Association Of E-cigarette Use Research Articles

Association of e-Cigarette Use and Postpartum Depression: Pregnancy Risk Assessment Monitoring System 2016-2019.

Background: Postpartum depression (PPD) is a prevalent public health concern. Combustible cigarette use is associated with increased risk of PPD. While electronic cigarette (e-cigarette) use during pregnancy is linked to increased risk of depressive symptoms during pregnancy, the relationship between e-cigarette use and PPD is not well understood. We sought to examine the association of e-cigarette use with PPD. Materials and Methods: Using Pregnancy Risk Assessment Monitoring System 2016-2019 data, unadjusted and adjusted logistic regression analyses for PPD were conducted via three analyses where e-cigarette use (any vs. none) was retrospectively self-reported (1) in past 2-year, (2) prepregnancy (i.e., 3 months before pregnancy), and (3) during pregnancy (i.e., last 3 months of pregnancy). We conducted an additional past 2-year e-cigarette use analysis excluding those who used combustible cigarette and/or hookah. Covariates included age, race, ethnicity, combustible cigarette, and/or hookah use, prenatal care during the last trimester, health insurance coverage during pregnancy, physical abuse during pregnancy, income, and survey type. Results: Only unadjusted odds ratios from past 2-year e-cigarette use (1.63, 95% confidence interval [CI]: 1.42-1.87) and past 2-year e-cigarette use excluding individuals with cigarette and/or hookah use (1.78, 95% CI: 1.30-2.38) were statistically associated with PPD. No adjusted analyses were statistically significant. Conclusion: Any e-cigarette use, as compared to no use, does not appear to be an independent risk factor of PPD, though it may be a useful clinical marker of increased risk of PPD. Future studies are warranted to advance our knowledge of impact of e-cigarette use on PPD.

Cigarette Smoking Abstinence Among Pregnant Individuals Using E-Cigarettes or Nicotine Replacement Therapy

Smoking cigarettes during pregnancy can impair maternal and child health, and pregnant individuals have increasingly used electronic cigarettes (e-cigarettes) for various reasons, including quitting smoking. To assess smoking abstinence rates among pregnant individuals who used e-cigarettes compared with those who used nicotine replacement therapy (NRT). This cohort study is a secondary data analysis of phase 8 of the US Pregnancy Risk Assessment Monitoring System, conducted between 2016 and 2020. Eligible participants included pregnant individuals who smoked combustible cigarettes within the 3 months before pregnancy and either used e-cigarettes or NRT during pregnancy. Data analysis was conducted from March 2022 to April 2023. Combustible cigarette use within 3 months before pregnancy and use of either e-cigarettes or NRT during pregnancy. The primary outcome was the individual's self-reported smoking abstinence status during the last 3 months of pregnancy. Weighted percentages were reported and weighted multivariable logistic regression models were used to examine the association of e-cigarette use vs NRT with smoking abstinence. A propensity score was used to control for confounding by sociodemographics, pregnancy characteristics, prepregnancy smoking intensity, depression, behavioral support, and hookah use. The cohort included 1329 pregnant individuals (759 ≥25 years [60.2%]; 766 non-Hispanic White individuals [79.8%]) of whom 781 had an education level of high school or lower (61.4%), and 952 had an annual household income of $48 000 or less (81.5%). Of the 1329 individuals, 890 (unweighted percentage, 67.0%) were existing e-cigarette users, 67 (unweighted percentage, 5.0%) were new e-cigarette users, and 372 (unweighted percentage, 28.0%) were NRT users. Compared with individuals who used NRT during pregnancy, individuals who used e-cigarettes had a higher rate of smoking abstinence in late pregnancy (456 individuals [50.8%] vs 67 individuals [19.4%]; propensity score adjusted odds ratio [OR], 2.47; 95% CI, 1.17-5.20; P = .02). In the secondary analysis stratified by the timing of e-cigarette use initiation, existing users of e-cigarettes who initiated before pregnancy had a higher smoking abstinence rate than NRT users (446 users [53.1%] vs 67 users [19.4%]; adjusted OR, 2.61; 95% CI, 1.23-5.51; P = .01). However, new e-cigarette users who initiated use during pregnancy had a similar smoking abstinence rate in late pregnancy when compared with NRT users (10 users [20.6%] vs 67 users [19.4%]; adjusted OR, 1.13; 95% CI, 0.22-5.87; P = .88). These findings suggest that individuals who used e-cigarettes during pregnancy had a higher smoking abstinence rate in late pregnancy than individuals who used NRT, especially for those who initiated e-cigarette use before pregnancy, indicating that replacement of cigarettes with e-cigarettes during pregnancy may be a viable strategy for harm reduction.

