Electronic Nicotine Delivery Devices Research Articles

Electronic Nicotine Delivery Devices: What We Know and Its Implications for India Electronic Nicotine Delivery Devices

Electronic Nicotine Delivery Devices: What We Know and Its Implications for India Electronic Nicotine Delivery Devices

Vaping lung damage (review)

The review presents data from meta-analyses and original studies on the study of the vapers disease electronic cigarette or vaping product use-associated lung injury (EVALI) a new nosological form in patients with acute and subacute respiratory diseases caused by the consumption of electronic nicotine delivery vehicles, or vaping. The number of users are growing in around the world, especially among young people. According to a 2022 meta-analysis, the global prevalence of vaping use was 23%, including 16% in women and 22% in men. Prevalence of electronic nicotine delivery systems among cigarette smokers reached 43%, while on different continents, except for Asia, during the life it was approximately the same: in America 24%, Europe 26%, Asia 16%, Oceania 25%. Vaping rates among children aged 15 to 17 are almost four times (21.3%) higher than those aged 1214 (5.4%). Two-thirds (66.1%) of children aged 12 to 17 using electronic nicotine delivery devices were also smokers, while they started with vapes. Nicotine cartridges used by 89.3% of teen vapers aged 15 to 19 years. Vaping lung diseases have been reported since invention e-cigarettes, but the number of cases increased sharply at the end of September 2019, and by February In 2020, the number of hospitalized patients in the United States reached 2807, with 68 confirmed deaths. Most of the cases are male adolescents and men aged 1334 years. The review discusses the etiology, clinical picture, imaging findings, pathological EVALI features. When examining patients with EVALI, computed tomography revealed images characteristic of acute lung injury and pneumonia, as well as those resembling non-fibrous hypersensitivity pneumonitis, acute eosinophilic pneumonia. The article discusses the main differences between these diseases and the computed tomography picture of COVID-19. Before EVALI, vaping was associated with a wide range of pulmonary manifestations, including lipoid pneumonia, acute respiratory distress syndrome and diffuse alveolar hemorrhage. Although the overall prevalence of EVALI has declined sharply compared to with a peak in September 2019, other chemicals may appear that cause various pulmonary diseases associated with vaping. EVALI is a new nosological form in patients with acute and subacute respiratory diseases caused by lung damage due to the use of electronic means delivery of nicotine. The appearance of radiographic images in EVALI is diverse: from bilateral opacities in the lungs to reveal centrilobular nodules resembling non-fibrous hypersensitivity pneumonitis. When interpreting acute lung injury in young people, the possibility of EVALI should be considered.

Smoking prevalence among adults in households with children: parental survey

The effects of tobacco smoke and nicotine on the health of adults and children remain one of the most burning problem in our days. In 2019 the prevalence of active smoking in Ukraine reached 42.0 among men and 14.4% among women. The negative effects of second-hand tobacco smoke exposure are most significant in children under 5 years of life, especially in families with smoking mothers. The goal of the study was to assess the current smoking prevalence in families with children, including the use of modern electronic nicotine delivery devices. A self-reported survey of 414 families living in Odessa and Odessa region (Ukraine) was conducted. All questionnaires were divided into two groups depending on the presence of tobacco smoke exposure. To asses the factor's relevance the odds ratio (OR) and its 95% confidence interval (CI) were used. The prevalence of smoking in families was associated with the age of the father up to 30 years (16.13 [95% CI 11.54–22.09]%; OR 2.73 [1.42–5.25]), mother’s and father’s low education lever (OR 2.73 [1.42–5.25] and 2.70 [1.64–4.44]), as well as with the residence of the family in the city (OR 4.30). The prevalence of smoking exposure was not associated with the income level or number of household members. The prevalence of smoking in women before pregnancy was more than 20%, and during pregnancy – 10%. After delivery women smoked in 23.91 (95% CI 20.06-28.25)% of cases. Proportion of families where smoked someone other than the mother reached 42.75 (95% CI 38.08–47.56)%. Other family members smoking negatively affected mothers’ tobacco consumption, both before and after childbirth. After pregnancy, women used both smoked tobacco and noncombustible forms of nicotine (51.52 vs 48.48%) with the same frequency. Other family members consumed smoking tobacco more often than e-cigarettes. All smokers who used electronic nicotine delivery devices more likely smoked at home (OR 5.33 [95% CI 0.53–54.04]).

