Cessation Devices Research Articles

E-Cigarette Aerosol Condensate Leads to Impaired Coronary Endothelial Cell Health and Restricted Angiogenesis

Cardiovascular disease (CVD) is a leading cause of mortality worldwide, with cigarette smoking being a major preventable risk factor. Smoking cessation can be difficult due to the addictive nature of nicotine and the withdrawal symptoms following cessation. Electronic cigarettes (e-Cigs) have emerged as an alternative smoking cessation device, which has been increasingly used by non-smokers; however, the cardiovascular effects surrounding the use of e-Cigs remains unclear. This study aimed to investigate the effects of e-Cig aerosol condensate (EAC) (0 mg and 18 mg nicotine) in vitro on human coronary artery endothelial cells (HCAEC) and in vivo on the cardiovascular system using a mouse model of 'e-vaping'. In vitro results show a decrease in cell viability of HCAEC when exposed to EAC either directly or after exposure to conditioned lung cell media (p < 0.05 vs. control). Reactive oxygen species were increased in HCAEC when exposed to EAC directly or after exposure to conditioned lung cell media (p < 0.0001 vs. control). ICAM-1 protein expression levels were increased after exposure to conditioned lung cell media (18 mg vs. control, p < 0.01). Ex vivo results show an increase in the mRNA levels of anti-angiogenic marker, FKBPL (p < 0.05 vs. sham), and endothelial cell adhesion molecule involved in barrier function, ICAM-1 (p < 0.05 vs. sham) in murine hearts following exposure to electronic cigarette aerosol treatment containing a higher amount of nicotine. Immunohistochemistry also revealed an upregulation of FKBPL and ICAM-1 protein expression levels. This study showed that despite e-Cigs being widely used for tobacco smoking cessation, these can negatively impact endothelial cell health with a potential to lead to the development of cardiovascular disease.

Case report of methemoglobinemia after using e-cigarettes

Background: Despite a drastic increase among smokers using e-cigarette products in an attempt to wean off more harmful combustible cigarettes, there is no clear evidence promoting either the use of e-cigarettes (e-cigs) as a cessation device or understanding of the potential risks and benefits of these products, as per the U.S. Food and Drug Administration. Case Presentation: This case has an unusual presentation of methemoglobinemia in the emergency department for the same patient twice, immediately after using e-cigs/vapes on two separate occasions. Results: There is a possible association between e-cigarette use and methemoglobinemia. The aforementioned patient was successfully treated with the ordinary management for methemoglobinemia: methylene blue and supportive care. Conclusion: E-cigarette use has many unrecognized and possibly fatal complications. Based on our observations, we recommend a further clinical trial to study e-cigs as a causation factor for methemoglobinemia.

Marketing claims on websites of brick-and-mortar vape shops in the Greater Los Angeles area.

INTRODUCTIONBrick-and-mortar vape shops have increased in recent years, but there is limited research on the types of marketing claims consumers are exposed to on their websites – a dominant channel for marketing electronic nicotine delivery systems (ENDS). We investigated the websites of vape shop retailers in the Greater Los Angeles Area to describe their ENDS marketing claims.METHODSData collection occurred between 25 March and 20 June 2020. Of the 104 brick-and-mortar vape shops identified, 37 were found to have active websites. Rules were established to analyze website content. ENDS Marketing Claims were coded as the presence or absence of: 1) a direct claim of ENDS as a quitting aid; 2) a disclaimer that ENDS are not approved as smoking cessation devices (i.e. ENDS products are not FDA-approved for smoking cessation); 3) a direct claim of ENDS as healthier/safer than combustible cigarettes; and 4) direct claims regarding social benefits, including that ENDS are less expensive, can be used in more places, are cleaner or less messy/smelly, and are more socially accepted than combustible cigarettes.RESULTSSmoking cessation-related benefits were claimed most frequently (43%), followed by health-related claims (30%), and disclaimers that ENDS are not approved as smoking cessation devices (24%). More than half (56.4%) of websites had an age restriction, requiring the user to click on a box to state that they were aged ≥21 years to view the site. None required proof or outside verification of age.CONCLUSIONSBrick-and-mortar vape shops in the Greater Los Angeles Area are marketing ENDS on their websites as a healthier alternative to smoking cigarettes. Although half of the websites had an age gate popup that consumers see when they enter the website, action is needed to better enforce age restriction on access to vape shop websites. Utility for smoking cessation was claimed most frequently, followed by the claims of healthier alternatives to smoking cigarettes, and disclaimers that ENDS are not approved as smoking cessation devices. We discuss implications for tobacco regulatory policy.