Prospective study of e-cigarette use and respiratory symptoms in adolescents and young adults

RationaleElectronic cigarette (e-cigarette) aerosol contains volatile aldehydes, including flavourings and oxidant metals with known pulmonary toxicity.ObjectivesTo evaluate the associations of e-cigarette use with symptoms of wheeze, bronchitic symptoms and shortness...

A Lifestyle Communication Tool: Association of E-cigarette Use and Pre-diabetes.

The aim of this study was to present a framework for clinicians to use when discussing electronic cigarette (e-cigarette) use and its association with pre-diabetes. A communication tool was designed using evidence-based strategies from the academic literature. A four-step framework is presented, which includes: step (1) helping patients to understand the association between e-cigarette use and pre-diabetes; step (2) the synergistic health impacts of e-cigarette use and pre-diabetes; step (3) management of diabetes-related lifestyle factors; and step (4) stages of change assessment related to e-cigarette reduction. This communication tool provides support for clinicians to discuss the risk of pre-diabetes associated with e-cigarette use. Moving forward, implementation and evaluation of this model are needed.

Respiratory and population effects of e-cigarettes: A Chinese perspective.

Respiratory and population effects of e-cigarettes: A Chinese perspective.

Examining the association of habitual e-cigarette use with inflammation and endothelial dysfunction in young adults: The VAPORS-Endothelial function study.

Acute exposure to e-cigarette aerosol has been shown to have potentially deleterious effects on the cardiovascular system. However, the cardiovascular effects of habitual e-cigarette use have not been fully elucidated. Therefore, we aimed to assess the association of habitual e-cigarette use with endothelial dysfunction and inflammation - subclinical markers known to be associated with increased cardiovascular risk. In this cross-sectional study, we analyzed data from 46 participants (23 exclusive e-cigarette users; 23 non-users) enrolled in the VAPORS-Endothelial function study. E-cigarette users had used e-cigarettes for ≥6 consecutive months. Non-users had used e-cigarettes <5 times and had a negative urine cotinine test (<30 ng/mL). Flow-mediated dilation (FMD) and reactive hyperemia index (RHI) were used to assess endothelial dysfunction, and we assayed high-sensitivity C-reactive protein, interleukin-6, fibrinogen, p-selectin, and myeloperoxidase as serum measures of inflammation. We used multivariable linear regression to assess the association of e-cigarette use with the markers of endothelial dysfunction and inflammation. Of the 46 participants with mean age of 24.3 ± 4.0 years, the majority were males (78%), non-Hispanic (89%), and White (59%). Among non-users, 6 had cotinine levels <10 ng/mL while 17 had levels 10-30 ng/mL. Conversely, among e-cigarette users, the majority (14 of 23) had cotinine ≥500 ng/mL. At baseline, the systolic blood pressure was higher among e-cigarette users than non-users (p=0.011). The mean FMD was slightly lower among e-cigarette users (6.32%) compared to non-users (6.53%). However, in the adjusted analysis, current e-cigarette users did not differ significantly from non-users in their mean FMD (Coefficient=2.05; 95% CI: -2.52-6.63) or RHI (Coefficient= -0.20; 95% CI: -0.88-0.49). Similarly, the levels of inflammatory markers were generally low and did not differ between e-cigarette users and non-users. Our findings suggest that e-cigarette use may not be significantly associated with endothelial dysfunction and systemic inflammation in relatively young and healthy individuals. Longer term studies with larger sample sizes are needed to validate these findings.

E-Cigarette Use Is Associated with Increased Psychological Distress among Youth: A Pooled Cross-Sectional Analysis of State-Level Data from 2019 and 2021.