The effects of dual IQOS and cigarette smoke exposure on airway epithelial cells: implications for lung health and respiratory disease pathogenesis.

Cigarette smoking remains a primary cause of chronic lung diseases. After a steady decline, smoking rates have recently increased especially with the introduction of newer electronic nicotine delivery devices, and it is also emerging that dual- or poly-product usage is on the rise. Additionally, with the introduction of IQOS (a heated tobacco product) globally, its impact on human health needs to be investigated. In this study we tested if dual exposure (cigarette smoke (CS)+IQOS) is detrimental to lung epithelial cells when compared with CS or IQOS exposure alone. Human airway epithelial cells (BEAS-2B) were exposed to either CS, IQOS or their dual combination (CS+IQOS) at concentrations of 0.1%, 1.0%, 2.5% and 5.0%. Cytotoxicity, oxidative stress, mitochondrial homeostasis, mitophagy and effects on epithelial-mesenchymal transition (EMT) signalling were assessed. Both CS and IQOS alone significantly induced loss of cell viability in a concentration-dependent manner which was further enhanced by dual exposure compared with IQOS alone (p<0.01). Dual exposure significantly increased oxidative stress and perturbed mitochondrial homeostasis when compared with CS or IQOS alone (p<0.05). Additionally, dual exposure induced EMT signalling as shown by increased mesenchymal (α-smooth muscle actin and N-cadherin) and decreased epithelial (E-cadherin) markers when compared with CS or IQOS alone (p<0.05). Collectively, our study demonstrates that dual CS+IQOS exposure enhances pathogenic signalling mediated by oxidative stress and mitochondrial dysfunction leading to EMT activation, which is an important regulator of small airway fibrosis in obstructive lung diseases.

Abstract 11674: Acute Effects of Nicotine-Containing Product Challenges on Cardiovascular and Autonomic Function Among Electronic Cigarette Vapers, Combustible Cigarette Smokers, and Controls: The CLUES Study

Background: The acute cardiovascular effects of electronic nicotine delivery devices (ENDs) have not been well-characterized. We hypothesized differences in acute cardiovascular and autonomic function responses to use of ENDS by chronic ENDs users (“vapers”), use of combustible cigarettes by chronic “smokers,” and no product use among non-smoking/non-vaping controls. Methods: CLUES (HL1393301) was a cross-sectional study of 395 individuals: 164 exclusive vapers (exhaled carbon monoxide [CO] &lt;5 ppm, positive urine NicCheck I test), 117 exclusive smokers (CO &gt;5 ppm, positive urine NicCheck), and 114 non-vaping/non-smoking controls (CO &lt;5 ppm, negative urine NicCheck). We measured systolic and diastolic blood pressure (BP), heart rate (HR), brachial artery diameter, and time domain HR variability (root mean square differences in successive normal intervals [RMSSD]; % adjacent normal intervals &gt;50 ms [PNN50]) before and 15’ after a product use challenge. Linear mixed models were created to predict outcome measures from group, time, and group*time with age, sex, and race as covariates, followed by group contrasts via post-hoc t-tests with Bonferroni-corrected p values. Results: Vapers were a mean (SD) 27.4 (10.6) years old (39% female, 86% white) and had vaped for 4.1 (2.7) years. Smokers were 42.8 (13.8) years old (44% female, 56% white) and had smoked for 23.0 (13.0) years. Controls were 30.8 (11.9) years old (50% female, 69% white). Model-adjusted mean (95% CIs) outcomes and p values for between group differences in challenge responses are in the Figure. Compared to controls, vapers had greater increases in systolic BP, diastolic BP, and HR (all p &lt; 0.002) and greater reductions in brachial artery diameter, RMSSD, and PNN50 (all p &lt; 0.003) than controls, with values similar to smokers. Conclusion: Chronic vapers showed acute increases in BP and HR, vasoconstriction, and reductions in time domain HR variability after using ENDS, similar to cigarette use by smokers.