An exploratory, randomised, crossover study to investigate the effect of nicotine on cognitive function in healthy adult smokers who use an electronic cigarette, after a period of smoking abstinence: study protocol

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Despite the known harmful effects of cigarette smoking, many individuals continue to smoke. Published scientific evidence suggests that smoking can influence various physiological and psychological functions (including effects on cognitive function, body weight and emotion). For some smokers, the loss of such effects have been cited as barriers to cigarette smoking cessation and the deficits in such effects may contribute to resumption of smoking post quitting. Whilst not positioned as cigarette cessation devices, the effect of e-cigarettes (and other potentially reduced risk alternatives to cigarette smoking) on such functions has not been widely researched. Such information would provide support for the proposition that smokers seeking alternatives may find e-cigarettes a satisfactory substitute for conventional cigarettes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This randomised, partially blinded, crossover study will test the hypothesis that acute nicotine delivery via an e-cigarette can influence cognitive parameters including sustained attention, episodic memory, working memory and executive function to the same extent as a combustible cigarette after a period of nicotine abstinence in current smokers. To determine participants’ cognitive ability, the study will utilise the Cambridge Neuropsychological Test Automated Battery (CANTAB) Connect Profile Software (CANTAB® www.cantab.com). Up to 40 current smokers will be recruited into the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The data from this trial will be a valuable addition to the growing body of literature assessing the impact of RRPs for existing smokers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;This study is registered with the ISRCTN registry, number ISRCTN35376793.&lt;/p&gt;

Compliance to Online Retail of Electronic Nicotine Delivery Systems (ENDS) in India before and after the 2018 Ban Order of the Government of India.

Since their launch globally in 2012, electronic nicotine delivery systems (ENDS) were positioned as a harm reduction strategy and cessation device but it is yet to be proven to have clinical safety or public health benefits. Instead, recent reports suggest that the tobacco industry targeted youth and sponsored research whose evidence was used to mislead policymaking. On August 28, 2018, Ministry of Health & Family Welfare's advisory banned the sale, purchase, and trade of ENDS. A survey was done in two waves. The first survey was done between August 10 and 25 2018 all websites which sold ENDS product were mapped and documented. The survey was repeated (November 30, 2018) were after the restriction to trade on ENDS was proposed by the Department of Customs. The two waves of survey found that no website, whether comprehensive e-commerce portals or dedicated ENDS marketing platforms fully complied with government orders. National and states government enforcement agencies are currently unaware of internet-based sale of ENDS. Although some states have given specific directions to stop the sale and delivery of ENDS within the state through e-commerce, there is limited monitoring and legal compliance by seller. Public health advocates need to stay vigilant and monitor the online sale and point of sale retail of ENDS to ensure strict compliance of national and state regulations.

