Neonatal nicotine withdrawal in a newborn exposed to maternal e-cigarette use.

High International Electronic Cigarette Use Among Never Smoker Adolescents

JUULing Epidemic Among Youth: A Guide to Devices, Terminology, and Interventions.

Maternal antidepressant use has increased during the past 2 decades, with venlafaxine emerging as a common agent during pregnancy. Both venlafaxine and its active metabolite possess prolonged half-lives in adults; however, abrupt discontinuation may lead to withdrawal including irritability, jitteriness, lethargy, restlessness, and insomnia. The drug and its metabolite readily cross the placenta, posing additional considerations during pregnancy. Two neonates were admitted to our hospital on 5 and 6 days of life with hypothermia and lethargy among other symptoms of neonatal abstinence syndrome (NAS) requiring an extensive medical workup. Both neonates were exposed to venlafaxine in utero and exclusively fed infant formula since birth. Given that venlafaxine crosses the placenta and into breastmilk, NAS was suspected as a result of the abrupt discontinuation of venlafaxine upon delivery, and the decision was made to introduce mothers' breast milk. Symptoms of NAS, including hypothermia, resolved in both patients. The reported incidence of NAS with venlafaxine alone is limited, likely due to variation in breastfeeding practices among new mothers. Diagnosis of NAS due to venlafaxine requires a high index of suspicion because symptoms are nonspecific and the presentation may be delayed after birth. The effective treatment of NAS using mothers' breast milk illustrates the importance of counseling mothers to provide breast milk as a preventative strategy for withdrawal in their newborns. The cases involving the 2 neonates described in this article emphasize the importance of assessing in utero exposure to medications beyond the immediate newborn period and their possible role in causing unusual symptoms in newborns.

The market sector of flavored commercial nicotine products without tobacco leaves recently expanded to nicotine pouches. Comprehensive epidemiologic analyses of patterns and trends in youth use of commercial nontobacco nicotine products are lacking. To estimate US youth nicotine pouch and e-cigarette use prevalence and associated sociodemographic variables in 2023 and 2024. This cross-sectional study used data from annual surveys conducted in school with a nationally representative sample of 10th and 12th graders in 2023 and 2024 as part of the Monitoring the Future Study. Self-reported sex, race, ethnicity, and college plans; survey year; grade; and population density. The primary outcomes were lifetime, past-12-month, and past-30-day self-reported nicotine pouch (yes or no) and e-cigarette (yes or no) use and co-use patterns (exclusive pouch without e-cigarettes, exclusive e-cigarette without pouches, or dual use). Of the 10 146 study participants (4886 [48.2%] male and 4818 [47.3%] female; 5674 [51.6%] in 10th grade and 4472 [48.4%] in 12th grade), nicotine pouch use increased from 2023 vs 2024 for lifetime use (3.0% [95% CI, 2.3%-4.0%] vs 5.4% [95% CI, 4.2%-6.8%]; risk difference [RD], 2.3% [95% CI, 1.0%-3.6%]; risk ratio [RR], 1.76 [95% CI, 1.30-2.40]), use in the past 12 months (2.4% [95% CI, 1.7%-3.2%] vs 4.6% [95% CI, 3.5%-5.9%]; RD, 2.2% [95% CI, 1.0%-3.4%]; RR, 1.95 [95% CI, 1.39-2.74]), and use in the past 30 days (1.3% [95% CI, 0.8%-1.8%] vs 2.6% [95% CI, 1.9%-3.4%]; RD, 1.3% [95% CI, 0.5%-2.1%]; RR, 2.05 [95% CI, 1.33-3.16]). E-cigarette use did not significantly change from 2023 to 2024 for lifetime use (28.5% [95% CI, 26.3%-30.7%] vs 26.7% [95% CI, 24.3%-29.3%]) and past-30-day use (13.4% [95% CI, 11.8%-15.2%] vs 11.8% [95% CI, 10.2%-13.7%]) but decreased for past-12-month use (20.0% [95% CI, 18.1%-22.0%] vs 17.6% [95% CI, 15.7%-19.7%]). From 2023 to 2024, exclusive nicotine pouch and pouch plus e-cigarette dual use generally increased, whereas exclusive e-cigarette use decreased, collectively constituting no significant change in the prevalence of any nontobacco nicotine use (using 1 or both products) across years. Demographic comparisons collapsed across 2023 to 2024 found that (1) male individuals reported higher nicotine pouch use prevalence than female individuals, whereas female individuals reported higher e-cigarette use prevalence than male individuals; (2) rural vs urban and non-Hispanic White vs Hispanic youths were more likely to use each product, with larger differences for pouches than e-cigarettes; and (3) nicotine pouch and e-cigarette use prevalence was higher among 12th vs 10th graders and those without vs with 4-year college plans. In this cross-sectional study, commercial nontobacco nicotine use in US 10th and 12th graders shifted from 2023 to 2024, marked by a doubling in nicotine pouch past-30-day use, an increase in pouch plus e-cigarette dual use, and a decrease in exclusive e-cigarette use. Prioritizing surveillance, regulation, and prevention addressing pediatric nicotine pouch use warrants consideration.

