Combustible Cigarette Smoking Research Articles

An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial.

Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute's QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002. PRR1-10.2196/52090.

A reduced exposure heated tobacco product was introduced then abruptly taken off United States shelves: results from a tobacco harm reduction natural experiment

BackgroundA heated tobacco product (HTP) authorized for purchase in the United States by the Food and Drug Administration as a reduced harm product was removed from the market after about 2 years of sales. Adults who used the HTP were surveyed to determine the impact of the introduction and removal of the HTP on past and current tobacco behaviors.MethodsAdults who were using the HTP before its United States market removal (n = 502) completed a cross-sectional online survey to determine their tobacco use behaviors at three timepoints: prior to HTP initiation, just before HTP market removal, and at the time of the survey which was administered approximately 10 months post-removal. Descriptive statistics summarized outcome variables and paired bivariate testing was used to compare percent change between timepoints. Multivariable logistic regression and general linear models estimated associations of tobacco use behaviors and cigarette consumption.ResultsOverall, significantly fewer adults consumed cigarettes while using HTP than before they tried the product (63.0% vs. 89.9%, p value < 0.0001) and the number of cigarettes consumed per week (CPW) decreased (106.3–39.0, p value < 0.0001). After HTP removal, the percent of adults who consumed cigarettes increased non-significantly (63.0–67.5%, p value = 0.0544) while CPW increased significantly (39.0–76.6 CPW, p value < 0.0001). At the time of the survey, over 25% of the sample continued to use the HTP and 7.2% reported use of no tobacco products. Electronic nicotine delivery system use had increased significantly from the prior period (27.4% increase, p value < 0.0001).ConclusionThis study demonstrates reduction or elimination of combustible cigarette smoking while adults were using HTPs and some increased smoking after market removal, albeit at lower levels. If unable to find satisfying alternatives, adults who smoke and transition to reduced harm products may return to smoking or purchase products illicitly if their preferred products are removed from the regulated market.

Combustible cigarette smokers versus e-cigarette dual users among Latinx individuals: Differences in alcohol and drug use severity.

The Latinx population in the United States (U.S.) experiences significant tobacco and other substance use-related health disparities. Yet, little is known about the couse of combustible cigarettes and e-cigarettes (dual use) in relation to substance use behavior among Latinx smokers. The present investigation compared English-speaking Latinx adults living in the United States who exclusively smoke combustible cigarettes versus dual users in terms of alcohol use and other drug use problem severity. Participants were 297 Hispanic/Latinx daily cigarette smokers (36.4% female, Mage = 35.9 years, SD = 8.87) recruited nationally across the United States using Qualtrics Panels to complete self-report measures of behavioral health outcomes. Five analysis of covariance models were conducted to evaluate differences in overall alcohol consumption, dependence, related problems, hazardous drinking, and drug use problem severity between exclusive combustible cigarette smokers (N = 205) and dual users (N = 92). Results indicated that dual users evinced greater levels of alcohol consumption, dependence, alcohol-related problems, and hazardous drinking compared to exclusive combustible cigarette smokers (ps < .001). Dual users also reported greater levels of drug use problems relative to exclusive combustible cigarette smokers (p < .001). The current findings are among the first to document that dual cigarette and e-cigarette use status (compared to exclusive combustible cigarette smoking) may serve as a clinically relevant risk indicator for a range of deleterious substance use problems among Latinx individuals. Future research is needed to corroborate these findings and examine dual-use status as a longitudinal predictor of alcohol and other substance-related problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association between Combustible Cigarettes and Noncombustible Nicotine or Tobacco Products and Generalized Anxiety Disorder Based on Data from the 8th Korea National Health and Nutrition Examination Survey 2021.

Despite the increasing prevalence of anxiety disorders in Korea, there have been no nationwide studies on the association between tobacco status and generalized anxiety disorder (GAD). Furthermore, despite the increasing number of people using noncombustible nicotine or tobacco products (NNTPs), the association between NNTP use and GAD remains unclear. Therefore, this study investigated the association between tobacco use and GAD. This nationwide study used data from the 8th Korea National Health and Nutrition Examination Survey (2021) and included 5,454 adults aged ≥19 years who self-reported on the tobacco use and mental health sections. Multivariable logistic regression analysis was performed to investigate the odds ratios (ORs) of GAD (Generalized Anxiety Disorder-7 score ≥10) according to tobacco status among Korean adults. The severity of anxiety was assessed using the Generalized Anxiety Disorder-7 scale. Compared to never tobacco users, the ORs of GAD for combustible cigarette smokers and NNTP users were 2.74 (95% confidence interval [CI], 1.66-4.50) and 2.11 (95% CI, 1.16-3.83), respectively. The OR of GAD for former tobacco users was 1.63 (95% CI, 0.98-2.72). Tobacco use (combustible cigarettes and NNTP) was positively associated with GAD. However, in former tobacco users, there was no significant association with GAD when compared with never tobacco users. Given the OR of GAD among tobacco users, it is crucial to pay attention to screening for GAD and implement appropriate early interventions.