Abstract 13269: Effects of Nicotine-Containing Product Challenges on Interleukin-6 Pathway Expression in Human Pluripotent-Derived Arterial Endothelial Cells: The Clues Study

Background: Electronic nicotine delivery devices (ENDs) induce interleukin-6 (IL-6) pathway expression in airway epithelial cells, but their systemic effects on arterial endothelial cells (AECs) are unknown. We hypothesized differential expression (DE) of IL-6 pathway genes by human pluripotent-derived AECs exposed in vitro to participant serum drawn before and after use of ENDS by chronic vapers, use of combustible cigarettes by smokers, and no product use by controls. Methods: For this pilot study, we randomly selected 30 participants from the CLUES Study: 10 exclusive vapers (exhaled carbon monoxide [CO] &lt;5 ppm, + urine NicCheck I), 10 exclusive smokers (CO &gt;5 ppm, + urine), and 10 non-vaping/non-smoking controls (CO &lt;5 ppm, negative urine). We generated purified populations of AECs (H9 CPTC C13 derivative human embryonic stem cell line) and exposed them for 6 hours to 50% concentrated participant serum drawn before and 15’ after a product use challenge. Total RNA was sequenced on a NextSeq 2000. The DESeq2 suite characterized DE with an a priori focus on genes in the IL-6 biosynthetic pathway gene ontology set. Z scores of normalized log2 gene expression values were determined and expressed as heat maps (Figure). Gene Set Variational Analysis (GSVA) was used to interrogate for enriched gene sets. P values were not adjusted for multiple hypothesis testing and are exploratory. Results: Vapers were a mean (SD) 28.9 (8.1) years old (30% female), smokers were 38.3 (11.6) years old (40% female), and controls were 33.6 (17.7) years old (50% female). Compared to controls, vapers had increased expression of the IL-6 pathway at baseline (p=0.004), but smokers did not (p=0.38). Following product use, vapers (p=0.0009) but not smokers (p=0.79) had increased expression of genes in the IL-6 biosynthetic pathway (Figure). Conclusion: Chronic vapers, but not smokers, may have increased expression of genes in the IL-6 pathway prior to product use with further increases afterwards.

Abstract 10218: Differences in Treadmill Exercise Stress Testing Parameters Among Electronic Cigarette Vapers, Combustible Cigarette Smokers, and Controls: The Clues Study

Background: Use of electronic nicotine delivery devices is increasing but their effects on exercise function are not well-characterized. We hypothesized that treadmill stress test outcomes would differ between chronic electronic cigarette users (“vapers”), combustible cigarette users (“smokers”), and non-smoking/non-vaping controls. Methods: CLUES (HL1393301) was a cross-sectional study of 395 individuals: 164 exclusive vapers (exhaled carbon monoxide [CO] &lt;5 ppm, positive urine NicCheck I), 117 exclusive smokers (CO &gt;5 ppm, positive urine NicCheck I), and 114 non-vaping/non-smoking controls (CO &lt;5 ppm, negative urine NicCheck I). Participants completed a symptom-limited Balke treadmill stress test protocol, a mean (SD) of 91.3 (16.2) minutes after vaping, smoking, or resting. Outcome measures were peak achieved metabolic equivalents (METs), rate-pressure product (RPP, peak heart rate [HR]*systolic blood pressure), HR reserve (peak HR/[220-age]), and 60-second HR recovery (HRR60). Group differences were compared by general linear models with omnibus p-values adjusted for age, race, and sex and with post-hoc t-tests using Bonferroni-corrected p-values. Results: Vapers were 27.4 (10.6) years old (39% female, 86% white) and had vaped for 4.1 (2.7) years (16.3 [30.0] vape-years). Smokers were 42.8 (13.8) years old (44% female, 56% white) and had smoked for 23.0 (13.0) years (28.7 [26.5] pack-years). Controls were 30.8 (11.9) years old (50% female, 69% white). Age, race, and sex-adjusted mean (95% CIs) outcome values by group are in the Figure. Vapers performed worse than controls on all 4 exercise parameters: peak METs (p&lt;0.001), peak RPP (p=0.020), HR reserve (p&lt;0.001), and HRR60 (p=0.025) with intermediate values compared to smokers. Conclusion: Vapers consistently performed worse than controls on 4 treadmill exercise parameters that predict adverse cardiovascular disease outcomes with intermediate values compared to smokers.

