The Message That E-Cigarettes Are Less Harmful Than Combustible Cigarettes Is Not Getting Through

Study protocol for approach bias retraining for nicotine addiction among dual combustible and electronic cigarette users

The associations of changes in noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use habits with subsequent cardiovascular disease (CVD) risk are still unclear. The study population consisted of 5 159 538 adult men who underwent health screening examinations during both the first (2014-2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. All participants were divided into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (≥5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. Propensity score matching analysis was conducted to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. Multivariable Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% CIs for CVD risk according to changes in NNTP and CC smoking habits. Compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79-0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78-0.84]) had lower risk for CVD. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01-1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Similarly, compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07-2.72]) had higher CVD risk. Switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. On CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs. Compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.

Combustible cigarette (CC) smokers often use heated tobacco products (HTPs) to quit CC smoking; however, the role of HTPs in quitting CC smoking is uncertain. We evaluated the link between HTP use and quitting CC smoking considering the intensity of HTP use among a large nationally representative sample of Korean adults. We performed a cross-sectional study using data from the 2019 Community Health Survey in Korea. A total of 46 781 adult participants (current CC smokers and former CC smokers <5 years) were included and Poisson regression analysis was performed to evaluate the association between HTP use and quitting CC smoking among ever-CC smokers. In ever CC smokers, compared with never HTP use, current daily HTP use was positively associated with quitting CC smoking (<1-year; prevalence ratio (PR) = 1.63, 95% confidence interval (CI) = 1.36 to 1.96, 1-5 years; PR = 1.47, 95% CI = 1.36 to 1.60), whereas current non-daily HTP use showed an inverse association with quitting CC smoking (<1-year; PR = 0.18, 95% CI = 0.12 to 0.29, 1-5 years; PR = 0.23, 95% CI = 0.17 to 0.31). Former HTP use was positively associated with short-term quitting CC smoking (PR = 1.38, 95% CI = 1.18 to 1.63), but negatively related to quit CC smoking after 1 year (PR = 0.81, 95% CI = 0.74 to 0.88). Daily use of HTPs appeared to be related to the increase in quitting CC smoking, but discontinuation of HTP use was significantly associated with the recurrence of CC smoking among former HTP users of 1-5 years. Among ever CC smokers, daily use of HTPs was positively associated with quitting CC smoking, but non-daily use of HTPs was inversely associated with quitting CC smoking. Former HTP use was linked to an increased likelihood of short-term quitting CC smoking but was significantly associated with CC smoking relapse after 1 year.

The current study examined changes in prevalence of e-cigarette use and perceptions of the harmfulness of e-cigarette and combustible cigarettes following a campus-wide tobacco ban. Undergraduate students completed surveys of tobacco use and perceived product harmfulness. Four samples were collected: in 2013 prior to the ban (n = 792) and in fall 2014 (n = 310), 2015 (n = 208), and 2016 (n = 417). E-cigarette use increased in the years following the ban (p = .01) while combustible cigarette use decreased from 2013 to 2016 (p = .02). Men were more likely than women to use both products (ps < .05). Students’ perceptions of the harmfulness of combustible and electronic cigarettes remained stable in the years following the ban (p > .05). This study is the first to examine the impact of including e-cigarettes in tobacco free policies. Combustible cigarette use declined, but e-cigarette use increased in the years following the e-cigarette ban. Prospective research is needed to understand the long-term impacts of e-cigarette bans.

Combustible and electronic cigarette use among patients at a large academic dental school clinic: A preimplementation needs assessment survey