Unveiling the Impact of Electronic Cigarettes (EC) on Health: An Evidence-Based Review of EC as an Alternative to Combustible Cigarettes.

Cigarette smoking has been considered a major public health concern due to its serious impact on health. However, smokers intending to quit may find long-term abstinence challenging. When smoking an electronic cigarette (EC), users can experience a sensation and taste similar to that of smoking a combustible cigarette. Therefore, manufacturers promote these products as a viable substitute for combustible cigarettes. However, several researchers report the serious health impacts experienced by EC users. Therefore, this review aims to examine the health impacts of EC use. Based on the findings of the research papers reported in the literature, the role of EC as a smoking cessation tool is unclear. Several researchers have also reported a significant association between EC usage among non-smokers at baseline and the future initiation of combustible cigarette smoking. EC use significantly impacts user health. The nicotine that is present in EC e-liquids can elevate blood pressure, resulting in blood vessel constriction and an increase in heart rate, ultimately leading the body to an ischemic condition, resulting in myocardial infarction (MI), stroke, and increased arterial stiffness. Researchers report a higher likelihood of prediabetes among EC users; its usage was associated with higher OR of having asthma attacks and higher OR of reporting depression and has an impact on birth outcomes among pregnant women. Men using EC are more likely to report erectile dysfunction than non-users. EC also has a significant impact on oral health, which includes periodontal diseases, mucosal lesions, irritation in the mouth and throat, reduced salivary flow, and an increased risk of developing cancer. The physical injury resulting from exploding EC is another health concern. The frequently burned areas included the hands, face, genitalia, and thighs. Marketers promote EC as an alternative to combustible cigarettes and a tool for quitting smoking. However, the Food and Drug Administration has not approved them for smoking cessation. EC can have a serious impact on the health of their users; hence, the findings of this paper have several implications, including the need for regulation of the sales and marketing of these products and educating the users on the impact of these products on their health and safety.

Nicotine Vaping Expectancies: Organization and Activation in Memory Based on Vaping Use Patterns.

Prevalence of smoking combustible cigarettes has decreased, but rates of nicotine vaping among adolescents and young adults have increased dramatically. Vaping is associated with acute health problems and exposes users to toxic metals with unknown long-term consequences. Research on factors influencing vaping is needed to inform development of effective prevention and intervention methods. Nicotine vaping expectancies, or expected effects related to vaping, may be an important target as they can predict vaping behaviors. The purpose of this study was to examine nicotine expectancy activation patterns with corresponding nicotine vaping behaviors. Using methods from alcohol expectancy research, we applied a memory model approach to identifying nicotine vaping expectancies and modeling organization and activation patterns in relation to frequency of nicotine vaping. We created a memory model-based nicotine expectancy measure based on information from 200 adolescents in 8th and 12th grades, and 429 college students. Our expectancy measure was completed by a second sample of 862 college students. We mapped expectancies into network format using Individual Differences Scaling (INDSCAL) and we modeled likely paths of expectancy activation using Preference Mapping (PREFMAP). Non-users primarily emphasized a positive-negative expectancy dimension and were more likely to activate expectancies of negative internal experiences in relation to vaping. Students who vaped nicotine daily or almost daily primarily emphasized an external appearance-internal experience expectancy dimension and were more likely to activate expectancies of negative affect reduction and withdrawal relief. Our results identify specific targets for expectancy-based prevention and intervention methods that have the potential to be as effective as similar approaches to preventing and reducing alcohol use.

Acceptability of Hormonal Contraceptives as a Smoking Cessation Aid for Women of Reproductive Age: A Web-Based Cross-Sectional Survey.