Electronic nicotine delivery systems (ENDS) flavours and devices used by adults before and after the 2020 US FDA ENDS enforcement priority: findings from the 2018 and 2020 US ITC Smoking and Vaping Surveys

BackgroundIn February 2020, the US Food and Drug Administration (FDA) prioritised enforcement efforts against flavoured prefilled cartridge/pod electronic nicotine delivery systems (ENDS), with the exception of tobacco and menthol. This...

Health effects of secondhand smoke on children under 5 years of life

Background. The high prevalence of smoking among adults suggests the almost inevitable effects of second-hand tobacco smoke (SHS) on children and adults who do not smoke. The negative effects of SHS are most pronounced in young children, especially in families where the mother is a smoker. The aim was to assess the effects of prenatal and postnatal exposure to SHS in children under five years of life. Materials and methods. The survey among 520 families with children was conducted using online self-reported questionnaire. Families with extremely and very preterm children and children with inherited diseases of bronchopulmonary system were excluded from the analysis. During the analysis, all children (n = 414; 55.07 % of boys and 44.93 % of girls, mean age — 36.38 ± 7.19 months) were divided according to SHS exposure. 186 children exposed to SHS were included in the main group, and 228 children without SHS exposure — in the control group. Results. 22.46 % of children were prenatally exposed to SHS. Maternal smoking during pregnancy significantly increased the risk of the intrauterine growth retardation (IUGR) (OR 2.43 [95% CI 1.07–5.52]). Postnatal exposure to SHS was present in 56.52 % of children. These children were significantly more likely to be formula-fed (OR 1.75 [95% CI 1.15–2.65]). The frequency of formula feeding was significantly increased by mothers’ use of both traditional tobacco products and electronic nicotine delivery systems (OR 2.10 and 2.99, respectively). Exclusively maternal smoking in the family increased the risk of frequent acute respiratory viral infections (ARI) in 3 years old children more than 1.5 times (OR 1.60 [95% CI 1.01–2.60]). Household SHS exposure increased the probability of bronchial obstruction (BO) during ARI in a child in 1.61 times, while exclusively maternal smoking increased the risk in 2.88 times. An increased risk of frequent ARI (OR 3.25 [95% CI 1.68–6.28]) was also present in the subgroup of children whose mothers smoked electronic nicotine delivery devices. The use of traditional tobacco products and electronic nicotine delivery systems, both by mothers and other family members, has significantly affected the risk of developing BO in children with respiratory disease. Conclusions. Maternal smoking during pregnancy in the studied cohort is a proven risk factor for IUGR. Household smoking is statistically likely to affect the incidence and likelihood of developing BO in children of the first five years of life, regardless of the type of tobacco product. This risk is greatest among children whose mothers are smokers.