A crisis of worsening youth mental health in recent years across the United States has created alarm among health professionals. As a result, health professionals have sought to improve methods of identifying youth in need of treatment services. Cigarette, cannabis, and alcohol use each consistently serve as behavioral markers of risk for youth mental health problems. Despite the recent growth of electronic cigarette (e-cigarette) use among youth, few studies have examined whether e-cigarettes follow the same associational pattern with mental health problems in the context of other substance use. Additionally, the COVID-19 pandemic may have altered the associations between youth substance use and mental health problems due to both reduced overall use and increased mental health problems after the onset of the pandemic. The current study examined associations between youth substance use and psychological distress before and after the onset of the COVID-19 pandemic using two state-representative samples of youth in grades 8, 10, and 12 from 2019 (N = 58,689) and 2021 (N = 46,823) from Utah. Pooled cross-sectional linear and negative binomial regression models clustered by grade, stratified by school district, and weighted to represent population characteristics estimated associations between recent e-cigarette, combustible cigarette, cannabis, and heavy alcohol use and two measures of psychological distress—depressive symptoms and mental health treatment needs. After controlling for sociodemographic factors and recent uses of other substances, results indicated that psychological distress increased from 2019 to 2021 and that recent e-cigarette, combustible cigarette, cannabis, and heavy alcohol use were each significantly associated with increased levels on both measures of psychological distress. Compared to other substances, e-cigarette use showed the strongest standardized associations. The association of e-cigarette use with depressive symptoms strengthened significantly from 2019 to 2021. Given the youth mental health crisis paired with the widespread adoption of e-cigarettes, health professionals should consider recent e-cigarette use an increasingly important behavioral marker for risks of mental health problems among youth. Results suggest that future research studies examining the temporal ordering of substance use and mental health among youth should include e-cigarettes.

Tests for confounding with cigarette smoking in the association of E-cigarette use with respiratory disorder: 2020 National-Sample Data

Associations of e-cigarette use with respiratory disorder have been demonstrated but it has been unclear whether these are confounded by current or previous cigarette smoking. We address this question through studying different time frames for e-cigarette use and respiratory disorders in 2020 BRFSS data (N = 214,945). E-cigarette use and combustible cigarette smoking were classified into four categories: Participant never used either (Nonuse); used e-cigarettes/cigarettes but not in the past 30 days (Former Use), used in past 30 days on some days (Nondaily Use), or used past 30 days on all days (Daily Use). Contrasts for e-cigarette status and cigarette status (with nonuse as reference group) were entered with covariates in logistic regression with asthma or COPD as criterion. Stratified analyses of e-cigarette use were also performed for smokers and nonsmokers. In the total sample, results showed independent positive associations with both lifetime and current asthma for Former, Nondaily, and Daily e-cigarette use (mostly p < .0001) and the three cigarette indices. Significant positive associations with COPD were found for the three e-cigarette indices (p < .0001) and all the cigarette indices. Stratified analyses showed significant associations of e-cigarette use with respiratory disorder among nonsmokers as well as among smokers. We conclude that independent associations for former e-cigarette use (controlling for current/former smoking) and significant associations of e-cigarette use with respiratory disorder among nonsmokers indicate these associations are not confounded with cigarette smoking and suggest reverse causation is implausible. Findings for former use are discussed with reference to possible mechanisms including sensitization effects.

Investigating the effect of e-cigarette use on quitting smoking in adults aged 25 years or more using the PATH study.

Background: The evidence on harms and benefits of e-cigarettes partly concerns whether their use encourages smokers to quit. We addressed this using data from the nationally representative PATH study, with detailed accounting for potential confounding variables. Methods: We considered adults aged 25+. Our original analyses, reported in version 1 of this paper, used data for Waves 1 to 3, separate analyses considering Waves 1 to 2, 2 to 3 and 1 to 3. These related baseline ever e-cigarette use (or e-product use at Wave 2) to quitting at follow-up, adjusting for confounders derived from 55 candidates. Sensitivity analyses omitted ever other product users, linked quitting to current e-cigarette use, and used values of some predictors modified using follow-up data. Additional analyses used data for Waves 1 to 4, separately considering sustained, delayed and temporary quitting during Waves 1 to 3, 2 to 4 and 1 to 4. Sensitivity analyses considered 30-day quitting, restricted attention to smokers attempting to quit, and considered ever smokeless tobacco or snus use. Results: In the original analyses, unadjusted odds ratios (ORs) of quitting smoking for ever e-cigarette use were 1.29 (95% CI 1.01-1.66), 1.52 (1.26-1.83) and 1.47 (1.19-1.82) for the Wave 1 to 2, 2 to 3, and 1 to 3 analyses. These reduced after adjustment, to 1.23 (0.94-1.61), 1.51 (1.24-1.85) and 1.39 (1.11-1.74). Quitting rates remained elevated in users in all sensitivity analyses. The additional analyses found associations of e-cigarette use with sustained, delayed and temporary quitting, associations little affected by considering 30-day quitting, and only slightly reduced restricting attention to quit attempters. Ever use of smokeless tobacco or snus also predicted increased quitting. Conclusions: As does most evidence from clinical trials, other analyses of PATH, and other epidemiological studies, our results suggest using e-cigarettes helps adult smokers to quit.