Cigarette smoking is the most common cause of preventable cancers and other premature morbidity and mortality. Modifying hormonal patterns using hormonal contraceptives (HCs) may lead to improved smoking cessation outcomes in women, though the acceptability of this is unknown. Therefore, we explored the willingness of reproductive-age women who smoke to use HC for cessation. A cross-sectional online survey was conducted with a convenience sample of reproductive-age women living in the United States who self-reported smoking combustible cigarettes. Questions covered smoking history, previous HC use, and willingness to use various HC methods (i.e., injectable, oral, patch, vaginal insert) for cessation. Chi-squared tests and logistic regression were conducted using StataBE 17.1. Of 358 eligible respondents, n = 312 (86.9%) reported previous HC use. Average age of those with HC use history was 32.1 ± 6.1 years compared with 27.8 ± 6.7 years for those without history of HC use (p = 0.001). Of respondents who reported previous HC use, 75.6% reported willingness to use HCs, compared with 60.9% of those without a history of HC use. Overall, willingness to use various types of HC ranged from 22.6% for the vaginal insert to 59.2% willing to use an oral contraceptive. These observations indicate that most women who smoke cigarettes are willing to use HC for a smoking cessation aid, especially if they have a history of HC use and with an oral form of HC. To improve the rate of smoking cessation for women of reproductive age, future interventions should explore how to incorporate HC for cessation.

E-cigarettes and heated tobacco products impact on dental color parameters

ObjectivesAbstaining from tobacco smoking may not only improve general health, but also reduce teeth staining and restore teeth whiteness. Compared with conventional cigarettes, E-cigarettes (ECs) and heated tobacco products (HTPs) may offer substantial reduction in exposure to pigmented tar-like compounds of cigarette smoke. It is possible that improvements in dental color indices may be observed in those who have stopped smoking combustible cigarettes by switching to tar-free nicotine delivery products. MethodsThis cross-sectional study evaluated and compared dental color parameters by digital spectrophotometry among five different groups: individuals who currently smoke ; individuals who used to smoke but have quit ; individuals who have never smoked ; exclusive users of electronic cigarettes (former smokers) ; and exclusive users of heated tobacco products (former smokers) . ResultsDental whiteness in current cigarette smokers was notably worse compared with never and former smokers, (13.38 Whiteness Index for Dentistry (WID) units vs. 19.96 and 16.79 WID units). Remarkably high WID values (i.e., whiter teeth) were also observed in ECs (16.72 WID units) and HTPs users (17.82 WID units). Compared to current smokers, difference in dental whiteness for ECs and HTPs users was visually noticeable (ΔWID difference being on average > 2.90 units). The colour differences measured as delta E*(ΔE*) were all visually detectable except for the comparison between ex-smokers and ECs users for which no perceptible color difference was observed (0.415). ConclusionExclusive use of ECs and HTPs is associated with better dental color measurements than current smoking, suggesting that tar-free nicotine delivery technologies are unlikely to have negative effects on dental appearance. Clinical significanceUse of alternative nicotine delivery systems may be associated with cosmetic benefits with important implications for those smokers perceiving dental aesthetics as a significant problem. For these an oral-based narrative may be a much more significant reason to refrain from smoking than the fear of developing smoking-related diseases in future.

A Deeper Dive into Young Adults’ Experiences with E-Cigarettes, E-Cigarette Cessation, and Transitioning to Cigarette Smoking

Introduction: E-cigarette use among young adults is prevalent, with some voicing their desire to quit using e-cigarettes but needing support to do so. Young adults who use e-cigarettes are at risk for progressing to smoking combustible cigarettes, placing them at risk for severe health consequences. Limited research exists describing young adults’ lived experiences with using e-cigarettes, e-cigarette cessation, and progression to combustible cigarettes. Methods: Between July and August 2022, nine focus groups were conducted with 33 young adults who either (1) currently used e-cigarettes, (2) formerly used e-cigarettes, or (3) transitioned to cigarettes. Transcripts were coded and themes were identified independently by two research team members while a third researcher reviewed the coding and themes. Results: Participants described social influences, stress, and curiosity as primary reasons why they initiated e-cigarette use. The most reported negative experiences or consequences associated with e-cigarettes include the health effects, addiction, and financial costs. Participants who transitioned to cigarettes reported social influences, a desire to reduce or quit using e-cigarettes by replacing them with cigarettes, curiosity, and stress as the primary reasons for this progression to combustible cigarettes. Participants described barriers to quitting e-cigarettes, including social influences, withdrawal, and easy access to e-cigarettes, as well as facilitators of quitting, such as social support, change in environment, and finding healthier ways to manage stress. Conclusions: This qualitative work provides an in-depth look into factors that may be helpful in the development of prevention and intervention programs for both e-cigarette and combustible cigarette use in young individuals.

