Nicotine Products Research Articles

Susceptibility to e-cigarette use and associated factors in high school youth, Oklahoma Youth Tobacco Survey, 2021-2022.

Susceptibility predicts subsequent uptake of e-cigarettes (EC) by youth. This study identified factors associated with EC susceptibility among high school students who have never used a tobacco/nicotine product. The Oklahoma Youth Tobacco Survey was administered to a random sample of 36 Oklahoma High Schools during the 2021-2022 school year (n = 1,220 participating students). Associations between EC susceptibility and covariates were identified using stepwise logistic regression for weighted survey data. More than one third of Oklahoma high school students who had never used tobacco or nicotine products (36.4%) were susceptible, and males had higher susceptibility than females (38.8 and 33.9%, respectively). In males, EC susceptibility was associated with race (Black, American Indian, and other were less susceptible), psychological distress (aOR = 2.4, 95% CI = 1.1, 4.8), disagreement that all tobacco products are dangerous (aOR = 3.1, 95% CI = 1.2, 7.9), and perception of little/no harm from secondhand vapor (aOR = 3.4, 95% CI = 2.1, 5.3). In females, identifying as gay, lesbian, or bisexual (aOR = 2.1, 95% CI = 1.1, 3.9), poor academic performance (aOR = 4.5, 95% CI = 1.6, 12.6), psychological distress (aOR = 2.6, 95% CI = 1.2, 5.5) and interacting with EC content on social media (aOR = 5.9, 95% CI = 1.9, 18.1) were associated with EC susceptibility. Males and females had different patterns of susceptibility to EC use. Understanding groups of adolescents most susceptible to using nicotine products can help target prevention efforts at home, in schools, and within communities.

Impact of electronic cigarettes on pediatric, adolescent and young adult leukemia patients.

Electronic cigarettes, which deliver an aerosolized, nicotine-containing product upon inhalation, are a public health issue that continue to gain popularity among adolescents and young adults in the United States. Use of electronic cigarettes is wide, and extends to pediatric patients with multiple comorbidities, including childhood cancer, leaving them vulnerable to further negative health outcomes. Acute leukemias are the most common type of cancer in pediatric populations, and treatment outcomes for these patients are improving; consequently, there is an increased emphasis on the effect of behavioral lifestyle factors on quality of life in survivorship. The rate of electronic cigarette use is higher among pediatric patients with a history of cancer than those without a history of cancer. Because electronic cigarettes are relatively new, much about their acute and long-term consequences remains unknown, as is their effect on therapy outcomes and long-term survivorship. This review article summarizes current knowledge about electronic cigarettes, including their composition and the trends in use among pediatric patients. Furthermore, this review provides a comprehensive description of the impact electronic cigarettes have on leukemia development, treatment and survivorship and highlights gaps in knowledge that will be necessary for developing recommendations, management strategies, and tailored treatments for pediatric leukemia patients and survivors who use these nicotine products.

Adolescent E-Cigarette Expectancies: Measure Development and Preliminary Validity of the Electronic Nicotine Vaping Outcomes Measure for Youth.