Preferences for different features of ENDS products by tobacco product use: a latent class analysis

BackgroundFrom a public health perspective, electronic nicotine delivery devices (ENDS) use may be beneficial for some populations (e.g., smokers who fully switch to ENDS) but detrimental for others (e.g., nonsmokers). Understanding the importance placed on different ENDS product features by user groups can guide interventions and regulations.MethodsParticipants were US adults who had used ENDS at least once and from a convenience sample drawn from a market research software in 2016. Participants chose between 9 different ENDS product features (harms of use, general effects of use, use as a cessation aid, initial purchase price, monthly cost, nicotine content, flavor availability, device design, and modifiability). A latent class analysis (LCA) identified subgroups of feature preferences and examined differences between groups by socio-demographics and tobacco product use.ResultsOf the 636 participants, 81% were White, the median age was 42, and 65% were current cigarette smokers. The LCA identified a 4-class solution as the most appropriate model: (1) people with high nicotine dependence who preferred ENDS similar to combustible cigarettes, (2) people with moderate tobacco use who were interested in low nicotine ENDS (3) people who use ENDS and combustible tobacco who preferred lower price and flavored ENDS products, and (4) people who used ENDS predominantly, without a strong preference for any of the features presented.ConclusionsTobacco use classes were associated with differences in preferences for ENDS features. These findings can inform regulations to reduce ENDS use among specific groups of people who use ENDS products.

Comparable Impairment of Vascular Endothelial Function by a Wide Range of Electronic Nicotine Delivery Devices.

Electronic nicotine delivery systems (ENDS; ie, vaping devices) such as e-cigarettes, heated tobacco products, and newer coil-less ultrasonic vaping devices are promoted as less harmful alternatives to combustible cigarettes. However, their cardiovascular effects are understudied. We investigated whether exposure to aerosol from a wide range of ENDS devices, including a new ultrasonic vaping device, impairs endothelial function. We measured arterial flow-mediated dilation (FMD) in rats (n = 8/group) exposed to single session of 10 cycles of pulsatile 5-second exposure over 5 minutes to aerosol from e-liquids with and without nicotine generated from a USONICIG ultrasonic vaping device, previous generation e-cigarettes, 5% nicotine JUUL pods (Virginia Tobacco, Mango, Menthol), and an IQOS heated tobacco product; with Marlboro Red cigarette smoke and clean air as controls. We evaluated nicotine absorption and serum nitric oxide levels after exposure, and effects of different nicotine acidifiers on platelet aggregation. Aerosol/smoke from all conditions except air significantly impaired FMD. Serum nicotine varied widely from highest in the IQOS group to lowest in USONICIG and previous generation e-cig groups. Nitric oxide levels were not affected by exposure. Exposure to JUUL and similarly acidified nicotine salt e-liquids did not affect platelet aggregation rate. Despite lack of heating coil, the USONICIG under airflow conditions heated e-liquid to ~77°C. A wide range of ENDS, including multiple types of e-cigarettes with and without nicotine, a heated tobacco product, and an ultrasonic vaping device devoid of heating coil, all impair FMD after a single vaping session comparably to combusted cigarettes. The need to understand the cardiovascular effects of various ENDS is of timely importance, as we have seen a dramatic increase in the use of these products in recent years, along with the growing assumption among its users that these devices are relatively benign. Our conclusion that a single exposure to aerosol from a wide range of ENDS impairs endothelial function comparably to cigarettes indicates that vaping can cause similar acute vascular functional impairment to smoking and is not a harmless activity.

E-Cigarettes as a Growing Threat for Children and Adolescents: Position Statement From the European Academy of Paediatrics.

As the tobacco epidemic has waned, it has been followed by the advent of electronic nicotine delivery devices (ENDS) primarily manufactured by the tobacco industry to try to recruit replacements for deceased tobacco addicts. This document sets out the ten recommendations of the European Academy of Paediatrics (EAP) with regard to e-cigarettes and children and young people (CYP). The EAP notes that nicotine is itself a drug of addiction, with toxicity to the foetus, child and adult, and were ENDS only to contain nicotine, their use to create a new generation of addicts would be rigorously opposed. However, e-cigarettes include numerous unregulated chemicals, including known carcinogens, whose acute and long term toxicities are unknown. The EAP asserts that there is incontrovertible evidence that the acute toxicity of e-cigarettes is greater than that of “traditional” tobacco smoking, and a variety of acute pulmonary toxicities, including acute lung injuries, have been recorded due to e-cigarettes usage. The chronic toxicity of e-cigarettes is unknown, but given the greater acute toxicity compared to tobacco, the EAP cannot assume that e-cigarettes are safer in the long term. The high uptake of e-cigarettes by CYP, including under-age children, is partly fuelled by deceitful marketing and internet exposure, which is also unregulated. Although proposed as aids to smoking cessation, there is no evidence that e-cigarettes add anything to standard smoking cessation strategies. In summary, the EAP regards these devices and liquids as very dangerous, and ineluctably opposed to their use, and their direct or indirect marketing.