A Practical Framework for Novel Electronic Nicotine Delivery System Evaluation: Chemical and Toxicological Characterization of JUUL2 Aerosol and Comparison with Reference Cigarettes.

Electronic nicotine delivery systems (ENDSs) are designed as a non-combustible alternative to cigarettes, aiming to deliver nicotine without the harmful byproducts of tobacco combustion. As the category evolves and new ENDS products emerge, it is important to continually assess the levels of toxicologically relevant chemicals in the aerosols and characterize any related toxicology. Herein, we present a proposed framework for characterizing novel ENDS products (i.e., devices and formulations) and determining the reduced risk potential utilizing analytical chemistry and in vitro toxicological studies with a qualitative risk assessment. To demonstrate this proposed framework, long-term stability studies (12 months) analyzing relevant toxicant emissions from six formulations of a next-generation product, JUUL2, were conducted and compared to reference combustible cigarette (CC) smoke under both non-intense and intense puffing regimes. In addition, in vitro cytotoxicity, mutagenicity, and genotoxicity assays were conducted on aerosol and smoke condensates. In all samples, relevant toxicants under both non-intense and intense puffing regimes were substantially lower than those observed in reference CC smoke. Furthermore, neither cytotoxicity, mutagenicity, nor genotoxicity was observed in aerosol condensates generated under both intense and non-intense puffing regimes, in contrast to results observed for reference cigarettes. Following the proposed framework, the results demonstrate that the ENDS products studied in this work generate significantly lower levels of toxicants relative to reference cigarettes and were not cytotoxic, mutagenic, or genotoxic under these in vitro assay conditions.

COVID-19 Outcome and Tobacco Product Use: Case-Control and Retrospective Cohort Studies Using Nationwide Samples.

Conflicting evidence exists regarding the association between smoking and the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association between combustible cigarette (CC) smoking, noncombustible tobacco product (NCTP) use, and the use of any tobacco product with various coronavirus disease 2019 (COVID-19) outcomes. A case-control study was conducted using the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service (NHIS) cohort. A retrospective cohort study was conducted using 12,571,698 individuals from the NHIS cohort. Logistic regression evaluated the association between CC smoking, NCTP use, and use of any tobacco product with SARS-CoV-2 infection. Poisson regression evaluated the association between these forms of tobacco product use and COVID-19-related hospitalization and mortality. In the case-control study, we identified 30,878 cases of SARS-CoV-2 infection. The odds ratios (95% confidence intervals [CIs]) for SARS-CoV-2 infection were lower among current CC smokers (0.51, 0.48-0.54), current- and former-NCTP users (0.80, 0.74-0.88; 0.82, 0.74-0.91), and current users of any tobacco product (0.52, 0.49-0.55) relative to never user controls. In retrospective cohort study, we identified 16,521 COVID-19-related hospitalization and 362 COVID-19-related deaths. The relative risks (95% CIs) for COVID-19-related hospitalization were lower among current CC smokers (0.51, 0.48-0.54) and current users of any tobacco product (0.53, 0.50-0.56) relative to never user controls. There was no association between the use of tobacco product and COVID-19-related mortality. Current CC smokers and current users of any tobacco product showed reduced risk of SARS-CoV-2 infection and COVID-19-related hospitalization. It remains uncertain whether these relationships are causal.

Association between psychosocial factors and co-morbid cigarette smoking and alcohol use in a population experiencing homelessness

The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6). Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.

Relative Efficacy of an Acceptance and Commitment Therapy-Based Smartphone App with a Standard US Clinical Practice Guidelines-Based App for Smoking Cessation in Dual Users of Combustible and Electronic Cigarettes: Secondary Findings from a Randomized Trial