Electronic nicotine delivery systems ("e-cigarettes") are the nicotine product most commonly used by adolescents. Research, treatment, and policy could benefit from measures of adolescent e-cigarette beliefs about outcomes of use (ie, expectancies). In the current study, we developed and tested an adolescent electronic nicotine vaping expectancy measure. A focus group with adolescents evaluated potential e-cigarette expectancy items. A panel of national experts assisted in revision of these items. Finally, items were administered to a sample of adolescents 14-17years old (N = 267, Mean age 15.6, SD = 1.1, 50.9% Female, 50.2% Non-Hispanic White, 22.5% Non-Hispanic Black, 14.2% Hispanic) in a large Southeastern metropolitan area in the United States. Exploratory Factor Analysis revealed a four factor solution: Negative Consequences (Cronbach's α = .92); Positive Reinforcement (α = .83); Negative Affect Reduction (α = .95); and Weight Control (α = .89). Subscales were significantly correlated with vaping susceptibility and lifetime vaping. Subscales successfully differentiated susceptible adolescents from confirmed non-susceptible adolescents, with susceptible adolescents reporting more positive expectancies, eg, Positive Reinforcement, M = 5.0, SD = 2.0 vs M = 3.0, SD = 2.1, P < .001, η2 = 0.19, and less negative expectancies, M = 5.5, SD = 2.3 vs M = 6.5, SD = 2.6, P = .001, η2 = 0.04. Similar results were found comparing adolescents who have never vaped nicotine with those who have vaped nicotine. Hierarchical linear regression demonstrated subscales were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. A preliminary version of an adolescent expectancy measure appears reliable and valid based on expert input and pilot testing with adolescents. Promising results were found in the domains of concurrent validity, discriminant validity, and incremental validity. Future research and evaluation efforts will be able to use this tool to further prevention and treatment goals.

The Italian National Institute of Health helpline to quit tobacco and nicotine dependence: 20 years of activity.

Tobacco use is one of the world's leading preventable causes of death and is a major preventable risk factor of non-communicable diseases. Although smokers are aware of the health risks, their attempts to quit often fail, primarily due to the strong nicotine and/or tobacco dependence. Antismoking helplines have become an integral part of tobacco control efforts in many countries. In Italy, the ISS Antismoking Helpine is active since 2000. The professional staff of the ISS Antismoking Helpline have gathered socio-demographic and smoking-related data via an electronic form, related to the received calls. The collected data have been processed in a dedicated database and analyzed to monitor the use and the quality of the service. In this study, a descriptive statistical analysis was conducted to inform about the activity of the helpline over the years. From May 2003 to June 2023 the helpline received 99,423 calls. Most smokers called to receive "support to quit" (82.6%). Counselling was provided in 11.4% of cases, and in the last two years has been strongly increased (40.0% of cases). The percentage of users requesting information on emerging tobacco and nicotine products is 1.2%, even if in 2023 this percentage has risen significantly (6.0%). Two legislative measures (in 2012 and in 2016) required to add the helpline number to all packets of tobacco cigarettes. Accordingly, the offer of counselling increased from 2.6% to 12.2%. The available resources in tobacco control, including the helpline, are still not sufficient to meet all the users needs. Adequate policies and stable funding to fight tobacco and nicotine dependence need increased commitment from government institutions to ensure equal access to treatments for all Italian citizens.

Exploring the prevalence, knowledge, attitudes and influencing factors of e-cigarette use among university students in Palestine: a cross-sectional study

ObjectivesE-cigarettes have gained popularity, especially among young adults. This study aims to determine the prevalence of e-cigarette smoking, assess knowledge and attitudes and identify associated factors among Palestinian university students.DesignA...

Pharmaceuticalisation as the tobacco industry’s endgame

ContextDeclining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they...

Use of nicotine products and awareness among young generation in university

Background With the increasing prevalence of the use of nicotine products in educational institutions by the young generation, this research investigates the prevalence and awareness of nicotine products at Shifa Tameer-e-Millat University in Islamabad, Pakistan. It explores demographics, consumption patterns, and perceptions related to nicotine products.&#x0D; Methods This study was conducted at Shifa Tameer-e-Millat University, Islamabad, from March 2022 to August 2023. Individuals aged 18 or older of both genders, including students from the university and Shifa Medical College, as well as healthcare employees and teachers who had consented to participate and had a history of nicotine product usage, were included.&#x0D; Results The sample size was 320, with most being students (83.0%) with a mean age of 22.31 years, predominantly using cigarettes (57.5%), followed by e-cigarettes (23.4%). Participants reported exposure mainly to university (41%) and college (37%). Usage frequency varied, with 34.7% using nicotine products once daily, 32.5% 2-3 times daily, 20.6% 4-6 times daily, and 12.2% more than seven times daily. Peer pressure had a moderate influence (mean rating of 5.96), and a significant association was found between gender and nicotine product usage (p=0.003). Preferences favoured modern nicotine products (n: 233) over conventional ones (n: 87), but no linear trend was observed. Health impact perception was linked to willingness to quit; 167 believed their health was affected and were willing to quit, while 48 hesitated, and 79 were indecisive (p=0.009), with a linear trend (p

171. Which Nicotine and Non-Nicotine Products do Adolescents and Young Adults Who Identify as LGBTQ+ Perceive as Most Harmful and Addictive?