Association of Smoking and E-Cigarette in Chronic Liver Disease: An NHANES Study.

BackgroundThere is an increased trend of e-cigarette but the toxic effects of e-cigarette metabolites are not widely studied especially in liver disease. Hence, we aimed to evaluate the prevalence and patterns of recent e-cigarette use in a nationally representative sample of US adults and adolescents and its association amongst respondents with liver disease.MethodsWe conducted a retrospective cross-sectional study using National Health and Nutrition Examination Survey (NHANES) database from 2015 to 2018. The self-reported NHANES questionnaire was used to assess liver disease (MCQ160L, MCQ170L and MCQ 510 (a-e)), e-cigarette use (SMQ900) and traditional smoking status (SMQ020 or SMQ040). We conducted univariate analysis and multivariable logistic regression models to predict the association of e-cigarette use, traditional smoking and dual smoking amongst the population with liver disease.ResultsOut of total 178,300 respondents, 7,756 (4.35%) were e-cigarette users, 48,625 (27.27%) traditional smoking, 23,444 (13.15%) dual smoking and 98,475 (55.23%) non-smokers. Females had a higher frequency of e-cigarette use (49.3%) compared to dual (43%) and traditional smoking (40.8%) (P < 0.0001). Respondents with a past history of any liver disease have lower frequency of e-cigarette use compared to dual and traditional smoking, respectively (2.4% vs. 6.4% vs. 7.2%; P < 0.0001). In multivariate logistic regression models, we found that e-cigarette users (odds ratio (OR): 1.06; 95% confidence interval (CI): 1.05 - 1.06; P < 0.0001) and dual smoking (OR: 1.50; 95% CI: 1.50 - 1.51; P < 0.0001) were associated with higher odds of having history of liver disease compared to non-smokers.ConclusionOur study found that despite the low frequency of e-cigarette use in respondents with liver disease, there was higher odds of e-cigarette use amongst patients with liver disease. This warrants the need for more future prospective studies to evaluate the long-term effects and precise mechanisms of e-cigarette toxicants on the liver.

Longitudinal associations between e-cigarette use and onset of multiple modes of cannabis use among US adolescents

ObjectiveTo examine the prospective associations between e-cigarette use and subsequent onset of various modes of cannabis use during a 12-month follow-up period among US adolescents. MethodsData were from the Wave 4 (2017, baseline) and Wave 4.5 (12-month follow-up) surveys of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study. Study population was cannabis-naïve US adolescents (12–16 years) at baseline who reported cannabis use status at follow-up (N = 9,692). Outcomes were modality-specific past-12-month cannabis use (vaping, blunting, smoking with hookah) and any cannabis use (past-12-month and past-30-day) at follow-up. Multivariate logistic regressions were used to estimate the weighted association between baseline past-30-day e-cigarette use and each outcome. ResultsBaseline e-cigarette use was significantly associated with onset of cannabis vaping (aOR = 4.00, 95% CI = 2.25–7.10), blunting (aOR = 5.30, 95% CI = 2.82–9.94), any cannabis use (aOR = 3.94, 95% CI = 2.35–6.62), and past-30-day cannabis use (aOR = 4.47, 95%CI = 2.64–7.58) at follow-up. Non-Hispanic blacks were more likely to report past-12-month blunting (aOR = 1.55, 95% CI = 1.07–2.24) and smoking cannabis with hookah (aOR = 3.13, 95% CI = 1.14–8.63) compared with non-Hispanic whites. Other tobacco use, alcohol use, perceiving e-cigarette use as having little or some harm, older age, high severity of externalizing mental health problems, and living in states legalized adult recreational cannabis use were significantly associated with future onset of cannabis vaping, blunting, and any cannabis use. ConclusionsThe association of e-cigarette use with cannabis vaping was not stronger than its association with other modes of cannabis use. Future studies are needed to explain the mechanisms linking e-cigarettes and cannabis use.

Association between e-cigarette use and food insecurity among low-income adults

IntroductionPrevious research quantifying the relationship between tobacco use and food insecurity has focused on cigarette smoking. E-cigarette use has become popular in recent years. Drawing on large, population-based survey data,...

Cancer Prevalence in E-Cigarette Users: A Retrospective Cross-Sectional NHANES Study.