Background While smartphone apps for smoking cessation have shown promise for combustible cigarette smoking cessation, their efficacy in helping dual users of combustible and electronic cigarettes (e-cigarettes) to quit cigarettes remains unknown. This study utilized data from a randomized trial to determine if an Acceptance and Commitment Therapy (ACT)-based app (iCanQuit) was more efficacious than a US Clinical Practice Guidelines-based app (QuitGuide) for combustible cigarette smoking cessation among 575 dual users. Methods The primary cessation outcome was self-reported, complete-case 30-day abstinence from combustible cigarettes at 12 months. Logistic regression assessed the interaction between dual use and treatment arm on the primary outcome in the full trial sample (N = 2,415). We then compared the primary outcome between arms among dual users (iCanQuit: n = 297; QuitGuide: n = 178). Mediation analyses were conducted to explore mechanisms of action of the intervention: acceptance of cues to smoke and app engagement. Results: There was an interaction between dual use of combustible and e-cigarettes and treatment arm on the primary outcome (p = 0.001). Among dual users, 12-month abstinence from cigarettes did not differ between arms (23% for iCanQuit vs. 27% for QuitGuide, p = 0.40). Mediation analysis revealed a significant positive indirect effect of the iCanQuit app on 12-month abstinence from cigarettes through acceptance of emotions that cue smoking (p = 0.004). Conclusions Findings from this study of dual users of combustible and e-cigarettes showed no evidence of a difference in quit rates between arms. Acceptance of emotions that cue smoking is a potential mechanism contributing to cigarette smoking abstinence among dual users.

Plasma Nicotine Pharmacokinetics of Oral Nicotine Pouches Across Varying Flavours and Nicotine Content *

SUMMARY Background In recent years several nicotine products have been introduced that aim to offer smokers an alternative to cigarettes. As well as having fewer toxicants than combustible cigarettes, such nicotine products must be able to deliver nicotine efficiently. The aim of this study was to determine and compare the pharmacokinetics of nicotine absorption from nine oral tobacco-free smokeless nicotine pouches with varying nicotine content and flavours. Methods In a randomised, open-labelled, controlled, crossover clinical study, nicotine pharmacokinetics and product-liking were compared between nine nicotine pouches (Velo, BAT; 4- or 7-mg nicotine per pouch and in eight flavours). During a 10-day confinement period, 42 healthy adult participants, who were current smokers of combustible cigarettes, used a single study product once each day during a 45-min use period following overnight nicotine abstinence. Results Maximum plasma nicotine concentration and area under curve for nicotine concentration versus time 180 min after the start of study product use were significantly greater for the 7-mg than for the 4-mg Velo pouches (p &lt; 0.0001). These values did not differ between flavours among the 7-mg Velo nicotine pouches after adjustment for multiple comparisons (both p &gt; 0.003). The median time to maximum plasma nicotine concentrations and mean product-liking scores were similar regardless of nicotine content and flavour. Conclusions Regardless of flavour, nicotine pouches with the same nicotine content and formulation produce similar pharmacokinetic parameters and can deliver nicotine efficiently. Nicotine pouches could be a satisfying alternative for smokers switching from conventional cigarettes. [Contrib. Tob. Nicotine Res. 32 (2023) 130–139]

Differences in Pain Severity and Interference between Latinx Combustible Cigarette Smokers and Dual Users with Current Pain

Latinx individuals who smoke represent a tobacco health disparities group. Yet, limited research has focused on examining dual combustible and electronic cigarette use among Latinx populations. Importantly, Latinx persons who smoke also evince elevated rates of pain problems and symptoms and prior research has consistently linked pain problems and severity to smoking prevalence, maintenance, and behavior. Accordingly, the current study sought to build from the limited work that exists among dual combustible cigarette and electronic cigarette Latinx users comparing levels of pain severity and interference. The current sample consists of 196 adult Latinx daily cigarette smokers (35.48 years old; 39.4% female), of which 72 reported current daily dual use of an e-cigarette. Results indicated that Latinx dual users reported greater levels of pain severity (ηp 2 = .12) and pain interference (ηp 2 = .10) than exclusive combustible cigarette users. The study adds uniquely to the limited literature on the clinical importance of dual cigarette use in relation to pain severity and interference in that pain may serve as an important risk factor for the initiation and maintenance of dual use for increased analgesic nicotine effects.

College health providers' knowledge and confidence in addressing students' vaping: Evidence from a pilot study in New York State.

