Health Effects Of E-cigarette Use Research Articles

E-cigarette use among university students in Palestine: Prevalence, knowledge, and determinant factors.

Recent reports indicated accelerated rates of e-cigarette use, especially among youth in various Middle Eastern countries, including Palestine. Nevertheless, little is known about knowledge, attitudes, and perceptions regarding this topic in Palestine. This study aimed to assess the prevalence of e-cigarette use among Palestinian university students, along with their knowledge, attitudes, and perceptions about e-cigarette use. An observational cross-sectional study, utilizing an online self-administered questionnaire, was conducted on Palestinian students from five universities between 17/04/2023 and 04/11/2023. A total of 1002 Palestinian university students completed the questionnaire. The prevalence of e-cigarette use among students was 18.1%. The mean knowledge score about e-cigarettes was significantly lower among the users of e-cigarettes compared to non-users. E-cigarette use was significantly associated with the participants' smoking status. Among e-cigarette users, 43.6% were also current traditional cigarette users, and 66.9% were current waterpipe users. E-cigarette use was significantly associated with having a friend who is a smoker and/ or a smoking mother. Binary logistic regression revealed a significant positive effect between the participant's smoking status, the mother's smoking status, knowledge about e-cigarettes, and the use of e-cigarettes (p-value < 0.05). Among e-cigarette users, 18.8% used them in indoor places at the university, and 25% reported using them daily in the past month. Affordability of e-cigarettes was the most reported reason for their use (47.5%). This study concluded that e-cigarette use is prevalent and rapidly rising among university students in Palestine. This is worrisome as it is significantly associated with insufficient knowledge about the adverse health effects of E-cigarette use, and its addictive nature. These findings focus on the importance of improving the students' knowledge about e-cigarette use by implementing educational campaigns and considering age regulations on e-cigarette availability and use.

Characterizing Anti-Vaping Posts for Effective Communication on Instagram Using Multimodal Deep Learning.

Instagram is a popular social networking platform for sharing photos with a large proportion of youth and young adult users. We aim to identify key features in anti-vaping Instagram image posts associated with high social media user engagement by artificial intelligence. We collected 8972 anti-vaping Instagram image posts and hand-coded 2200 Instagram images to identify nine image features such as warning signs and person-shown vaping. We utilized a deep-learning model, the OpenAI: contrastive language-image pre-training with ViT-B/32 as the backbone and a 5-fold cross-validation model evaluation, to extract similar features from the Instagram image and further trained logistic regression models for multilabel classification. Latent Dirichlet Allocation model and Valence Aware Dictionary and sEntiment Reasoner were used to extract the topics and sentiment from the captions. Negative binomial regression models were applied to identify features associated with the likes and comments count of posts. Several features identified in anti-vaping Instagram image posts were significantly associated with high social media user engagement (likes or comments), such as educational warnings and warning signs. Instagram posts with captions about health risks associated with vaping received significantly more likes or comments than those about help quitting smoking or vaping. Compared to the model based on 2200 hand-coded Instagram image posts, more significant features have been identified from 8972 AI-labeled Instagram image posts. Features identified from anti-vaping Instagram image posts will provide a potentially effective way to communicate with the public about the health effects of e-cigarette use. Considering the increasing popularity of social media and the current vaping epidemic, especially among youth and young adults, it becomes necessary to understand e-cigarette-related content on social media. Although pro-vaping messages dominate social media, anti-vaping messages are limited and often have low user engagement. Using advanced deep-learning and statistical models, we identified several features in anti-vaping Instagram image posts significantly associated with high user engagement. Our findings provide a potential approach to effectively communicate with the public about the health risks of vaping to protect public health.

Perceiving E-Cigarettes as Safe and Safer Alternative to Cigarettes Among Young Adults.

Young adults are using e-cigarettes at high rates. While the literature on the health risks associated with e-cigarettes is extensive and growing, little is known about young adults' thoughts and perceptions of the safety and harms of e-cigarettes. We conducted one-on-one interviews with young adults aged 18 to 25 years in Los Angeles, California between June 2018 and June 2019. We interviewed and audio-recorded young adults (N = 62) who consented to the study and self-reported to have used e-cigarettes on a weekly basis or more for at least 5 months prior to study enrollment. Interviews examined participants' thoughts, feelings, and experiences related to e-cigarette use. We audio-recorded, transcribed, and coded the interviews using grounded theory analysis methods. Young adults often believed that e-cigarettes were safer than cigarettes and were safe to use, especially following positive vaping experiences. Young adults were skeptical of the available science on e-cigarette use and felt there was not conclusive data on the harms of e-cigarettes. In their selection of e-cigarettes over cigarettes, young adults felt they were making a conscious and healthier choice. Because young adults viewed e-cigarettes to be better for them based on their personal experiences with vaping, they felt e-cigarettes were a superior alternative to combustible tobacco. Young adults in our study believed that the long-term health effects of e-cigarette use are not clearly understood and were generally skeptical of the research on e-cigarette harms. Policy, education, and anti-smoking campaigns need to clarify the negative health-related consequences of e-cigarette use for young people.