BackgroundIt is well known that traditional smoking causes various types of cancer, leading to the current decline in traditional smoking among US adults from 20.9% in 2005 to 14.0% in 2019. Electronic cigarettes (e-cigarettes) are commonly marketed as a safe alternative and gaining popularity especially among never-smokers and adolescents. However, there is limited evidence of effects of e-cigarette on cancer. Hence, we aim to find the prevalence and association of e-cigarette and traditional smoking among cancer respondents.MethodsWe conducted a retrospective cross-sectional study using the NHANES database from 2015 to 2018. We assessed history of cancer (MCQ220), type of cancers (MCQ230a), and smoking status (e-cigarette: SMQ900 or SMQ905 and traditional smoking: SMQ020) using questionnaires. We performed multivariable logistic regression models to find the association of e-cigarette use, traditional smoking, and no smoking with cancer after adjusting for confounding variables.ResultsA total of 154,856 participants were included, of whom 5% were e-cigarette users, 31.4% were traditional smokers, and 63.6% were nonsmokers. There is a higher prevalence of e-cigarette use among younger participants, females (49 vs. 38) in comparison to traditional smokers (P < 0.0001). The e-cigarette users have lower prevalence of cancer compared to traditional smoking (2.3% vs. 16.8%; P < 0.0001), but they were diagnosed with cancer at a younger age. Among cancer subtypes, cervical cancer (22 vs. 2.6), leukemia (8.5 vs. 1.1), skin cancer (non-melanoma) (15.6 vs. 12.3), skin (other) (28 vs. 10) and thyroid (10.6 vs. 2.4) had higher prevalence of e-cigarette use compared to traditional smokers (P < 0.0001). Our regression analysis showed that e-cigarette users have 2.2 times higher risk of having cancer compared to non-smokers (odds ratio (OR): 2.2; 95% confidence interval (CI): 2.2 - 2.3; P < 0.0001). Similarly, traditional smokers have 1.96 higher odds of having cancer compared to nonsmokers (OR: 1.96; 95% CI: 1.96 - 1.97; P < 0.0001).ConclusionIn our study, e-cigarette users had an early age of cancer onset and higher risk of cancer. Hence, this is stepping stone for future research to evaluate the safety and effects of e-cigarettes in patients with cancer.

Association of Electronic Cigarette Use with Respiratory Symptom Development among U.S. Young Adults.

Rationale: Electronic cigarette (e-cigarette) use is highly prevalent among young adults. However, longitudinal data assessing the association between e-cigarette use and respiratory symptoms are lacking. Objectives: To determine whether e-cigarette use is associated with the development of respiratory symptoms in young adults. Methods: Data are derived from the PATH (Population Assessment of Tobacco and Health) study waves 2 (2014-2015), 3 (2015-2016), 4 (2016-2018), and 5 (2018-2019). Young adults aged 18-24 years at baseline with no prevalent respiratory disease or symptoms were included in the analyses. Binary logistic regression models with a generalized estimating equation were used to estimate time-varying and time-lagged associations of e-cigarette use during waves 2-4, with respiratory symptom development approximately 12 months later at waves 3-5. Measurements and Main Results: The per-wave prevalence of former and current e-cigarette use was 15.2% and 5.6%, respectively. Former e-cigarette use was associated with higher odds of developing any respiratory symptom (adjusted odds ratio [aOR], 1.20; 95% confidence interval [CI], 1.04-1.39) and wheezing in the chest (aOR, 1.41; 95% CI, 1.08-1.83) in multivariable adjusted models. Current e-cigarette use was associated with higher odds for any respiratory symptom (aOR, 1.32; 95% CI, 1.06-1.65) and wheezing in the chest (aOR, 1.51; 95% CI, 1.06-2.14). Associations persisted among participants who never smoked combustible cigarettes. Conclusions: In this nationally representative cohort of young adults, former and current e-cigarette use was associated with higher odds of developing wheezing-related respiratory symptoms, after accounting for cigarette smoking and other combustible tobacco product use.