This study examines the knowledge and confidence of college healthcare providers in discussing vaping with their college student populations. This is a mixed-methods descriptive study using a sequential-explanatory approach, consisting of a cross-sectional, online survey followed by qualitative interviews. Survey data was collected from 50 college health providers located at 26 colleges in the 64-campus State University of New York system. Targeted semi-structured interviews (N = 11) were conducted by telephone with providers who completed the survey. Despite high reported levels of knowledge and confidence, few providers had participated in educational activities relative to vaping. There was evidence of misinformation about e-cigarettes, and they did not know what product (nicotine/cannabis) students typically vape. Findings indicate a potential disconnect between providers' perceived and actual knowledge of college student vaping and demonstrate areas of opportunity to assist college health providers in comprehensively addressing vaping with their college student populations. College health providers played a key role in lowering rates of combustible cigarette smoking, but little is known about how they are now are communicating with college students about e-cigarette and cannabis vaping. This paper examines college health providers' knowledge, confidence, and training needs relative to vaping communications.

Expansion and Blunted Inflammatory Responses of Jak2 V617F Cells in the Setting of Electronic Cigarette Aerosol Inhalation

Clonal hematopoiesis of intermediate potential (CHIP) increases the risk for hematological malignancies and cardiovascular disease with Jak2 being a commonly mutated gene in CHIP. Age is the strongest determinant of CHIP but environmental factors also play a role since only a fraction of the individuals with CHIP eventually present with overt clonal hematopoiesis. The popularity of electronic (E-) cigarette (E-cig) usage has increased but their health effects are not well-established. E-cigarettes have been associated with inflammation and oxidative stress and these can provide a selective pressure for the outgrowth of CHIP mutant cells. Here, we determined the impact of E-cig aerosol inhalation on the survival and/or expansion of Jak2 mutant hematopoietic cells by exposing bone marrow transplanted mice to E-cig aerosols. Competitive bone marrow transplant assays were established to determine expansion of Jak2V617F mutant cells to E-cigarette aerosols. Lethally irradiated recipient mice in the CD45.1/2 background were transplanted with equal numbers of whole bone marrow cells from wild type (WT) (CD45.1) and Jak2V617F(CD45.2) mice (WT:Jak2V617F), or WT (CD45.1) and WT (CD45.2) (WT:WT) as transplant controls. Eight weeks post-transplant, mice were exposed to E-cigarette aerosols using a nose-only inhalation exposure system for 2 hours/day, 4 days/week for 3 months. Control mice were exposed to room air using the nose-only inhalation approach. At regular intervals, peripheral blood was drawn to determine the percentage of WT and Jak2V617F cells by flow cytometry. At euthanasia, the percentage of WT and mutant cells in the bone marrow (BM) and spleen was determined. In competitive bone marrow transplants in a 1:1 ratio, this mouse model of Jak2V617F does not gain a selective advantage in relation to WT cells. Instead, we observe declining levels of Jak2V617F cells in the peripheral blood over time. The time point at which the Jak2V617F cells were at their minimum was recorded as time point 0 (T0). Mice were exposed for 12 weeks and then allowed to rest, to determine how E-cig exposure promotes Jak2V617F expansion, until termination of the experiment (Tend). Mice exposed to E-cig aerosols demonstrated significant expansion of Jak2V617F cells at the end of the experiment compared to air exposed controls (Wilcoxon paired test, p&amp;lt;0.05). Jak2V617F Lin-, c-Kit+, Sca-1+ (LKS) cells in the bone marrow were also slightly increased in the E-cig group compared to the air group. To assess how inflammation is altered in the setting of prior E-cig aerosol inhalation, bone marrow derived macrophages (BMDMs) from exposed mice were stimulated with lipopolysaccharide (LPS) and secretion of the pro-inflammatory cytokines, TNFα and IL-6, were quantified by ELISA. WT:WT BMDMs from the E-cig cohort produced more TNFα and IL-6 than the WT:WT BMDMs from the air cohort. However, interestingly E-cig exposed WT:Jak2V617F BMDMs produced significantly less TNFα and IL-6 than the E-cig exposed WT:WT BMDMs. This indicates that prior E-cig aerosol inhalation can sensitize WT cells to inflammatory stimuli while Jak2V617F mutant cells are more resistant to LPS mediated inflammation post E-cig exposure. This is particularly relevant in inflammation-induced hematopoietic stem cell exhaustion since a diminishing pool of WT HSCs provides selection pressure for the outgrowth of mutant HSCs. Environmental factors such as combustible cigarette smoke and E-cigarette products can play a role in the clinical consequences of CHIP. We observed that in vivo exposure to E-cigarette aerosols supports the survival and expansion of Jak2V617F cells in bone marrow transplanted mice. Our data also indicates that E-cig exposure sensitizes WT cells to inflammation more than Jak2V617F mutant cells. Future work is aimed at determining E-cig exposure mediated inflammatory and apoptotic effects on WT and mutant HSCs and subsets of mature hematopoietic cells.

