A systematic review comparing the health effects of dual use of electronic and conventional cigarettes with health effects of exclusive smoking of conventional cigarettes

Background: A high prevalence of dual use (DU) of e-cigarettes and conventional cigarettes has been reported across the world. In some countries most users of e-cigarettes are dual users (DUs). We wanted to investigate the health effects of DU and compare with the health effects of exclusive smoking of conventional cigarettes (ESCC). Methods: A systematic search was carried out in PubMed, EMBASE, CINAHL, and Cochrane library. The last search was conducted on April 26, 2021. We included original articles on any topic relevant to health, in all languages. Reviewers independently assessed the main risks of bias without the use of automated tools. We followed the PRISMA guidelines. Both reviewers independently screened and read all publications. Results: Fifty-five publications (52 studies) were included, 12 of the studies were prospective. There was great heterogeneity across studies both in methodology and outcome. Several studies, especially experimental studies with short-term outcome, found higher levels of harmful substances in ESCC than in DUs, however, the two largest population-based studies, with low risk of selection-bias, found higher levels of harmful substances in DUs than in ESCC. Most studies investigating symptoms or risk of disease were large population-based surveys. One study found that DUs reported a significantly better health than ESCC, while fifteen found a higher risk of e.g., pulmonary, cardiovascular or metabolic risk factors/symptoms, self-reported general health or cancer in DUs than in ESCC. The study with the longest follow-up, six years, found that DUs had an adjusted odds ratio of 1.48 (95% confidence interval 0.81–2.70) of a possibly smoking-related disease (confirmed by hospital discharge abstracts) compared with ESCC. Many methodological weaknesses were identified, such as risk of reverse causality. We found a correlation between high tobacco consumption in DUs and findings of negative health outcomes.Conclusion: Due to many methodological weaknesses, it is difficult to draw any strong conclusions, but the results indicate that DU might be as or even more harmful than ESCC. Well-designed longitudinal studies are needed. Before recommending EC for smoking cessation health authorities should consider the high risk of DU and its potential consequences.

Differential price responses for tobacco consumption: implications for tax incidence

Increasing tobacco taxes is considered the most effective an cost-effective policy to reduce tobacco consumption. However, a common objection to tobacco taxes is that they tend to rely disproportionately on the poorest individuals since less affluent smokers incur proportionately greater expenditures on cigarettes compared with more affluent smokers. Such objections usually assume that all smokers throughout the income distribution react similarly to an increase in tobacco prices. But, if less affluent smokers are more sensitive to price changes (ie, they have a higher demand price elasticity), reductions in tobacco consumption should be higher at the bottom of the income distribution. This paper uses data from Argentina’s Household Expenditure Survey to estimate demand price elasticities for tobacco by income and age groups. Results indicate that less affluent smokers present higher demand price elasticities for cigarettes than more affluent ones. A 10% increase in cigarette prices would decrease consumption by 8.5% (4.4%) for the poorest (richest) smokers. In addition, young people are the most elastic group. These differential elasticities have relevant implications in terms of the distributional incidence of increasing tobacco taxes. As less well-off individuals reduce consumption relatively more, they bear a relatively lower tax burden. Thus, tobacco tax increases may not be regressive as is often believed. As a whole, this paper provides policymakers with relevant arguments for policy discussion and the public debate on common objections to increasing tobacco taxes.

The Impact of the COVID-19 Pandemic on the Lifestyles and Levels of Anxiety and Depression of Patients with Schizophrenia: A Retrospective Observational Study

The movement restrictions put in place as a result of the COVID-19 pandemic required modification of the population’s usual routines, including those of the most vulnerable groups such as patients with schizophrenia. This was a retrospective observational study. We used an online survey to collect information on patient adherence to the Mediterranean diet (Mediterranean Diet Adherence Screener questionnaire), physical exercise (International Physical Activity Questionnaire Short Form), and tobacco consumption and levels of anxiety and depression (Hospital Anxiety and Depression Scale) before and during the movement restrictions. A total of 102 people with schizophrenia participated in this study. During the COVID-19 pandemic lockdown the participants significantly increased the number of minutes spent sitting per day (z = −6.73; p < 0.001), decreased the time they spent walking (z = −6.32; p < 0.001), and increased their tobacco consumption (X2 = 156.90; p < 0.001). These results were also accompanied by a significant increase in their reported levels of anxiety (z = −7.45; p < 0.001) and depression (z = −7.03, p < 0.001). No significant differences in patient diets during the pandemic compared to before the movement restrictions were reported. These results suggest the need to implement specific programs to improve lifestyle and reduce anxiety and depression during possible future pandemic situations.

INTERACTION OF TOBACCO ABUSE WITH OTHER CONVENTIONAL RISK FACTORS OF CARDIOVASCULAR RISK - SYNERGISTIC IMPACT OR AN INDEPENDENT MENACE?

