Nicotine Users Research Articles

Effect of Exposure to e-Cigarettes With Salt vs Free-Base Nicotine on the Appeal and Sensory Experience of Vaping

Alkaline free-base nicotine is bitter and a respiratory irritant. High-nicotine electronic cigarette (e-cigarette) products contain acid additives that change nicotine from a free-base to a protonated salt chemical form, which could improve the sensory experience of vaping, particularly among never smokers unaccustomed to inhaling free-base nicotine. To determine whether exposure to e-cigarettes with salt vs free-base nicotine formulations improves the appeal and sensory experience of vaping e-cigarettes and whether nicotine formulation effects differ by e-cigarette flavor and ever combustible cigarette smoking status. Single-visit double-blind within-participant randomized clinical trial was conducted in an academic medical center outpatient clinical research facility in Southern California. Participants were 119 individuals with past 30-day e-cigarette or combustible cigarette use aged 21 years or older recruited from November 2019 to March 2020. Participants self-administered standardized puffs of each 10 differently flavored e-cigarette solutions using a pod-style device. Each flavor was administered in salt (benzoic acid added) and free-base (no benzoic acid) nicotine formulations with commensurate nicotine concentrations (mean, 23.6 mg/mL). The 20 solutions were administered in randomly assigned sequences. Immediately after puffing each solution, participants rated appeal and sensory attributes. Self-reported appeal (mean of like, dislike [reverse-scored], and willingness to use again ratings) and 4 sensory attributes (sweetness, smoothness, bitterness, and harshness; analyzed individually) on visual analog scales with not at all and extremely anchors (range, 0-100). Of the 119 participants; 39 (32.8%) were female. The mean (SD) age was 42.1 (14.4) years; 105 (88.2%) were ever combustible cigarette smokers, and 66 (55.5%) were current e-cigarette users. Salt vs free-base nicotine formulations produced higher ratings of appeal (salt vs free-base mean difference effect estimate: b = 12.0; 95% CI, 9.9-14.1; P < .001), sweetness (b = 9.3; 95% CI, 7.1-11.4; P < .001), and smoothness (b = 17.4; 95% CI, 15.2-19.6; P < .001) and lower ratings of bitterness (b = -13.3; 95% CI, -15.4 to -11.2; P < .001) and harshness (b = -21.0; 95% CI, -23.2 to -18.7; P < .001). Nicotine formulation effects largely generalized across different flavors and the smoothness-enhancing and harshness-reducing effects of nicotine salt were stronger in never vs ever cigarette smokers. In this randomized clinical trial of adult current nicotine or tobacco product users, controlled exposure to e-cigarette puffs with salt vs free-base nicotine formulations appeared to increase product appeal and improve the sensory experience of vaping, particularly among never smokers. Regulatory policies limiting acid additives in e-cigarettes might reduce the appeal of high-nicotine e-cigarettes among populations deterred from vaping e-cigarettes that emit harsh aerosol. ClinicalTrials.gov Identifier: NCT04399031.

SARS-Cov-2, Smoking, and Nicotine Consumption: Investigating the Intended and Unintended Consequences of Responses to COVID-19 around the World

The COVID-19 pandemic brought isolation, social distancing, and economic downturn. The pandemic, and government’s response, also appears to have affected the use of tobacco and nicotine products. Stress and anxiety, both well understood drivers of nicotine use, coupled with a reduction in time spent in areas where smoking is banned, may have driven increased consumption. But the pandemic also disrupted social interactions that may promote smoking; reduction in environmental triggers and disposable income coupled with heightened focus on pulmonary health may have promoted cessation. Additionally, two further features of the pandemic require investigation: Misinformation surrounding the unfounded theory that smoking might have a protective effect COVID-19 (resulting from an incomplete scientific understanding of the viral pathology) could have changed perceptions of risk. Regulatory responses to the crisis also likely affected the availability and accessibility of products. The pressure on governments to respond to the pandemic left little time for regulators to consider possible unintended consequences of unprecedented interventions. Tobacco bans in South Africa and Botswana may have inadvertently increased illicit trade in tobacco products (ITTP). And in other locations, the differential lockdown policies for vape-shops and tobacco retailers may have nudged consumers of safer nicotine products towards combustible tobacco. This paper explores how tobacco and nicotine users altered their consumption in response to the pandemic, and investigates which features of the pandemic, and the world’s response, drove those changes. A review of English-language, peer-reviewed and pre-print research articles published in the PubMed database, is supplemented with a brief analysis of industry data for combustible tobacco and SNPs to explore how the pandemic affected demand for and behaviors around tobacco and nicotine.

