Traditional Cigarettes Research Articles

A qualitative study of the views about smoking, licensed cessation aids and e-cigarettes in people with schizophrenia spectrum disorders

Smoking prevalence remains high among people with a mental health condition compared to those without. Understanding people’s motivation to quit and their views of smoking cessation support may help to develop future interventions. We conducted a qualitative study to explore the perceptions of 30 people with schizophrenia spectrum disorders who were current smokers, about smoking traditional cigarettes, the appeal of licensed medicines and e-cigarettes for smoking cessation or smoking reduction. The experiences of participants who were motivated to quit were compared with those who were not motivated to quit. Findings suggest traditional cigarettes were pleasurable and licensed cessation aids and e-cigarettes unappealing to participants who were unmotivated to quit. Whereas nicotine replacement products and e-cigarettes may be an appealing smoking cessation or reduction strategy for those motivated to quit. There is a need to find ways of making traditional cigarettes less appealing and alternative less harmful nicotine products (licensed and unlicensed) more appealing and accessible to this group of high risk smokers.

Effects of e-cigarettes and vaping devices on cardiac and pulmonary physiology.

E-cigarette aerosols are exceedingly different from conventional tobacco smoke, containing dozens of chemicals not found in cigarette smoke. It is highly likely that chronic use of e-cigarettes will induce pathological changes in both the heart and lungs. Here we review human and animal studies published to date and summarize the cardiopulmonary physiological changes caused by vaping. In terms of cardiac physiology, acute exposure to e-cigarette aerosols in human subjects led to increased blood pressure and heart rate, similar to traditional cigarettes. Chronic exposure to e-cigarette aerosols using animal models caused increased arterial stiffness, vascular endothelial changes, increased angiogenesis, cardiorenal fibrosis and increased atherosclerotic plaque formation. Pulmonary physiology is also affected by e-cigarette aerosol inhalation, with increased airway reactivity, airway obstruction, inflammation and emphysema. Research thus far demonstrates that the heart and lung undergo numerous changes in response to e-cigarette use, and disease development will depend on how those changes combine with both environmental and genetic factors. E-cigarettes have been advertised as a healthy alternative to cigarette smoking, and users are under the impression that vaping of e-cigarettes is harmless, but these claims that e-cigarettes are safer and healthier are not based on evidence. Data from both humans and animal models are consistent in demonstrating that vaping of e-cigarettes causes health effects both similar to and disparate from those of cigarette smoking. Further work is needed to define the long-term cardiopulmonary effects of e-cigarette use in humans.

Nicotine, Cotinine, and Tobacco-Specific Nitrosamines Measured in Children's Silicone Wristbands in Relation to Secondhand Smoke and E-cigarette Vapor Exposure.

Simple silicone wristbands (WB) hold promise for exposure assessment in children. We previously reported strong correlations between nicotine in WB worn by children and urinary cotinine (UC). Here, we investigated differences in WB chemical concentrations among children exposed to secondhand smoke from conventional cigarettes (CC) or secondhand vapor from electronic cigarettes (EC), and children living with nonusers of either product (NS). Children (n = 53) wore three WB and a passive nicotine air sampler for 7 days and one WB for 2 days, and gave a urine sample on day 7. Caregivers reported daily exposures during the 7-day period. We determined nicotine, cotinine, and tobacco-specific nitrosamines (TSNAs) concentrations in WB, nicotine in air samplers, and UC through isotope-dilution liquid chromatography with triple-quadrupole mass spectrometry. Nicotine and cotinine levels in WB in children differentiated between groups of children recruited into NS, EC exposed, and CC exposed groups in a similar manner to UC. WB levels were significantly higher in the CC group (WB nicotine median 233.8 ng/g silicone, UC median 3.6 ng/mL, n = 15) than the EC group (WB nicotine median: 28.9 ng/g, UC 0.5 ng/mL, n = 19), and both CC and EC group levels were higher than the NS group (WB nicotine median: 3.7 ng/g, UC 0.1 ng/mL, n = 19). TSNAs, including the known carcinogen NNK, were detected in 39% of WB. Silicone WB show promise for sensitive detection of exposure to tobacco-related contaminants from traditional and electronic cigarettes and have potential for tobacco control efforts. Silicone WB worn by children can absorb nicotine, cotinine, and tobacco-specific nitrosamines, and amounts of these compounds are closely related to the child's urinary cotinine. Levels of tobacco-specific compounds in the silicone WB can distinguish patterns of children's exposure to secondhand smoke and e-cigarette vapor. Silicone WB are simple to use and acceptable to children and, therefore, may be useful for tobacco control activities such as parental awareness and behavior change, and effects of smoke-free policy implementation.