171. Which Nicotine and Non-Nicotine Products do Adolescents and Young Adults Who Identify as LGBTQ+ Perceive as Most Harmful and Addictive?

Content analysis of IQOS direct mail and email marketing in the US

ObjectiveNovel nicotine and tobacco products, including heated tobacco products (HTPs) like IQOS, are growing in global popularity. IQOS was the first HTP authorized for sale by the US Food and Drug Administration, entering the US market in 2019 and being removed in 2021 due to patent-related legal challenges, with the possibility of returning in 2024. Direct marketing is one method tobacco companies use to reach consumers of these products. The purpose of this study was to investigate the content of US IQOS direct mail and email marketing. MethodsDirect marketing items were collected between September 2019 and July 2021 by seven team members in the first US IQOS test market, Atlanta, Georgia. ResultsOverall, 101 marketing items were collected, 59 of which were unique. Among the unique items that showed images of persons (“models”), 70 % showed models appearing to be from racial/ethnic minoritized groups, 86.8 % showed at least one female-presenting model, and 37.5 % showed models appearing to be young adults (18–29 years). Items often had an embedded link/URL (91.5 %) and mentioned topics such as online services (54.2 %; for example, online ordering and tutorials), user experience (49.2 %), social media (44.1 %), and purchasing locations (37.3 %). When examined for their main purpose, items focused on subjects such as store experience (37.7 %), product introduction (18.6 %), and product use (15.3 %). ConclusionsOur study highlights the importance of better understanding how novel tobacco products are marketed, which can inform policymakers’ regulatory efforts and product authorization decisions.

Association of transitioning from combustible cigarettes to noncombustible nicotine or tobacco products with subsequent cancer risk: a nationwide cohort study in South Korea

Association of transitioning from combustible cigarettes to noncombustible nicotine or tobacco products with subsequent cancer risk: a nationwide cohort study in South Korea

Use of Machine Learning Tools in Evidence Synthesis of Tobacco Use Among Sexual and Gender Diverse Populations: Algorithm Development and Validation.

From 2016 to 2021, the volume of peer-reviewed publications related to tobacco has experienced a significant increase. This presents a considerable challenge in efficiently summarizing, synthesizing, and disseminating research findings, especially when it comes to addressing specific target populations, such as the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, Two Spirit, and other persons who identify as part of this community) populations. In order to expedite evidence synthesis and research gap discoveries, this pilot study has the following three aims: (1) to compile a specialized semantic database for tobacco policy research to extract information from journal article abstracts, (2) to develop natural language processing (NLP) algorithms that comprehend the literature on nicotine and tobacco product use among sexual and gender diverse populations, and (3) to compare the discoveries of the NLP algorithms with an ongoing systematic review of tobacco policy research among LGBTQ+ populations. We built a tobacco research domain-specific semantic database using data from 2993 paper abstracts from 4 leading tobacco-specific journals, with enrichment from other publicly available sources. We then trained an NLP model to extract named entities after learning patterns and relationships between words and their context in text, which further enriched the semantic database. Using this iterative process, we extracted and assessed studies relevant to LGBTQ+ tobacco control issues, further comparing our findings with an ongoing systematic review that also focuses on evidence synthesis for this demographic group. In total, 33 studies were identified as relevant to sexual and gender diverse individuals' nicotine and tobacco product use. Consistent with the ongoing systematic review, the NLP results showed that there is a scarcity of studies assessing policy impact on this demographic using causal inference methods. In addition, the literature is dominated by US data. We found that the product drawing the most attention in the body of existing research is cigarettes or cigarette smoking and that the number of studies of various age groups is almost evenly distributed between youth or young adults and adults, consistent with the research needs identified by the US health agencies. Our pilot study serves as a compelling demonstration of the capabilities of NLP tools in expediting the processes of evidence synthesis and the identification of research gaps. While future research is needed to statistically test the NLP tool's performance, there is potential for NLP tools to fundamentally transform the approach to evidence synthesis.