IntroductionE-liquid flavor is typically presented by flavor category (e.g. menthol, mint, fruit, dessert). Cooling sensations produced by flavor additives such as menthol enhance appeal of e-cigarettes among youth, but not all e-liquids that produce cooling sensations are labeled as menthol. Sensory experiences produced by flavors may allow for a new way to capture e-cigarette flavor use. This study aims to examine use of flavors that produce cooling sensations among youth and its association with e-cigarette use behaviors.MethodsA 2019 survey of high school students (n = 4875) examined use of e-cigarette flavors that produced cooling sensations (cooling flavors) among past 30-day e-cigarette users. E-cigarette use behaviors (flavor use, nicotine use, frequency of use) were examined between those who did and did not use cooling flavors. A binary logistic regression was used to examine associations between vaping frequency, nicotine (vs. non-nicotine) use, and vaping cooling flavors while controlling for demographics, number of flavors vaped in the past month, and vaping age of onset.Results51.6% (n = 473/916) of the analytic sample endorsed vaping cooling flavors. There were no demographic differences by vaping cooling flavors. Vaping cooling flavors was associated with vaping more frequently (AOR:1.04,95% CI:1.03,1.05) and vaping nicotine (AOR:2.37,95% CI:1.53,3.67).ConclusionVaping cooling flavors was associated with greater nicotine vaping and frequency of e-cigarette use. Assessing sensory experience, such as cooling, in addition to flavor category may more fully capture e-cigarette flavor use and its impacts on youth e-cigarette use behaviors.

Electronic cigarette (e-cigarette) use in pregnancy has been steadily increasing and has been hyped as being a safe alternative to cigarette smoking during pregnancy. This review discloses what is currently known about e-cigarette use in pregnancy and the effects of its use on pregnancy outcomes. To determine what is currently known about the prevalence of e-cigarette use in pregnancy and the effects of e-cigarette use on pregnancy and perinatal/neonatal outcomes. A PubMed, CINAHL, and EMBASE search was undertaken using the search terms "pregnancy" OR "pregnancy complications" OR "pregnancy outcome" OR "newborn" OR "neonate" OR "birth" AND "electronic cigarettes" OR "e-cigarettes" OR "ecigarettes" OR "vaping" OR "vape." The search was limited to the English language and between 2007 and October 12, 2017. The search identified 91 articles, 40 of which are the basis for this review. The prevalence of e-cigarette use is 0.6% to 15%. The amount of nicotine consumed by e-cigarette users is comparable to that consumed by cigarette smokers. Most of the animal model studies suggest a potential danger to the developing fetus primarily because of the nicotine consumed and that consumption has multiple effects on the immune system, neural development, lung function, and cardiac function. There is a widespread flawed perception that e-cigarettes are safe to use during pregnancy. The marketing of e-cigarette use as a safer alternative to cigarette smoking has led to an increasing use even in pregnancy. The nicotine consumed by e-cigarettes is similar to that consumed by cigarette smoking. Animal studies confirm the dangers of nicotine to the developing fetus. More research needs to be done specifically assessing e-cigarette use, pregnancy, and pregnancy outcomes. The amount of nicotine consumed in cigarette smoking is similar to the amount of nicotine consumed with e-cigarettes. The effects of nicotine exposure during fetal development are well known and include effects on multiple organ systems.