Incidence of Cigarette Smoking Relapse Among Individuals Who Switched to e-Cigarettes or Other Tobacco Products

Although e-cigarettes are not approved as a cessation device, many who smoke believe that e-cigarettes will help them quit cigarette smoking successfully. To assess whether people who recently quit smoking and who had switched to e-cigarettes or another tobacco product were less likely to relapse to cigarette smoking compared with those who remained tobacco free. This cohort study analyzed a nationally representative sample of US households that participated in 4 waves of the Population Assessment of Tobacco and Health Study (conducted 2013 through 2017), combining 2 independent cohorts each with 3 annual surveys. Eligible participants were individuals who smoked at baseline, had recently quit at the first follow-up, and completed the second follow-up survey. Use of e-cigarettes or alternate tobacco products at follow-up 1 after recently quitting smoking. Weighted percentage of participants with over 12 months abstinence by follow-up 2. Of a total of 13 604 participants who smoked cigarettes at baseline, 9.4% (95% CI, 8.7%-10.0%) recently had quit smoking (mean age, 41.9; 95% CI, 39.7-46.6 years; 641 [43.2%] women) Of these, 22.8% (95% CI, 19.7%-26.0%) had switched to e-cigarettes, with 17.6% (95% CI, 14.8%-20.5%) using them daily. A total of 37.1% (95% CI, 33.7%-40.4%) used a noncigarette tobacco product and 62.9% (95% CI, 59.6%-66.3%) were tobacco free. Rates of switching to e-cigarettes were highest for those who were in the top tertile of tobacco dependence (31.3%; 95% CI, 25.0%-37.7%), were non-Hispanic White (26.4%; 95% CI, 22.3%-30.4%), and had higher incomes (annual income ≥$35 000, 27.5%; 95% CI, 22.5%-32.4% vs <$35 000, 19.3%; 95% CI, 16.3%-22.3%). At follow-up 2, unadjusted relapse rates were similar among those who switched to different tobacco products (for any tobacco product: successfully quit, 41.5%; 95% CI, 36.2%-46.9%; relapsed with significant requit, 17.0%; 95% CI, 12.4%-21.6%; currently smoking, 36.2%; 95% CI, 30.9%-41.4%). Controlled for potential confounders, switching to any tobacco product was associated with higher relapse rate than being tobacco free (adjusted risk difference, 8.5%; 95% CI, 0.3%-16.6%). Estimates for those who switched to e-cigarettes, whether daily or not, were not significant. While individuals who switched from cigarettes to e-cigarettes were more likely to relapse, they appeared more likely to requit and be abstinent for 3 months at follow-up 2 (17.0%; 95% CI, 12.4%-21.6% vs 10.4%; 95% CI, 8.0%-12.9%). This large US nationally representative study does not support the hypothesis that switching to e-cigarettes will prevent relapse to cigarette smoking.

Critical research gaps in electronic cigarette devices and nicotine aerosols.

Electronic cigarettes (e-cigs) are devices that aerosolize nicotine-containing liquids for delivery as an inhaled vapor. E-cigs are currently marketed as smoking cessation devices, though the emergence and rapid adoption of these devices in recent years has sparked a great deal of concern over their safety. Given the plethora of devices and nicotine solutions available on the market and the lack of regulation and quality control, it is imperative that these devices and nicotine formulations are studied to assess critical operating parameters, the pharmacokinetic profiles of the inhaled nicotine, and the toxicity profiles of the e-cig aerosols. This review aims to deliver an overview of current research regarding electronic cigarette devices, nicotine-containing liquid formulations, pharmacokinetics of nicotine, and toxicology studies in order to highlight areas lacking in research or requiring greater standardization and regulation.

Electronic cigarettes: Emerging trends and research hotspots.