Content Analysis of YouTube Videos Related to E-Cigarettes and COVID-19

Background E-cigarettes are frequently promoted on social media and portrayed in ways that are attractive to youth. While the COVID-19 pandemic significantly affected people’s lives, less is known about how the pandemic influenced e-cigarette-related marketing and information on social media. This study examined how e-cigarettes were portrayed on youtube, one of the most popular social media platforms during the COVID-19 pandemic. Methods We searched for combinations of search terms related to e-cigarettes (e.g., “electronic cigarette” and “vape”) and COVID-19 (e.g., “corona” and “COVID”) in July of 2021. To be included in analyses, videos must be: uploaded after February 1, 2020, in English, related to e-cigarettes and COVID-19, and less than 30 min in length. We conducted a content analysis of included videos, coding for uploader characteristics, what e-cigarette products were showcased, and specific themes that intersected between e-cigarettes and COVID-19. Results We examined N = 307 videos and found that N = 220 (73.6%) discussed the health effects of e-cigarette use on COVID-19, followed by videos on how COVID-19 affects e-cigarette sales (N = 40, 12.9%), face mask-related videos (N = 16, 5.1%; e.g., vape tricks including masks) and instructional videos (N = 10, 3.2%; e.g., sanitizing vape devices during COVID-19). Instructional videos had the highest number of likes (Median = 23; IQR = 32) and comments (Median = 10; IQR = 7). Conclusions Our findings support the need for continuous surveillance and research on novel vaping-related content in reaction to policies and events, such as the global pandemic. More research is needed to understand the impact of this content on young people’s perceptions and use of e-cigarettes.

E-Cigarette Toxicology and Public Health — Exploring the Safety of E-Cigarette Compared to Traditional Cigarette

With the popularity of e-cigarettes, there are concerns about the potential health risks associated with inhaling e-cigarette aerosols, which contain a complex mixture of chemicals including nicotine, flavourings and poisons. This paper presents a systematic toxicological analysis of several chemicals commonly found in e-cigarettes. The chemical properties and toxicity of nicotine, propylene glycol, vegetable glycerin, benzaldehyde and cinnamaldehyde are discussed in relation to their use in e-cigarettes, with an emphasis on the hidden health risks involved. Nicotine is a highly addictive alkaloid that causes oxidative stress, neuronal apoptosis, DNA damage, and is highly toxic. E-cigarette solvents, such as vegetable glycerine and propylene glycol, can activate melanin production in the skin and raise the likelihood respiratory infections. Flavouring agents like benzaldehyde and cinnamaldehyde can induce cellular damage and heighten the susceptibility to disease like cancer and cardiovascular disease, particularly in individuals with specific genetic variants of the ALDH2 enzyme. The discussion revealed a lack of research to fully understand and assess prolonged health effects of e-cigarette use. However, both clinical and marketing should highlight the known possible risks. Clinicians should advise patients accordingly, and regulators must closely monitor the sale and promotion of e-cigarettes and be transparent about any potential harms to safeguard the welfare of consumers.

Abstract 4470: E-cigarette aerosol exposure increases NF-kB and modulates inflammatory markers in oral epithelial cells