INTRODUCTIONPositive perceptions of electronic cigarettes (e-cigarettes) relative to combustible cigarettes (CCs) may erode support for endgame policies on CCs through smoking renormalization (increasing public acceptance of smoking). We investigated the associations between perceptions of e-cigarettes relative to CCs and support for endgame policies on CCs in Hong Kong.METHODSAdult respondents (N=2004) were surveyed using landline random digit dialing in 2015. Perceived relative harm and relative addictiveness of e-cigarettes were combined as an overall perception of e-cigarettes relative to CCs with 5 levels and we analyzed individually ‘neutral/positive/mixed/unknown’ perceptions against the ‘negative’ perception. Five individual items with dichotomous responses assessed the support for endgame policies on CCs. Support for banning the sale/use of CCs (yes/no) was also assessed. Multivariable regressions yielded adjusted odds ratios (AORs) of supporting endgame policies (individual policy items, all 5 policy items, at least 1 policy item, banning the sale/use of CCs) in relation to perceptions of e-cigarettes relative to CCs, adjusting for age, education attainment, marital status, CC smoking status and ever e-cigarette use.RESULTSSupport for individual endgame policy items (from 51.8% to 80.0%), banning the sale (63.8%) and use (67.5%) of CCs were generally high. Few respondents perceived e-cigarettes as more harmful (16.6%) or more addictive (9.3%) than CCs. Positive perceptions of e-cigarettes (24.0%) were associated with less support for ‘ban CC sales in 10 years if there is a product providing nicotine not made from tobacco’ (AOR=0.62, 95% CI: 0.40–0.97), ‘ban CC use when it’s prevalence falls below 5%’ (AOR=0.66, 95% CI: 0.44–0.98) and ‘banning the sale of CCs’ (AOR=0.63, 95% CI: 0.42–0.94).CONCLUSIONSPositive perceptions of e-cigarettes relative to CCs were associated with less support for endgame policies on CCs in Hong Kong. Public health actions are needed to disseminate evidence-based knowledge of e-cigarettes.

The influence of neuroticism in terms of E-cigarette dependence and beliefs about use and quitting among dual users of combustible and electronic cigarettes

One of the important problems facing modern society is the increase in the number of people with various types of addictions, the most common of which is smoking. Smoking and its medical-demographic and economic consequences are in the circle of scientific interests of many domestic and foreign scientists. That is why the aim of the scientific article is to study the peculiarities of the state of the respiratory system in women at rest and during the burning of another cigarette. The study was conducted in the Laboratory of Medical and Biological Monitoring and Public Health at the Department of Human and Animal Physiology, Faculty of Biology and Forestry, Lesya Ukrainka Volyn National University for 60 women aged 17-21. At the first stage of the study, absolute anthropometric indicators were measured, such as height, weight, chest circumference. In the second stage women were interviewed on the Fagerström test. According to its results, the study is divided into 3 groups: Group I – women who have a history of smoking more than 3 years, burn more than 10 cigarettes per day and have a high level of dependence, Group II – women who have a history of smoking 1-3 years, up to 10 cigarettes are smoked per day and have a low and medium level of dependence, Group III – (control) women who do not smoke. The next stage of the study involved a functional diagnosis of the external respiratory system in women at rest and 15 minutes after smoking a cigarette using the functional method of pneumotachography (PTG). Registration and analysis of relevant indicators was carried out using a diagnostic automated complex “Cardio+”. Statistical data processing was performed using generally accepted methods of variation statistics (because the distribution of the results was normal) using MS Excel 2007 software. This article presents a study of the state of external respiration at rest and 15 minutes after burning another cigarette, which revealed the negative effects of smoking on the respiratory system of women who smoke. The study made it possible to make a detailed analysis of indicators of respiratory function in women aged 17-21 years, smokers and compare them with non-smokers. Based on the obtained results, it was found that in women smokers (groups I and II) there is a significant decrease in volume (FVC, VC, FEV1) indicators of external respiration, as well as the Tiffeneau-Pinelli test at p&lt;0.05, compared with the group of women control group both at rest and 15 minutes after firing the next cigarette. Analysis of velocity (MEF at the level of exhalation 25 %, 50 %, 75 %, PEF) of airflow through the bronchi to the lungs indicates a gradual decrease from MEF 25 % to MEF 75 % in women of the experimental groups, but a significant decrease is observed only at the level sight of 75 % in 15 min after burning of the next cigarette between I and III groups (at p&lt;0.05). A statistically significant difference between the values of the calculated Tiffeneau-Pinelli index, which characterizes the presence of obstructive respiratory failure, in women of groups II and III both at rest and 15 minutes after burning another cigarette. Thus, a decrease in these indicators indicates the presence of bronchial obstruction of the middle and small bronchi, as well as a violation of respiratory muscle strength and bronchial patency. It has also been shown that the reactivity (reduction) of volumetric and velocity indicators of external respiration to cigarette burning was higher in the group of women who do not smoke (control).