INTRODUCTIONResearch on electronic cigarettes is an emerging field, with the number of articles in this field noted to have grown exponentially over recent years. We used a bibliometric analysis method (co-word analysis) to analyze the emerging trends and research hotspots in this field.METHODSPublication data on electronic cigarettes from 2010 to 2018 were retrieved and downloaded from the PubMed database. Theme trends and knowledge structures were analyzed on the relevant research fields of electronic cigarettes by using a biclustering analysis, strategic diagram analysis, and social network analysis methods. Research hotspots were extracted and compared from three periods.RESULTSCore topics that have continuously develop between the years 2010 and 2018 include: tobacco use cessation devices; tobacco products; tobacco use cessation devices/adverse effects; smoking prevention and adverse effects; electronic nicotine delivery systems/economics; and public health. Some currently undeveloped topics that could be considered as new future research directions include: tobacco use disorder/therapy; tobacco use disorder/epidemiology; students/psychology; students/statistics and numerical data; adolescent behavior/psychology; nicotine/toxicity; nicotinic agonists/administration and dosage; and electronic nicotine delivery systems/legislation and jurisprudence.CONCLUSIONSResults suggest that some currently immature topics in strategic coordinates and emerging hotspots in social network graphs can be used as future research directions.

Associations of Socioeconomic Status, Parental Smoking and Parental E-Cigarette Use with 10–11-Year-Old Children’s Perceptions of Tobacco Cigarettes and E-Cigarettes: Cross Sectional Analysis of the CHETS Wales 3 Survey

Background: This study examines primary schoolchildren’s perceptions of e-cigarettes and tobacco cigarettes, and associations with parental smoking, vaping and socioeconomic status. Methods: Survey of 2218 10–11-year-old children in 73 schools in Wales. Results: Overall, 36% reported that a parent figure smoked compared to 21% for vaping, with parental smoking lower in affluent families (OR = 0.72; 95% CI = 0.68 to 0.76). Overall, 1% had tried a cigarette, while 5% had tried an e-cigarette. Most said they would not smoke or vape in 2 years’ time; susceptibility to vaping (20%) was higher than smoking (12%). Exposure to and perceptions of tobacco cigarettes were more positive for children of smokers. Having a parent who vaped was associated with exposure to and positive perceptions of e-cigarettes, but not smoking. Most children perceived e-cigarettes as used by adults to stop smoking (64%). Susceptibility to smoking (OR = 0.57; 95% CI = 0.41 to 0.79) and vaping (OR = 0.78; 95% CI = 0.62 to 0.99) were lower among children who perceived e-cigarettes as cessation aids. Conclusions: Parental smoking continues to be concentrated in poorer families. This study provides no evidence that parental vaping in the absence of smoking is associated with more positive perceptions of tobacco cigarettes. Communicating to children the role of e-cigarettes as cessation devices for smokers may help to limit their appeal to young people.

Health claims made in vape shops: an observational study and content analysis

BackgroundPrior to the final deeming rule, federal law in the USA prohibited electronic cigarettes (e-cigarettes) from being marketed as smoking cessation products; for other therapeutic purposes and in ways that...

New Zealand tobacco retailers’ understandings of and attitudes towards selling Electronic Nicotine Delivery Systems: a qualitative exploration

IntroductionIn 2017, the New Zealand Government signalled its intent to legalise the widespread sale of Electronic Nicotine Delivery Systems (ENDS), which many New Zealand retailers have actually sold for several...

Analysis of Toxic Metals in Electronic Cigarette Aerosols Using a Novel Trap Design.

Since 2006 the domestic popularity and sales of electronic cigarettes (i.e., electronic nicotine delivery systems or ENDS) have grown rapidly. Although the constituents of the aerosol produced by ENDS have been previously investigated, differences in puff regimens and aerosol trapping schema in published literature often complicate result comparisons and data interpretation. As the ENDS product designs continue to evolve, there is a critical need to develop and validate robust methodologies for laboratory testing, appropriate aerosol generation and trapping media required for accurate determinations of ENDS aerosol metals deliveries. A simple, high metals purity, fluoropolymer trap was developed and validated that meets standard machine puffing regimen (CORESTA Recommended Method 81) specifications and exhibits negligible acid extractable metal backgrounds. Using a standard machine puffing regimen in combination with a fluoropolymer condensation trap, aerosol was generated and collected from select ENDS devices for analysis of chromium, nickel, copper, zinc, cadmium, tin, and lead with triple quadrupole inductively coupled plasma mass spectrometry. Devices tested spanned a range of commercial products, including flavored variants of JUUL pods, refillable tank systems, rechargeable cartridges, and single-use ENDs devices. Results showed that for aerosols generated under a fixed puffing regimen (50 puffs/collection), metal concentrations ranged from below the detection limits (LOD) to 614ng copper and 339ng zinc per 10 puffs. Cadmium concentrations were below LOD for all devices tested. Device specific aerosol levels of Sn and Pb ranged from below LOD to low nanogram levels. Cr and Ni were transported in aerosols at levels equivalent to, or slightly higher than in mainstream cigarette smoke using a standard smoking regimen. The generally lower levels of specific metals, Cd and Pb, transmitted in ENDS aerosols compared to mainstream cigarette smoke reflect possible reduction of harm for smokers who substitute the use of ENDS as cessation devices in place of smoking cigarettes.