Abstract Background: E-cigarette use has skyrocketed among youth, in part because e-cigarettes are perceived as a safer substitute for traditional cigarettes. However, the resulting health effects of e-cigarette use are still unclear. E-cigarette aerosols contain harmful and potentially harmful substances such as flavorings, carbonyl compounds, heavy metals, carcinogens and reactive oxygen species (ROS). A recent in vitro study from our laboratory showed that e-cigarette aerosols can increase cellular ROS and suppress cellular antioxidant capacity. An imbalance between the ROS production and the availability of antioxidants or free radical scavengers, can lead to chronic inflammation. Here we examine the effect of exposure to e-cigarette aerosols on the expression of the inflammatory regulator NF-kB and its downstream inflammatory targets in oral epithelial cells. Methods: Human oral epithelial cancer (UM-SCC-1) cells were exposed, every other day for 2 weeks, to e-cigarette aerosol extracts (18 mg/ml of nicotine; tobacco flavor) prepared from two distinct e-cigarette brands. Standard tobacco extracts were used as a positive control. Whole-cell RNA was isolated and processed for RNA-sequencing. The altered gene expression was further validated by western blotting and ELISA using a human cytokine array. Data were analyzed by Student's t-test. Results: RNA sequencing data showed that a 2-week exposure of oral epithelial cells to e-cigarette aerosol extracts resulted in significant changes in several key cellular signaling pathways, including inflammatory and immune response signals. Exposure to e-cigarette aerosol extracts resulted in a significant increase in the expression of proteins involved in inflammatory pathways, such as TLR3, TGF beta, ERK1/2 and NF-kB. We also observed a significant increase in pro-inflammatory and anti-inflammatory cytokines after exposure to e-cigarette aerosol extracts, including CD54, IL-1a and IL-10. Conclusion: Our data suggest that chronic exposure to e-cigarette aerosol increases the expression of TLR3, TGF beta, and ERK1/2, which possibly contributed to the observed increase in NF-kB and its down-stream targets (e.g., CD54, IL-1a and IL-10). NF-kB is a pleiotropic transcription factor with key roles in multiple biological processes, such as immune homeostasis and development. Chronic NF-kB activation by e-cigarette aerosol exposure could contribute to chronic inflammation and tumorigenesis. Citation Format: Vengatesh Ganapathy, Jimmy Manyanga, Dehra McGuire, Daniel Brobst, Balaji Sadhasivam, Mayilvanan Chinnaiyan, Constantin Georgescu, Jonathan Wren, Lurdes Queimado. E-cigarette aerosol exposure increases NF-kB and modulates inflammatory markers in oral epithelial cells. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4470.

Impact of Electronic Cigarette use on Cardiovascular Health: Current Evidence, Causal Pathways, and Public Health Implications.

Electronic cigarette (e-cigarette) use is increasing in Europe and the USA. While mounting evidence exists regarding an array of associated adverse health effects, to date limited evidence exists regarding the health effects of e-cigarette use on cardiovascular (CV) disease (CVD). The present review summarizes the effects of e-cigarette use on CV health. A search strategy of in vivo experimental, observational studies (including population-based cohort studies), and interventional studies was conducted in PubMed, MEDLINE, and Web of Science (April 1, 2009-April 1, 2022). The main findings revealed that the influence of e-cigarette on health are attributed mainly to the individual and interactive effects of flavors and additives used in e-cigarette fluids, along with the extended heating. The above collectively stimulate prolonged sympathoexcitatory CV autonomic effects, such as increased heart rate and diastolic blood pressure (BP), as well as decreased oxygen saturation. Hence, e-cigarette users are at increased risk of developing atherosclerosis, hypertension, arrhythmia, myocardial infarction, and heart failure. Such risks are anticipated to increase, especially among the young who are increasingly adopting e-cigarette use particularly with flavored additives. Further investigations are urgently needed to evaluate the long-term effects of e-cigarette use, particularly among susceptible population groups such as youth.

Current Knowledge and Challenges of Particle Size Measurements of Mainstream E-Cigarette Aerosols and Their Implication on Respiratory Dosimetry

The E-cigarette has been promoted as an alternative nicotine delivery device with potentially fewer toxicant emissions. The objective of this review is to summarize the current knowledge on the particle size distribution (PSD) of e-cigarette emissions and to analyze the knowledge gaps between existing particle size measurements and the vision toward harm reduction from e-cigarette use. Here, we focus on firstly describing the physical parameters used to characterize PSD, followed by comparing particle size measurement approaches, investigating the factors that impact the PSD of e-cigarette mainstream aerosols, and conclude by linking size distribution to the respiratory dosimetry by demonstrating the modeling results of particle deposition in the respiratory tract. This review calls for a harmonized testing protocol to conduct inter-comparisons and further understand e-cigarette particle sizes. Among the influencing factors investigated, puff topography, operation power, flavorings, PG/VG ratio, and nicotine strength impose a substantial impact on the PSD, but the underlying mechanisms have not yet been fully investigated. The effects brought by the type of device refill and nicotine are yet inconclusive due to lack of evidence. Coil aging has no significant impact on the PSD of e-cigarette aerosols within the coil lifetime. Lastly, while computational models of particle deposition have been adopted to profile the deposition of e-cigarette mainstream emissions, existing models have limited applicability and generality when dealing with e-cigarette aerosols that have high volatility and hygroscopicity, which can dynamically evaporate or grow during the transport process. Additionally, the size-dependent chemical composition (e.g., nicotine and harmful and potentially harmful constituents) of e-cigarette aerosols is unknown, impeding the understanding of the health effects of e-cigarette use. Therefore, it is essential for future studies to bridge these knowledge gaps and unveil the mechanisms determining PSD and respiratory deposition.