Heat-not-burn tobacco products: an emerging threat to cardiovascular health.

Cigarette smoking is at all-time lows globally, but the use of electronic cigarettes has increased profoundly. Recent reports of electronic cigarette or vaping use-associated lung injury may lead individuals to explore novel methods of nicotine consumption, such as heat-not-burn devices. IQOS from Philip Morris, a heat-not-burn device, became available for purchase in the United States in October 2019. Philip Morris claims that 8.8 million people have abandoned traditional cigarettes in favor of IQOS; however, evidence suggests that it may act as a gateway or complement to cigarette smoking, rather than a replacement. Surveys indicate that 96% of Korean IQOS users also smoke cigarettes, and 45% of Italian users of IQOS had never smoked cigarettes. In the United States, Canada, and England, susceptibility of youth to trying IQOS was slightly lower than electronic cigarettes, but higher than cigarette smoking. Heat-not-burn products produce mainstream and second-hand emissions of harmful chemicals, including nicotine, particulate matter, benzene, acrolein, and tobacco-specific nitrosamines. The levels of these emissions, despite being less than those of traditional cigarettes, are potentially harmful to cardiovascular health. A study of current smokers showed similar acute effects of heat-not-burn tobacco products and traditional cigarettes on heart rate, blood pressure, and arterial stiffness. Rats exposed to IQOS had similar vascular endothelial function impairment to those exposed to cigarettes. Heat-not-burn aerosol exposure of cultured macrophages elicited increased oxidative stress, although less than that induced by cigarette smoke. Further studies are needed to better understand the cardiovascular effects of heat-not-burn tobacco products.

ASSESSMENT OF VAPING PRACTICES IN PATIENTS WITH CYSTIC FIBROSIS

SESSION TITLE: Diffuse Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Smoking prevalence has decreased over the last several decades in the United States. However, new generations of tobacco and non-tobacco products such as electronic cigarettes (e-cigarettes) are being increasingly used, particularly in the young adult population. E-cigarettes are battery-powered devices that heat a liquid in order to develop vaporized products, including nicotine and marijuana. While originally thought to be less harmful than traditional cigarettes, e-cigarettes have been shown to have significant consequences including hospitalization and mechanical ventilation. Beginning in July 2019, there have been reports of previously healthy, young individuals developing respiratory failure, with e-cigarette use being identified as an antecedent factor. This new entity, E-cigarette or Vaping Associated Lung Injury (EVALI) has resulted in bans in several states. While the prevalence of e-cigarette use, and the rise of EVALI has been studied in the general population, to our knowledge there is no existing data about the prevalence of e-cigarette use among young adults with chronic lung disease. Individuals with Cystic Fibrosis (CF) offer a unique perspective on the impact of e-cigarette use on the young adult population with lung disease. METHODS: We administered a voluntary survey for patients with CF seen at the Rhode Island Cystic Fibrosis Center, as well as for adolescent and young adult primary care patients seen in the Medicine-Pediatrics Primary Care Clinic. The survey addressed patient experience with cigarettes and e-cigarettes, perceptions of substance use, validated quality of life scales (CFQR for CF patients, RAND-SF36 for non-CF patients), and an assessment of social desirability in order to assess risk of bias. RESULTS: Preliminary results from this observational study demonstrate avoidance of tobacco products and smoking amongst patients with CF compared to an age-matched cohort of the general population (Table 1). CONCLUSIONS: Patients with CF overwhelmingly described e-cigarette use as likely to cause significant lung damage within a brief period of time. A small portion of CF patients had tried smoking in the past, but no patients were identified as having a recent smoking history. Patients without CF averaged higher quality of life measures. While feelings of anxiety, sadness, and isolation were roughly comparable between the groups, physical symptoms were notably more bothersome in the CF patient group. CLINICAL IMPLICATIONS: This study demonstrates different social behaviors among CF and non-CF individuals in regards to cigarette and e-cigarette use. Adult CF patients were specifically able to verbalize risks associated with recreational inhalational products implying that a targeted educational program about EVALI is likely not necessary. DISCLOSURES: No relevant relationships by Roger Auth, source=Web Response no disclosure submitted for Debasree Banerjee; No relevant relationships by Michael Blundin, source=Web Response No relevant relationships by Sarah Rhoads, source=Web Response

