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In recent years, the prevalence of tobacco and electronic cigarette (e-cigarette) use among adolescents has raised significant public health concerns worldwide. This study aimed to investigate respiratory symptoms among Polish adolescents. We conducted an online survey among Polish school students from all provinces, collecting data over two months in spring 2021. Students voluntarily complete the anonymous survey, answering questions about respiratory symptoms, smoking habits (both traditional and electronic cigarettes), and demographic information. The analysis focused on four subgroups, namely non-tobacco users, traditional cigarette smokers, e-cigarette users, and dual users, totaling 10,388 pupils aged 12–18 years, predominantly attending secondary technical and comprehensive schools. A total of 10,388 pupils participated in the study, 55.6% (5778) of whom were girls and 44.4% (4610) boys. Adolescents who admitted using both e-cigarettes and traditional cigarettes experienced more frequent episodes of cough during the day (39.70%) and at night (18.40%) compared to their peers in other groups. Chest discomfort, including pain and pressure, was also reported more often by adolescents who used e-cigarettes and traditional cigarettes concurrently (27.60%) compared to their peers in other groups. Chest pressure was experienced less commonly by non-smoking adolescents (14.40%) than by smokers (18.90%). Higher severity of cough during the day and at night was observed in the group of adolescents using traditional cigarettes and e-cigarettes concurrently compared to the other groups. The adolescents in the dual-user group experienced more severe dyspnea and wheezing compared to the other groups included in the comparison. The results of this study confirm the correlation between the occurrence of respiratory symptoms in adolescents who smoke cigarettes, adolescents who use e-cigarettes, and adolescents who are dual users. The respiratory symptoms occur most frequently and are the most severe in the group of adolescents who use e-cigarettes and traditional cigarettes

E-cigarettes emerged in the early 21st century as a safer health alternative to conventional cigarettes. E-cigarettes use e-liquids based on glycerine and propylene glycol. This results in smaller amounts of toxic substances in the aerosol they produce compared to traditional cigarettes. The rather short existence of such replacements does not make it clear whether they are actually better for smokers’ health. The increasing number and younger age of smokers has prompted researchers to expand their research on the subject. A review of literature has shown that e-cigarettes affect many biochemical mechanisms, affecting the health of their users. They cause oxidative stress and, consequently, a cytotoxic effect; an increase in the production of mucins, taking part in lung diseases; affect the formation of DNA damage, carcinogenesis, sensitivity to chemotherapy, inflammatory response and disrupt cytokine levels in tissues. In addition, they cause thinning of the laryngeal mucosa, autophagy of middle ear epithelial cells, apoptosis of gingival fibroblasts, weakening of the tooth attachment apparatus and promote dental caries. It will take some time to test the theory of whether e-cigarettes are a healthier substitute for classic cigarettes, but based on current knowledge, one should be aware that these substances can cause adverse health effects.

Objective. To document tobacco industry strategies to influence regulation of new and emerging tobacco and nicotine products (NETNPs) in Latin America and the Caribbean. Methods. We analyzed industry websites, advocacy reports, news media and government documents related to NETNPs, focusing on electronic cigarettes and heated tobacco products. We also conducted a survey of leading health advocates. We applied the policy dystopia model to analyze industry action and argument- based strategies on NETNP regulations. Results. Industry actors engaged in four instrumental strategies to influence NETNP regulation – coalition management, information management, direct involvement in and access to the policy process, and litigation. Their actions included: lobbying key policy-makers, academics and vaping associations; providing grants to media groups to disseminate favorable NETNP information; participating in public consultations; presenting at public hearings; inserting industry-inspired language into draft NETNP legislation; and filing lawsuits to challenge NETNP bans. The industry disseminated its so-called harm reduction argument through large/influential countries (e.g., Argentina, Brazil, and Mexico). Industry discursive strategies claimed NETNPs were less harmful, provided safer alternatives, and should be regulated as so-called harm reduction products or have fewer restrictions on their sale and use than those currently in place. Conclusion. Our analysis provides a better understanding of industry strategies to undermine tobacco and nicotine control. To help counter industry efforts, health advocates should proactively strengthen government capacities and alert policy-makers to industry attempts to create new regulatory categories (so-called reduced-risk products), provide misleading information of government authorizations of NETNPs, and co-opt so-called harm-reduction messages that serve the industry’s agenda.

BackgroundA major public health hazard is youth e-cigarette use. Although new, e-cigarette health hazards are becoming well-known in the literature. E-cigarette sale restrictions and laws differ globally. In this cross-sectional study, we studied medical university students’ tobacco and e-cigarette use and characteristics in a country where sales and import of e-cigarettes are banned. The primary objective is to determine the prevalence of electronic cigarette use and understand consumption patterns among medical faculty students in this setting.Materials and methodsThe questionnaire was sent using a web-based student information system. Sociodemographic features, tobacco and e-cigarette use, consumption patterns, and e-cigarette risk perceptions were covered in 54 questions.ResultsThe study comprised 1,054 students (48.7% male) aged 21.5 ± 2.6 years who completed the questionnaire. 37.7%, 20.9% and 23.6% have smoked cigarettes, e-cigarettes, or water pipes. Current cigarette smokers were 17.0%, e-cigarette users 4.0%, and water pipe smokers 4.5%. E-cigarette users were 52.3% dual smokers. The most common symptoms reported by e-cigarette users were cough (58.4%) and dyspnea (54.2%). Multivariable models showed that the male sex, greater monthly income, and a current smoker friend were independent risk factors for e-cigarette ever use, while the male sex, paternal current smoking, and close friends’ current smoking status were risk factors for dual use among medical trainees. Many medical students who used electronic cigarettes underestimated nicotine’s health hazards and harmful chemicals in e-cigarettes. Despite e-cigarette sales being prohibited in our country, 56.4% and 25.4% of e-cigarette users provided e-cigarettes from tobacco shops and through online sales, respectively.ConclusionMedical university students use tobacco most often by smoking cigarettes. Despite medical university students being aware of the health hazards of e-cigarettes, the current use of electronic cigarettes is 4.0%. Male sex, greater monthly income, and having current smoker friends are independent risk factors for e-cigarette use, while paternal smoking is a risk factor for dual use among medical trainees. Although in the country, sales of e-cigarettes are banned, ever-use rates for e-cigarettes were remarkably high at 20.9%, and the ease of accessing e-cigarettes was striking.

IntroductionOn January 2, 2020, the FDA announced a policy focused in part on prioritizing enforcement of flavored (other than tobacco- or menthol-flavored) cartridge-based electronic nicotine delivery systems (ENDS) without premarket authorization.MethodsWe used a query to identify Reddit conversations relevant to the policy from January 2 to May 6, 2020. Our sample included 576 posts (46 posts and 530 accompanying comments). Two analysts coded posts for mentions of use behaviors (e.g., switching, quitting), purchasing behaviors (e.g., purchasing from retailer new to the user), and flavored products. We summarized frequencies of coded data and provided illustrative quotes.ResultsOnly 21.0% (121/576) of posts mentioned use behavior. Switching behavior was the most common use behavior mentioned (50.4%, 61/121). Most switching behavior posts focused on ENDS-related switching (91.8%, 56/61). The most common ENDS-related switching behaviors mentioned were switching to an open tank (45.9%, 28/61) or device with refillable pods/cartridges (44.3%, 27/61); 8.2% (5/61) mentioned switching to disposables. Just 15.5% (89/576) of posts mentioned purchasing behavior, with the most common being purchasing from a retailer new to the user (32.6%, 29/89). Only 6.8% (39/576) of posts mentioned specific flavors.ConclusionReddit posts about the policy commonly discussed switching to non-cartridge-based ENDS products, such as open tank systems or disposable devices, and purchasing products from different online sources that were still selling these products. Findings suggest that publicly available Reddit data can complement data from traditional sources (e.g., surveys, sales) to understand potential unintended consequences associated with policies by exploring the public’s reactions.