Pubertal development at age 14 is associated with male adolescents’ combustible cigarette smoking and dual use, but not with e-cigarette use – Findings from the UK Millennium Cohort Study

BackgroundAdolescent nicotine exposure via electronic cigarettes (e-cigarettes) is a global health concern. Pubertal development earlier than peers increases the risk of tobacco smoking compared to peers experiencing on-time or late maturation, yet relationships of pubertal timing with e-cigarettes are unknown. We examine whether early pubertal timing is associated with risk for e-cigarette use, tobacco cigarettes, or both by age 14. MethodsThe Millennium Cohort Study follows a representative cohort of 18,552 9-month-old children born 2000–2002 in the United Kingdom. Our sample includes 11,445 adolescents (5697 boys, 5748 girls) classified at age 14 as early, on-time, or late in pubertal development timing (PDT) relative to same-age, same-sex peers using the Pubertal Development Scale. Outcomes were use of e-cigarettes, tobacco cigarettes, or both by age 14. We included childhood liability confounders and demographics measured from age 7–11. ResultsFor girls, no PDT differences in age 14 e-cigarette or tobacco cigarette use were observed. All relative to on-time PDT boys, early maturing boys’ odds of tobacco cigarette use were 59% higher (OR=1.59, 95% confidence interval (CI)=1.08,2.35), and odds of dual-use were 49% higher (OR=1.49, CI=1.11,1.99), both compared to odds of never use. Among late PDT boys, dual-use odds were lower than never use by 35% (OR=0.65, CI=0.47,0.91) and lower than e-cigarette use only by 36% (OR=0.64, CI=0.42,0.97). ConclusionsAt age 14, PDT was not associated with e-cigarette use for either sex, yet it was linked with tobacco use and dual use among boys.

A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study.

There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. DERR1-10.2196/54236.

Evaluation of functional aerobic exercise capacity among chronic e-cigarette users compared to combustible cigarette smokers and non-smokers: a comparative study

BackgroundElectronic cigarettes or e-cigarettes have gained significant popularity as an alternative to traditional combustible tobacco smoking particularly among the youth. Although there is a growing prevalence of e-cigarette usage, the effects on cardiovascular function and physical capacity have not been adequately studied. The toxic products in combustible tobacco cigarettes negatively impact functional exercise capacity. However, the available data regarding the effect of e-cigarette use on functional exercise capacity are scarce. Thus, in the current study, we aimed to evaluate the functional aerobic exercise capacity among chronic e-cigarette users compared to combustible cigarette smokers and non-smokers.ResultsThis comparative, cross-sectional study was conducted on 105 healthy volunteers. Participants were assigned into three study groups each consisting of 35 participants: chronic e-cigarette users, combustible cigarette smokers, and a non-smoker control group. Basal demographic and clinical data were similar in all groups. Mean heart rates and respiratory rates were significantly higher among e-cigarette smokers and combustible cigarette smokers compared to non-smoker controls (p < 0.001). Chronic e-cigarette users and combustible cigarette smokers had shorter 6-MWT distances compared to non-smokers (508.3, 488, and 616.6 m, respectively, p < 0.001). Borg scale scores after performing the six-minute walking test were significantly higher in chronic e-cigarette users and combustible cigarette smokers groups compared to non-smokers, where perceived exertion (4.9, 5.5, 2.1, respectively, p < 0.001), dyspnea (5.7, 6.5, 0.1, respectively, p < 0.001) and leg fatigue (4.2, 5.4, 1.4, respectively, p < 0.001).ConclusionIn this cross-sectional study, significant evidence demonstrates that e-cigarette use is not harmless. This was particularly presented in apparently healthy e-cigarette users in comparison to the healthy non-smoker control group. Chronic e-cigarette use is associated with reduced functional capacity compared to non-smoker controls. This was signified by decreased 6MWT walking distances, higher Borg scale scores, and lower oxygen saturation percentages among the chronic electronic cigarette users as compared to non-smoker controls after performing the six-minute walking test. All the evaluated parameters in the current study were similarly reduced among both the e-cigarette users group and the combustible cigarette smokers group compared to non-smokers with no statistically significant differences between both smoker groups.