Virtual Reality Technology Use in Cigarette Craving and Smoking Interventions (I "Virtually" Quit): Systematic Review.

BackgroundOver the last 2 decades, virtual reality technologies (VRTs) have been proposed as a way to enhance and improve smoking cessation therapy.ObjectiveThis systematic review aims to evaluate and summarize the current knowledge on the application of VRT in various smoking cessation therapies, as well as to explore potential directions for future research and intervention development.MethodsA literature review of smoking interventions using VRT was conducted.ResultsNot all intervention studies included an alternative therapy or a placebo condition against which the effectiveness of the intervention could be benchmarked, or a follow-up measure to ensure that the effects were lasting. Virtual reality (VR) cue exposure therapy was the most extensively studied intervention, but its effect on long-term smoking behavior was inconsistent. Behavioral therapies such as a VR approach-avoidance task or gamified interventions were less common but reported positive results. Notably, only 1 study combined Electronic Nicotine Delivery Devices with VRT.ConclusionsThe inclusion of a behavioral component, as is done in the VR approach-avoidance task and gamified interventions, may be an interesting avenue for future research on smoking interventions. As Electronic Nicotine Delivery Devices are still the subject of much controversy, their potential to support smoking cessation remains unclear. For future research, behavioral or multicomponent interventions are promising avenues of exploration. Future studies should improve their validity by comparing their intervention group with at least 1 alternative or placebo control group, as well as incorporating follow-up measures.

Effect of Electronic Cigarettes on Oral Microbial Flora

Background: Despite well-documented adverse effects of tobacco consumption, cigarettes use is still rising and part of this increase is related to the popularization of alternative electronic nicotine delivery devices, such as electronic cigarettes (ECs). The aim of the performed research was to assess the effect of electronic cigarettes aerosol on the oral microbiota, using culture methods.&#x0D; Methodology: 30 ten-week-old WAG rats (female 76-81 g and male 86-94 g) were randomly distributed in two groups, as follows: Group 1 – control animals (n = 10); Group 2 – EC aerosol exposed (n = 20). EC aerosol exposures were carried out by using the Boyarchuck chamber. During the study, the rat oral microbiota were collected four times: at the beginning of the experiment, on the 30th, 60th and 90th days. Microorganisms were identified using standard microbiological techniques.&#x0D; Results: EC exposure to Group 2 rats resulted in a depletion of colonies commensal microbes and a greater incidence of atypical species such as Klebsiella pneumoniae, Acinetobacter lwoffii, Candida albicans compared to Group 1 on day 90. The test of independence between frequency distibution of opportunistic microbes and duration of EC exposure showed a significance for Klebsiella pneumoniae – χ2= 8.017, p=0.0456, Acinetobacter lwoffii – χ2= 36.772, p=0.0001, and Candida albicans – χ2=8.689, p=0.0337.&#x0D; Conclusions: The impact of electronic cigarettes facilitated colonization of the oral cavity by opportunistic bacteria and yeast.

Drugs of Abuse: How Clinical Pharmacology Brings Clarity to the Shadows.

Drugs of Abuse: How Clinical Pharmacology Brings Clarity to the Shadows.

Introduction to the Special Issue on JUUL Use.