Abstract Objectives Electronic nicotine delivery systems (e‐cigarette, pod, and vape) are currently among the tobacco consumption of adolescents and young adults. The aim is to show oral mucosa and saliva alterations related to vape. Material and Methods A vape‐user patient, presenting a white plaque in the posterior region of the hard palate, underwent clinical examination, sialometry, pH evaluation, and excisional biopsy of the white lesion. Molecular changes in saliva and vape liquid were analyzed by vibrational spectroscopy. Results The histopathological analyses showed hyperparakeratosis without dysplasia. Formaldehyde, ketones, and aromatic hydrocarbon species were identified in e‐cig liquid by the FTIR. Conclusions The use of vape may be related to the development of hyperkeratotic lesions in the oral mucosa as well as significantly modify the patient's salivary patterns as the vape liquid presents carcinogenic and cytotoxic components in its composition.

Introduction: The use of electronic cigarettes (e-cigarettes) has increased in Brazil. Objective: To assess the prevalence of e-cigarette use and the factors associated with its use among college students. Methods: This is a cross-sectional observational study, carried out with undergraduate students from two private colleges. The prevalence of the consumption of e-cigarettes, conventional cigarettes, alcohol and marijuana was evaluated. The motivations for initiating e-cigarette use and the respondents' perceptions about their use were also reported. Results: 518 undergraduate students were evaluated, with a mean age of 23±5.7 years, 64.09% were female and 60.42% were medical students. The prevalence of e-cigarette use was 24.32%, and the highest consumption occurred in medical school. The main motivations for starting the use of e-cigarettes were curiosity (47.70%), and the influence of friends and/or family (31.61%). Advancing age and being employed reduced the chance of using e-cigarettes by 7% and 67%, respectively, while higher family income increased the chance of e-cigarette use by 28%. The use of conventional cigarettes, alcohol and marijuana increased this chance by 6.4; 11.8 and 3.7 times, respectively. Conclusion: The high prevalence of e-cigarette use among undergraduate students stands out. The main reasons to start e-cigarette use were curiosity, and the influence of friends and/or family. Further, e-cigarette use was associated with age, family income, being employed, use of conventional cigarettes, alcohol and marijuana. Due to the high prevalence of e-cigarette use among Brazilian undergraduate students, higher education institutions should initiate awareness campaigns that communicate the health risks linked to their use.

This perspective discusses how to best define “e-cigarette use” among youth in a way that is relevant to individual and human health. Commonly-used definitions of youth e-cigarette use have been adapted from measures validated for tobacco cigarette smoking among adults, but may not carry the same meaning for a different product (with a much lower risk profile and very different patterns of use) and a different population (whose use is more often transient and experimental, rather than frequent and persistent). We discuss strengths and weaknesses of different definitions, and recommend improvements in defining youth e-cigarette use. We find that current literature employs a range of definitions of e-cigarette use, from lifetime use (“even a puff”) to daily use. More lenient measures capture more potentially at-risk youth, but much of this is transient experimentation that has negligible risks in and itself, if not persistent. More stringent measures such as daily use are more relevant to individual and public health. Future research should examine possible improvements to definitions which include intensity of use (e.g., number of puffs per day) and persistence/duration of use, either via self-report or technology-assisted data capture.

In the past few years, technological advancements enabled the development of novel electronic nicotine delivery systems (ENDS). Several empirical measures such as “nicotine flux” are being proposed to evaluate the abuse liability potential of these products. We explored the applicability of nicotine flux for clinical nicotine pharmacokinetics (PK) and 52-week quit success from cigarettes for a wide range of existing nicotine delivery systems. We found that the differences in nicotine flux for various nicotine delivery systems are not related to changes in PK, as nicotine flux does not capture key physiological properties such as nicotine absorption rate. Further, the 52-week quit success and abuse liability potential of nicotine nasal sprays (high nicotine flux product), and nicotine inhalers (nicotine flux similar to ENDS) are low, suggesting that nicotine flux is a poor metric for the assessment of nicotine delivery systems. PK indices are more dependable for characterizing nicotine delivery systems, and a nicotine plasma CmaxTmax > 1 could improve 52-week quit success from cigarettes. However, a single metric may be inadequate to fully assess the abuse liability potential of nicotine delivery systems and needs to be further studied. A combination of in vitro and in silico approaches could potentially address the factors influencing the inhaled aerosol dosimetry and resulting PK of nicotine to provide early insights for ENDS assessments. Further research is required to understand nicotine dosimetry and PK for ad libitum product use, and abuse liability indicators of nicotine delivery systems. This commentary is intended to (1) highlight the need to think beyond a single empirical metric such as nicotine flux, (2) suggest potential PK-based metrics, (3) suggest the use of in vitro and in silico tools to obtain early insights into inhaled aerosol dosimetry for ENDS, and (4) emphasize the importance of considering comprehensive clinical pharmacology outcomes to evaluate nicotine delivery systems.

The use of E-Cigarettes is a growing public health challenge among adolescents. Exposure to nicotine early in life causes a number of adverse effects among the adolescent population including adversely affecting neurodevelopment, lung development, and lung function, increased risk of cardiovascular risk, altering the gut microbiota and increasing susceptibility to a number of infections. There is a serious dearth of data from low-middle-income countries which necessitates the need for epidemiological studies and strict tobacco regulation and strengthening global policies.

Abstract Background Evidence indicates that electronic nicotine delivery systems (ENDS) pose lower risk than cigarettes; however, many smokers harbor misperceptions that ENDS are equally or more harmful, possibly deterring them from switching. This study examines whether comparative risk perceptions of JUUL vs. smoking are associated with subsequent switching, among smokers who recently purchased JUUL. Methods N = 16,996 current established smokers who recently purchased a JUUL Starter Kit were followed 6 times over 12 months. Comparative risk perceptions were assessed using both direct and indirect measures (i.e., contrasting JUUL and smoking directly in questions, and deriving from separate absolute scales). Repeated-measures logistic regression examined switching across follow-up (no smoking in past 30 days) as a function of baseline risk perceptions, adjusting for demographics and baseline smoking behavior. Results Perceiving JUUL as less harmful than smoking was associated with higher switching rates, using both direct (e.g., adjusted odds ratio [AOR] = 1.48 for “JUUL much less” vs. “more/much more harmful”) and indirect (AOR = 1.07, for each 10-unit increase in fraction; AOR = 1.51 for highest (6-100) vs. lowest (0 to

Introduction Tobacco users are categorized as single, dual, and triple users based on the number of tobacco products (cigarettes, e-cigarettes, and heated tobacco products) used. This study addressed a literature gap by examining how adult Korean tobacco users’ quit attempts/plans differed based on the user type, and the associated psychosocial and subjective health-related factors. Methods We used a questionnaire to examine participants' self-reported health, stress, health concerns, health behavior, tobacco addiction, intentions/plans to quit, and demographic characteristics. Data were analyzed using chi-squared tests, one-way analysis of variance, and multiple linear regression. Results Of the 1288 tobacco users, 55.4%, 28.3%, and 16.4% were single, dual, and triple users, respectively. Self-rated health and stress were lowest among single users and highest among triple users. Most user types had intentions/plans to quit, especially triple users. Quit attempts and plans increased with increasing health behaviors and time elapsed before first tobacco use in the morning, but decreased with higher stress and self-rated addiction. Conclusions Intentions/plans to quit tobacco use varied based on the type of tobacco user. Multiple users had higher self-rated health, plans to quit, and self-reported addiction; they considered themselves healthy or engaged in healthy behaviors to offset problems from tobacco use and used multiple tobacco products to quit smoking. Highly stressed users had fewer plans to quit and used tobacco for stress relief. Thus, the provision of accurate information about tobacco products and stress management is important to promote successful quitting.