AimsThis study aims to analyze the association between combustible/electronic cigarettes and the risk of stroke.MethodsWe obtained data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). The stroke history and combustible/electronic cigarette use were acquired by questionnaires. Considering the sole or dual use of combustible cigarettes and electronic cigarettes (e-cigarettes), we divided all the individuals into four subgroups, including nonsmokers (reference group), sole combustible cigarette, sole e-cigarette, and dual use of both combustible cigarettes and e-cigarettes. We performed multivariable logistic regression to determine the association between cigarette use with the prevalence of stroke. We used odds ratios (ORs) with 95% confidence intervals (CIs) to show the effect size. Finally, we developed a prediction model to evaluate the risk of stroke for individuals with combustible or electronic cigarette use based on a random forest model.ResultsWe included a total of 4022 participants in the study. The median age was 55, and 48.3% of the participants were males. When we adjusted for age, gender, education attainment, race, total-to-HDL cholesterol (< 5.9 or ≥ 5.9), diabetes, hypertension, and alcohol consumption, the groups of sole e-cigarette use, sole combustible cigarette use, and dual use of combustible and electronic cigarettes were significantly associated with the prevalence of stroke with ORs (with 95%CI) of 2.07 (1.04–3.81), 2.36 (1.52–3.59), 2.34 (1.44–3.68), respectively. In the testing set, the AUC was 0.74 (95%CI = 0.65–0.84), sensitivity was 0.68, and specificity was 0.75.ConclusionSole e-cigarettes and dual use of e-cigarettes with combustible cigarettes might increase the risk of stroke.

Smoking of combustible cigarettes is a risk factor for cardiovascular disease. Heated tobacco products (HTPs) have recently increased in use due to their perceived lower toxicity compared with combustible cigarettes, yet their direct effects on cardiomyocytes remain unclear. In the present study, we compared the effects of nicotine- and tar-free cigarette smoke extracts (CSE) from two HTPs ('HTP-1' and 'HTP-2') and a combustible reference cigarette (RF) on cultured neonatal rat ventricular myocyte. All CSEs reduced cell viability and the spontaneous beating rate, with toxicity ranked as RF>HTP-2>HTP-1. HTP-2 and RF also induced intracellular Ca2+-overload, contractile dysfunction, and mitochondrial reactive oxygen species production, whereas HTP-1 did not. Mitochondrial respiration and ATP production were suppressed by all CSEs, while glycolysis was upregulated only by HTP-2 and RF, indicating different metabolic alterations. Acrolein, a shared toxicant in all products, also reduced cell viability, suggesting its involvement in CSE-induced cardiotoxicity. In summary, we revealed that HTPs, like combustible cigarettes, exhibit direct cardiomyocyte toxicity, but the underlying mechanisms appear to differ between different cigarette products with regard to abnormal Ca2+ regulation and metabolic inhibition. These findings raise concern regarding the cardiac safety of HTPs.

Experts Call For More Action to Thwart Youth Vaping ‘Epidemic’