Objectives: To determine the prevalence, patterns and behavioural attributes of tobacco abuse in patients of acute coronary syndrome (ACS). Furthermore, to assess the interaction of tobacco abuse with other conventional risk factors of cardiovascular disease (CVD). Methodology: This observational study included 230 consecutive patients with ACS. Data was collected regarding total duration and extent of tobacco consumption, “tobacco addiction” and various behavioural patterns related to it. Risk factors profile was acquired for hypertension, diabetes, obesity, family history of premature CVD and dyslipidemia. Odds ratios (OR) with 95% confidence intervals (CI) for these risk factors were calculated for tobacco abusers compared to non-abusers. Results: Among the study population, 63(27.4%) were active tobacco users. Urban residents had lesser odds of being tobacco abusers compared to non-urban residents (0.49, [0.27 – 0.89]). Tobacco abusers had a lower prevalence of hypertension compared to non-abusers (0.44 [0.24 – 0.81]). A similar trend was observed for diabetes, obesity and dyslipidemia, however, the differences could not reach significance thresholds. Cigarette smoking was the commonest mode of tobacco consumption (90.5%). “Tobacco addiction” could be attributed to 84.1% of abusers. Most (82.5%) were willing to give up tobacco abuse and 63.3% had already made attempts at quitting. Conclusion: About one-third of ACS patients were tobacco abusers with the majority being tobacco addicts. Tobacco abuse was observed to be independently implicated as a risk factor in ACS patients. Furthermore, tobacco abuse was inversely related to hypertension translating into a sub-multiplicative / additive impact of hypertension as a risk factor.

Relapse-like behavior and nAChR sensitization following intermittent access nicotine self-administration

Many tobacco smokers consume nicotine intermittently, but the underlying mechanisms and neurobiological changes associated with intermittent nicotine intake are unclear. Understanding intermittent nicotine intake is a high priority, as it could promote therapeutic strategies to attenuate tobacco consumption. We examined nicotine intake behavior and neurobiological changes in male rats that were trained to self-administer nicotine during brief (5 min) trials interspersed with longer (15 min) drug-free periods. Rats readily adapted to intermittent access (IntA) SA following acquisition on a continuous access (ContA) schedule. Probabilistic analysis of IntA nicotine SA suggested reduced nicotine loading behavior compared to ContA, and nicotine pharmacokinetic modeling revealed that rats taking nicotine intermittently may have increased intake to maintain blood levels of nicotine that are comparable to ContA SA. After IntA nicotine SA, rats exhibited an increase in unreinforced responses for nicotine-associated cues (incubation of craving) and specific alterations in the striatal proteome after 7 days without nicotine. IntA nicotine SA also induced nAChR functional upregulation in the interpeduncular nucleus (IPN), and it enhanced nicotine binding in the brain as determined via [11C]nicotine positron emission tomography. Reducing the saliency of the cue conditions during the 5 min access periods attenuated nicotine intake, but incubation of craving was preserved. Together, these results indicate that IntA conditions promote nicotine SA and nicotine seeking after a nicotine-free period.

Factors associated with the perception of fear of COVID-19 in university students

ABSTRACT Objective: to analyze the factors associated with the perception of fear of COVID-19 in Brazilian university students. Methods: this is an online, cross-sectional analytical study conducted at a Brazilian public university with 1,437 undergraduate students between September and November 2020. The Fear of COVID-19 Scale was used to measure the main construct. Data analysis was performed using Mann-Whitney U test, Cohen’s r test and multiple linear regression analysis. Results: factors associated with fear of COVID-19 in university students were the variables biological sex, perception of good sleep quality, many days of access to information, not complying with social distancing, reporting sufficient hours of sleep, not having a partner, guidance sexual non-heterosexual, being in the risk group for COVID-19 and tobacco consumption. Conclusions: the study findings can contribute to the discussion about the weaknesses that the university population is experiencing in this pandemic period.

Justification of measures to protect against exposure nicotine-containing products in enclosed spaces