STAPHYLOCOCCUS AUREUS PNEUMONIA AND EMPYEMA AS A COMPLICATION OF E-CIGARETTE USE

SESSION TITLE: Medical Student/Resident Tobacco Cessation and Prevention Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Electronic-cigarettes (e-cigarettes), popularized in the late 2000s, were introduced as a safer alternative to traditional tobacco cigarettes. However, emerging data suggests a considerable risk for developing pulmonary diseases in users of e-cigarettes. Despite this concern, e-cigarette use is on the rise with up to 20% of Americans aged 25 to 44 now using e-cigarettes [1]. We present an interesting case which explores the relationship between e-cigarettes and the development of methicillin sensitive Staphylococcus aureus (MSSA) pneumonia. CASE PRESENTATION: A 38-year-old female was admitted with a five-day history of fever, dyspnea, and a productive cough. Her medical history was only notable for daily use of nicotine products via an e-cigarette. Vital signs on arrival revealed a temperature of 37.9 degrees centigrade, tachycardia with a pulse rate of 133 beats per minute, and tachypnea with a respiratory rate of 26 breaths per minute. She was able to maintain appropriate oxygen saturations on room air. Physical examination was notable for diminished air movement in left lower lung base. Admission labs were notable for a white blood cell (WBC) count of 12.83 x10(9)/L, and a procalcitonin of 11.3 ng/mL. Notably, both urine streptococcus and legionella antigens were negative. A chest radiograph demonstrated a left lower lobe opacity with associated effusion [Figure 1], which was also present on a computed tomography scan of her chest [Figure 2A-B]. Therefore, a diagnostic thoracentesis was performed from which pleural fluid analysis revealed a pH of 6.6, lactate dehydrogenase of 1,478 units/L, protein of 4.7g/dL, and WBC count of 5,082 cells/mL. Subsequent cultures from both the pleural fluid and sputum grew MSSA. The patient was started on empiric antibiotics and had a left-sided chest tube inserted for drainage of her empyema. Given the presence of loculations, additional therapy with intrapleural dornase alpha and tissue plasminogen activator was initiated. The patient clinically improved, her chest tube was removed, and she was discharged home to complete four weeks of nafcillin. The patient reported continued recovery and success in quitting e-cigarettes at her subsequent follow up. DISCUSSION: As the long-term effects of e-cigarette use become more evident, it is clear that they pose significant risks to patients. E-cigarettes decrease host ability to fight infection by promoting virulence in bacterial colonizers of the airways and by increasing pro-inflammatory markers [2]. Furthermore, vapors from e-cigarettes have been implicated in increasing biofilm formation. Biofilms lead to an increase of virulence in a variety of lung pathogens, including Staphylococcus aureus [3]. CONCLUSIONS: Clinicians should be aware of an increase in virulence from bacterial pathogens (particularly MSSA) responsible for community acquired bacterial pneumonia amongst e-cigarette users. Reference #1: Hwang, John H., et al. “Electronic cigarette inhalation alters innate immunity and airway cytokines while increasing the virulence of colonizing bacteria.” Journal of molecular medicine 94.6 (2016): 667-679. Reference #2: Gilpin, Deirdre F., et al. “Electronic cigarette vapour increases virulence and inflammatory potential of respiratory pathogens.” Respiratory Research 20.1 (2019): 267. Reference #3: Shi, L., Wu, Y., Yang, C. et al. Effect of nicotine on Staphylococcus aureus biofilm formation and virulence factors. Sci Rep 9, 20243 (2019). https://doi.org/10.1038/s41598-019-56627-0 DISCLOSURES: No relevant relationships by Ethan Karle, source=Web Response No relevant relationships by Armin Krvavac, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response No relevant relationships by Richard Swaney, source=Web Response

Vaping and e-cigarette use. Mysterious lung manifestations and an epidemic.

Electronic (e)-cigarette use and the practice of vaping has rapidly expanded both in adult smokers and previously nicotine naïve youths. Research has focused on harm reduction in adults using e-cigarettes to stop or reduce traditional cigarette use, but the short and long-term safety of these products has not been established. Vaping has more recently been associated with a growing list of pulmonary complications with the most urgent being the e-cigarette or vaping product use-associated lung injury (EVALI) epidemic. This review details the inhalant toxicology of vaping products, the described lung diseases associated with vaping with a focus on EVALI, and the predicted long-term consequences of e-cigarette use, including increased asthma severity.