Electronic Nicotine Delivery Systems (ENDS) contain numerous volatile aerosol constituents (e.g., nicotine, propylene glycol, flavors, etc.). Past work clearly indicates the temporal and chemical dynamics of ENDS aerosol requires consideration of these volatile constituents when measuring the particle size distribution. An MSP-135-8 Mini MOUDI™ and Electrical Low Pressure Impactor (ELPI®+) were used to measure the particle size distribution of two JUUL ENDS products. Volatile chemicals were measured from each cascade impactor's exhaust airflow to assess their effect on collection efficiency. Similar mass median aerodynamic diameters were obtained for both ENDS products by both cascade impactors, however the geometric standard deviation from the ELPI®+ measurements were larger for both products than measurements using the Mini MOUDI™ impactor. Although the measured mass of volatile chemicals was greater in the exhaust from the Mini MOUDI™ impactor, a greater variety of volatile chemicals were found within the exhaust of the ELPI®+. The greater variety of volatile chemicals correlated with more room air sampling by the ELPI®+. The reduced amount of volatile chemicals measured in the exhaust of the ELPI®+ may be due to their collection by the vacuum oil used in the sintered collection plates of the ELPI®+. Accounting for the measured volatile chemicals improved the recovery efficiency of the Mini MOUDI™ impactor by 2.9–7.5% with the average recovery efficiency exceeding 82% for the two JUUL ENDS Products. In comparison, accounting for the measured volatile constituents increased the recovery efficiency of the ELPI®+ impactor by 0.4% or less, which did not narrow the recovery efficiency range, that based upon the estimated dilution, consistently exceeded the measured mass loss from both JUUL ENDS products.

E-liquids contain combinations of chemicals, with many enhancing the sensory attractiveness of the product. Studies are needed to understand and characterize e-liquid ingredients, particularly flavorings, to inform future research and regulations of these products. We identified common flavor ingredients in a convenience sample of commercial e-liquids using gas chromatography–mass spectrometry. E-liquid flavors were categorized by flavor descriptors provided on the product packaging. A Flavor Ingredient Wheel was developed to link e-liquid flavor ingredients with flavor categories. An analysis of 109 samples identified 48 flavor ingredients. Consistency between the labeled flavor and ingredients used to produce such flavor was found. Our novel Flavor Ingredient Wheel organizes e-liquids by flavor and ingredients, enabling efficient analysis of the link between ingredients and their flavor profiles and allowing for quick assessment of an e-liquid ingredient’s flavor profile. Investigating ingredient profiles and identifying and classifying commonly used chemicals in e-liquids may assist with future studies and improve the ability to regulate these products.

Abstract Background Electronic nicotine delivery systems (ENDS), such as the JUUL system, are nicotine products for adults who currently smoke cigarettes but are looking for an alternative to combustible cigarettes. Sales of ENDS products were legislatively acknowledged and authorized federally in Canada with the Royal Assent of the Tobacco and Vaping Products Act in 2018. Methods With the unique dataset from a major chain retailer in Canada, we evaluated the impacts of JUUL market entry on cigarette sales across Canada from January 2017 to August 2019 using two-way fixed effects panel regression models by leveraging on the entry time variation at the city level. We conducted various robustness checks and a permutation test to validate our results. Results Our estimates suggested that JUUL market entry was, on average, significantly correlated with a 1.65% per-month decrease in cigarette sales during the initial months, and with a potentially larger impact on urban areas. Our results were robust across various specifications and tests. These findings implied that JUUL and combustible cigarettes act as economic substitutes during the study time period in Canada. Conclusions These results suggested that local availability of ENDS products, such as JUUL, has the potential to reduce local cigarette consumption.

A woman in her 40s who vaped reported rapid onset of shortness of breath and cough. Pulmonary function testing showed severe obstruction and no substantial response to an inhaled bronchodilator, and chest computed tomography revealed extensive air trapping. A lung cryobiopsy was done after a comprehensive and unrevealing evaluation, which showed characteristics of airway inflammation and prominent bronchial-associated lymphoid tissue. With this knowledge and her vaping history, we diagnosed vaping-associated constrictive bronchiolitis. This phenomenon has not been well described. Clinicians should know to consider vaping when a patient with a vaping history presents with severe airway obstruction.

In Slovenia, tobacco smoking remains one of the most important preventable risk factors for death and healthy years of life lost. Slovenia and numerous developed countries are experiencing a decline in smoking prevalence. In order to maintain or increase sales and profits, the industry is launched various types of tobacco or nicotine products, such as electronic cigarettes, heated tobacco products and nicotine pouches, which are also present in Slovenia. Smokeless tobacco products are also becoming increasingly popular in Slovenia. Heated tobacco products, electronic cigarettes and nicotine pouches expose the user to significant levels of harmful substances. The long-term effects of their use on health have not yet been adequately studied, as they are in use for too short a time. However, the available data indicate that they have adverse effects on health, some already in the short term, and that they are likely to lead to significant health consequences in the long term. It cannot be claimed that these products are less harmful than smoking, as there is a lack of good quality studies. The harmful effects of long-term use of smokeless tobacco products are known. All of these products are also often promoted as effective smoking cessation aids, but again there is not enough good quality research to draw conclusions about their role in smoking cessation, so they are not recommended for this purpose. All of these products contain nicotine (the exception being nicotine-free electronic cigarettes) and are addictive to the user. The use of nicotine products by youth is associated with additional important risks, such as addiction, which develops more rapidly and more strongly than in adults, and adverse effects on brain development. The use of electronic cigarettes and smokeless tobacco products among youth is also associated with increased risk of cigarette smoking in the future. Data for Slovenia show that the use of these products among youth increases with age and that the percentages of users among youth mostly exceed that of the population aged 25 and over. In recent years, the percentages of users of electronic cigarettes and smokeless tobacco products have been increasing more markedly among adolescents than adults. It is crucial to regulate these products more strictly as soon as possible to prevent and reduce their use, especially among youth.