To identify factors that predict the expression of neonatal abstinence syndrome (NAS) in infants exposed to methadone or buprenorphine in utero. Multi-site randomized clinical trial in which infants were observed for a minimum of 10 days following birth, and assessed for NAS symptoms by trained raters. A total of 131 infants born to opioid dependent mothers, 129 of whom were available for NAS assessment. Generalized linear modeling was performed using maternal and infant characteristics to predict: peak NAS score prior to treatment, whether an infant required NAS treatment, length of NAS treatment and total dose of morphine required for treatment of NAS symptoms. Of the sample, 53% (68 infants) required treatment for NAS. Lower maternal weight at delivery, later estimated gestational age (EGA), maternal use of selective serotonin re-uptake inhibitors (SSRIs), vaginal delivery and higher infant birthweight predicted higher peak NAS scores. Higher infant birthweight and greater maternal nicotine use at delivery predicted receipt of NAS treatment for infants. Maternal use of SSRIs, higher nicotine use and fewer days of study medication received also predicted total dose of medication required to treat NAS symptoms. No variables predicted length of treatment for NAS. Maternal weight at delivery, estimated gestational age, infant birthweight, delivery type, maternal nicotine use and days of maternal study medication received and the use of psychotropic medications in pregnancy may play a role in the expression of neonatal abstinence syndrome severity in infants exposed to either methadone or buprenorphine.

P39: Predictive value of meconium concentrations of buprenorphine and methadone in neonatal abstinence syndrome (NAS)

Management of nonobstetric pain during pregnancy and lactation.

Management of Nonobstetric Pain During Pregnancy and Lactation

Breast milk has been reported to ameliorate the severity and outcome of neonatal abstinence syndrome (NAS). The mechanism of this beneficial effect of breast milk on NAS remains unclear, as the negligible amount of methadone transmitted via breast milk is unlikely to have an impact on NAS. The aim of this study was to compare the impact of different feeding modalities on the onset of NAS. A retrospective medical record review was conducted on 194 methadone-maintained mother/infant dyads. Infants were categorized on the first 2 days of life as predominantly breastfed, fed expressed human breast milk (EBM), or formula fed. The feeding categories were then analyzed using the onset of NAS as the outcome measure. After adjusting for confounders, there was no significant effect of the modality of feeding on the rates of NAS requiring treatment (p = 0.11). Breastfeeding significantly delayed the onset of NAS (p = 0.04). The act of breastfeeding in the first 2 days of life had no effect on whether an infant required treatment for NAS when compared to those fed EBM or formula. This only suggests that the advantages of breastfeeding on NAS cannot be substantiated in a small cohort and should not discourage breastfeeding.

Information about longitudinal associations of attention-deficit/hyperactivity disorder (ADHD) diagnosis, symptom severity, pharmacotherapy, and incident nicotine and tobacco use, including e-cigarettes, among US youths is limited. To evaluate whether ADHD diagnosis, symptom severity, and pharmacotherapy are associated with incident e-cigarette and tobacco use over a 9-year period. This longitudinal cohort study followed up a nationally representative sample of US youths and their parents in the Population Assessment of Tobacco and Study via questionnaires from wave 1 (September 2013 to December 2014) to waves 2 to 7 (October 2014 to April 2023). Participants were representative of the US civilian noninstitutionalized population. Youths aged 12 to 17 years at wave 1 (N = 13 572) and their parents were interviewed. Time in years and history of ADHD diagnosis, symptom severity, and pharmacotherapy at wave 1 were used to construct 9 mutually exclusive subgroups of US youths, including those with ADHD diagnosis and pharmacotherapy, ADHD diagnosis without pharmacotherapy, and population controls without ADHD diagnosis; within each of these 3 subgroups, ADHD symptom severity was categorized as none, 1 to 2, or 3 to 4 symptoms. Incident e-cigarette use, cigarette smoking, other tobacco use, and dual use (e-cigarette and cigarette and/or other tobacco use) in weighted percentages with 95% CIs. Of the 13 572 youths included in the analysis, 6967 (51.3%; 95% CI, 51.2%-51.5%) were male. An estimated 1881 participants (14.1%; 95% CI, 13.2%-15.0%) were diagnosed with ADHD. Multivariable logistic regression analyses indicated that the adjusted odds of incident e-cigarette use, cigarette smoking, other tobacco use, and dual use did not significantly differ between those with asymptomatic ADHD (with or without pharmacotherapy) compared with population controls. In contrast, all subgroups who had 3 or more ADHD symptoms (with or without pharmacotherapy) had significantly higher adjusted odds of e-cigarette use (adjusted odds ratio [AOR], 1.60; 95% CI, 1.34-2.04), cigarette smoking (AOR, 1.52; 95% CI, 1.22-1.89), other tobacco use (AOR, 1.61; 95% CI, 1.27-2.02), and dual use (AOR, 1.72; 95% CI, 1.38-2.14) compared with youths with asymptomatic ADHD or population controls. Among youths with ADHD, those with highly symptomatic ADHD were significantly more likely to initiate e-cigarette (AOR, 1.68; 95% CI, 1.16-2.44) and dual use (AOR, 1.82; 95% CI, 1.17-2.83) than youths without symptoms. In this cohort study of US youths, ADHD symptoms were associated with the onset of nicotine and tobacco use. Findings highlight the importance of early diagnosis and effective treatment of ADHD to alleviate symptoms and reduce the risk of later nicotine and tobacco use.