Reducing cigarette use is a major public health goal in the United States. Questions remain, however, about the potential for the social environment in the adult years-particularly in the 30s and beyond-to influence cigarette use. This study tested pathways hypothesized by the social development model to understand the extent to which social environmental factors at age 33 (eg, involvement with smokers or with physically active people) contribute to changes in cigarette use from age 30 to age 39. Both combustible and electronic cigarette use were investigated. Data were from the Seattle Social Development Project, a longitudinal study of 808 diverse participants with high retention. Self-reports assessed social developmental constructs, combustible and electronic cigarette use, and demographic measures across survey waves. At age 30, 32% of the sample reported past-month cigarette use. Using structural equation modeling, results showed high stability in cigarette use from age 30 to 39. After accounting for this stability, cigarette-using social environments at age 33 predicted personal beliefs or norms about smoking (eg, acceptability and social costs), which in turn predicted combustible cigarette use at age 39. Cigarette-using environments, however, directly predicted electronic cigarette use at age 39, with no significant role for beliefs about smoking. Cigarette use was highly stable across the 30s, but social environmental factors provided significant partial mediation of this stability. Pathways were different for combustible and electronic cigarette use, however, with personal smoking norms playing an important role for the former but not the latter. This study addresses the need for longitudinal investigation of social mechanisms and cigarette use in the 30s. Findings reinforce efforts to prevent the uptake of cigarettes prior to the 30s because, once started, smoking is highly stable. But social environmental factors remain viable intervention targets in the 30s to disrupt this stability. Addressing personal norms about smoking's acceptability and social costs is likely a promising approach for combustible cigarette use. Electronic cigarettes, however, present a new challenge in that many perceived social costs of cigarette use do not readily translate to this relatively recent technology.

Depression is a risk factor for nicotine use and withdrawal. Population level epidemiologic studies that include users of either combustible or electronic cigarette (NICUSER) could inform interventions to reduce nicotine dependence in vulnerable populations. The current study examined the relationship between depression diagnosis (DEPDX), NICUSER, and lifetime rates of DSM-V nicotine withdrawal (NW) symptoms in a nationally representative sample of US adults (N = 979), who answered related questions in surveys administered through GfK’s KnowledgePanel. Over 42% of the sample reported lifetime ever combustible cigarette use, 15.6% electronic-cigarette use, and 45.9% either (NICUSER). Weighted logistic regression analyses (controlling for age and gender) found that DEPDX was associated with 2.3 times increased odds (ratio (OR); 95% Confidence Interval (CI): 1.5–3.5) of being a NICUSER. Regarding risks of NW symptoms among NICUSER, models that additionally controlled for frequency of nicotine use found that DEPDX was significantly associated with increased odds of concentration problems (OR = 2.4; 95% CI: 1.3–4.5) and depressed mood (OR = 2.2; 95% CI: 1.1–4.1) when quitting or cutting down on nicotine use. Results highlight the consistent comorbidity between depression, nicotine use, and symptomatic nicotine withdrawal in a population-based sample of combustible and electronic cigarette users.

Electronic and conventional cigarette use and risk of spinal disc disorders: a nationwide cohort study.

Vaporized nicotine (VN) use is increasing among people with HIV (PWH). We examined demographics, patterns of use, depression, and panic symptoms associated with VN and combustible cigarette (CC) use among PWH. We analyzed VN use among PWH in care at 7 US sites. PWH completed a set of patient-reported outcomes, including substance use and mental health. We categorized VN use as never vs. ever with the frequency of use (days/month) and CC use as never, former, or current. We used relative risk regression to associate VN and CC use, depression, and panic symptoms. Linear regression estimated each relationship with VN frequency. Models were adjusted for demographics. Among 7431 PWH, 812 (11%) reported ever-using VN, and 264 (4%) reported daily use. Half (51%) of VN users concurrently used CC. VN users were more likely than those without use to be younger, to be White, and to report ever-using CC. PWH reporting former CC use reported ≥8.5 more days per month of VN use compared with never CC use [95% confidence interval (95% CI): 5.5 to 11.5 days/month] or current CC use (95% CI: 6.6 to 10.5 days/month). Depression (relative risk: 1.20 [95% CI: 1.02 to 1.42]) and panic disorder (1.71 [95% CI: 1.43 to 2.05]) were more common among PWH ever-using VN. Depression was common among PWH using VN (27%) and CC (22%), as was panic disorder (21% for VN and 16% for CC). Our study elucidated demographic associations with VN use among PWH, revealed the overlap of VN and CC use, and associations with depression/panic symptoms, suggesting roles of VN in self-medication and CC substitution, warranting further longitudinal/qualitative research.