Well on the way: An exploratory study on occupational health in hospitality

This study conducted a comprehensive review of work conditions and health risks/problems for various hospitality workers and summarized the various health and wellness promotion programs available in the workplace with the aim of identifying the key elements of successful employee wellness programs. In this review, physical health problems, such as musculoskeletal disorders, lung diseases, and dermatologic diseases, as well as mental health problems that are common among hospitality employees were discussed. In addition, different types of wellness programs that may help employees to overcome these health problems were included. In the next stage, interviews with hotel staff holding multiple positions were conducted to identify the most significant health challenges and assess their preference for various types of wellness initiatives. Using MAXQDA Pro, health-related categories and themes were extracted from the interviews. Participants believed that the lack of time, physical challenges and stress are the top three wellness challenges in the hospitality industry. In order to tackle the challenges, they stated that hospitality businesses should provide various wellness initiatives including healthy eating and weight management, smoking cessation, stress management, exercise programs, and fitbits or other wellness tracker devices.

Characteristics of US adults attempting tobacco use cessation using e-cigarettes

BackgroundUse of e-cigarettes for tobacco cessation efforts is a growing trend in the United States. However, little is known about the factors that determine the use of e-cigarettes for this specific purpose. MethodsThis study examined current and former cigarette smokers that reported ever using e-cigarettes. Data were obtained from a 2018 Texas population health assessment survey (n = 569) and weighted to be representative to Texas. A multivariable logistic regression was used to assess the socio-demographic and behavioral correlates of using e-cigarettes for tobacco cessation. ResultsOverall, 41.3% of e-cigarette users reported using them for tobacco cessation. Among ever e-cigarette users, Non-Hispanic blacks (aOR: 0.21; 95% CI, 0.07–0.64), males (aOR: 0.40; 95% CI, 0.20–0.80), and individuals not confident in obtaining health information (aOR: 0.38; 95% CI, 0.15–0.96) were less likely to use e-cigarettes for tobacco use cessation. Conversely, among ever e-cigarette users, odds of using e-cigarettes for tobacco cessation were higher among those who were 35–44 years old (aOR: 3.68, 95% CI: 1.26–10.71), those who received advice to quit smoking from a healthcare professional (aOR: 2.77, 95% CI, 1.36–5.64), and those with more than 5 years since their last routine checkup (aOR: 3.91; 95% CI, 1.23–12.45). ConclusionFindings from this study suggest that both health behaviors and sociodemographic factors predict use of e-cigarettes for the purpose of tobacco cessation. Furthermore, the relationship between use of e-cigarettes as a cessation device and being advised to quit tobacco use by a healthcare professional calls for additional investigation.