Association of e-Cigarette Use With Discontinuation of Cigarette Smoking Among Adult Smokers Who Were Initially Never Planning to Quit

Cigarette smokers not planning to quit are often overlooked in population studies evaluating the risk-benefit potential of electronic nicotine delivery products (e-cigarettes). To evaluate whether e-cigarette use is associated with discontinuing cigarette smoking among smokers who were initially never planning to quit. This cohort study used US nationally representative data from the longitudinal Population Assessment of Tobacco and Health Study (waves 2-5 conducted between October 2014 and November 2019), with participants evaluated in 3 pairs of interviews. Adult daily cigarette smokers initially not using e-cigarettes and with no plans to ever quit smoking for good (2489 observations from 1600 individuals) were included. e-Cigarette use (ie, daily use, nondaily use, or no use) at follow-up interview among smokers not using e-cigarettes at baseline interview. The main outcomes were discontinuation of cigarette smoking (ie, no cigarette smoking) and discontinuation of daily cigarette smoking (ie, no daily cigarette smoking) at follow-up interview. Generalized estimating equations were used to evaluate the association between the exposure and each outcome, controlling for demographic characteristics and cigarettes smoked per day at baseline interview; all estimates were weighted. The weighted population of adult daily cigarette smokers who were not using e-cigarettes and had no plans to ever quit smoking, based on data from 1600 participants, was 56.1% male (95% CI, 53.4%-58.7%), 10.1% Hispanic (95% CI, 8.2%-12.3%), 10.1% non-Hispanic Black (95% CI, 8.7%-11.7%), 75.6% non-Hispanic White (95% CI, 72.9%-78.2%), and 4.2% of other non-Hispanic race (95% CI, 3.3%-5.4%); 29.3% were aged 55 to 69 years (95% CI, 26.2%-32.6%), 8.9% were aged 70 years or older (95% CI, 6.8%-11.5%), 36.8% did not graduate from high school (95% CI, 34.1%-39.6%), 55.2% had an annual household income of less than $25 000 (95% CI, 52.3%-58.1%), 37.6% smoked 20 to 29 cigarettes per day (95% CI, 34.7%-40.6%), and 12.7% smoked 30 or more cigarettes per day (95% CI, 10.9%-14.7%). Overall, 6.2% of the population (95% CI, 5.0%-7.5%) discontinued cigarette smoking. Discontinuation rates were higher among those who used e-cigarettes daily (28.0%; 95% CI, 15.2%-45.9%) compared with not at all (5.8%; 95% CI, 4.7%-7.2%; adjusted odds ratio [aOR], 8.11; 95% CI, 3.14-20.97). Furthermore, 10.7% (95% CI, 9.1%-12.5%) discontinued daily cigarette smoking, with higher rates of discontinuation observed among those who used e-cigarettes daily (45.5%; 95% CI, 27.4%-64.9%) compared with not at all (9.9%; 95% CI, 8.2%-11.8%; aOR, 9.67; 95% CI, 4.02-23.25). Nondaily e-cigarette use was not associated with cigarette discontinuation (aOR, 0.53; 95% CI, 0.08-3.35) or daily cigarette discontinuation (aOR, 0.96; 95% CI, 0.44-2.09). In this cohort study, daily e-cigarette use was associated with greater odds of cigarette discontinuation among smokers who initially had no plans to ever quit smoking. These findings support the consideration of smokers who are not planning to quit when evaluating the risk-benefit potential of e-cigarettes for smoking cessation in the population.