To assess prevalence of electronic cigarette (e-cigarette) use, reported changes in smoking status due to e-cigarette use and correlates of e-cigarette use in the European Union (EU) member states in 2014. Cross-sectional survey of EU citizens representative of the population (Special Eurobarometer 429). All 28 Member States of the EU. A total of 27 460 EU citizens aged ≥15years (after excluding those who responded 'Do not know' to the questions about smoking status and e-cigarette use). Descriptive analysis [%, 95% confidence interval (CI)] of e-cigarette use prevalence (current use, past use and past experimentation) according to smoking status, self-reported changes in smoking status according to patterns of e-cigarette use and logistic regression analysis to examine correlates of e-cigarette use, especially socio-demographic factors and smoking status. Ever e-cigarette use was reported by 31.1% (95% CI=30.0-32.2%) of current smokers, 10.8% (95% CI=10.0-11.7%) of former smokers and 2.3% (95% CI=2.1-2.6%) of never smokers. Past experimentation [7.2% (95% CI=6.9-7.5%)] was more common than current [1.8% (95% CI=1.6-1.9%)] and past use [2.6% (95% CI=2.4-2.8%)]. Extrapolated to the whole population, approximately 48.5 million EU citizens were ever e-cigarette users, with 76.8% using nicotine-containing e-cigarettes. An estimated 6.1 and 9.2 million EU citizens had quit and reduced smoking with the help of e-cigarettes, respectively. Initiation with e-cigarettes was reported by 0.8% (95% CI=0.6-0.9%) of participants who reported ever use of any tobacco-related product. Only 1.3% (95% CI=1.1-1.5%) of never smokers used nicotine-containing e-cigarettes, with 0.09% (95% CI=0.04-0.14%) reporting daily nicotine use. Smoking cessation with the help of e-cigarettes was reported by 35.1% (95% CI=30.7-39.5%) of current e-cigarette users, while a further 32.2% (95% CI=29.9-36.5%) reported smoking reduction. Being current [odds ratio (OR)=21.23, 95% CI=18.32-24.59) or former smokers (OR=6.49, 95% CI=5.49-7.67) were the strongest correlates of ever e-cigarette use. E-cigarette use in the European Union appears to be largely confined to current or former smokers, while current use and nicotine use by people who have never smoked is rare. More than one-third of current e-cigarette users polled reported smoking cessation and reduction.

Living under a cloud: Electronic cigarettes and the dental patient

Background: Individuals experienced increased social isolation resulting from the COVID-19 pandemic. Studies have found social isolation and loneliness to be strongly associated with anxiety and depression, which have been associated with increased smoking and vaping rates among young adults, including college students. Objectives: To examine relationships between psychological distress and nicotine use within the context of the COVID-19 pandemic. Methods: A cross-sectional online survey (n = 4634; 77.9% female) was used to collect nicotine use and psychological measures from students enrolled at a large Midwestern university. Timeline follow-back data were collected from students reporting current cigarette or electronic cigarette (e-cigarette) use in the week before and immediately following the closure of campus due to the pandemic. Generalized estimating equations were used to examine the interaction between nicotine use and psychological symptoms across the 2-week period. Results: Both cigarette (Rate ratio (RR) = 1.115, 95% CI = 1.061, 1.171, p < .0001) and e-cigarette (β = 0.258, 95% CI = 0.166, 0.351, p < .0001) use increased significantly following campus closure. Students experiencing higher levels of depression reported greater increases in e-cigarette use frequency over time as compared to students reporting fewer symptoms of depression (β = 0.018, 95% CI = 0.006, 0.030, p = .004). Conclusions: Increases in nicotine use were found immediately following the implementation of public health safety measures that closed most university campuses. Additional and/or increased stressors have potentially impacted young adults who are college students as a result of campus closures resulting from the pandemic, which may have contributed to further increases in nicotine use.