#NicotineAddictionCheck: Puff Bar Culture, Addiction Apathy, and Promotion of E-Cigarettes on TikTok.

This study aimed to classify and delineate types of user-generated content about the disposable e-cigarette Puff Bar shared on the popular video-based social media platform TikTok. We qualitatively analyzed 148 popular TikTok videos collected in July 2020. During an iterative process of data reduction and thematic analysis, we categorized videos by overarching genres and identified emergent themes. Young adults were engaged at all stages of the research process. Together, videos were viewed over 137 million times on TikTok. Seven genres of Puff Bar content emerged: skits and stories, shared vaper experiences, videos to show off, product reviews, product unboxing, promotion of Puff Bar, and crafts. Videos depicted Puff Bar users’ apathy about addiction and a lack of concern of the health effects of e-cigarette use. Additionally, Puff Bar promotion content from underground retailers was extensive and some targeted underage persons. Qualitative analysis of social media content can richly describe emerging online culture and illuminate the motivations of adolescent and young adult e-cigarette use. Social media can facilitate new product adoption; comprehensive e-cigarette regulation and enforcement can counteract these effects by closing loopholes through which new products emerge.

Characteristics of and User Engagement With Antivaping Posts on Instagram: Observational Study.

BackgroundAlthough government agencies acknowledge that messages about the adverse health effects of e-cigarette use should be promoted on social media, effectively delivering those health messages is challenging. Instagram is one of the most popular social media platforms among US youth and young adults, and it has been used to educate the public about the potential harm of vaping through antivaping posts.ObjectiveWe aim to analyze the characteristics of and user engagement with antivaping posts on Instagram to inform future message development and information delivery.MethodsA total of 11,322 Instagram posts were collected from November 18, 2019, to January 2, 2020, by using antivaping hashtags including #novape, #novaping, #stopvaping, #dontvape, #antivaping, #quitvaping, #antivape, #stopjuuling, #dontvapeonthepizza, and #escapethevape. Among those posts, 1025 posts were randomly selected and 500 antivaping posts were further identified by hand coding. The image type, image content, and account type of antivaping posts were hand coded, the text information in the caption was explored by topic modeling, and the user engagement of each category was compared.ResultsAnalyses found that antivaping images of the educational/warning type were the most common (253/500; 50.6%). The average likes of the educational/warning type (15 likes/post) were significantly lower than the catchphrase image type (these emphasized a slogan such as “athletesdontvape” in the image; 32.5 likes/post; P<.001). The majority of the antivaping posts contained the image content element text (n=332, 66.4%), followed by the image content element people/person (n=110, 22%). The images containing people/person elements (32.8 likes/post) had more likes than the images containing other elements (13.8-21.1 likes/post). The captions of the antivaping Instagram posts covered topics including “lung health,” “teen vaping,” “stop vaping,” and “vaping death cases.” Among the 500 antivaping Instagram posts, while most posts were from the antivaping community (n=177, 35.4%) and personal account types (n=182, 36.4%), the antivaping community account type had the highest average number of posts (1.69 posts/account). However, there was no difference in the number of likes among different account types.ConclusionsMultiple features of antivaping Instagram posts may be related to user engagement and perception. This study identified the critical elements associated with high user engagement, which could be used to design antivaping posts to deliver health-related information more efficiently.