Dual and poly-nicotine and tobacco use among adolescents in the United States from 2011 to 2022

BackgroundAdolescent nicotine and tobacco product use remains common despite declining smoking rates in the United States, likely due to the emergence of novel products. Concurrent use of multiple products may increase the risk of nicotine dependency and subsequent substance use. AimTo identify patterns and trends of dual and poly nicotine and tobacco use among adolescents in the US and explore associations of dual and poly nicotine and tobacco use with sociodemographic factors. Methods12 years of annual National Youth Tobacco Survey data (2011–2022) from 242,637 respondents were used to examine prevalence trends of different combinations of nicotine or tobacco product use among adolescents in the US using weighted point estimates for each year. Poisson regression models examined sociodemographic factors associated with different patterns of dual and poly-product use from 2011 to 2022. ResultsOverall, the prevalence of dual (i.e. at least two products) and poly (i.e. at least three products) use decreased between 2011 and 2021 (from 9.5 % to 2.8 % and from 5.1 % to 1.1 %, respectively), but showed signs of increase between 2021 and 2022 (3.7 % for dual and 1.7 % for poly use). The most common combinations included a combustible product with either a novel or noncombustible product. The risk for dual and poly-product use was higher among non-Hispanic Whites, males, and high school students. ConclusionsPreviously declining trends in the prevalence of tobacco/nicotine dual and poly use may have been reversed. Close monitoring and targeted tobacco control policies are essential to tackle multiple product use among adolescents.

Oxidative stress and inflammation: elucidating mechanisms of smoking-attributable pathology for therapeutic targeting

Abstract Background Tobacco smoking remains a major preventable cause of disease and death worldwide. Combustible cigarettes release thousands of chemicals that can initiate inflammatory pathways leading to smoking-related illness. This review aims to synthesize current scientific knowledge on mechanisms of smoking-induced disease, epidemiological trends, and clinical strategies from recent literature. Main body of the abstract At the cellular level, cigarette smoke triggers oxidative stress through reactive oxygen species (ROS), causing DNA damage. This provokes inflammatory signaling cascades mediated by damage-associated molecular patterns (DAMPs), receptors like RAGE and TLRs, and downstream cytokines. Smoking also disrupts apoptosis and autophagy. In the lungs, oxidative stress and inflammation from smoking play central roles in COPD pathogenesis. Smoking-induced oxidative DNA damage, chronic inflammation, and impaired immunity combine to promote lung carcinogenesis. For cardiovascular disease, smoking triggers endothelial dysfunction, platelet activation, and atherogenesis through oxidized LDL and effects on nitric oxide and adhesion molecules. Short conclusion Given the unequivocal evidence of health risks, smoking cessation is critical to reducing preventable death and disability. Both counseling and pharmacotherapy have proven efficacy for quitting, but efficacy remains limited long-term. Emerging nicotine products like e-cigarettes have unknown impacts on cessation and population health. Comprehensive efforts encompassing prevention, screening, treatment innovation, harm reduction, and policy reform focused on curbing smoking-attributable morbidity and mortality are warranted.