Estimating the Population Attributable Fraction of Asthma Due to Electronic Cigarette Use and Other Risk Factors Using Kentucky Behavioral Risk Factor Survey Data, 2016–2017

Introduction: Electronic nicotine delivery systems ENDS have become popular in the United States among both new users of nicotine and those seeking less harmful alternatives to traditional cigarettes. Users often perceive ENDS as being less harmful than traditional cigarettes. This study investigated the relationship between use of ENDS and asthma in a representative sample of adults. Methods: For this cross-sectional study, we used data from the Kentucky Behavioral Risk Factor Surveillance System telephone survey data from 2016-2017. Using a weighted multivariable logistic regression analysis, we identified important covariates to adjust for to calculate the population attributable fraction (PAF) of asthma due to ENDS and other modifiable risk factors factors (cigarette use, obesity, education, and employment). The confidence intervals for the PAFs were estimated using bootstrap methods of variance estimation. Results: We found that 10.6% of those aged 18-30 reported currently had asthma. After adjusting for noted covariates, ENDS use did not significantly increase the odds of asthma. In the final PAF model, the PAF of asthma due to ENDS was 0.4% (95% CI: -5.41, 6.21). Conclusion: While these findings suggest only modest effects of ENDS use on asthma prevalence, future research including older age groups and more long-term users might produce different results.

Adolescent nicotine and marijuana vaping activity and the use of other illicit substances

PurposePrevious research links cigarette use and marijuana use in adolescence with the use of other illicit substances. Limited research, however, has explored whether vaping nicotine and marijuana, along with using these substances through multiple modes of delivery (traditional cigarette/marijuana use and vaping) is associated with the use of other illicit substances in adolescence. ProceduresThis study addresses this gap in the literature by employing negative binomial regression to examine the relationships between three categories of nicotine users (traditional cigarettes only, nicotine vaping only, and dual mode nicotine use), three categories of marijuana users (traditional marijuana use only, marijuana vaping only, and dual mode marijuana use), and the use of other illicit substances in a sample of Florida middle school and high school students. FindingsOur findings reveal that nicotine vaping and dual mode use of both nicotine and marijuana are associated with the use of a greater variety of illicit substances compared to non-users. ConclusionsIn conclusion, our findings suggest that dual mode use of nicotine and marijuana are associated with greater likelihood of using other illicit substances. The implications of these findings for future research are discussed.

Main and Interactive Effects of Nicotine Product Type on Sleep Health Among Dual Combustible and E-Cigarette Users.

E-cigarette use is associated with concurrent use of combustible cigarettes among adults and may increase the risk of future combustible cigarette use in adolescents and young adults. Detrimental effects of combustible cigarette use on sleep health are well documented, but little is known about the additive effects of concurrent e-cigarette use. The current study examined the main and interactive effects of daily nicotine product frequency on various components of sleep health. Two hundred and twenty-seven dual-product users (54.2% female, Mage = 36.89, SD = 10.17) completed questionnaires regarding demographic information, average number of cigarettes smoked per day, average number of times e-cigarettes used per day, and sleep health. Combustible cigarette frequency uniquely predicted shorter sleep duration, whereas e-cigarette frequency uniquely predicted increased daytime dysfunction due to sleepiness. Further, there was an interactive effect of combustible and electronic cigarettes on the use of sleeping medications. Findings may suggest differential adverse effects on sleep, depending on the type of nicotine product used, and highlight potential intervention targets for users. Future work should examine these associations prospectively and/or use objective measurements of sleep and nicotine use to further elucidate the nature of these relationships. This is the first study to explore the main and interactive effects of dual-product use on various dimensions of subjective sleep quality. This is important to investigate, given that dual nicotine users are at greater risk for physical health problems as well as the adverse effects of nicotine on sleep health. (Am J Addict 2020;00:00-00).

Estimating the price elasticity of demand for JUUL E-cigarettes among teens

BackgroundThe widespread popularity of e-cigarettes, particularly JUUL, has led to an alarming increase in teen nicotine use, reversing a 40-year trend. One key question is how sensitive teens’ demand for JUUL is to changes in price. MethodsWe estimate the price elasticity of demand using results from an experimental auction where teen nicotine users and nonusers bid on a JUUL kit. ResultsWe find that a 10 % increase in price leads to as much as a 24 % reduction in JUUL demand among teens using nicotine, and as much as a 45 % reduction among teens not currently using nicotine. The teens in our study were more price sensitive than older adults who took part in a similar earlier study. ConclusionsFrom a public health standpoint, these are promising results. High e-cigarette taxes may dissuade relatively few older adult cigarette smokers from switching to e-cigarettes, but at the same time be highly effective at preventing teens from becoming e-cigarette users in the first place.

EVALUATING PULMONARY/CRITICAL CARE FELLOWS’ PRACTICE HABITS REGARDING NICOTINE USE AFTER IMPLEMENTING A NOVEL INTERNET-BASED EDUCATIONAL SERIES

SESSION TITLE: Tobacco Cessation and Prevention Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Smoking remains the leading preventable cause of death in the US. Pulmonologists are positioned to identify nicotine use disorders and intervene with evidence-based treatments. However, limited education exists for pulmonary/critical care medicine (PCCM) trainees on this topic. This quality improvement project aimed to evaluate PCCM fellows’ practice patterns regarding nicotine use disorders after introducing an internet-based educational series. METHODS: At a single, academic US fellowship program PCCM fellows were introduced to a videocast series on nicotine use disorders. We performed a retrospective chart review of select PCCM fellow outpatient encounters at a large university-based practice during two timeframes: (i) pre-intervention period (3 months immediately prior), (ii) post-intervention period (3 months immediately after). We manually reviewed the electronic medical record for each encounter including social history, progress note, diagnostic codes, prescriptions, and patient instructions. Information reviewed included whether any care team member addressed nicotine history, fellow addressed nicotine history, patient was an active nicotine user, pack-year history was documented, diagnostic code used, prescription provided for nicotine use treatment, and referral was provided to quit-line and/or nicotine use treatment specialist. RESULTS: A total of 7 fellows were included in the analysis and chart review. 377 fellow outpatient encounters were reviewed, including 195 pre- and 182 post-intervention period encounters. Overall, a nicotine history was obtained by the collective care team in 99.2% of encounters, in which 58.0% of active nicotine users had documented “pack-year” history and 41.9% with diagnostic codes. Notably, after implementing education series, there was a statistically significant increase in the number of outpatient encounters in which the fellow captured information about patient nicotine use (66.7% vs 76.3%, p<0.05). There was a non-significant increase in treatments prescribed in the post-intervention group (41.9% vs 51.6%, p=0.45). CONCLUSIONS: In conclusion, we demonstrated that implementation of an online educational series to PCCM fellows resulted in a measurable increase the proportion of outpatient encounters in which the fellow captured history of nicotine use. There were no significant differences found in the reported “pack-year” history, diagnostic codes, and prescriptions for treatment, likely due to our small cohort. Such novel-based curricula should be evaluated in larger cohorts including repeated educational reinforcement. CLINICAL IMPLICATIONS: By implementing a brief online educational series on nicotine use disorders for fellows in-training, fellows can capture nicotine use in a higher proportion of patients. Further efforts should be explored in educating providers regarding nicotine use treatment and referrals. DISCLOSURES: No relevant relationships by Janaki Deepak, source=Web Response No relevant relationships by Jason Stankiewicz, source=Web Response No relevant relationships by Avelino Verceles, source=Web Response

Perceived relative harm of heated tobacco products (IQOS), e-cigarettes, and cigarettes among adults in Canada: Findings from the ITC Project.

INTRODUCTIONTobacco companies have introduced heated tobacco products (HTPs), such as IQOS, which may compete with e-cigarettes among smokers interested in switching to potentially reduced-risk products. Non-smokers may also start using IQOS if they believe this product is less harmful than other nicotine products. Smokers’ and non-smokers’ decisions may be driven by relative harm perceptions of emerging nicotine products. We aimed to examine relative harm perceptions between IQOS, e-cigarettes, and cigarettes, among nicotine product users and non-users.METHODSWe conducted a web survey with Canadian respondents (aged ≥20 years; n=268) in September–October 2018. Perceptions about relative harm between IQOS (available for sale since 2017 and subject to the same comprehensive marketing restrictions as cigarettes in Canada), e-cigarettes, and cigarettes, were assessed among non-users (n=79), exclusive smokers (n=78), exclusive e-cigarette users (n=32), and dual users (n=79). Multiple logistic regression explored the association between relative harm perceptions and nicotine-use status, adjusting for sociodemographic variables.RESULTSOver half of respondents perceived IQOS as equally or more harmful than e-cigarettes (53.7%), while almost a quarter either reported IQOS as less harmful than e-cigarettes or were uncertain (22.7% and 23.5%, respectively). Two-thirds of respondents (65.7%) perceived e-cigarettes as less harmful than cigarettes, yet only half (48.1%) perceived IQOS as less harmful than cigarettes. Both exclusive and dual e-cigarette users, but not exclusive smokers, had higher odds of perceiving IQOS as more harmful than e-cigarettes and less harmful than cigarettes compared to non-users.CONCLUSIONSMost nicotine users and non-users perceive differential health risk across IQOS, e-cigarettes, and cigarettes. Although e-cigarettes are generally viewed as less harmful than cigarettes, the perceived harm of IQOS was unclear.

Prevalence Of Nicotine Use and Dependence in Depression

&#x0D; Introduction: Prevalence of tobacco use is universal and individuals suffering from mental disorders come with no exceptions. There is paucity of study looking into prevalence of tobacco use and nicotine dependence in patients with depression in low income countries like Nepal. Thus this study aimed at determining the prevalence of tobacco consumption, nicotine dependence and motivation to quit in patients with major depressive disorders.&#x0D; Material And Method: A descriptive cross-sectional study was done among inpatient and out patients with diagnosis of depression at department of psychiatry and mental health, Tribhuvan University Teaching Hospital (TUTH). Data were collected using semi-structured Porforma and WHO STEPS Instrument for Nicotine Use. Fagerström Test for Nicotine Dependence, Modified Fagerström - Smokeless Tobacco, and Assessment of Motivation: Readiness to Quit Ladder was applied for nicotine users. Data were tabulated and analyzed using Statistical Package for Social Sciences version 20.0 (SPSS version 20.0).&#x0D; Results: A total of 121 patients with diagnosis of depression were enrolled in the study. 37.2% (n=45) of patient used smoked tobacco only, 9.1% (n=13) used smokeless tobacco and 10.7% (n=11) used both smoked and smokeless tobacco. 92.3% of patients using smokeless forms of tobacco were nicotine dependent whereas this figure reaches to 81.8% in combined users. Median value of readiness to quit tobacco was 6 which indicates they often think about quitting but without any plans which was statistically significant (p&lt;0.05).&#x0D; Conclusion: Prevalence of nicotine use and dependence was found high among people with depression. Use of standardized and translated screening tools can be used efficiently to evaluate the burden of nicotine use in standard clinical practice in low resource setting like Nepal.

What is the face of new nicotine users? 2012–2018 e-cigarettes and tobacco use among young students in Italy

BackgroundWith increased use of electronic-nicotine delivery devices (e-cigarettes) and non-cigarettes tobacco products (heated tobacco products, shisha, moist snuff/snus) among adolescents, the percentage of Italian students who use nicotine products is at its highest level of the past ten years, even though prevention and anti-smoking policies have produced tangible results in decreasing tobacco smoking prevalence. This cross-sectional study examined trends in exclusive and dual smoking, identified new poly-consumption patterns and profiled old and new nicotine users. MethodsWe used the annual cross-sectional ESPAD® Italia survey which sampled students (aged 15–19), currently used for surveillance and monitoring of at risk population, between 2012 and 2018 (N = 170,974) to describe Italian trends in exclusive cigarette, exclusive vaping, and dual cigarette and vaping use. . For the 2018 sample, patterns of poly-consumption were described, and a multinomial logistic regression (N = 15,732) estimated characteristics associated with exclusive and dual cigarette and vaping use. ResultsThe lifetime prevalence of cigarette smokers slightly decreased from 60.9% in 2012 to 56.9% in 2018, whereas the proportion of vaping users substantially increased from 32.9% in 2013 to 52.0% in 2018. Combining cigarette and vaping use, these trends result in an increase in the lifetime prevalence of any use from 60.8% in 2013 to 66.2% in 2018. Three out of every 10 minors have experienced smoking and/or vaping, and younger students were more prone to be dual users. Overall, current vapers were generally less prone to risky behaviours. ConclusionIn contrast to a slight decrease in cigarette smoking, the prevalence of Italian students approaching old and/or new smoking habits in their lifetime is substantially increasing. The popularity of alternative nicotine-based products, particularly e-cigarettes, has increased among teenagers, resulting in a summation of usage patterns rather than a compensation, and attracting a novel slice of young users. The lack of regulation within current drug policy to limit the access to such licit psychoactive substance use, is urgently needed to avoid a future nicotine addicted population.

Impact of Cigarette Smoking on Re-operation and Revision Surgery after Femoral Neck Fracture Treatment

Smokers and nicotine users have a higher risk of femoral neck fracture non-union and prolonged time to fracture union. The impact of smoking resulting in revision surgery after fixation of femoral neck fractures, however, rarely has been studied. The aim of this retrospective study was to review if cigarette smoking had an influence on re-operation and revision after femoral neck fracture treatment. Three groups of patients (Group 1: active smokers; Group 2: former smokers; and Group 3: non-smokers) who sustained a femoral neck fracture from January 2012 through August 2018 were included. Outcomes investigated included femoral neck fracture type, operative fixation type, fixation failure, and time interval between initial fixation and revision. A total of 1,452 subjects were identified (Group 1: 165 subjects; Group 2: 507 subjects; and Group 3: 780 subjects). In the male population, Groups 1 and 2 had higher rates of femoral neck fracture than Group 3. Twelve cases required revisions (Group 1: three cases (6%); Group 2: two cases (2%); Group 3: seven cases (4%)), with all but one revision within the first year following initial fixation. Group 1 patients tended to be younger than the other two groups. Smoking has a positive association with the risk of femoral neck fracture amongst active and former male smokers. This study concluded that active smokers have a higher risk of non-union compared with non-smokers or former smokers. Smoking history, especially heavy or long-term, should play a role in deciding which fixation construct type to use for femoral neck fractures.

The effects of nicotine and cannabis co-use during adolescence and young adulthood on white matter cerebral blood flow estimates.

Co-use of cannabis and nicotine is common among adolescents/young adults and is associated with poorer psychological and physical outcomes, compared with single substance use. Little is known about the impact of co-use on the developing brain. Preliminary investigation of the effects of nicotine on white matter (WM) cerebral blood flow (CBF) in adolescents/young adults and its potential moderation by cannabis use. Adolescent/young adult (16-22 years old) nicotine and tobacco product users (NTP; N = 37) and non-nicotine users (non-NTP; N = 26) underwent a neuroimaging session comprised of anatomical, optimized pseudo-continuous arterial spin labeling, and diffusion tensor imaging scans. Groups were compared on whole-brain WM CBF estimates and their relation to past-year cannabis use. Follow-up analyses assessed correlations between identified CBF clusters and corresponding fractional anisotropy (FA) values. Group by cannabis effects were observed in five clusters (voxel-wise alpha < 0.001, cluster-wise alpha < 0.05; ≥ 11 contiguous voxels): non-NTP exhibited positive correlations between CBF and cannabis use in all clusters, whereas no significant relationships were observed for NTP. Greater CBF extracted from one cluster (including portions of right superior longitudinal fasciculus) was associated with reduced FA for non-NTP group only. This is the first investigation of WM health as indexed by CBF, and its association with FA, in adolescents/young adults with nicotine and/or cannabis use. Results suggest that cannabis use by itself may be related to increased CBF in WM fiber tracts demonstrating poorer structural intergrity, yet the occurrence of even infrequent NTP use (greater than once per month) appears to diminish this relationship.

Prevalence of Substance Use in Medical and Dental Students of a Medical University of Nepal

Introduction: Medical and Dental students are vulnerable to higher levels of psychological distress than other age matched peers. Many studies reveal that there is high prevalence of psychoactive substance use and psychiatric co-morbidities among them.&#x0D; Objective: To identify prevalence of substance use (alcohol, nicotine, cannabis) among medical and dental students.&#x0D; Methods: A cross sectional study was done among medical and dental students (2nd year to interns) of B PKIHS. A total of 600 students were enrolled through systematic random sampling and only 588(98%) responded. Semi-structured questionnaire was used which included socio-demographic variables, AUDIT (Alcohol Use Disorders Identification Test), Fagerstrom (for Nicotine dependence) and Cannabis Abuse Screening Test (CAST).&#x0D; Result: The mean age of participants was 22±2years. Among them, 61.2% (360) were male; 69.7% (410) were MBBS; 90.5% (532) were Nepalese and 9.5% (56) were Indians. The prevalence of alcohol users was 47.75% (281) in which 32% (90) were harmful users. Among 19.55% (115) nicotine users; 56.5% (65), 37.4% (43), 6.1% (7) had low, low to moderate and moderate dependence respectively. The prevalence of cannabis users was 9% (53) with 45.3% (24), 18.9% (10) having low and high addiction respectively.&#x0D; Conclusion: High percentage of medical and dental students showed substance use, harmful use and dependence. It is expected that they have knowledge about the harmful consequences of psychoactive substances.

Prevalence, Trends, and Distribution of Nicotine and Marijuana use in E-cigarettes among US adults: The Behavioral Risk Factor Surveillance System 2016–2018

Use of substances other than nicotine in e-cigarettes, especially marijuana, is becoming increasingly popular in the US. However, population-representative data on such poly-use (nicotine and marijuana) remains limited. We therefore conducted a cross-sectional logistic regression analysis of the 2018 Behavioral Risk Factor Surveillance System among 16 US states/territories with data on past 30-day marijuana use to describe the emerging dual nicotine and marijuana vaping population. We additionally examined trends in marijuana use, including marijuana vaping, from 2016 to 2018.Of the 131,807 participants studied, 3068 were current e-cigarette users, among whom 7.1% also vaped marijuana. Prevalence of nicotine-predominant, dual nicotine marijuana, and marijuana-predominant vaping was 3.36%, 0.38% and 1.09%, respectively. Compared to nicotine-predominant vapers, dual and marijuana-predominant vapers were older, had greater proportions of non-Whites, particularly Hispanics, and less likely to be current smokers (nicotine-predominant vs dual vs marijuana-predominant vaping: current tobacco use 44.7 vs 23.7 vs 11.1%). Proportion of dual vapers among current e-cigarette users was 8.6%, 2.6% and 7.1% for 2016, 2017 and 2018, respectively. Prevalence of marijuana use increased from 8.97% (2016) to 13.1% (2018) while no clear trend was observed for marijuana vaping.Dual nicotine and marijuana vaping is prevalent in the US, and compared to predominantly nicotine vapers such users have higher mean ages, and are more likely to be Blacks, Hispanics, and never cigarette smokers. Marijuana use overall increased from 2016 to 2018. Dual vapers represent a large and important emerging population that will require dedicated study of health effects and tailored regulatory strategies.

Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018.

Recent nicotine use trends raise concerns that electronic cigarettes (ECs) may act as a gateway to cigarettes among adolescents. The aims of this study were to examine prevalence trends of exclusive EC use, exclusive cigarette use and dual use to determine the corresponding ages of initiation and to investigate hypothetical trends in total nicotine use and cigarette use in the absence of ECs among US adolescents. Observational study using data from the National Youth Tobacco Survey (NYTS) to statistically model trends in the prevalences of each user group and their initiation ages. Projections from counterfactual models based on data from 1999 to 2009 (before EC introduction) were compared with actual trends based on data from 1999 to 2018. Rigorous error analyses were applied, including Theil proportions. USA. Adolescents aged 12-17years who were established exclusive cigarette users (≥100 cigarettes smoked and≤100days vaped), established exclusive EC users (<100 cigarettes smoked and>100days vaped) and established dual users (≥100 cigarettes smoked and>100days vaped), based on cumulative life-time exposure (n≈12 500-31 000 per wave). Exclusive cigarette use prevalence declined from 1999 to 2018, while exclusive EC use and dual use prevalences increased since their introduction in 2009. The age of cigarette initiation began a slight increase after 2014, whereas the age for EC use remained approximately constant and was higher than that of cigarettes. The counterfactual comparison results were consistent with ECs not increasing the number of US adolescent nicotine users, and in fact diverting adolescents from cigarettes. Electronic cigarettes may have offset conventional smoking among US adolescents between 2010 and 2018 by maintaining the total nicotine use prevalence and diverting them from more harmful conventional smoking. Additionally, electronic cigarette users appear to initiate at older ages relative to conventional smokers, which is associated with lower risk.

Urinary Cyanoethyl Mercapturic Acid, a Biomarker of the Smoke Toxicant Acrylonitrile, Clearly Distinguishes Smokers From Nonsmokers.

Cyanoethyl mercapturic acid (CEMA) is a urinary metabolite of acrylonitrile, a toxicant found in substantial quantities in cigarette smoke, but not in non-combusted products such as e-cigarettes or smokeless tobacco and rarely in the diet or in the general human environment. Thus, we hypothesized that CEMA is an excellent biomarker of combusted tobacco product use. We tested this hypothesis by analyzing CEMA in the urine of 1259 cigarette smokers (urinary cotinine ≥25 ng/mL) and 1191 nonsmokers. The analyses of CEMA and cotinine were performed by validated liquid chromatography-tandem mass spectrometry methods. Logistic regression was fit for log-transformed CEMA to construct the receiver operating characteristic curve. We found that a CEMA cutpoint of 27 pmol/mL urine differentiated cigarette smokers from nonsmokers with sensitivity and specificity greater than 99%. The use of different cotinine cutpoints to define smokers (10-30 ng/mL) had little effect on the results. CEMA is a highly reliable urinary biomarker to identify users of combusted tobacco products such as cigarettes as opposed to users of non-combusted products, medicinal nicotine, or nonusers of tobacco products. CEMA can be used to distinguish users of combusted tobacco products from non-combusted products such as e-cigarettes, smokeless tobacco, and medicinal nicotine. Levels of CEMA in the urine of people who use these non-combusted products are extremely low, in contrast to cotinine.

Invited Commentary: The Epidemiology of Electronic Cigarettes and Reproductive Health Begins.

Harlow et al. (Am J Epidemiol. 2021;190(3):353-361) are among the first to tackle the complex subject of electronic cigarette use and reproductive health, focused on fecundity but pertinent to the full spectrum of reproductive health concerns. Despite extensive documentation of the health harm from tobacco use and a shared exposure to nicotine, electronic cigarette (e-cigarette) users have a markedly different exposure profile. Because e-cigarettes might help to curtail or eliminate tobacco smoking, the health comparisons of interest for e-cigarettes should include cigarette smoking as well as no use of such products. These researchers confront significant methodological challenges in the study of reproductive health effects of e-cigarettes: addressing confounding with little information on the characteristics of e-cigarette users, a complex connection between e-cigarette and tobacco use, multiple and poorly understood exposure to e-cigarette vapors, and lack of a standard method for quantifying exposure. Evidence is urgently needed to inform regulation and individual decisions regarding the use of this potentially harmful product that might well entice new users of nicotine, some of whom progress to tobacco use, but that also has the potential to enable otherwise recalcitrant smokers to substitute a less harmful product.

The effect of vaping on the development and craniofacial morphology of Xenopus laevis embryos.

Vaping is a type of nicotine usage in which an artificial cigarette is used as the delivery system. Originally marketed as the healthier alternative to smoking cigarettes, vaping has led to an increase in the amount of pulmonary issues by users. Our objective for this research was to test whether the consumption of nicotine and flavor additives through vaping is as harmful to developing embryos as that obtained through smoking traditional cigarettes. For this research, we exposed developing Xenopus laevis embryos to nicotine from vaping solution with 3 differing propylene glycol: vegetable glycerin ratios (30:70, 50:50, 70:30) as well as smoke from a well-known cigarette brand, all of which contain 12 mg of nicotine. We exposed the embryos to the same amount of nicotine and byproducts that would be consumed by the average pregnant American woman who either vapes or smokes traditional cigarettes. Embryos were exposed from Stage 10 (yolk plug) to Stage 43 (freeswimming tadpole with most yolk consumed). Tadpoles were sacrificed and mounted, and Image J was used to determine if there were any differences in craniofacial morphology between treatments. Preliminary results are encouraging and indicate possible developmental effects of different VG: PG ratios. This research was funded by a NASA Space Grant awarded to Camden Cutlip.

Lung histomorphological alterations in rats exposed to cigarette smoke and electronic cigarette vapour.

Electronic cigarettes are becoming increasingly common as a form of nicotine usage, known as vaping. Numerous studies have demonstrated that using electronic cigarettes may lead to nicotine dependence and has a potentially harmful impact on health. The present study compared the impact of electronic and conventional cigarettes on lung tissue. The experiment included 30 male Wistar rats. The animals were divided into three groups: Group A was exposed to electronic cigarette liquid vapour; group B to conventional smoke; and group C constituted the control group without exposition to the nicotine. In both experimental groups numerous alterations were observed, including a collapse of parenchyma, hyperhagia, hyperplasia of type II of pneumocytes, collagen deposition and an increased number of macrophages within thickened alveolar septa. Additionally, an initial elastolysis was observed. The elastic fibers were disrupted, sparse, irregular and thickened, whereas the numbers of α-SMA positive myofibroblasts and blood vessels were highest in the group exposed to conventional cigarette smoke. In conclusion, the usage of the electronic cigarettes leads to milder pathological alterations compared with traditional cigarette smoking. Nevertheless, the histopathological damage caused by vaping may lead to the development of alterations in the lung tissue which consequently hinder gas exchange.

Nicotine patch for cannabis withdrawal symptom relief: a randomized controlled trial.

Given that tetrahydrocannabinol (THC) and nicotine have similar effects on negative affect (NA), we hypothesized that a 7-mg nicotine patch (NP) would reduce NA-related cannabis (CAN) withdrawal symptoms in cannabis-dependent (CD) individuals who were not nicotine dependent. We sought to determine whether NP reduces NA across 15days of CAN abstinence in two groups: non-tobacco smokers (NTS) and light tobacco smokers (LTS). CD participants (N = 127; aged 18-35) who used CAN at least 5 times/week for the past 12 + months were randomized to (1) NP or (2) a placebo patch (PP) and received $300 for sustained biochemically verified CAN abstinence. Of those randomly assigned, 52 of 63 NP, and 56 of 64 PP maintained biochemically verified CAN abstinence and 51 NP and 50 PP participants complied with all aspects of the study. Affect and other withdrawal symptoms were measured every 48h across 15days of CAN abstinence. After controlling for age, tobacco use, baseline THC concentration, and baseline measurements of the dependent variable, NP reduced NA symptoms across the 15-day treatment relative to PP. Differences in NA and CAN withdrawal symptoms were not moderated by tobacco user status. The findings provide the first evidence that NP may be able to attenuate NA-related withdrawal symptoms in individuals with cannabis use disorder who are not heavy users of tobacco or nicotine. NCT01400243 http://www.clinicaltrials.gov.