Smoking, Vaping, While Breastfeeding in the Era of COVID-19

Breastfeeding MedicineAhead of Print EditorialFree AccessSmoking, Vaping, While Breastfeeding in the Era of COVID-19Arthur I. EidelmanArthur I. Eidelman—Arthur I. Eidelman, MD, FABM, Editor in Chief, Breastfeeding Medicine Search for more papers by this authorPublished Online:28 Sep 2021https://doi.org/10.1089/bfm.2021.29192.aieAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This month's issue of Breastfeeding Medicine includes a most balanced summary by our regular esteemed contributor Phil Anderson regarding the dilemma of proscribing smoking cessation/reduction products to breastfeeding mothers. Estimates as to maternal postpartum smoking prevalence vary, but surveys of high-income countries report a rate of ∼10%.1 These levels do not include data from recent reports regarding the additional exposure to nicotine that results from the increased prevalence of >7% of e-cigarette use (vaping), particularly by teenagers and young adults.2 Unfortunately, specific data as to prevalence in nursing mothers are, to date, lacking.Smoking by breastfeeding mothers has been associated with reduced volume of breast milk, earlier weaning, and an increased risk for sudden infant death syndrome.3 Tobacco smoking itself has a negative effect on the macrocomposition of the milk as it decreases lipids, protein, and caloric content. In addition, smoking results in decreased antioxidant property of human milk. These negative effects have been attributed primarily to the pharmacologic effect of nicotine, but also to the effect of other toxic substances such as tar, lead, and cadmium. As such, use of e-cigarettes that results in less exposure of the mother to these toxic substances might well be preferable. Unfortunately data as to such a therapeutic trial are unavailable. However, one should note the recent disturbing report from McBride4 that noted an association of e-cigarette use during pregnancy and a decreased frequency of breastfeeding postpartum.In these days of the COVID-19 pandemic, the inevitable question is does smoking increase the risk of severe disease in those infected with the virus. Given the fact that smoking is an established risk factor for a myriad of pulmonary diseases, one would expect a clear-cut association with COVID-19 severity. Surprisingly, to date the population epidemiological surveys are inconclusive, with reports such as that of Karanasos5 who reported that smoking was associated with higher odds of severe disease, whereas another meta-analysis by Farsalinos,6 using a different methodology reported that in patients who were smokers, there was no increased risk for COVID-19 severe disease and or mortality.This seeming counter-intuitive finding may be supported by our understanding more fully the function of the nicotinic acetyl choline receptors who when stimulated (by nicotine) facilitate a pathway that modulates the activity of the immune system. Thus, it is postulated that exposure to nicotine (paradoxically) minimizes an uncontrolled immune response that is triggered by the COVID-19 virus, a response that may well be a major factor (mechanism) in inducing a severe morbidity/mortality outcome.These preliminary data surely do not legitimate the use of nicotine as a therapeutic modality in the treatment of COVID-19. In fact as Anderson details, the primary goal in the situation where a breastfeeding mother is also a smoker should be to maximize the continued and well-documented benefits of exclusive breastfeeding while minimizing the infant's exposure to the combined toxicity of smoking as much as possible. Thus, as he recommends the absolute goal should be to have the mother stop smoking and provide cautiously and judiciously an alternative less toxic source of nicotine such as patches and e-cigarettes for the mother to proceed with a weaning process. It is clear that no smoking cessation therapy appears to be ideal for nursing mothers as the various drugs have a theoretical potential toxicity for the breastfed infant or they have not been adequately studied for efficacy. But as Anderson so simply puts it, smoking cessation products are preferable to continued smoking during breastfeeding. Surely in these days of COVID-19.

Prevalence, Risk Factors, Harm Perception, and Attitudes Toward E-cigarette Use Among University Students in Qatar: A Cross-Sectional Study.

Background: Electronic cigarette (e-cigarette) use is becoming more popular worldwide, especially among youth. Studies report that university students have inadequate knowledge as well as misconceptions about the health risks of e-cigarettes, which may lead to their use even in populations where smoking prevalence is relatively low. At this age, the influence of peers is also significant. Understanding attitudes of university students toward the use of e-cigarettes is important for effective tobacco prevention interventions. In this study, we assess the prevalence of e-cigarette use among students in Qatar's largest national university, as well as their knowledge, attitudes, and perceptions of harm in relation to e-cigarettes.Methodology: We conducted a cross-sectional study among Qatar University students using a self-administered online questionnaire. Descriptive univariate analyses were conducted as well as bivariate analyses to check the association of e-cigarette use with variables of interest. A binary logistic regression analysis was conducted to assess determinants of e-cigarette use among students.Results: One hundred ninety-nine students completed the questionnaire. The prevalence of e-cigarette use among students was 14%, with no significant difference by gender (16.2% in males and 12.8% in females). In bivariate analyses, significantly fewer e-cigarette users believed that e-cigarettes cause disease compared to non-users. 67.9% of e-cigarette users compared to 37.6% of non-users believed that e-cigarettes were less harmful than traditional cigarettes, and 78.6% of users compared to 40.4% of non-users believed that their use could be helpful in preventing smoking traditional cigarettes. Bivariate associations between e-cigarette use and knowledge items were significant (p < 0.05) as well as having a smoker among siblings or friends. In the multivariate analysis, only having a friend who was a smoker remained significant after controlling for other variables (OR = 7.3, p < 0.001).Conclusion: Our study found that university students have knowledge gaps and misconceptions with regard to the harms associated with e-cigarettes use, especially among users. A comprehensive smoking prevention policy, educational interventions, and quit support are needed to enhance awareness among university students about the health effects associated with e-cigarettes use. Such interventions should also take into account the influence of peers on smoking practices.