BackgroundIn February 2020, FDA prioritized enforcement of flavored (other than tobacco- or menthol-flavored) cartridge-based electronic nicotine delivery systems (ENDS) without premarket authorization. To explore potential marketing changes, we conducted a content analysis of brands' social media posts, comparing devices and flavors before/after the policy.MethodsWe sampled up to three posts before (November 6, 2019–February 5, 2020) and after the policy (February 6–May 6, 2020) from brands' Instagram (n = 33) and Twitter (n = 30) accounts (N = 302 posts). Two analysts coded posts for device type and flavor. We summarized coded frequencies by device, flavor, and device-flavor combination, and by platform.ResultsIn posts mentioning devices and flavors, those featuring flavored (other than tobacco- or menthol-flavored) cartridge-based devices (before: 2.5%; after: 0%) or tobacco- or menthol-flavored cartridge-based devices (before: 0%; after: 2.8%) were uncommon while any flavor disposables were most common (before: 10.8%; after: 14.6%) particularly after the policy. Half of posts featured devices without flavor (before: 50.0%; after: 50.0%) and one-fifth had no device or flavor references (before: 21.5%; after: 18.8%).ConclusionsIn the months before and after the policy, it appears ENDS brands were not using social media to market flavored (excluding tobacco- or menthol-flavored) cartridge-based ENDS (i.e., explicitly prioritized) or tobacco- or menthol-flavored cartridge-based devices (i.e., explicitly not prioritized). Brands were largely not advertising specific flavored products, but rather devices without mentioning flavor (e.g., open/refillable, disposable devices). We presented a snapshot of what consumers saw on social media around the time of the policy, which is important to understanding strategies to reach consumers in an evolving ENDS landscape.

Introduction This study examined the various factors in the selection of JUUL (and/ or), a pod-mod type electronic cigarette (EC), and the changes in EC patterns before and after the JUUL debut on 24 May 2019, using follow-up survey data of adult tobacco users in South Korea. Methods This study examined transition outcomes among tobacco users and factors associated with future JUUL use. Convenience sample data were collected from adult tobacco users in South Korea, from March–April 2019 (baseline, n=2173) to September 2019 (follow-up, n=779). Results were obtained from the 779 respondents in the follow-up survey, and user data of one or more tobacco products were analyzed. The changes in the proportion of EC and JUUL use during this period were calculated, and multivariate logistic regression analysis was conducted to investigate the selection factors of JUUL. Results Four months after the JUUL launch, the proportion of current EC and JUUL users among the whole sample increased by 10.3% (42.6–52.9%, p

Background: Electronic cigarettes (EC) and heated tobacco products (HTP) have been introduced in the global market as safer nicotine delivery systems; however, there is skepticism about their link to smoking and long-term risks. The aim of this study was to evaluate the prevalence, patterns, and determinants of EC/HTP use in Greece. Methods: This was a cross-sectional survey of 1,044 individuals aged ≥15 years old, who were randomly selected from the general Greek population. The study was conducted in May 2022, and participants were assessed through face-to-face interviews using a questionnaire designed to collect information on smoking and EC/HTP use, as well as their sociodemographic, lifestyle, and medical data. Results: The use of EC/HTP was reported by 16.2% of the participants, slightly more prevalent in males (17.2%) than in females (15.2%), and significantly more prevalent in

Introduction: Smokers use electronic nicotine delivery systems (ENDS), including e-cigarettes, as a harm reduction strategy even though the Food and Drug Administration (FDA) has not approved them for tobacco cessation. The limited literature about ENDS use for cigarette cessation is concerning for the U.S. military, which is largely comprised of young adults at increased risk for tobacco use. Thus, the current study aims to evaluate use of ENDS products as a cessation tool in relation to point-prevalence tobacco abstinence at one-year follow-up in a cohort of 8,901 U.S. Air Force personnel attending entry-level job training from March 2016 to April 2019. Methods: A propensity-score adjusted multinomial logistic regression model was used to assess the association between the baseline motives for ENDS use (i.e., for cigarette cessation versus alternative reasons) and tobacco use at the one-year follow-up (cigarette use, non-cigarette tobacco product use, and tobacco abstinence) among those reporting history of cigarette use at baseline. Results: Smokers reporting ENDS use for cigarette cessation were more likely to be abstinent at one-year follow-up (Odds Ratio[OR] = 1.62, 95% CI: 1.06–2.49, P =.03) as well as quit using non-cigarette tobacco products (OR = 2.11, 95% CI: 1.65–2.70, P

Aim: To determine the effects of e-cigarette use on oral health-related quality of life (OHRQOL) in young people in Metropolitan Lima. Materials and Methods: This observational, analytical and cross-sectional study was performed with 189 individuals (age, 18–29 years) who used electronic cigarettes. The OHIP-Sp5 instrument was used to assess OHRQOL. Results: The use of e-cigarettes was higher among male participants (47.79%) than that among the female participants (26.32%). The mean OHRQOL scores of individuals who did and did not use e-cigarettes were 3.17 (2.26) and 3.12 (2.47), respectively These scores for people who did and did not use mouthwash were 2.92 (2.34) and 3.57 (2.43), respectively. Regarding orofacial pain 2.65% participants frequently re-ported “painful discomfort” and 7.41% of the young people presented such discomfort of orofacial aspect “frequently.” Conclusions: Recording e-cigarette uses and frequency in patients’ medical records is important, as well as incorporating educational strategies to reduce e-cigarette consumption and avoiding harmful effects on general health.

Introduction: E-cigarettes (ECs) portable battery-operated devices developed as a strategy for tackling tobacco-related harm are now becoming a global threat to human health. Objectives: This integrative review aims to throw some light on the effect of ECs on human health and determine the safety of ECs with or without nicotine with long-term usage. Methods: This integrative review includes findings from Randomized and non-randomized clinical trials, and laboratory-based Human studies; published in the English language in the last four years. Literature search sources were online databases such as PubMed, Medline, EMBASE, Web of Science, Google Scholar. Results: Following systematic search using inclusion and exclusion criteria, 21 articles were included in the final review. ECs result in an acute increase in cardiac Sympathetic Nerve Activity (SNA), pronounced as Electrocardiogram (ECG) changes resulting in a greater risk of sudden death for those with co-morbidities. ECs with or without nicotine can adversely affect lung function and can precipitate obstructive pulmonary diseases. ECs may also adversely affect oral health due to increased bacterial pathogenicity and periodontitis. At last, these nicotine-containing ECs can yield nicotine comparable to Traditional cigarettes (TCs) and sometimes to a much greater extent, thus posing the threat of the user becoming nicotine dependent. Conclusion: Although ECs are less harmful than TCs in combustible inhaled constituents, their long-term safety can still not be ascertained due to the scarcity of long-term studies and conflicting results.

Background: Trends in young adult use of electronic nicotine delivery systems (ENDS) and experimentation with do-it-yourself (DIY) e-juice mixing are growing around the world. Theoretical frameworks for examining secondary behaviors (i.e., mixing) embedded within a primary behavior (i.e., vaping) are limited, leading to challenges in scholarly understanding of behavioral performance. This study explored the theoretically driven factors surrounding ENDS users’ decision to mix DIY e-juice through a multiple behavior test of the theory of planned behavior (TPB).Methods: An international sample of young adult participants aged 18-19 (n=203) was recruited from Prolific for an online cross sectional survey. Path modeling tested four theoretically driven models to explore behavioral performance of mixing. Findings: The data supported TPB expectations and revealed new paths for secondary behavior. Primary perceptions of attitudes, norms, and intention were predictive of the same secondary perceptions. In addition, for both primary and secondary behaviors, perceived norms were a function of perceived attitudes. For the secondary behavior, normative influence was experienced indirectly through perceived attitudes. Conclusion: DIY e-juice mixing is a product of perceived attitudes and behavioral control surrounding mixing as well as perceived attitudes, norms, and intention surrounding general ENDS use. While unregulated DIY experimentation increases among youth, these findings provide a lens for public health efforts seeking to reach and reduce use. Understanding DIY e-juice behaviors isessential to anticipate stockpiling behaviors and negative outcomes from amateur experimentation.