Introduction. The introduction of amendments and additions to the anti-smoking Federal Law No. 15-FZ of 23.02.2013 in 2020 contributed to the cardinal revision of the name of this law and the introduction of a ban on consumption of any nicotine-containing products in public places. There are no separate, specially allocated isolated premises provided for the consumption of tobacco products and other types of nicotine-containing products by law, even though specially conducted studies have shown significantly different levels of additional inhalation risk arising from air pollution when consuming tobacco products and electronic nicotine delivery systems or heating tobacco. The aim of the study: based on experimental data, to justify the multiplicity of air exchange in unique isolated rooms designed to protect against the effects of ambient tobacco smoke, the consequences of tobacco consumption or nicotine-containing products. Materials and methods. The study was subject to 3 types of nicotine-containing products: tobacco cigarettes (cigarettes), an electronic nicotine delivery system (ENDS) and an electronic tobacco heating system (ETHS). In the course of the study were carried out: a series of experiments on the consumption of nicotine-containing products in various ways in a specially equipped indoor room, air sampling and laboratory studies were performed, the gross and specific emissions of chemicals entering the air environment from one unit of production per hour were calculated, the selection of priority chemicals for calculating the air removed from the room when using nicotine-containing products of each type was carried out, the necessary level of air exchange of premises was calculated, intended for the consumption of tobacco or nicotine. Results. The indoor air quality assessment showed that the main components of the gross intake into the air environment are suspended particles and carbon monoxide when smoking cigarettes. However, taking into account the values of the maximum permissible concentrations, the most significant contribution to the integral indicator is made by acetaldehyde and suspended particles PM10 and PM2.5. Using ENDS, the most significant pollutants were acetaldehyde and carbon monoxide, using ETHS - acetaldehyde and suspended particles PM10 and PM2.5. For all the investigation types of products, the priority substance for calculating the removed air is acetaldehyde, its share in the structure of all detected pollutants was: for cigarettes - 56.27%, for ENDS - 62.7%, for ETHS - 82.51%, in connection with which its specific values can be used to calculate the consumption of the removed air when modelling a specially allocated room intended for the consumption of tobacco products and other types of nicotine-containing products. Conclusion. The obtained findings demonstrated an obvious, more than 10-fold difference in the requirements for air exchange of premises intended for cigarette smoking and premises intended for the consumption of ENDS or ETHS, at the same intensity of consumption. Therefore, when organizing specially designated places for smoking or the consumption of nicotine-containing products, it is advisable to separate them depending on the type of products consumed: tobacco smoking separately, ENDS and ETHS consumption separately.

Examining Twitter Discourse on Electronic Cigarette and Tobacco Consumption During National Cancer Prevention Month in 2018: Topic Modeling and Geospatial Analysis

Background Examining public perception of tobacco products is critical for effective tobacco policy making and public education outreach. While the link between traditional tobacco products and lung cancer is well established, it is not known how the public perceives the association between electronic cigarettes (e-cigarettes) and lung cancer. In addition, it is unclear how members of the public interact with official messages during cancer campaigns on tobacco consumption and lung cancer. Objective In this study, we aimed to analyze e-cigarette and smoking tweets in the context of lung cancer during National Cancer Prevention Month in 2018 and examine how e-cigarette and traditional tobacco product discussions relate to implementation of tobacco control policies across different states in the United States. Methods We mined tweets that contained the term “lung cancer” on Twitter from February to March 2018. The data set contained 13,946 publicly available tweets that occurred during National Cancer Prevention Month (February 2018), and 10,153 tweets that occurred during March 2018. E-cigarette–related and smoking-related tweets were retrieved, using topic modeling and geospatial analysis. Results Debates on harmfulness (454/915, 49.7%), personal experiences (316/915, 34.5%), and e-cigarette risks (145/915, 15.8%) were the major themes of e-cigarette tweets related to lung cancer. Policy discussions (2251/3870, 58.1%), smoking risks (843/3870, 21.8%), and personal experiences (776/3870, 20.1%) were the major themes of smoking tweets related to lung cancer. Geospatial analysis showed that discussion on e-cigarette risks was positively correlated with the number of state-level smoke-free policies enacted for e-cigarettes. In particular, the number of indoor and on campus smoke-free policies was related to the number of tweets on e-cigarette risks (smoke-free indoor, r49=0.33, P=.02; smoke-free campus, r49=0.32, P=.02). The total number of e-cigarette policies was also positively related to the number of tweets on e-cigarette risks (r49=0.32, P=.02). In contrast, the number of smoking policies was not significantly associated with any of the smoking themes in the lung cancer discourse (P>.13). Conclusions Though people recognized the importance of traditional tobacco control policies in reducing lung cancer incidences, their views on e-cigarette risks were divided, and discussions on the importance of e-cigarette policy control were missing from public discourse. Findings suggest the need for health organizations to continuously engage the public in discussions on the potential health risks of e-cigarettes and raise awareness of the insidious lobbying efforts from the tobacco industry.

An obstetric outcome in pregnant women with consumption of tobacco

Background: Tobacco is known to be an established cause of adverse pregnancy outcome. Scientific studies, encompassing various ethnic groups, cultures and countries, have shown that cigarette smoking during pregnancy significantly affects mother, unborn fetus and the newborn baby.Methods: A hospital based cross sectional study was performed on 933 patients, separated in two groups: tobacco users and tobacco non-users and findings from each group were compared.Results: Incidence of complications like anemia, PIH and abruption increase with maternal usage of tobacco during pregnancy, chances of preterm delivery and ectopic pregnancy was raised, rate of wound complication was more in tobacco user women. There was no significant difference in mode of delivery.Conclusions: In the present study may establish association of tobacco consumption with adverse neonatal and obstetrics outcome and may encourage administration to focus on IEC (information, education, communication) to reduce tobacco consumption during pregnancy. Incidence of complications like anemia, PIH, abruption increase with maternal usage of tobacco during pregnancy. Chances of preterm delivery and ectopic pregnancy, was raised usage with of tobacco.