Knowledge, perception, and willingness of emerging Public Health Advocates to effectively communicate about smoking cessation and Tobacco Harm Reduction in Africa

BackgroundMedia campaigns targeting young people are a valuable tool for promoting awareness about tobacco harm reduction (THR). Advocacy and communication efforts that inform about the risks of tobacco use, THR strategies, and smoking cessation methods can enhance policy compliance, minimize tobacco-related damages, and motivate individuals to quit smoking. This study investigates the understanding, perceptions, and capabilities of burgeoning public health advocates in effectively communicating smoking cessation and THR strategies in Africa.MethodsThis research adopts a concurrent explanatory sequential design. The target demographic population consists of public health enthusiasts, healthcare students, health communicators, and budding journalists aged 18–30 in Nigeria. The questionnaire, validated through an extensive literature review, was distributed via Google Forms. From 450 individuals expressing interest in the THRjourno project, 415 agreed to participate, responding to open-ended questions on smoking cessation and THR among young people. Data were analysed with Microsoft Excel and IBM SPSS for quantitative aspects, while Atlas.ti was used for the qualitative interpretation of open-ended responses.ResultsOf the 415 participants, 73.7% lacked prior knowledge or proper understanding of THR. Most respondents (60.0%) regarded Nicotine Replacement Therapy (NRT) as the most effective THR strategy, with 26.7% favoring e-cigarettes. A majority (73.3%) perceived NRT to be safer than smoking, while 48.3% believed e-cigarettes were safer. Approximately 70.8% agreed that THR products aid in smoking cessation. However, 38.3% were uncertain if these products are addictive. Participants referenced strategies/activities for creating awareness for THR, which include, “More advocacy and sensitization programs should be organized”, and “These programs should engage people who smoke tobacco and nicotine products themselves as champions.”Ambassadorial roles in public Universities should be granted to students as a medium to proliferate the central message of the THR.ConclusionIdentified barriers to effective THR communication included misinformation propagated by health professionals and the media, religious and cultural constraints, and challenges in reaching remote areas. Strategies to enhance THR communication encompass increased advocacy and communication, government engagement and policy development, simplification of THR messages, and capacity building and engagement of advocates and stakeholders.

Warning Labels as a Public Health Intervention: Effects and Challenges for Tobacco, Cannabis, and Opioid Medications.

Warning labels help consumers understand product risks, enabling informed decisions. Since the 1966 introduction of cigarette warning labels in the United States, research has determined the most effective message content (health effects information) and format (brand-free packaging with pictures). However, new challenges have emerged. This article reviews the current state of tobacco warning labels in the United States, where legal battles have stalled pictorial cigarette warnings and new products such as electronic cigarettes and synthetic nicotine products pose unknown health risks. This article describes the emerging research on cannabis warnings; as more places legalize recreational cannabis, they are adopting lessons from tobacco warnings. However, its uncertain legal status and widespread underestimation of harms impede strict warning standards. The article also reviews opioid medication warning labels, suggesting that lessons from tobacco could help in the development of effective and culturally appropriate FDA-compliant opioid warning labels that promote safe medication use and increased co-dispensing of naloxone.

Patterns of cigarette, heated tobacco product, and nicotine vaping product use among Korean adults: Findings from the 2020 ITC Korea Survey.