This article provides a snapshot of the market structure and regulatory approaches around novel and emerging tobacco and nicotine products, both globally and in Latin America, with a focus on excise taxation. Using data from leading market research companies, the WHO Report on the Global Tobacco Epidemic 2021, and country laws and decrees, the article analyses the evolution and market structure of heated tobacco products (HTPs), electronic nicotine delivery systems (ENDS), and electronic non-nicotine delivery systems (ENNDS). This is followed by a summary review of regulatory approaches adopted by countries toward these products, with a particular focus on excise tax policies currently implemented. Based on the well-established knowledge about tobacco taxation best practices and on WHOs recent recommendations on the taxation of novel and emerging tobacco and nicotine products, the authors then discuss possible elements of a good tax policy approach for countries to consider.

Objectives. To evaluate the prevalence of exposure to Internet communications on and advertising of electronic cigarettes (e-cigarettes) and their association with perceptions of the social acceptability of e-cigarettes in Mexico. Methods. Data were analyzed from eight surveys (2018–2021) of an online sample of Mexican adult (> 18 years) smokers and dual users (of combustible and electronic cigarettes). Self-reported exposure to e-cigarette advertising across various marketing channels was assessed, as well as visits to e-cigarette websites. Logistic regression analysis was used to evaluate the association between perceptions of the social acceptability of e-cigarette use and level of advertising exposure and visits to e-cigarette websites. Results. The Internet and outside e-cigarette stores were where exposure to advertising most occurred, as reported by 47.4% and 46.8% of respondents, respectively. Respondents who noticed e-cigarette advertisements on the Internet (adjusted odds ratio (OR) 1.43, 95% confidence intervals (CI) 1.25, 1.63), outside e-cigarette stores (adjusted OR 1.31, 95% CI 1.14, 1.50), and in temporary outlets (adjusted OR 1.16, 95% CI 1.01, 1.34), and those who visited e-cigarette websites (adjusted OR 1.48, 95% CI 1.25, 1.76) were more likely to perceive e-cigarettes as socially acceptable. Noticing advertisements across more channels was also associated with higher perceived social acceptability of e-cigarette use. Conclusions. Being exposed to e-cigarette marketing, either online or through traditional marketing channels, is associated with perceived social acceptability of e-cigarette use, as is contact with provaping sites. Regulatory options to avoid the proliferation of promotional websites disguised as opinion or user sites need to be considered.

Objective: To determine the prevalence and determinants of electronic nicotine delivery systems (ENDS) use among Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: Cross-sectional data collected between the years 2015–2017 were analyzed to assess ENDS use (ever (current: use ≤ past 30 days; former: use > past 30 days) and never) among 11,623 adults (mean age 47 years±0.3 years; 52% women). Weighted prevalence estimates were reported, and age-adjusted logistic regression models were used to examine associations between sociodemographic and clinical exposures with ENDS use. Results: The prevalence of current and former ENDS use was 2.0% and 10.4%, respectively. Having ever used ENDS was associated with prevalent coronary artery disease. Current ENDS use was higher in males and associated with higher education, English language preference, and Puerto Rican background compared with nonsmokers and cigarette-only smokers (all p

Background: Drug use and electronic nicotine delivery systems (ENDS) are independently associated with increased risk of cardiovascular and respiratory outcomes. Literature on the association between the dual use of these key substances and potential health outcomes is limited. Methods: We examined the association between dual use of ENDs and drugs (including heroin, methamphetamine, cocaine, painkillers, and misused stimulant medications) with adverse cardiovascular and respiratory outcomes in a longitudinal analysis using waves 1–5 from the Population Assessment of Tobacco and Health survey (2014–2018). Multivariable logistic regression with Generalized Estimating Equations was utilized. Results: About 0.9% (n = 368) of respondents at wave 2 used both ENDS and drugs, 5.1% (n = 1,985) exclusively used ENDS, and 5.9% (n = 1,318) used drugs. Compared with people who do not use drugs, both those who used only ENDS (Adjusted Odds Ratio (AOR) 1.11 [95% CI 0.99-1.23], P = 0.07758) and those who used only drugs (AOR 1.36 [95% CI 1.15–1.60], P = 0.00027) were more likely to experience adverse respiratory conditions. Individuals who used drugs and ENDS compared to people who did not use drugs or ENDS had the largest odds of respiratory problems among all drug use category comparisons (AOR 1.52 [95% CI 1.20-1.93], P = 0.00054). Individuals who only used drugs had elevated odds of cardiovascular ailments compared to people who did not use drugs or ENDS (AOR 1.24 [95% CI 1.08–1.42], P = 0.00214) and compared to people who only used ENDS (AOR 1.22 [95% CI 1.04–1.42], P = 0.0117). Conclusions: Inhaling electronic nicotine delivery systems and other substances may negatively affect the users' respiratory health.

Although the long-term harms associated with vaping remain largely unknown, there have been numerous accounts of acute vaping-related injuries in the paediatric population. The study of vaping-related injuries is an important yet challenging undertaking, complicated by a lack of appropriate reporting mechanisms and the absence of consensus on definitions and diagnostic codes. We discuss the results of a 12-month national cross-sectional study from the Canadian Paediatric Surveillance Program conducted in 2021–2022 and situate these results within the broader context of other Canadian surveillance and reporting mechanisms. Fewer than five cases of vaping-associated injuries were reported, contrasting with previous surveys which had revealed much higher case numbers. Hypotheses for the low case numbers include decreased exposure to vaping in the context of COVID-19, changes in vaping products, increases in public awareness of vaping-related harms, as well as recent modifications in policies related to vaping product marketing and sales. There is a great need for a multi-pronged surveillance approach leveraging multiple data sources, including self-reported provider and consumer data, as well as administrative data to help inform clinicians and policymakers on how to prevent vaping-associated injuries among youth.

Background: Electronic nicotine delivery systems (ENDS) come in numerous flavors and may aid smoking cessation. This systematic review examines evidence on the role of ENDS flavors in smoking cessation. Methods: We searched EMBASE OVID, PsychInfo, and Medline databases for studies that: 1) examined cigarette cessation outcomes for persons using ENDS (intent, attempts, and success) and 2) reported results separated by respondent's ENDS flavor used. We extracted crude and adjusted odds ratios for associations between cessation outcomes and types of ENDS flavors used (nontobacco vs. tobacco/unflavored; nontobacco and nonmenthol vs. tobacco/unflavored and menthol). We did not consider cessation outcomes among people not using ENDS. We evaluated the evidence using the GRADE approach, focusing on consistency and reliability of findings across studies. Results: 29 studies met inclusion criteria, producing 36 odds ratios (ORs) comparing cessation outcomes across ENDS flavor groups. Three ORs examined quit intent, five examined quit attempts, and 28 examined quit success. Using GRADE, we reached Low levels of certainty that there was not an association between ENDS flavor use and intention to quit smoking or making a quit attempt. There were Very Low levels of certainty that nontobacco flavored versus tobacco/unflavored ENDS use was not associated with smoking cessation success, with similar findings for nonmenthol and nontobacco compared to tobacco and menthol flavored ENDS. Conclusion: The evidence about the role of different flavored ENDS use and smoking cessation outcomes is inconclusive, reflecting highly heterogeneous study definitions and methodological limitations. More high-quality evidence, ideally from randomized controlled trials, is required.