Investigating the DNA methylation profile of e-cigarette use

BackgroundLittle evidence exists on the health effects of e-cigarette use. DNA methylation may serve as a biomarker for exposure and could be predictive of future health risk. We aimed to investigate the DNA methylation profile of e-cigarette use.ResultsAmong 117 smokers, 117 non-smokers and 116 non-smoking vapers, we evaluated associations between e-cigarette use and epigenome-wide methylation from saliva. DNA methylation at 7 cytosine-phosphate-guanine sites (CpGs) was associated with e-cigarette use at p < 1 × 10–5 and none at p < 5.91 × 10–8. 13 CpGs were associated with smoking at p < 1 × 10–5 and one at p < 5.91 × 10–8. CpGs associated with e-cigarette use were largely distinct from those associated with smoking. There was strong enrichment of known smoking-related CpGs in the smokers but not the vapers. We also tested associations between e-cigarette use and methylation scores known to predict smoking and biological ageing. Methylation scores for smoking and biological ageing were similar between vapers and non-smokers. Higher levels of all smoking scores and a biological ageing score (GrimAge) were observed in smokers. A methylation score for e-cigarette use showed poor prediction internally (AUC 0.55, 0.41–0.69) and externally (AUC 0.57, 0.36–0.74) compared with a smoking score (AUCs 0.80) and was less able to discriminate lung squamous cell carcinoma from adjacent normal tissue (AUC 0.64, 0.52–0.76 versus AUC 0.73, 0.61–0.85).ConclusionsThe DNA methylation profile for e-cigarette use is largely distinct from that of cigarette smoking, did not replicate in independent samples, and was unable to discriminate lung cancer from normal tissue. The extent to which methylation related to long-term e-cigarette use translates into chronic effects requires further investigation.

Electronic cigarette use and its association with asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome among never cigarette smokers.

INTRODUCTIONAlthough smoking is a strong risk factor for lung diseases including asthma, COPD, and asthma-COPD overlap syndrome (ACOS), studies are needed to examine the association between e-cigarettes and asthma, COPD, and ACOS. This study evaluated the association between e-cigarette use and self-reported diagnosis of asthma, COPD, and ACOS using a large nationally representative sample of adults aged ≥18 years in the United States.METHODSCross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2016 to 2018 was used to examine self-reported information on current e-cigarette use, demographic variables, and asthma and COPD status among never cigarette smokers (n=8736). Asthma and COPD were measured by self-reported diagnosis, and respondents who reported having both diagnoses were then classified as having ACOS. Of the 46079 never cigarette smokers, 4368 non-e-cigarette smokers were 1:1 propensity score-matched to e-cigarette smokers on age, sex, race/ethnicity and education level. We used multinomial logistic regression to examine association between current e-cigarette use and self-report asthma, COPD, and ACOS while controlling for marital status and employment in addition to matching variables.RESULTSCompared with never e-cigarette smokers, e-cigarette smokers had increased odds of self-reported ACOS (OR=2.27; 95% CI: 2.23–2.31), asthma (OR=1.26; 95% CI: 1.25–1.27) and COPD (OR=1.44; 95% CI: 1.42–1.46).CONCLUSIONSData from this large nationally representative sample suggest that e-cigarette use is associated with increased odds of self-reported asthma, COPD, and ACOS among never combustible cigarette smokers. The odds of ACOS were twice as high among e-cigarette users compared with never smokers of conventional cigarettes. The findings from this study suggest the need to further investigate the long-term and short-term health effects of e-cigarette use, since the age of those at risk in our study was 18–24 years.

Prevalence and Distribution of Electronic Cigarette Use Before and During Pregnancy Among Women in 38 States of the United States.

To examine the prevalence and the changing pattern of e-cigarette use from preconception to pregnancy. This is a cross-sectional study using data from the multi-site Pregnancy Risk Assessment Monitoring System in the United States, 2016-2017. All participating mothers with information on e-cigarette use before and during pregnancy were included. Self-reported information about e-cigarette use were assessed using questionnaires. Weighted prevalences of e-cigarette use before and during pregnancy were calculated. Multivariable logistic regressions were used to examine the association between various demographic characteristics and e-cigarette use before or during pregnancy. This study included 69 508 pregnant women from 38 states in the United States. The weighted prevalence of e-cigarette use before pregnancy and during the last 3 months of pregnancy was 3.6% (95% confidence interval [CI] 3.4%-3.9%) and 1.1% (0.9%-1.2%), respectively. The prevalence varied across states, ranging from 1.3% to 8.3% for e-cigarette use before pregnancy and from 0.1% to 3.4% for e-cigarette use during the last 3 months of pregnancy. Among women who used e-cigarettes before pregnancy, 24.4% (21.7%-27.1%) continued to use e-cigarettes during pregnancy. Among women who used e-cigarettes during pregnancy, 62.3% (56.5%-68.0%) were dual users. In multivariable analyses, cigarette smoking was most strongly associated with e-cigarette use. The adjusted odds ratio comparing smokers with nonsmokers before pregnancy was 11.10 (95% CI 9.34-13.20) for e-cigarette use before pregnancy and 6.72 (95% CI 4.38-10.31) for e-cigarette use during pregnancy. Using data from 38 states in the United States, we showed geographical variations in the prevalence of e-cigarette use before and during pregnancy. Among women who used e-cigarettes before pregnancy, a quarter of them continued to use e-cigarettes during pregnancy. Conventional cigarette use is a strong risk factor for e-cigarette use before and during pregnancy. The prevalence of e-cigarette use needs to be monitored continuously. This study provides important information to understand the status and changing patterns of e-cigarette use in pregnant women in the United States. Among pregnant women in 38 states in the United States, 3.6% of them used e-cigarettes during the 3 months before pregnancy and 1.1% used them during the last 3 months of pregnancy. The prevalence varied across states. A quarter of women who used e-cigarettes before pregnancy continued to use e-cigarettes during pregnancy. Cigarette smoking is the strongest predictor of e-cigarette use. Future research about health effects of e-cigarette use during pregnancy is in urgent need.