Point-of-sale marketing of heated tobacco products in Israel: cause for concern

Understanding how PMI markets IQOS at the point-of-sale in Israel is critical to determining whether marketing practices adhere to regulations and appeal to groups most at risk at initiating new tobacco products, such as adolescents. An article by Bar-Zev, Levine, Rubinstein, Khateb, and Berg (2019) examined the marketing of IQOS in retail stores in Israel. They found that while no free samples or promotions were provided at the point-of-sale, IQOS and their related HEETS (HeatSticks) were placed near youth-oriented merchandise and in prominent locations easily seen by youth. Further, package colors were used to indicate tobacco flavorings and strength, and retailers described the IQOS products as being less harmful, a cessation device, and not producing smoke. These findings are concerning given numerous studies linking marketing of novel tobacco products, product misperceptions, and subsequent tobacco use. Studies are needed to ensure that the marketing of IQOS, including the use of package colors, product placement at point-of-sales, and other product characteristics are significantly reducing harm and risk of tobacco-related disease to IQOS users, and that the health of the population as a whole, including those not using IQOS or other tobacco products, will not be harmed. Until such evidence is available, caution is warranted and regulations needed in the marketing of these novel products.

SUN-067 E-cigarettes and High Fat Diet Cause Alteration in Cardiac Structure and Function

Smoking is the major cause of cardiovascular diseases (CVD) and is the single largest cause of death in the USA. Smoking cessation can reduce the mortality from CVD. Electronic cigarettes, also known as electronic nicotine delivery systems (ENDS), have been marketed as a smoking cessation device. In spite of the widespread use of ENDS and the proposed detrimental cardiac and atherosclerotic effects of nicotine, the effects of ENDS on these systems are not well known. Recently, using Apolipoprotein E null mice, we demonstrated that mice exposed to e-cigarettes have decreased cardiac fractional shortening and ejection fraction together with ventricular ultrastructural abnormalities indicative of cardiomyopathy in comparison with controls. In this study, we investigated the detrimental effects of ENDS at doses similar to the clinically relevant concentrations found in habitual smokers and a high fat diet (HFD) on cardiac structure and function in a commonly used model of diet-induced obesity. C57 BL6 mice fed HFD were exposed to ENDS in the presence (2.4%) or absence (0%) of nicotine and saline aerosol for 12 weeks. Mice exposed to ENDS (2.4%) had increased serum free fatty acid levels in comparison with saline and ENDS (0%). Echocardiographic data show that mice treated with ENDS (2.4%) had decreased left ventricular fractional shortening and ejection fraction compared to ENDS (0%) and saline. Transmission electron microscopy revealed that cardiomyocytes of mice treated with ENDS (2.4%) exhibited ventricular abnormalities, including lipid accumulation (ventricular steatosis), myofibrillar derangement and destruction, and mitochondrial hypertrophy. Additionally, ENDS (2.4%) also caused increased cardiac oxidative stress and triggered cardiomyocyte apoptosis. These results demonstrate profound adverse effects of ENDS on ventricular structure and function in obese mice. We surmise that ENDS exposure may cause heart failure and other forms of cardiomyopathy in obese patients. This is important information for patients that use ENDS and regulatory agencies that regulate ENDS.

The Messages Presented in Electronic Cigarette-Related Social Media Promotions and Discussion: Scoping Review.