This perspective summarizes available evidence on biomarkers of exposure in electronic nicotine delivery system (ENDS) users to aid the overall assessment of the health consequences of using ENDS. Identification of novel biomarkers of exposure specific to ENDS use remains challenging because chemicals emitted from ENDS devices have many familiar sources. The biomarker levels of many tobacco-related toxicants measured in biological samples collected from ENDS users did not differ significantly from non-users, except for nicotine metabolites and a small number of biomarkers of exposure to volatile organic compounds and tobacco-specific tobacco nitrosamines. Several studies have shown that while exposed to nicotine, long-term exclusive ENDS users showed significantly lower levels of toxicant biomarkers than cigarette smokers. Studies have also shown that concurrent users of ENDS and combustible cigarettes (‘dual users’) are not reducing overall exposure to harmful toxicants compared to exclusive cigarette smokers. Because of an absence of validated ENDS-specific biomarkers, we recommend combining several biomarkers to differentiate tobacco product user groups in population-based studies and monitor ENDS compliance in randomized controlled trials. Using a panel of biomarkers would provide a better understanding of health effects related to ENDS use.

The use of electronic nicotine delivery systems (ENDS) has exploded, especially among teenagers and new smokers, amid widespread awareness of the dangers of traditional tobacco and restrictions on smoking. However, the risk effects of ENDS on physical health, especially oral health, are still ambiguous. The purpose of this study was to review the available evidence on risks of ENDS on oral health, and compares the differences between ENDS and traditional cigarettes. For heavy smokers, transferring the addiction of tobacco to ENDS can be less harmful to periodontal condition and physical health but is not completely without risk. The components of ENDS vapor have cytotoxic, genotoxic, and carcinogenic properties, and its usage may be associated with a wide range of oral health sequelae. The chemicals in ENDS increase the susceptibility to tooth decay, increase the risk of periodontal disease, peri-implant, and oral mucosal lesions. Nicotine aerosols from ENDS can be a potential risk factor for oral cancer due to the presence of carcinogenic components. Compared to smoking traditional cigarettes, the harm associated with ENDS use may be underestimated due to the reduced ability to control vaping behavior, ease of ENDS access, fewer vaping area restrictions, and better taste. Currently, the available evidence suggests that ENDS may be a safer alternative to traditional tobacco products. Though most oral symptoms experienced by ENDS users are relatively mild and temporary compared to traditional cigarettes, the dangers of ENDS still exist. However, further research with longer follow-up periods is required to establish the long-term safety of ENDS.

(1) Background: Adverse childhood experiences (ACEs), which are potentially traumatic childhood events, have been associated with increased tobacco product use. Less is known about electronic cigarette (e-cigarette) use during young adulthood. This study explored the associations between ACEs and current e-cigarette use among U.S. young adults. (2) Methods: This study was a secondary analysis of 2021 Behavioral Risk Factor Surveillance System data including 2537 young adults aged 18–24 years. Unadjusted and adjusted logistic regression analyses were conducted. (3) Results: Of the participants, 19.2% currently used e-cigarettes, and 22.1% reported 1 ACE, 13.0% reported 2 ACEs, 10.7% reported 3 ACEs, and 30.6% reported ≥4 ACEs. Unadjusted results indicated that participants who experienced 1 ACE (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.01–3.07), 2 ACEs (OR = 2.18, 95%CI = 1.24–3.83), 3 ACEs (OR = 2.63, 95%CI = 1.41–4.90), and ≥4 ACEs (OR = 3.69, 95%CI = 2.23–6.09) were at increased odds of reporting current e-cigarette use than participants who experienced 0 ACEs. Adjusted results indicated that participants who experienced 3 ACEs were at 2.20 times higher odds (95%CI = 1.15–4.23) and participants who experienced ≥4 ACEs were at 2.73 times higher odds (95%CI = 1.58–4.71) of reporting current e-cigarette use than participants who experienced 0 ACEs. (4) Conclusions: Young adults exposed to ACEs are at risk of using e-cigarettes.

Objective. To explore the association between reporting conflict of interest (COI) and having a positive outcome toward vaping in scientific articles. Methods. A cross-sectional study that analyzed a sample of 697 articles published between 2017 and 2020 regarding vaping. Information on the reporting of COI, type of COI (no conflict, conflict with the tobacco industry, pharmaceutical industry, or other), and country of publication were collected. To explore the association between reporting COI and having a positive result for vaping, two logistic regression models were fitted, both adjusted by country of publication. Results. From 88 articles that reported COI, 23 reported COI with the tobacco industry, 44 with the pharmaceutical industry, and 21 reported another type of conflict. We found that reporting any type of COI increased by 4.7 times the odds (OR 4.70; 95% CI [2.89, 7.65]) of having a positive result for vaping. Additionally, compared to other countries, manuscripts published in England had 2 times higher odds (OR 2.40; 95% CI [1.16, 4.98]) of reporting a positive result for vaping. Reporting COI with the tobacco and pharmaceutical industries increased the odds of favorable results by 29 times (OR 29.95; 95% CI [9.84, 90.98]) and 2 times (OR 2.87; 95% CI [1.45, 5.69]), respectively. Conclusions. In scientific articles, reporting COI and having positive results for vaping are highly associated. COI should be considered and caution should be exercised when using data for policy-making.

The use of electronic nicotine delivery systems (ENDS) is increasing among young adults. However, there are few studies regarding predictors of ENDS initiation in tobacco-naive young adults. Identifying the risk and protective factors of ENDS initiation that are specific to tobacco-naive young adults will enable the creation of targeted policies and prevention programs. This study used machine learning (ML) to create predictive models, identify risk and protective factors for ENDS initiation for tobacco-naive young adults, and the relationship between these predictors and the prediction of ENDS initiation. We used nationally representative data of tobacco-naive young adults in the U.S drawn from the Population Assessment of Tobacco and Health (PATH) longitudinal cohort survey. Respondents were young adults (18–24 years) who had never used any tobacco products in Wave 4 and who completed Waves 4 and 5 interviews. ML techniques were used to create models and determine predictors at 1-year follow-up from Wave 4 data. Among the 2,746 tobacco-naive young adults at baseline, 309 initiated ENDS use at 1-year follow-up. The top five prospective predictors of ENDS initiation were susceptibility to ENDS, increased days of physical exercise specifically designed to strengthen muscles, frequency of social media use, marijuana use and susceptibility to cigarettes. This study identified previously unreported and emerging predictors of ENDS initiation that warrant further investigation and provided comprehensive information on the predictors of ENDS initiation. Furthermore, this study showed that ML is a promising technique that can aid ENDS monitoring and prevention programs.

ABSTRACT Objective: To estimate the prevalence of current commercial cigarette smoking, as well as those of e-cigarette and hookah experimentation and current use among adults (≥ 18 years of age) in Brazil. Methods: This study was based on a countrywide cross-sectional telephone-based survey conducted in 2022. The sample was designed to be representative of the five macroregions in Brazil and included 1,800 individuals from each of the regions. Telephone numbers, using a random digit dialing procedure, were proportionally selected for each direct distance dialing code in each region and then electronically validated (i.e., 900 cell and 900 landline phone numbers per region). Information on current commercial cigarette smoking (regardless of frequency/amount), as well as lifetime history of or current e-cigarette and hookah use (regardless of amount), were collected. Results: The prevalence of lifetime history of e-cigarette and hookah use was identical (7.3%; 95% CI: 6.0-8.9), whereas the prevalence of current commercial cigarette smoking was 12.2% (95% CI: 10.4-14.1). Young adults (18-24 years) had the highest prevalence of e-cigarette experimentation (19.7%; 95% CI: 15.1-17.0) and hookah experimentation (17%; 95% CI: 12.2-23.2). E-cigarette and hookah use was more common in the Central-West region and among those with a high level of education, whereas current commercial cigarette smoking was more common among those with a lower level of education. Individuals who used the three forms of nicotine delivery corresponded to 1.5% of the sample (nearly 2 million individuals based on the estimated size of the Brazilian adult population). Conclusions: Surveillance is essential for the monitoring and prevention of these new forms of nicotine consumption.

