CO), nicotine, and tar from heated tobacco products (HTPs), electronic cigarettes (e-cigarettes) and conventional cigarettes were compared, and their health risks were evaluated by applying the same smoking regime and a loss mechanism of smoking. Twenty VOCs were identified in aerosols from HTPs, 18 VOCs were identified in aerosols from e-cigarettes, and 97 VOCs were identified in aerosols from cigarettes by GC–MS and HPLC analysis. The concentrations of total VOCs (TVOCs) emitted by the three types of tobacco products decreased as follows: e-cigarettes (795.4 mg/100 puffs) > cigarettes (83.29 mg/100 puffs) > HTPs (15.65 mg/100 puffs). The nicotine content was 24.63 ± 2.25 mg/100 puffs for e-cigarettes, 22.94 ± 0.03 mg/100 puffs for cigarettes, and 8.817 ± 0.500 mg/100 puffs for HTPs. When using cigarettes of the same brand, the mass concentrations of VOCs, tar, and CO emitted by HTPs were approximately 81.2%, 95.9%, and 97.5%, respectively, lower than the amounts emitted by cigarettes. The health risk results demonstrated that the noncarcinogenic risk of the three types of tobacco products decreased as follows: cigarettes (3609.05) > HTPs (2449.70) > acceptable level (1) > e-cigarettes (0.91). The lifetime cancer risk (LCR) decreased as follows: cigarettes (2.99 × 10−4) > HTPs (9.92 × 10−5) > e-cigarettes (4.80 × 10−5) > acceptable level (10−6). In general, HTPs and e-cigarettes were less harmful than cigarettes when the emission of VOCs and CO was considered.

Association between the use of electronic cigarettes and the prevalence of chronic rhinosinusitis and allergic rhinitis: a nationwide cross-sectional study

Background: Whether the use of electronic cigarettes (ECs) is associated with upper airway diseases, including chronic rhinosinusitis (CRS) and allergic rhinitis (AR), remains unclear. Methods: We analyzed data from the nationwide cross-sectional surveys: the Korea National Health and Nutrition Examination Survey VI (2013–2015), VII (2016–2018), and VIII (2019). Logistic regression analysis was performed to assess the association between EC use and CRS or AR. Results: Among a total of 38,413 participants, 6.4% were former EC users and 2.5% were current EC users. Former EC users and current EC showed a significantly increased OR for CRS or AR compared with never EC users. In the subgroup analysis, the “current CC (conventional cigarette)-current EC” and the “current CC-formal EC” group had a significantly higher OR for CRS or AR than the “current CC-never EC” group. In addition, former CC smokers who currently use ECs showed a significantly higher OR for AR than former CC smokers without EC use. Conclusions: EC use is significantly associated with a high prevalence of CRS and AR in the adult population. These results indicate that the use of ECs may increase the risk of upper airway disease.

Effect of Conventional and Electronic Cigarettes Smoking on the Color Stability and Translucency of Tooth Colored Restorative Materials: An In Vitro Analysis

This in vitro study compared the effects of conventional and electronic cigarettes on the aesthetics (color stability and translucency) of two types of composite resins: micro and nano-hybrid. Methods: A total of 120 specimens from two different composite materials Filtek Z250 XT (Nano-hybrid, 3M) and Filtek Z250 (Micro-hybrid, 3M) were divided into four groups (n = 30); shade A2 was used. The samples were exposed to conventional and electronic cigarette smoke via a custom made chamber device. The color values and measurements were recorded using a spectrophotometer before and after the exposure. The color and translucency were evaluated using the three-dimensional CIE Lab. Results: There was a significant change in the color (ΔE) and the translucency parameter (TP) in all of the specimens exposed to electronic cigarettes and conventional cigarettes. The results showed that the highest ΔE mean is for the nano-hybrid composite exposed to conventional cigarettes with 1.74 ΔE while the same material is 0.64 under the electronic cigarettes and the difference is significant with (p < 0.05). The micro-hybrid composite data showed less changes in color under both exposures with 0.85 ΔE mean under the conventional cigarette smoke and 0.48 under the electronic cigarette smoke with (p < 0.004). Conclusions: The conventional cigarette smoke has more effect on the color stability of the composite resins than electronic cigarettes. From a clinical point of view, the effect of smoke exposure on the tested specimens’ color, for the time duration to which the specimens were exposed, were moderate (ΔE < 2). The micro-hybrid composites showed better color stability as compared to the nano-hybrid composites.