BackgroundThere has been a rapid rise in the popularity of electronic cigarettes (e-cigarettes) over the last decade, with growth predicted to continue. The uptake of these devices has escalated despite inconclusive evidence of their efficacy as a smoking cessation device and unknown long-term health consequences. As smoking rates continue to drop or plateau in many well-developed countries, transnational tobacco companies have transitioned into the vaping industry and are now using social media to promote their products. Evidence indicates e-cigarettes are being marketed on social media as a harm reduction alternative, with retailers and manufacturers utilizing marketing techniques historically used by the tobacco industry.ObjectiveThis study aimed to identify and describe the messages presented in e-cigarette–related social media (Twitter, YouTube, Instagram, and Pinterest) promotions and discussions and identify future directions for research, surveillance, and regulation.MethodsData sources included MEDLINE, Scopus, ProQuest, Informit, the Journal of Medical Internet Research, and Google Scholar. Included studies were published in English between 2007 and 2017, analyzed content captured from e-cigarette–related social media promotions or discussions, and reported results for e-cigarettes separately from other forms of tobacco and nicotine delivery. Database search ceased in October 2017. Initial searches identified 536 studies. Two reviewers screened studies by title and abstract. One reviewer examined 71 full-text articles to determine eligibility and identified 25 studies for inclusion. This process was undertaken with the assistance of the Web-based screening and data extraction tool—Covidence. The review was registered with the Joanna Briggs Institute (JBI) Systematic Reviews database and followed the methodology for JBI Scoping Reviews.ResultsSeveral key messages are being used to promote e-cigarettes including as a safer alternative to cigarettes, efficacy as a smoking cessation aid, and for use where smoking is prohibited. Other major marketing efforts aimed at capturing a larger market involve promotion of innovative flavoring and highlighting the public performance of vaping. Discussion and promotion of these devices appear to be predominantly occurring among the general public and those with vested interests such as retailers and manufacturers. There is a noticeable silence from the public health and government sector in these discussions on social media.ConclusionsThe social media landscape is dominated by pro-vaping messages disseminated by the vaping industry and vaping proponents. The uncertainty surrounding e-cigarette regulation expressed within the public health field appears not to be reflected in ongoing social media dialogues and highlights the need for public health professionals to interact with the public to actively influence social media conversations and create a more balanced discussion. With the vaping industry changing so rapidly, real-time monitoring and surveillance of how these devices are discussed, promoted, and used on social media is necessary in conjunction with evidence published in academic journals.

To "vape" or smoke? Experimental evidence on adult smokers.

A growing share of the United States population uses e-cigarettes but the optimal regulation of these controversial products remains an open question. We conduct a discrete choice experiment to investigate how adult tobacco cigarette smokers' demand for e-cigarettes and tobacco cigarettes varies by four attributes: (i) whether e-cigarettes are considered healthier than tobacco cigarettes, (ii) the effectiveness of e-cigarettes as a cessation device, (iii) bans on use in public places, and (iv) price. We find that adult smokers' demand for e-cigarettes is motivated more by health concerns than by the desire to avoid smoking bans or higher prices.

Smokers' knowledge and perception of electronic cigarettes (e-cigarettes): a qualitative study of non-quitting smokers in a North London general practice.

The introduction of electronic cigarettes (e-cigarettes) has provided smokers with an alternative source of nicotine. Interest and use of the device has increased exponentially in the last decade with an estimated 2.9 m adult users in Great Britain. Research so far on the attitudes and perceptions of smokers to this new product has largely focussed on the views of current e-cigarette users, smokers attempting to quit and former cigarette smokers. This study aimed to explore the views of current tobacco smokers who were not using e-cigarettes and not looking for a cessation method, their understanding and knowledge of e-cigarettes, and their views of e-cigarettes as a smoking cessation aid provided by the National Health Service (NHS). Semi-structured in-depth interviews were conducted with 14 patients from a general practice in North London, who smoked conventional tobacco cigarettes on a daily or weekly basis, over 18 years old. An iterative approach allowed for constant data analysis using a thematic approach throughout the data collection stage, and generated four recurring themes. E-cigarettes were primarily seen as a smoking cessation device, with the supply of nicotine viewed as a benefit helping to reduce withdrawal symptoms, although for some participants this supply could also be a hindrance to dealing with their addiction. Despite uncertainty about the components, e-cigarettes were mostly viewed as healthier due to their lack of carcinogens, tar and smoke inhalation. The lack of reliable information and strong evidence for both the effectiveness and the safety of e-cigarettes led participants to be apprehensive about their provision by the NHS, and acted as a barrier to their use as an aid to quitting. The recurring appeal for more information regarding e-cigarettes make it clear that further high-quality research is urgently needed in this field to provide reliable and accurate information to smokers.

Are E-Cigarettes a Less Harmful Alternative to Smoking?

Are E-Cigarettes a Less Harmful Alternative to Smoking?