Smokers employing electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) are currently the most common types of smoking patients seen in the dental practice. Both types of smoking are currently viewed as less harmful than cigarette smoking. However, many studies already indicate that they could harm oral health. This systematic review and meta-analysis aimed to collect a comprehensive overview of the actual knowledge regarding ENDS and HTP from a clinical and a laboratory perspective. Publications available through PubMed, Embase, the Web of Science, Scopus, and Google Scholar were used to summarize the effects of ENDS and HTP on oral health. Six surveys on self-perceived gum disease (T2 = 9.47 I2 = 99.32%), three cross-sectional studies reporting the BOP score (T2 = 8.68 I2 = 99.13%), and four in vitro studies on apoptosis after vaping exposure in human oral fibroblasts (T 2 = 8.10 I2 = 91.50%) were separately analyzed. The risk of bias ranged from critical to low. Both ENDS and HTP seem to have detrimental effects on periodontal and peri-implant parameters, and laboratory tests confirmed the presence of carcinogenic and inflammatory biomarkers. flavored e-liquids may also be a caries risk factor. Comprehensive smoking counseling should be carried out with all types of smoking patients, investigating the type of habit in terms of duration, nicotine percentage, and additional flavorings. Additional research is necessary to assess the long-term effects of alternative tobacco products on oral health.

Because little is known about the effects of individual flavorants in electronic cigarette (e-cig) fluids on human platelet aggregation, we tested for the direct effects of 15 common e-cig flavorants on adenosine diphosphate (ADP)-induced human platelet aggregation ex vivo. To better understand a potential mechanism of action of flavorants, we quantified 2 phases of aggregation. Human platelet-rich plasma (PRP) was obtained from whole blood of healthy volunteers and used in a platelet aggregometry assay. PRP was incubated with 1 of 15 different flavorant compounds (e.g., benzyl alcohol, eugenol, citronellol, menthol, menthone, diacetyl, maltol, limonene, methylbutyric acid, isoamyl acetate, acetylpyridine, eucalyptol, 2,5-dimethylpyrazine, cinnamaldehyde, and vanillin) at 100 µM for 5 min at 37 °C prior to addition of ADP (10 µM). Subsequent ADP-induced platelet aggregation was tracked for 5 min using an aggregometer. Aggregation curves were analyzed for flavorant-induced effects on total (%) aggregation, Phase 1 and Phase 2 components, and compared with their ADP-only control via One-Way ANOVA. Notably, eugenol significantly inhibited total aggregation; an effect due solely to inhibition of Phase 2. No other flavor tested had any effect on total or phase-specific ADP-induced platelet aggregation. These results indicate that parent flavorant compounds commonly found in e-cig liquids neither activate nor inhibit ADP-induced human platelet aggregation. However, as flavorants are chemically altered during heating of e-cig, thermally-derived products of flavorants (e.g., flavor acetals) also will need to be tested for effects on platelet activation.

Abstract Objective The use and effects of electronic (e)‐cigarettes (e‐cigs) are particularly relevant for otolaryngology providers as tobacco plays a major role in benign and malignant diseases of the upper aerodigestive tract. This review aims to (1) summarize the recent policies regarding e‐cigs and important patterns of use and (2) serve as a comprehensive resource for clinical providers on the known biologic and clinical effects of e‐cigs on the upper aerodigestive tract. Data Sources PubMed/MEDLINE. Review Methods We conducted a narrative review on (1) general information on e‐cig use and informative findings in the lower respiratory system and a comprehensive review on (2) the effects of e‐cigs on cell and animal models and the clinical implications of these products on human health as is relevant to otolaryngology. Conclusions Although e‐cigs are likely less harmful than conventional cigarettes, preliminary research on e‐cigs suggest several deleterious effects including in the upper aerodigestive tract. Due to this, there has been increased interest in restricting e‐cig usage, particularly among the adolescent population, and caution in recommending e‐cigs to current smokers. Implications for Practice Chronic e‐cig use is likely to have clinical implications. It is critical for otolaryngology providers to be aware of the rapidly changing regulations and use patterns regarding e‐cigs and how e‐cigs influence human health, particularly with regards to the upper aerodigestive tract, to accurately council patients regarding potential risks and benefits of use.

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.

Abstract Background Although the harm to health from electronic nicotine delivery systems (ENDS) compared to smoked tobacco remains highly uncertain, society and governments still need to know the likely range of the relative harm to inform regulatory policies for ENDS and smoking. Methods We identified biomarkers with specificity of association with different disease groupings e.g., volatile organic compound (VOCs) for chronic obstructive pulmonary disease; and tobacco-specific N´-nitrosamines (TSNAs) and polycyclic aromatic hydrocarbons (PAHs) for all cancers. We conducted a review of recent studies (post January 2017) that compared these biomarkers between people exclusively using ENDS and those exclusively smoking tobacco. The percentage differences in these biomarkers, weighted by study size and adjusted for acrolein from other sources, were used as a proxy for the assumed percentage difference in disease harm between ENDS and smoking. These relative differences were applied to previously modelled estimates of smoking-related health loss (in health-adjusted life-years; HALYs). Results The respective relative biomarker levels (ENDS vs smoking) were: 28% for respiratory diseases (five results, three studies); 42% for cancers (five results, four studies); and 35% for cardiovascular (seven results, four studies). When integrated with the HALY impacts by disease, the overall harm to health from ENDS was estimated to be 33% that of smoking. Conclusions This analysis, suggests that the use of modern ENDS devices (vaping) could be a third as harmful to health as smoking in a high-income country setting. But this estimate is based on a limited number of biomarker studies and is best be considered a likely upper level of ENDS risk given potential biases in our method (i.e., the biomarkers used being correlated with more unaccounted for toxicants in smoking compared to with using ENDS).

Limited evidence exists on the association between electronic nicotine delivery systems (ENDS) and chronic respiratory disorders. This study examines the association of combustible tobacco and ENDS use with chronic respiratory disorders among US adults. Public-use data from the Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013–2014), Wave 2 (2014–2015), Wave 3 (2015–2016), and Wave 4 (2016–2018) were pooled. Analyses focused on adults with W1–W4 respiratory disorder data and current tobacco use at W4, as well as youth entering the adult cohort at W2 through W4 (N = 26,072). We fit weighted multivariable logistic regression models for each respiratory outcome (asthma, COPD, bronchitis) using W4 longitudinal weights. Cigarette smokers (adjusted odds ratio [AOR] = 0.8, 95 % CI 0.7–0.9) were less likely to report an asthma diagnosis (p = 0.013). In contrast, ENDS users (AOR = 6.5, 95 % CI 3.7–11.5), cigarette smokers (AOR = 6.1, 95 % CI 4.0–9.1), dual users of cigarettes and ENDS (AOR = 5.4, 95 % CI 3.4–8.7), current users of non-cigarette combustible, smokeless, and polytobacco products (AOR = 4.4, 95 % CI 3.1–6.4), and former users of any product (AOR = 3.0, 95 % CI 1.9–4.7) had significantly elevated odds of reporting a diagnosis of COPD (p

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.