Cross-Sectional Association Between Lifetime Use of Electronic Cigarettes With or Without Marijuana and Self-Reported Past 12-Month Respiratory Symptoms as well as Lifetime Respiratory Diseases in U.S. Adults.

IntroductionThe use of electronic cigarettes (vaping), especially with marijuana, has become increasingly popular among adults.Aims and MethodsThe Population Assessment of Tobacco and Health study Wave 4 data on 33 606 adult participants who indicated ever using electronic cigarettes were included in the study. By controlling for confounding variables (such as age and smoking history), multivariable weighted logistic regression models were used to examine the cross-sectional association between lifetime e-cigarette use with or without marijuana and self-reported past 12-month respiratory symptoms as well as lifetime respiratory diseases.ResultsCompared to adults who never vaped, adults who had ever vaped with marijuana had a significantly higher association with self-reported past 12-month respiratory symptoms but not lifetime respiratory diseases. Compared to adults who had ever vaped without marijuana, adults who had ever vaped at least sometimes with marijuana had a significantly greater risk of having wheezing/whistling in the chest (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI]: 1.01, 1.44), chest sounded wheezy during or after exercise (aOR = 1.59, 95% CI: 1.31, 1.93), and had a dry cough at night (aOR = 1.35, 95% CI: 1.16, 1.57), while adults who had ever vaped rarely with marijuana had a significantly greater risk of having wheezing/whistling in the chest (aOR = 1.31, 95% CI: 1.06, 1.61), chest sounded wheezy during or after exercise (aOR = 1.24, 95% CI: 1.01, 1.52), and had a dry cough at night (aOR = 1.24, 95% CI: 1.04, 1.47).ConclusionsLifetime e-cigarette use with marijuana is associated with self-reported past 12-month respiratory symptoms in adults.ImplicationsThe use of e-cigarettes with marijuana has become prevalent in recent years. Our cross-sectional study suggests that there may be respiratory health symptoms associated with ever vaping with marijuana that is independent of nicotine vaping, which should raise public awareness of potential health risks associated with the use of e-cigarettes with marijuana. Further longitudinal studies on the respiratory health effects of e-cigarette use with marijuana are warranted.

Electronic Cigarettes and Head and Neck Cancer Risk-Current State of Art.

Simple SummaryThe risk of developing cancer is always higher for tobacco smokers than for non-smokers. Electronic cigarettes (e-cigarettes) have become increasingly popular in the last decade and are considered less harmful than traditional tobacco products, due to the lower content of toxic and carcinogenic compounds. However, this is still a controversial issue. This paper contains a review of previous reports on the composition of e-cigarettes and their impact on the pathogenesis and risk of head and neck cancer (HNC). The authors reviewed articles on both toxic and carcinogenic compounds contained in e-cigarettes and their molecular and health effects on the upper respiratory tract in comparison to traditional tobacco cigarettes. In conclusion, the studies discussed in the review strongly suggest that more long-term studies are needed to better address the safety of e-cigarettes.E-cigarettes have become increasingly popular in the last decade and are considered less harmful than traditional tobacco products due to the lower content of toxic and carcinogenic compounds. However, this is still a controversial issue. This paper contains a review of previous reports on the composition of e-cigarettes and their impact on the pathogenesis and risk of head and neck cancer (HNC). The objective of the review was to compare the molecular and health effects of e-cigarette use in relation to the effects of traditional cigarette smoking in the upper respiratory tract, and to assess the safety and effect of e-cigarettes on HNC risk. A review for English language articles published until 31 August 2020 was made, using a PubMed (including MEDLINE), CINAHL Plus, Embase, Cochrane Library and Web of Science data. The authors reviewed articles on both toxic and carcinogenic compounds contained in e-cigarettes and their molecular and health effects on the upper respiratory tract in comparison to tobacco cigarettes. The risk of developing head and neck squamous cell carcinoma (HNSCC) remains lower in users of e-cigarettes compared with tobacco smokers. However, more long-term studies are needed to better address the safety of e-cigarettes.