This special issue addresses key topics relating to the public health impact of the use of electronic nicotine delivery devices (ENDS), particularly JUUL-brand ENDS. Smokers smoke for nicotine, but are harmed by the byproducts of combustion. ENDS can play a role in tobacco harm reduction offering a noncombustible alternative source of nicotine for adult smokers who would otherwise continue smoking. Papers presented here estimate the prevalence of ENDS and JUUL use among young and older adults, and document the 12-month smoking trajectories of adults who purchased a JUUL Starter Kit. Overall, smoking prevalence was halved, with most smokers switching completely as dual use declined. This held for subpopulations defined by demographics and psychiatric comorbidity. For those who did not switch, most significantly reduced (50%+) their cigarette consumption. Another study reports that dependence declines as smokers switch from smoking to using JUUL. The public health potential of ENDS is undermined by use of ENDS by nonsmokers, especially underage individuals. Some smoking was reported by adult former and never smokers, with little evidence of persistent smoking, and lower risk of smoking among those using JUUL more frequently. Regarding underage use, one paper reports that technology can ensure age-verification at point of sale. Population modeling integrating impacts on diverse populations indicates that availability of ENDS is expected to avert millions of premature deaths in the US. We believe these papers make a substantial contribution to the field of tobacco science and smoking control.

Flavored e-liquids increase cytoplasmic Ca2+ levels in airway epithelia.

E-cigarettes are noncombustible, electronic nicotine-delivery devices that aerosolize an e-liquid, i.e., nicotine, in a propylene glycol-vegetable glycerin vehicle that also contains flavors. While the effects of nicotine are relatively well understood, more information regarding the potential biological effects of the other e-liquid constituents is needed. This is a serious concern, because e-liquids are available in >7,000 distinct flavors. We previously demonstrated that many e-liquids affect cell growth/viability through an unknown mechanism. Since Ca2+ is a ubiquitous second messenger that regulates cell growth, we characterized the effects of e-liquids on cellular Ca2+ homeostasis. To better understand the extent of this effect, we screened e-liquids for their ability to alter cytosolic Ca2+ levels and found that 42 of 100 flavored e-liquids elicited a cellular Ca2+ response. Banana Pudding (BP) e-liquid, a representative e-liquid from this group, caused phospholipase C activation, endoplasmic reticulum (ER) Ca2+ release, store-operated Ca2+ entry (SOCE), and protein kinase C (PKCα) phosphorylation. However, longer exposures to BP e-liquid depleted ER Ca2+ stores and inhibited SOCE, suggesting that this e-liquid may alter Ca2+ homeostasis by short- and long-term mechanisms. Since dysregulation of Ca2+ signaling can cause chronic inflammation, ER stress, and abnormal cell growth, flavored e-cigarette products that can elicit cell Ca2+ responses should be further screened for potential toxicity.

Biochemical Verification of Tobacco Use and Abstinence: 2019 Update.

The changing prevalence and patterns of tobacco use, the advent of novel nicotine delivery devices, and the development of new biomarkers prompted an update of the 2002 Society for Research on Nicotine and Tobacco (SRNT) report on whether and how to apply biomarker verification for tobacco use and abstinence. The SRNT Treatment Research Network convened a group of investigators with expertise in tobacco biomarkers to update the recommendations of the 2002 SNRT Biochemical Verification Report. Biochemical verification of tobacco use and abstinence increases scientific rigor and is recommended in clinical trials of smoking cessation, when feasible. Sources, appropriate biospecimens, cutpoints, time of detection windows and analytic methods for carbon monoxide, cotinine (including over the counter tests), total nicotine equivalents, minor tobacco alkaloids, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol are reviewed, as well as biochemical approaches to distinguishing cigarette smoking from use of electronic nicotine delivery devices (ENDS). Recommendations are provided for whether and how to use biochemical verification of tobacco use and abstinence. Guidelines are provided on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of ENDS use. Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the costs, including the cost of the assays, the feasibility of sample collection, the ability to draw clear conclusions based on the duration of abstinence, and the variability of the assay within the study population. This paper provides updated recommendations from the 2002 SRNT report on whether and how to use biochemical markers in determining tobacco use and abstinence.