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

Contemporary research reveals that electronic devices for nicotine consumption produce not so negative effects on health due to adverse chemicals being emitted in substantially lower quantities. Nevertheless, such consumption still results in emission of various organic and non-organic substances with their effects on health being rather unpredictable. It is necessary to conduct additional studies, including those focusing on passive smoking of electronic cigarettes and assessing health risks caused by exposure to them. Our research goal was to assess acute health risks caused by passive consumption of tobacco and nicotine-containing products. We built a model for tobacco or nicotine consumption by actual consumers (volunteers) and the process was evened as per a number of consumption sessions. We examined three products: tobacco cigarettes (cigarettes), electronic nicotine delivery system (ENDS), and a tobacco heating system (IQOS). Background air quality parameters were measured in a specifically organized enclosed space prior to each study session. We also conducted experiments in so called «reference groups» when research participants didn’t consume the examined products but were in the same conditions. Health risks were assessed as per the Guide R 2.1.10.1920-04 «The Guide on assessing health risks caused by exposure to chemicals that pollute the environment». Use of ENDS and IQOS does not result in significant changes in air composure and does not cause unacceptable acute health risk. Combined effects produced by contaminants on organs and systems resulted in health risks for respiratory organs, eyes, and body as a whole being insignificantly higher than permissible levels; these risks were practically the same as those detected for a reference group. Tobacco smoking resulted in unacceptable acute risks 1.5 hours after an experiment started; these risks were caused by elevated concentrations of such contaminants as acetaldehyde, formaldehyde, PM2.5, PM10, and carbon monoxide.

Introduction Past 30-day e-cigarette use increased by 78% among high school students from 2017 to 2018, an increase attributable to pod-style devices. JUUL Labs (JUUL) insists they do not market their product to teenagers. We created several scenarios to estimate the percentages of JUUL’s net revenue from adults and youth in the US in 2018. Methods We used the number of youth (aged 12–17 years) and adults (aged ≥18 years) who reported using JUUL in the nationally representative Population Assessment of Tobacco and Health (PATH) Study wave 4 (Dec 2016–Jan 2018) to estimate the youth proportion of JUUL users. As a sensitivity analysis, we also used data from the nationally representative Truth Longitudinal Cohort (TLC) study to estimate the youth proportion of JUUL users. Based on this percentage, we then applied several scenarios to estimate JUUL’s net revenue from youth in the US in 2018. Results From the PATH Study, 31% of JUUL users were youth (aged 12–17 years). In the TLC study, 30% of current JUUL users were aged 15–17 years. Given that JUUL’s net revenue was $1.3 billion in 2018, we calculated that JUUL made between $130 million and $650 million of its net revenue from youth, depending on consumption scenarios. Conclusions A substantial proportion of JUUL’s profits in 2018 were a result of use by youth. It could be required that all e-cigarette companies actively ensure that use by youth is below a pre-determined small fraction of their sales, requiring that a high penalty be paid by those that fail to do so.

We wanted to establish prevalence of e-cigarette sale via English community pharmacies. A cross-sectional survey of 500 retail-pharmacies was completed. Seventeen out of the 66respondents sold e-cigarettes, indicating a sales-prevalence of 25.76%. NRT was widely available for sale (n=16, 94.1%), cessation services were less frequently available (n=7, 41.2%), or not available (n=9, 52.9%). ‘Daily smokers’ were likely to use e-cigarette (n=8, 47.1%). Accessories were sold to0-2 people (n=13, 76.5%), χ² p=2.454 x 10-4. Young women purchased e-cigarettes (n=4, 23.5%), p=0.049, which were placed on top of the counter (n=7,41.2%), reflecting ‘impulse sales’ strategy. NRT was available for self-selection (n=14, 82.4%) (p=0.004), however staff-assistance was required(n=12, 70.6%), posing barriers. Costs for e-cigarette (£10.99-£29.99) versus NRT (£4.25-£35.99) represents value for money. Labelling and packaging were found to be attractive, p=0.049, fashionable, colourful p=0.049, healthy, potentially breaching laws. All respondents provided NRT counselling, p

Objective: to study the current state of the legislative regulation of nicotine-containing products turnover and consumption; to identify the main problems in this area and to suggest possible ways to solve them. Methods: the methodological basis of the work is interdisciplinary, systematic and comparative approaches, as well as general scientific methods of cognition: induction and deduction, analysis and synthesis, abstraction, observation, and empirical methods. Results: the trend of the recent years has been the transition from the use of traditional nicotine products to electronic means of nicotine delivery, which is confirmed by a large amount of data and is explained by a number of advantages. However, the potential threats from the use of alternative nicotine-containing products have not been sufficiently studied and are accompanied by a weak legal framework for their use. In the article, the author considers the features of state regulation of nicotine-containing products that are not related to tobacco products, and analyzes the contradictions and shortcomings of legislative solutions in this area. The main consequences of equating nicotine-containing products with tobacco products are systematized, both in terms of the impact on the nicotine use restriction and of referring them to excisable products. Legislative solutions concerning the use of food nicotine-containing products and products intended for chewing, sucking, and sniffing are also analyzed. Scientific novelty: recommendations are proposed to eliminate the problems identified during the analysis of the regulation of the nicotine-containing products turnover and use. The presented measures are aimed at mitigating the regulatory impact of the nicotine-containing products use while reducing the negative impact of such products on public health.Practical significance: the provisions and conclusions presented in this paper can be used in the development of regulatory legal acts aimed at amending the legislation regulating the nicotine-containing products turnover and consumption.

Introduction: The use of Electronic Cigarettes (ECs) has been increased over the last years but their long term effects on health and microbiota has not yet been explored fully. Aim: To examine the oral and nasal microbial profile and antibiotics susceptibility in the ECs users, smokers and nonsmokers and to assess the microbial contamination of the ECs juice. Materials and Methods: Nasal and oral swabs were collected from 30 non-smokers, 30 tobacco smokers and 30 from candidates who have been using ECs for more than six months. Nasal Methicillin Susceptible Staphylococcus aureus (MSSA) and Methicillin Resistant Staphylococcus aureus (MRSA), and oral Streptococcus viridans and Candida albicans were isolated and identified using standard laboratory methods. ECs juice was also cultured to test for microbial presence and the antibiogram for all isolated bacteria was carried out by disc diffusion or broth dilution methods according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The statistical analysis was performed with Stata Statistical Software: Release 13. Results: MSSA was isolated from 9 (30%) non-smokers, 5 (16.7%) ECs users and 2 (6.7%) smokers, respectively. Only 1 (3.3%) MRSA was isolated from a smoker. Streptococcus viridians was detected in 14 (46.7%) non-smokers, 9 (30%) ECs user and 5 (16.7%) smokers. Candida albicans was isolated from 7 (23.3%) smokers, 3 (10%) ECs users and in 1 (3.3%) non-smokers. When both groups of ECs users and smokers were compared to nonsmokers; the statistical intergroups difference in carriage of MSSA and Streptococcus viridans using Chi-Square test was only significant in the smokers group (p-value