Improved Documentation of Electronic Cigarette Use in an Electronic Health Record.

The use of electronic cigarettes (e-cigarettes) can affect patient health and clinical care. However, the current documentation of e-cigarette use in the electronic health records (EHR) is inconsistent. This report outlines how the ambulatory clinical practices of a large U.S. hospital system optimized its electronic health records (EHR) framework to better record e-cigarettes used by patients. The new EHR section for e-cigarette information was implemented for outpatient appointments. During a 30-week evaluation period post-implementation, 638,804 patients (12 yrs and older) completed ambulatory appointments within the health system; of these, the new section contained e-cigarette use information for 37,906 (6%) patients. Among these patients, 1005 (2.7%) were identified as current e-cigarette users (current every day or current some day e-cigarette use), 941 (2.5%) were reported as former e-cigarette users, and 35,960 (94%) had never used e-cigarettes. A separate EHR section to document e-cigarette use is feasible within existing clinical practice models. Utilization of the new section was modest in routine clinical practice, indicating the need for more intensive implementation strategies that emphasize the health effects of e-cigarette use, and how consistent ascertainment could improve clinical practice.

The perceived health effects of e-cigarette use among adult smokers

Background: Vaping and e-cigarettes have been an epidemic among youths in recent years. In addition, as of April 2020, there has been hundreds of vaping related illnesses causing fatalities. As such there has been increased coverage by media and the government in regard to reporting vaping-related dangers and implementing regulatory changes such as bans. These actions could deter the target population from engaging in vaping – tobacco users. Research has shown that e-cigarettes are significantly less toxic relative to tobacco and that it could be more effective as a cessation treatment relative to nicotine gums or patches. This study surveyed current perceptions of Canadians with regards to vaping in order to determine if certain groups (i.e. varying ages, smoking status) hold different opinions in terms of harm, health benefits, and support for stricter e-cigarette regulations. Methods: Self-administered online surveys created on Survey Monkey were distributed to Canadians via online platforms Reddit and Facebook. The survey assessed opinions and perceptions of Canadians through multiple choice questions and were collected over a three week period. Results: This study received 157 respondents the majority of which were under 35 (73.08%) and from British Columbia (65.38%). Thirteen chi-square tests were performed comparing group variables (age, smoking status, and awareness of vaping related news) to perception variables (perceived harm, health benefits, safety). There was no association found between age and the tested perception variables. Several associations were found where e-cigarette users viewed e-cigarettes more favourably relative to tobacco users and non-users based on chi-square results. Chi-square associations between media awareness and harm perceptions could not be established due to a small sample size (n&lt; 30). Conclusion: The results indicated that there are associations with e-cigarette perceptions and a person’s smoking status. This may be an indication that there is possible misinformation between groups when it comes to evaluating objective health effects of e-cigarettes. Non-users and a percentage of tobacco users seem to overstate

Vaping and Cardiovascular Health: the Case for Health Policy Action

E-cigarette smoking is rapidly increasing, especially in adolescents and adults, although data on their safety or harm is still scarce. There have been few systematic studies of the health effects of e-cigarette use and most studies report on the use of e-cigarettes in past or current cigarette smokers. In this paper, we want to summarize cardiovascular effects of e-cigarettes. E-cigarettes could cause cardiovascular harm especially by the toxic effects and of the e-liquid and induction of oxidative stress. Nicotine has known effects on cardiovascular function that are not different in e-cigarettes to those in combustible cigarettes. Moreover, vaping nicotine could be the driver for future revival of combustible smoking. Although it seems that e-cigarettes are a safer alternative than combustible cigarettes for people that want to stop smoking, toxic effects of the e-liquid can induce an increase in cardiovascular risk. Long-term data of their safety are still scarce or even lacking and most data are generated in studies with active or past regular cigarette smokers. More data on the cardiovascular and metabolic side effects of vaping are warranted in people naive for smoking combustible cigarettes.