The Transnational Tobacco Industry and Oral Health.

All tobacco products carry established or probable adverse oral health effects. This study highlights several examples of actions by transnational tobacco corporations to obscure those effects, including several in which they were aided by the oral health community. Information was derived primarily from a search of records in the Truth Tobacco Industry Documents Database, supplemented by other published material and the author's personal experiences. Tobacco companies attempted to interfere with oral cancer research and dissemination of its findings the 1950s and 1960s. Philip Morris, Inc. partnered with the American Dental Association's periodontal research centre until 1973 and the Council for Tobacco Research supported its dental student research program until 1972. Swedish Match funded much of the Swedish research on oral health effects of its smokeless tobacco products and helped foster the current "tobacco harm reduction" strategy. Electronic nicotine delivery devices are the current focus of that strategy, though data on oral health effects are sparse. The transnational tobacco industry has a long history of deception, corruption, and devastation, and oral health was no exception. Organized dentistry may have unwittingly aided and abetted the tobacco industry during a critical period of history.

Preventing Liquid Nicotine Toxic Effects on Children

Electronic nicotine delivery devices, such as electronic cigarettes (e-cigarettes) and vaping pens, are battery-powered devices that deliver nicotine, flavorings (eg, fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. 1 Govindarajan P Spiller HA Casavant MJ Chounthirath T Smith GA E-cigarette and liquid nicotine exposures among young children. Pediatrics. 2018; e20173361 Crossref PubMed Scopus (26) Google Scholar In some states, there are no restrictions on the sale of e-cigarettes to minors. 2 Marynak K Holmes CB King BA Promoff G Bunnell R McAfee T State laws prohibiting sales to minors and indoor use of electronic nicotine delivery systems: United States, November 2014. MMWR. 2014; 63: 1145-1150 PubMed Google Scholar Although e-cigarette use is increasing among US adolescents and adults, its overall impact on public health remains unclear. One area of concern is the potential of e-cigarettes to cause acute nicotine toxicity, especially in children. In 2014, the e-cigarette industry was predicted to be worth $130 million and rising. E-cigarette use in teenagers is 3 times higher than traditional smoking, especially in middle and high school students. More than 2 million middle and high school students were current users of e-cigarettes in 2016. 3 Centers for Disease Control and Prevention (CDC) Tobacco use among middle and high school students: United States, 2011–2016. MMWR. 2017; 66: 597-603 PubMed Google Scholar Over the last decade, traditional smokers have decreased; however, in the past 5 years e-cigarette use in nonsmokers has doubled. 1 Govindarajan P Spiller HA Casavant MJ Chounthirath T Smith GA E-cigarette and liquid nicotine exposures among young children. Pediatrics. 2018; e20173361 Crossref PubMed Scopus (26) Google Scholar , 3 Centers for Disease Control and Prevention (CDC) Tobacco use among middle and high school students: United States, 2011–2016. MMWR. 2017; 66: 597-603 PubMed Google Scholar Although e-cigarettes have fewer carcinogens than cigarettes, depending on the milligrams of nicotine in the liquid, the exposure to nicotine can be significantly higher. 1 Govindarajan P Spiller HA Casavant MJ Chounthirath T Smith GA E-cigarette and liquid nicotine exposures among young children. Pediatrics. 2018; e20173361 Crossref PubMed Scopus (26) Google Scholar , 4 Nationwide Children's Hospital Liquid nicotine used in e-cigarettes still a danger to children despite recent decline in exposures: study recommends further regulation of liquid nicotine to keep children safer. ScienceDaily, 2018, April 23www.sciencedaily.com/releases/2018/04/180423085426.htmDate accessed: May 12, 2018 Google Scholar (See Figs. 1 and 2). Figure 2Prevent child injury infograph on nicotine poisoning View Large Image Figure Viewer Download Hi-res image Salina Nicol Nordstrom is Emergency Department FNP in Blauvelt, NY.