Exploring the gateway hypothesis of e-cigarettes and tobacco: a prospective replication study among adolescents in the Netherlands and Flanders

BackgroundStudies demonstrated that adolescent e-cigarette use is associated with subsequent tobacco smoking, commonly referred to as the gateway effect. However, most studies only investigated gateways from e-cigarettes to tobacco smoking....

Association of Cigarette Type Initially Smoked With Suicidal Behaviors Among Adolescents in Korea From 2015 to 2018

Assessment of whether past electronic cigarette (e-cigarette) use or initiating smoking with e-cigarettes is associated with suicidal behaviors among adolescents is needed to inform future research and public health interventions. To evaluate the association between starting smoking with e-cigarettes or conventional cigarettes and suicidal behaviors among Korean adolescents. This cross-sectional study analyzed data on adolescents in grades 7 through 12 who participated in the nationwide Korea Youth Risk Behavior Web-Based Survey between 2015 and 2018. Type of cigarette initially smoked: electronic or conventional. Multiple logistic regression analysis was performed to examine the association between initial cigarette type and suicidal behaviors, including suicidal ideation and suicide planning and attempts. All participants completed questionnaires about their history of suicidal behavior and were categorized into groups according to the type of cigarette used at initiation of smoking and any subsequent change (or lack of change) in the type of cigarette used. A total of 255 887 Korean adolescents (51.2% male; mean (SD) age, 15.0 [1.8] years) were included in the primary analysis. Among 131 094 male adolescents, 3310 boys (2.5%) initially used e-cigarettes and 27 368 boys (20.9%) initially used conventional cigarettes. Among 124 793 female adolescents, 952 girls (0.8%) initially used e-cigarettes and 9296 girls (7.4%) initially used conventional cigarettes. Of those who initially used e-cigarettes, 178 of 3310 boys (5.4%) and 134 of 952 girls (14.1%) attempted suicide. Of those who initially used conventional cigarettes, 946 of 27 368 boys (3.5%) and 911 of 9296 girls (9.8%) attempted suicide. Adolescents who initially used e-cigarettes had a higher risk of suicidal behaviors, including suicide planning (boys: adjusted odds ratio [AOR], 1.63 [95% CI, 1.40-1.89]; P < .001; girls: AOR, 1.55 [95% CI, 1.23-1.95]; P < .001) and suicide attempts (boys: AOR, 1.55 [95% CI, 1.28-1.87]; P < .001; girls, AOR, 1.64 [95% CI, 1.29-2.10]; P < .001) compared with those who initially used conventional cigarettes. Changing from e-cigarettes to conventional cigarettes was associated with a higher risk of suicide attempts among both boys (AOR, 1.89; 95% CI, 1.39-2.57; P < .001) and girls (AOR, 2.36; 95% CI, 1.53-3.64; P < .001) compared with changing from conventional cigarettes to e-cigarettes. In this study, the initial use of e-cigarettes vs conventional cigarettes was associated with suicidal behaviors among adolescents. In future research on the association of e-cigarette use with adolescent mental health and interventions for suicide prevention, the type of cigarette initially used and changing the cigarette type should be considered.

E-cigarette users are associated with asthma disease: A meta-analysis.

At present, there are more than 300 million asthma patients in the world. Electronic cigarettes (e-cigarettes) are considered as a new way of smoking and are loved by young people. The relationship between e-cigarettes and asthma risk is still controversial. Therefore, we conducted a meta-analysis to explore the relationship between e-cigarettes and asthma. We searched PubMed, Embase, and Web of Science for research results published before august 2020. All data analysis was through R version 3.6.3. Publication bias was assessed using funnel plots, Begg's rank correlation test, and Egger regression asymmetry tests. Most of the included studies were adjusted for potential confounding factors. This meta found the association of e-cigarette use with asthma, and the combined OR value was 1.27 (95% CI=1.17-1.37). We found the significant association of current e-cigarette usage with asthma (OR=1.30, 95% CI=1.17-1.45), and the former use of e-cigarettes also had an association with asthma (OR=1.22, 95% CI=1.08-1.39). Then, when e-cigarettes were used in combination with traditional cigarettes, the association odds with asthma was 1.47 (95% CI=1.13-1.91), which was higher than that of users who used traditional cigarettes (OR=1.33, 95% CI=1.19-1.49). In subgroup analysis, adult and female e-cigarette users were more closely associated with asthma. In short, in this meta-analysis, we found that current or former use of e-cigarettes are associated with the prevalence of asthma. However, the specific relationship required more rigorous design for further verification.