Perceived health effects of vaping among Hungarian adult e-cigarette-only and dual users: a cross-sectional internet survey

BackgroundKnowledge about the health effects of e-cigarette use (or vaping) among past and current combustible cigarette users is limited. Several studies have assessed vaping-related adverse events (AEs) and beneficial health effects, however, most studies focused on AEs in general and examined only a few physiological changes that vapers experience. This study aims to explore self-reported AEs and perceived health changes due to e-cigarette use among Hungarian adult e-cigarette-only users (former smokers who switched completely to e-cigarette use) and dual users (smokers who use e-cigarettes and combustible tobacco cigarettes concomitantly).MethodsA cross-sectional, web-based survey of 1042 adult Hungarian e-cigarette users was conducted in 2015. Participants reported AEs and changes in physiological functions since they switched from smoking to e-cigarette use or while dually using e-cigarettes and combustible cigarettes. Confirmatory factor analysis with covariates was applied to explain perceived health changes due to e-cigarette-only use and dual use.ResultsDual users (17.6%) were significantly more likely to report AEs of vaping than e-cigarette-only users (26.2% vs. 11.8%, p < 0.001). Experiencing health improvements were significantly more likely among e-cigarette-only users than for dual users for all surveyed physiological functions. E-cigarette-only users reported larger effects of vaping on sensory, physical functioning, and mental health factors compared to dual users. Self-reported changes in sensory and physical functioning were significantly higher among individuals using e-cigarettes more than a year and people who were past heavy smokers (smoked ≥20 cigarettes per day). Gender was related to sensory improvement only; males reported greater improvement than females.ConclusionsThe majority of e-cigarette-only users reported more perceived beneficial changes in physiological functions and fewer AEs than dual users. Perceived short-term benefits of e-cigarette use may reinforce users despite the uncertainty of long-term health consequences. Health professionals should provide balanced information regarding the possible short- and long-term positive and negative health effects of e-cigarette use during consultations with patients.

Abstract P399: Two-Year Trends and Determinants of Electronic Cigarette Use Among Patients With Cardiovascular Disease in the United States

Background: The use of electronic cigarettes (e-cigarettes) is on the rise in the US. It increased in adults aged 25-44 years from 2.4% in 2012 to 4.2% in 2016 and from 2% to 2.8% between ages 55 to 64 over the same period. Among the youth, the increase was 900% between 2011 and 2015. Much remains to be known about the health effects of e-cigarette use, but epidemiologic studies suggest an independent association between e-cigarette use and cardiovascular disease. There is a need for data on the social and demographic factors that are predictive of use in adults with cardiovascular disease (CVD), to identify the appropriate focus of intervention. Methods: This is an analysis of the 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) data, an annual chronic disease and behavioral risk factor survey conducted by the CDC. The sample included the 110,028 respondents that reported a history of heart attack, angina/coronary heart disease or stroke. The rates of e-cigarette use were calculated, and a multiple logistic regression analysis was used to assess associated factors. Results: Among respondents with CVD, there was no change in e-cigarette use between 2016 and 2017 [3.1% to 2.8% adjusted OR (aOR) 1.08 (95% CI 0.95 - 1.24)]. The median age of e-cigarette users was 58 years and that of non-users was 69 years (p&lt;0.0001). Women had a higher rate of e-cigarette use compared with men [3.2% vs 2.7% aOR 1.17(1.04-1.31)]. Other factors associated with e-cigarette use were: race [blacks vs whites 1.9% vs 3% aOR 0.37(0.28-0.49], sexual orientation [LGBTQ vs non-LGBTQ 7.1% vs 2.9% aOR 1.56 (1.24-1.96)], smoking [current smokers vs non-smokers 11.1% vs 1.2% aOR 6.0 (5.3-6.8), smoking on some days vs never smoked 12.7% vs 0.24 aOR 51(35.4-73.5)], mental illness [6.4% vs 1.8% aOR 1.57 (1.37-1.810)] and state of residence (p&lt;0.0001). Conclusion: In conclusion, there was no significant change in e-cigarette use between 2016-2017 among respondents with CVD. The highest rates of e-cigarette use were among subjects who were: smokers on some days, current smokers, LGBTQ and had a mental illness.