Non-combustible nicotine products (NCNPs), such as heated tobacco products (HTPs) and nicotine vaping products (NVPs) have gained a significant nicotine market share in South Korea. This descriptive study examined patterns of regular cigarette and NCNP use among South Korean adults. Data were from the 2020 International Tobacco Control Korea Survey and included 4016 adults (aged ≥19 years) in the Republic of Korea who were regularly (at least weekly) using at least one NCNP (NVP/HTP, n=2117) and/or smoked cigarettes (n=3763) at the time of the survey. Weighted descriptive estimates were computed to assess respondents' nicotine product use among all respondents (exclusive, dual, or triple use). Thereafter, we identified sociodemographic characteristics associated with NCNP use (n=2117). Among Korean adults who were smoking cigarettes, 83.1% (95% CI: 81.6-84.6) did so exclusively, and 16.9% (95% CI: 15.4-18.4) smoked cigarettes and used NCNPs. Among those who used HTPs (n=1877), 14.9% (95% CI: 11.5-18.4) did so exclusively, 59.6% used HTPs and smoked cigarettes (95% CI: 55.4-63.1), 4.2% used HTPs and vaped (95% CI: 11.5-18.4), and 21.6% (95% CI: 18.9-24.2) used all three products. Of adults who used HTPs and smoked cigarettes, 86.6% smoked daily. Among those who vaped (n=865), 13.3% did so exclusively (95% CI: 9.4-17.1), 55.6% (95% CI: 49.6-61.5) vaped and smoked cigarettes, 5.1% (95% CI: 1.7-8.6) used HTPs and vaped, and 26.1% (95% CI: 22.1-30.1) used all three products. Of adults who vaped and smoked cigarettes, 82.4% (95% CI: 77.1-87.7) smoked daily. Cigarettes remain the most commonly used nicotine product in South Korea, and among adults using heated tobacco and/or vaping products, the majority were also smoking. Research is urgently needed to assess whether adults who are using an NCNP are doing so to quit, or rather to complement their cigarette smoking.

Applying new approach methodologies to assess next-generation tobacco and nicotine products.

In vitro toxicology research has accelerated with the use of in silico, computational approaches and human in vitro tissue systems, facilitating major improvements evaluating the safety and health risks of novel consumer products. Innovation in molecular and cellular biology has shifted testing paradigms, with less reliance on low-throughput animal data and greater use of medium- and high-throughput in vitro cellular screening approaches. These new approach methodologies (NAMs) are being implemented in other industry sectors for chemical testing, screening candidate drugs and prototype consumer products, driven by the need for reliable, human-relevant approaches. Routine toxicological methods are largely unchanged since development over 50 years ago, using high-doses and often employing in vivo testing. Several disadvantages are encountered conducting or extrapolating data from animal studies due to differences in metabolism or exposure. The last decade saw considerable advancement in the development of in vitro tools and capabilities, and the challenges of the next decade will be integrating these platforms into applied product testing and acceptance by regulatory bodies. Governmental and validation agencies have launched and applied frameworks and "roadmaps" to support agile validation and acceptance of NAMs. Next-generation tobacco and nicotine products (NGPs) have the potential to offer reduced risks to smokers compared to cigarettes. These include heated tobacco products (HTPs) that heat but do not burn tobacco; vapor products also termed electronic nicotine delivery systems (ENDS), that heat an e-liquid to produce an inhalable aerosol; oral smokeless tobacco products (e.g., Swedish-style snus) and tobacco-free oral nicotine pouches. With the increased availability of NGPs and the requirement of scientific studies to support regulatory approval, NAMs approaches can supplement the assessment of NGPs. This review explores how NAMs can be applied to assess NGPs, highlighting key considerations, including the use of appropriate in vitro model systems, deploying screening approaches for hazard identification, and the importance of test article characterization. The importance and opportunity for fit-for-purpose testing and method standardization are discussed, highlighting the value of industry and cross-industry collaborations. Supporting the development of methods that are accepted by regulatory bodies could lead to the implementation of NAMs for tobacco and nicotine NGP testing.

1069 Risk of perinatal mortality associated with expectant management in patients who used nicotine products

1069 Risk of perinatal mortality associated with expectant management in patients who used nicotine products

Puff alert: addiction to nicotine products among young people

Consumption of e-cigarettes (particularly the famous "puffs") and other nicotine products has risen sharply among Swiss teenagers, and now exceeds consumption of traditional cigarettes. Yet these products are harmful to health. Nicotine is highly addictive for young people, and e-cigarette use causes significant respiratory morbidity for both active and passive users. We are just measuring the extent of the toxic effects of these products, given their recent appearance on the market, but the initial scientific evidence is extremely worrisome and calls for a rapid response. Prevention among young people is crucial, and better legislation is urgently needed.

Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial

ObjectivesPublic health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended...