Non-combustible Tobacco Products Research Articles

Unhealthy Weight Control Behaviors according to the Status of Combustible Cigarette and Noncombustible Nicotine or Tobacco Product Use among Korean Adolescents with Experience Attempting to Reduce or Maintain Their Body Weight: The 15th Korea Youth Risk Behavior Survey, 2019.

Noncombustible nicotine or tobacco product (NNTP) use, and cigarette smoking are associated with a high likelihood of unhealthy weight control behaviors (UWCBs) among adolescents. However, no study has addressed the differences in UWCBs among non-users, single users of combustible cigarettes (CCs) or NNTPs and dual users. This study compared the frequencies of weight control behaviors according to the status of CC and NNTP use among Korean adolescents. This was a cross-sectional study of 25,094 adolescents who had attempted to reduce or maintain their body weight during the past 30 days, using data from the 15th Korea Youth Risk Behavior Survey, 2019. Data on the status of CC and NNTP use, weight status, and weight control behaviors were obtained using self-report questionnaires. Subjects were categorized into four groups: non-users, cigarette-only users, NNTP-only users, and dual users. Among boys and girls, current smokers and NNTP users were 8.9%±0.3% and 5.5%±0.3%, and 4.2%±0.2% and 1.7%±0.1%, respectively. Among boys, NNTP-only users were more likely to engage in extreme weight control behaviors than non-users. Among girls, users of either CCs or NNTPs were more likely to engage in extreme weight control behaviors and less extreme weight control behaviors than non-users. This study shows that users of either CCs or NNTPs are more likely to engage in UWCBs, and NNTP-only users are the most likely to do so.

Socioecological factors associated with multiple nicotine product use among U.S. youth: Findings from the population assessment of tobacco and health (PATH) study 2013–2018

ObjectiveThis study utilized a socioecological approach to prospectively identify intrapersonal, familial, and environmental factors associated with single nicotine product use (NPU) and multiple NPU among U.S. youth. MethodsParticipants were 10,029 youths (ages 12–17 years) who had completed the Population Assessment of Tobacco Health study's Wave 1 (2013–2014) and Wave 4 (2016–2018) assessments and data on past 30-day nicotine product use. Multinomial logistic regression was fit for the 3-level outcome (no use, single NPU, multiple NPU) to estimate adjusted associations between the predictors and the outcome. ResultsThe current study found that intrapersonal (sex, age, race/ethnicity, internalizing symptoms, sensation seeking, harm perceptions, lifetime history of using two or more tobacco products), familial (parental discussion about not using tobacco and living with someone who uses tobacco products) and environmental factors (exposure to tobacco advertising) commonly associated with tobacco use differentiated between individuals who later reported past 30-day NPU (either multiple or single NPU) from those who did not report past 30-day NPU. One familial factor only differentiated between lifetime users who were single NPUs from those who reported no NPU: non-combustible tobacco product use allowed anywhere in the home. Intrapersonal factors differentiated multiple NPU from single NPU: older age, being male, lifetime history of using nicotine product and less harm perceptions. ConclusionsThis study identified factors that may be studied to prevent any NPU, along with factors that may be studied to promote harm reduction by preventing escalation of single NPU to problematic patterns of multiple NPU.

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

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

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

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

Applications of biomarkers of exposure and biological effects in users of new generation tobacco and nicotine products: Tentative proposals.

Despite efforts to eliminate smoking, more than 1 billion people worldwide continue to use combustible cigarettes through choice or inability to quit. With an associated 8 million deaths, the provision of noncombustible tobacco and nicotine products that smokers will accept to replace combustible cigarettes can lessen harm. However, most of these products have entered the market only in the past 20 years. Therefore, particularly for some smoking-related diseases, epidemiological studies to test harm reduction potential are only now becoming feasible. For cancer and chronic obstructive pulmonary disease, around two decades of data might be required. In this article, we discuss how the use of biomarkers might be applied to supplement epidemiological research for regulators. We further discuss how health providers and insurers can keep up with the rapid changes in biomarker research and recognize these reduced risks.

Assessment of Substance Use Among High School Students in Northern Cyprus Based on the Gateway Hypothesis

This study is a quantitative survey study based on the data of the research project on the Use of Alcohol, Cigarettes and Other Addictive Substances in Northern Cyprus High Schools students conducted by the Turkish Republic of Northern Cyprus Anti-Drug Commission. In this study, data were collected from 763 high school students in 6 districts in the north of Cyprus through the European School Research Project Alcohol and Other Drugs (ESPAD Survey) Survey, using the stratified sampling method, through the guidance and psychological counselling services of the schools. According to findings of this study, as the smoking age falls, so does the age of switching to e-cigarettes. Similarly, as the age of first cigarette and e-cigarette smoking declines, so does the age of daily use of cigarettes and e-cigarettes. When the regression results of the research are evaluated, it is seen that students' lifetime smoking frequency, age at beginning smoking, e-cigarette smoking frequency, age at first e-cigarette smoking, hookah smoking frequency, and usage of heated non-combustible tobacco products did not predict bonsai use. However, an increase in the frequency of cannabis use among students significantly predicts bonsai consumption.

CO135 Clinical and Economic Outcomes Associated with Transitions of Tobacco Use Among a Cohort of Adult Male Smokers Using U.S. Real-World Data

Real-world data on the clinical and economic impact of switching from cigarettes to non-combustible (NC) tobacco products are lacking. This study describes select clinical outcomes and healthcare costs among adult males who continued to use combustible cigarettes (CS), switched to non-combustible smokeless products (ST), or quit tobacco (NT).

A Comprehensive Study on the Acidic Compounds in Gas and Particle Phases of Mainstream Cigarette Smoke

Acidic compounds constitute a group of chemicals present in mainstream cigarette smoke, among which organic acids contribute to flavoring. In order to obtain a comprehensive understanding of the constituents of acidic compounds in both the particulate and gaseous phases of the mainstream smoke of commercial cigarettes, and to delineate the difference between two types of cigarettes, the yields of acidic constituents from nine cigarettes of two commercial brands (L- and M-types) were collected and analyzed in detail by gas chromatography–mass spectrometry (GC-MS). The results identified and quantitatively analyzed 46 compounds, grouped according to the substituent groups. Compositional differences between the two cigarette types were evaluated with statistical approaches. Comparison between individual, grouped, and total acid contents, between the particulate and the gaseous phases, and between the commercial L- and M-type tobaccos were conducted and characterized by the p values obtained from Student’s t-test. Multivariate analysis was performed using principal component analysis (PCA) and orthogonal projections to latent structures discriminant analysis (OPLS-DA) models to identify the acids that enable a reliable differentiation of the two types. Seventeen acidic compounds whose p < 0.05 and variable importance in projection (VIP) > 1 were identified as key components that could discriminate between the two groups of commercial cigarettes. This study may be beneficial for the development of non-combusted tobacco products, which could serve as alternatives to traditional cigarettes.

Role of untargeted omics biomarkers of exposure and effect for tobacco research

Tobacco research remains a clear priority to improve individual and population health, and has recently become more complex with emerging combustible and noncombustible tobacco products. The use of omics methods in prevention and cessation studies are intended to identify new biomarkers for risk, compared risks related to other products and never use, and compliance for cessation and reinitation. to assess the relative effects of tobacco products to each other. They are important for the prediction of reinitiation of tobacco use and relapse prevention. In the research setting, both technical and clinical validation is required, which presents a number of complexities in the omics methodologies from biospecimen collection and sample preparation to data collection and analysis. When the results identify differences in omics features, networks or pathways, it is unclear if the results are toxic effects, a healthy response to a toxic exposure or neither. The use of surrogate biospecimens (e.g., urine, blood, sputum or nasal) may or may not reflect target organs such as the lung or bladder. This review describes the approaches for the use of omics in tobacco research and provides examples of prior studies, along with the strengths and limitations of the various methods. To date, there is little consistency in results, likely due to small number of studies, limitations in study size, the variability in the analytic platforms and bioinformatic pipelines, differences in biospecimen collection and/or human subject study design. Given the demonstrated value for the use of omics in clinical medicine, it is anticipated that the use in tobacco research will be similarly productive.

Responses of African American Individuals Who Use Menthol Cigarettes to Potential Flavored Tobacco Bans

The U.S. Food and Drug Administration has proposed new product standards regarding the availability of menthol cigarettes and flavored cigars in the U.S. However, it is unclear whether limiting characterizing flavors in cigarettes and cigars as proposed, or across all tobacco products, produces differential effects on the tobacco use behaviors of African American/Black individuals who use menthol cigarettes. This study assessed whether limiting characterizing flavors in combusted products only or across all tobacco products produces differential impacts on the tobacco use behaviors of African American/Black individuals who use menthol cigarettes. Adult African American/Black individuals who use menthol cigarettes in the U.S. were recruited through Qualtrics (n=373) and in Richmond, VA (n=206) for an online experiment from September 2021 to August 2022. Participants reported how their tobacco use behaviors would change under 3 scenarios: maintenance of the status quo, limited flavor ban (ban characterizing flavors in cigarettes and cigars), and comprehensive flavor ban (ban characterizing flavors in all tobacco products). Seemingly unrelated regressions compared differences in expected responses to policy scenarios (p<0.05). Both flavor ban scenarios resulted in higher quitting intentions for cigarettes and all tobacco products than the status quo (p<0.05). The comprehensive ban resulted in greater intentions to quit all tobacco products and lower intentions to switch to certain alternative products (e.g., E-cigarettes, smokeless tobacco, heated tobacco products) than the limited ban (p<0.05). African American/Black individuals who use menthol cigarettes appear more likely to quit smoking if characterizing flavors in combusted products (e.g., menthol cigarettes) are banned, regardless of if characterizing flavors are available in noncombusted alternative tobacco products.

Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence.

One-third of adults in the United States who use tobacco regularly use two or more types of tobacco products. As the use of e-cigarettes and other noncombusted tobacco products increases-making multiple tobacco product (MTP) use increasingly common-it is essential to evaluate the complex factors that affect product use. In this update to our 2019 conceptual framework, we review and evaluate recent literature and expand the model to include ways in which MTP use may be affected by market factors such as the introduction of new products and socioenvironmental factors like marketing and advertising. MTP use patterns are complex, dynamic, and multiply determined by factors at the level of individuals, products, situations or contexts, and marketplace. Substitution, or using one product with the intent of decreasing use of another, and complementarity, or using multiple products for different reasons or purposes, explain patterns in MTP use. Moreover, substitution and complementarity may inform our understanding of how market changes targeted at one product, for instance, new product standards, bans, product pricing, and taxation, affect consumption of other tobacco products. New data from natural experiments and novel laboratory-based techniques add additional data and expand the framework. A substantial proportion of people who use tobacco use more than one product. This review synthesizes and evaluates recent evidence on the diverse factors that affect MTP use in addition to expanding our framework. Our review is accompanied by suggested research questions that can guide future study.

Abstract 9922: Increased Susceptibility to Arrhythmias, Hypertension, and Hypertrophy in a Rat Model of Exposure to Electronic, Heat-Not-Burn, or Conventional Cigarettes, or Marijuana

Pathogenicity of cardiovascular disease (CVD) from smoking tobacco is well-known, but the CVD effects of vaping non-combustible tobacco products like e-cigarettes and heat-not-burn products (e.g., IQOS), and smoking marijuana (MJ), are less studied. We asked if 8 weeks of chronic use of e-cigs, IQOS, or MJ in rats would cause less adverse cardiac effects than tobacco cigarettes. We exposed SD rats to 1 session/day (10 puffs over 5 min) for 8 weeks with Marlboro Red cigarettes (Cig), JUUL, IQOS, 10% THC MJ (MJ), cannabinoid-depleted “placebo” MJ (pb-MJ), or air. We performed echocardiography and measured conscious systolic blood pressure (SBP) every 2 weeks. We then performed 24-hour conscious ECG telemetry and ex vivo optical mapping (OM) of arrhythmias and analyzed interstitial fibrosis. By 1 hour after exposure, SBP was acutely increased by all tobacco products and pb-MJ, while only marijuana reduced SBP. SBP of all non-air groups rose progressively over 8 weeks, exceeding 130 mmHg after 2 weeks, and 140 mmHg after 4 weeks. SBP increased by MJ was higher than those by JUUL, IQOS, or pb-MJ. Cardiac performance declined and ventricular mass increased. All non-air conditions led to reduced overall heart rate variability, including the total power, low and high frequency from the power spectrum, and SDNN, RMSSD, and NN9 from time-domain method. Poincaré plot suggested a similar distribution pattern of RR interval. Interestingly, when compared with air, reduced physical activity was found in all experimental groups. OM revealed that more arrhythmias were induced by electrical stimulation: Cig, JUUL, IQOS, pb-MJ, MJ had atrial fibrillation of 50%, 85.71%, 50%, 50%, 37.5% and left ventricular (LV) tachycardia of 62.5%, 71.43%, 37.5%, 37.5%, 75% respectively vs. 0% in air, P &lt; .05. Sirius red fibrotic staining showed significantly more interstitial fibrosis of atria and LV in all groups compared to air. Although no significant difference in interstitial fibrosis was found among tobacco products, MJ promoted more LV fibrosis than pb-MJ. Therefore, the use of different non-cigarette tobacco products and marijuana can increase CVD risks by causing hypertension, reduced cardiac performance, increased LV hypertrophy, and susceptibility to arrhythmias.

Correction to: Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

Correction to: Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

Optimal Cutoff Concentration of Urinary Cyanoethyl Mercapturic Acid for Differentiating Cigarette Smokers From Nonsmokers.

Cotinine is a widely used biomarker for classifying cigarette smoking status. However, cotinine does not differentiate between the use of combustible and noncombustible tobacco products. The increasing use of noncombustible tobacco drives the need for a complementary biomarker for distinguishing cigarette smokers from users of noncombustible tobacco products. We evaluated the urinary acrylonitrile metabolite, 2CyEMA, as a biomarker of exposure to cigarette smoke in the US population-representative data from the National Health and Nutritional Examination Survey (NHANES). Smoking status was categorized based on the recent tobacco use questionnaire. The receiver operating characteristic (ROC) curve analysis was performed to identify optimal cutoff concentrations by maximizing Youden's J index. The area under the curve (AUC) was used to compare 2CyEMA effectiveness with respect to serum cotinine. The overall cutoff concentration for the classification of cigarette smokers from nonsmokers was 7.32 ng/ml with high sensitivity and specificity (≥0.925). When stratified by demographic variables, the cutoff concentrations varied among subgroups based on age, sex, and race/Hispanic origin. Non-Hispanic Blacks had the highest cutoff concentration (15.3 ng/ml), and Hispanics had the lowest (4.63 ng/ml). Females had higher cutoff concentrations (8.80 ng/ml) compared to males (6.10 ng/ml). Among different age groups, the cutoff concentrations varied between 4.63 ng/ml (21-39 years old) and 10.6 ng/ml (for ≥60 years old). We also explored the creatinine adjusted cutoff values. 2CyEMA is an effective biomarker for distinguishing cigarette smokers from nonsmokers (users of noncombustible tobacco products or nonusers). Distinguishes smokers from noncombustible tobacco product users.

High-throughput cell-based assays for identifying antagonists of multiple smoking-associated human nicotinic acetylcholine receptor subtypes

There is substantial evidence that in addition to nicotine, other compounds found in tobacco smoke significantly influence smoking behavior. Further, recent years have seen an explosion in the availability of non-combusted products that deliver nicotine, such as e-cigarettes and “home-brew” vaping devices that are essentially unregulated. There are many thousands of compounds in tobacco smoke alone, and new products are constantly introducing new compounds. Uncovering which of these compounds are active, across multiple smoking-relevant subtypes of the nicotinic acetylcholine receptor (nAChR) that influence tobacco/nicotine addiction, requires a high-throughput screening (HTS) approach. Accordingly, we developed a panel of HTS-friendly cell-based assays, all performed in the same cellular background and using the same membrane potential dye readout, to measure the function of the α3β4-, α4β2-, and α6β2-nAChR subtypes. These subtypes have each been prominently and consistently associated with human smoking behavior. We validated our assays by performing pilot screening of an expanded set of the Prestwick FDA-approved drug library. The screens displayed excellent performance parameters, and moderate hit rates (mean of 1.2% across all three assays) were achieved when identifying antagonists (chosen since effects of endogenous antagonists on consumption of nicotine/tobacco products are under-studied). Validation rates using an orthogonal assay (86Rb+ efflux) averaged 73% across the three assays. The resulting panel of assays represents a valuable new platform with which to screen and identify nAChR subtype-selective compounds. This provides a resource for identifying smoking-related compounds in both combusted and non-combusted tobacco products, with potential relevance in the search for additional smoking-cessation therapies.

Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

The associations of changes in noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use habits with subsequent cardiovascular disease (CVD) risk are still unclear. The study population consisted of 5 159 538 adult men who underwent health screening examinations during both the first (2014-2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. All participants were divided into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (≥5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. Propensity score matching analysis was conducted to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. Multivariable Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% CIs for CVD risk according to changes in NNTP and CC smoking habits. Compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79-0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78-0.84]) had lower risk for CVD. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01-1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Similarly, compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07-2.72]) had higher CVD risk. Switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. On CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs. Compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.

Validation of the Wave 1 and Wave 2 Population Assessment of Tobacco and Health (PATH) Study Indicators of Tobacco Dependence Using Biomarkers of Nicotine Exposure Across Tobacco Products.

This study examined the predictive relationships between biomarkers of nicotine exposure and 16-item self-reported level of tobacco dependence (TD) and subsequent tobacco use outcomes. The Population Assessment of Tobacco and Health (PATH) Study surveyed adult current established tobacco users who provided urine biospecimens at Wave 1 (September 2013-December 2014) and completed the Wave 2 (October 2014-October 2015) interview (n = 6872). Mutually exclusive user groups at Wave 1 included: Cigarette Only, E-cigarette Only, Cigar Only, Hookah Only, Smokeless Tobacco Only, Cigarette Plus E-cigarette, multiple tobacco product users who smoked cigarettes, and multiple tobacco product users who did not smoke cigarettes. Total Nicotine Equivalents (TNE-2) and TD were measured at Wave 1. Approximate one-year outcomes included frequency/quantity used, quitting, and adding/switching to different tobacco products. For Cigarette Only smokers and multiple tobacco product users who smoked cigarettes, higher TD and TNE-2 were associated with: a tendency to smoke more, smoking more frequently over time, decreased likelihood of switching away from cigarettes, and decreased probability of quitting after one year. For other product user groups, Wave 1 TD and/or TNE-2 were less consistently related to changes in quantity and frequency of product use, or for adding or switching products, but higher TNE-2 was more consistently predictive of decreased probability of quitting. Self-reported TD and nicotine exposure assess common and independent aspects of dependence in relation to tobacco use behaviors for cigarette smokers. For other product user groups, nicotine exposure is a more consistent predictor of quitting than self-reported TD. This study suggests that smoking cigarettes leads to the most coherent pattern of associations consistent with a syndrome of TD. Because cigarettes continue to be prevalent and harmful, efforts to decrease their use may be accelerated via conventional means (eg, smoking cessation interventions and treatments), but also perhaps by decreasing their dependence potential. The implications for noncombustible tobacco products are less clear as the stability of tobacco use patterns that include products such as e-cigarettes continue to evolve. TD, nicotine exposure measures, and consumption could be used in studies that attempt to understand and predict product-specific tobacco use behavioral outcomes.

Knowledge and Perceptions of Tobacco-Related Harm Associated with Intention to Quit among Cigarette Smokers, e-Cigarette Users, and Dual Users: Findings from the US Population Assessment of Tobacco and Health (PATH) Wave 1

Objective: To study the association between knowledge of diseases caused by smoking, perceptions of harm of cigarettes and intention to quit among cigarettes and e-cigarettes users. Methods: Using US Population Assessment of Tobacco and Health (PATH) Wave 1 data (2013–2014), we investigated the mean knowledge of diseases due to smoking and perceptions of harm of cigarettes scores among cigarette smokers (n = 8,263), e-cigarette users (n = 829), and dual users (n = 745) and examined the association between knowledge, perceptions of harm and intention to quit. Results: E-cigarette users had the highest scores in both knowledge and perceptions of harm items. We found a stronger association between knowledge and intention to quit among females (aOR: 1.25; 95% CI: 1.18, 1.34) compared to males (aOR: 1.11; 95% CI: 1.05, 1.18). We observed a strong association between perceptions of harm and intention to quit among cigarette smokers (p < 0.0001) and dual users (p = 0.0001), but not e-cigarette users. Conclusions: Our study indicates it is urgent for federal and state governments to develop comprehensive guidelines for targeted health messaging regarding the harms of cigarettes, noncombustible tobacco products, and dual use, and the benefits of cessation. Further, findings suggest that effective health education should include tobacco product-specific risks and the comprehensive negative health impacts of tobacco given the strong positive association of perceptions of harm and intention to quit. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1879145.

Alternative tobacco products use and its impact on urologic health - will the lesser evil still be evil? A commentary and review of literature.

IntroductionAlternative tobacco products, including electronic cigarettes (e-cigarettes) and non-combustible tobacco products or heat-not-burn (HNB) products, are substitutes to conventional combustible cigarettes with the potential to impact urologic health, similar to traditional smoking. Most urologists, however, have limited knowledge of these products and are unfamiliar with their potential health implications. We conducted a review to assess the impact of e-cigarettes and HNB products on urologic health.Material and methodsA bibliographic search covering the period up to April, 2021 was conducted using MEDLINE®/PubMed® and Google Scholar. Articles were reviewed and categorized based on the potential impact on erectile dysfunction, semen quality, lower urinary tract symptoms, genitourinary malignancies, and smoking cessation. Data were extracted, analyzed and summarized.ResultsMature data on the long-term impact of e-cigarette and HNB product use on urologic health are lacking. E-cigarette and HNB vapors appear to contain decreased concentrations of chemicals responsible for erectile dysfunction compared to tobacco smoke but may play a role through endothelial damage. Use of e-cigarettes is associated with lower sperm counts. No definitive data has shown a link between e-cigarette or HNB product use and lower urinary tract symptoms. Multiple carcinogens including those specifically linked to bladder cancer have been identified in the urine of e-cigarette and HNB product users. Limited data suggest e-cigarettes may aid in smoking cessation.ConclusionsUrologists may benefit from understanding the urologic health concerns surrounding e-cigarettes and HNB product use and patients may benefit from being properly educated.

The Interplay Between Respiratory Microbiota and Innate Immunity in Flavor E-Cigarette Vaping Induced Lung Dysfunction.

Global usage of electronic nicotine delivery systems (ENDS) has been increasing in the last decade. ENDS are non-combustible tobacco products that heat and aerosolize a liquid containing humectants, with added flavorings and often nicotine. Though ENDS are promoted as a less harmful alternative to smoking, current evidence links their use to a wide range of deleterious health effects including acute and chronic lung damage. ENDS can elicit an inflammatory response and impair the innate immune response in the lungs. Exposure to ENDS flavorings results in abnormal activation of the lung epithelial cells and β-defensins, dysfunction of the macrophage phagocytic activity, increased levels of mucin (MUC5AC) and abnormal activation of the neutrophilic response (NETosis). ENDS menthol flavorings disrupt innate immunity and might be associated with allergies and asthma through activation of transient receptor potential ankyrin 1 (TRAP1). Recent studies have expanded our understanding of the relationship between the homeostasis of lung innate immunity and the immunomodulatory effect of the host-microbiota interaction. Alterations of the normal respiratory microbiota have been associated with chronic obstructive pulmonary disease (COPD), asthma, atopy and cystic fibrosis complications which are strongly associated with smoking and potentially with ENDS use. Little is known about the short-and long-term effects of ENDS on the respiratory microbiota, their impact on the innate immune response and their link to pulmonary health and disease. Here we review the interaction between the innate immune system and the respiratory microbiota in the pathogenesis of ENDS-induced pulmonary dysfunction and identify future areas of research.