CHANGING TRENDS IN THE POPULARITY OF E-CIGARETTE USE AMONG ADOLESCENTS IN THE UNITED STATES

For most of these prior 2 decades, tobacco use disorder in American adolescents has decreased dramatically. However, in recent years, the fall of traditional cigarettes has been replaced by an alarming rise in e-cigarette use among youths in the United States. Various legislative efforts have been tried at the state level. Prior to August 2016, e-cigarette regulation varied significantly among the states, and the prevalence of e-cigarette use differed greatly geographically as well. In August 2016, e-cigarette regulation changed from a variety of state regulations to officially being regulated by the FDA, such as banning access to minors as well as restricting the ability to advertise e-cigarettes as safer than other tobacco products. This study uniquely analyzes the trends in e-cigarette popularity by states before and after the change in e-cigarette legislation in 2016.

Analysis of the safety of using e-cigarettes during pregnancy. The literature review

Introduction and objective: The popularity of e-cigarettes around the world has been increasing in recent years. The reason for this may be a relatively lower cost of use and a lower amount of toxins compared to traditional cigarettes. E-cigarettes are more often picked by women of reproductive age compared to the general group of women. Abbreviated description of the state of knowledge: According to recent studies, pregnant women consider e-cigarettes safer than tobacco cigarettes, which may be due to being advertised as a less harmful product compared to traditional cigarettes. Although some electronic cigarettes do not contain nicotine, they also consist of glycol, glycerin, fragrances and heavy metals that may adversely affect the development of the fetus. Furthermore, the statements of some significant healthcare institutions are divided on the safe use of e-cigarettes by pregnant women, even in the case of treating them as an aid in the smoking cessation process. Summary: No clear understanding is noticed regarding the effects of using electronic nicotine delivery systems during pregnancy on maternal, fetal or newborn health, so there is a high need of further studies assessing the safety of these noncombustible tobacco products. However, it can be an feasible alternative to traditional cigarettes, when trying to quit smoking by pregnant women.

The clove tree and its products (clove bud, clove oil, eugenol): prosperous today but what of tomorrow’s restrictions?

Context of the study – The clove tree, farmed primarily in Indonesia, Madagascar, the Comoros, Tanzania and Sri Lanka, produces two major commodities: the clove and the eugenol-rich essential oil. At the present time, the clove caters to the spice market, which is concentrated in India, as well as the market for the traditional Indonesian cigarette, the kretek, which accounts for 70% of world output. The essential oil extract is exploited for its various properties: plasticising, anaesthetic, antimicrobial and organoleptic, which are deployed in the cosmetics, dentistry and agro-food sectors. Several innovative, often cutting edge, applications are currently being researched, taking advantage of its profile as an organic product derived from green chemistry, implicated in the agroecology approach. The main areas concerned are medicine, agri-food and agronomy. Aim of the study – We are considering a series of plausible hypotheses of evolutions in demand on the international market, to assess how the development of current and potential applications might steer the market in the coming years and decades. We are exploring their impact on the offer of producing countries, and therefore, on the incomes of local farmers and distillers. Methodology – Our approach is based on an extensive bibliography. Remarkable results – The clove sector is under threat from various sources: American cigarette manufacturers' offensive to conquer the vast Indonesian market, disregard for quality, inter-annual variation of production, competition between clove producing countries, as well as substitute products, impact of oil extraction methods on firewood consumption. A few forward-looking elements are given, particularly concerning the impact of climate change and the COVID-19 pandemic. Conclusion – These threats need to be anticipated and taken into consideration by all actors of the sectors for the clove and its products to continue providing a reliable source of income to thousands of small farmers in the producing countries.

Awareness and use of e-cigarettes among university students in Shanghai, China.

INTRODUCTIONThe use of electronic cigarettes (e-cigarettes) in adults is increasing globally, and similar trends may be observed in the young population. Our objective was to estimate the awareness and use of e-cigarettes among the students from two comprehensive universities in Shanghai, China, and to identify the factors that may influence their decision to use e-cigarettes and their possible adverse effects.METHODSAn online cross-sectional survey was conducted among the students of Shanghai Jiao Tong University and Fudan University. A total of 869 students (412 males and 457 females), mean age 21.09 years (SD=2.44), were recruited in 2018. Multivariate binary logistic regression analyses were performed to explore the associations between ever e-cigarette use and influencing factors.RESULTSOf the responding students, 88.4% were aware of e-cigarettes, 4.6% had used e-cigarettes at least once in their lifetime, and 1.7% were current e-cigarettes users. Males and smokers were more likely to use e-cigarettes (ever used e-cigarettes even once) than females (OR=3.51; 95% CI: 1.69–7.27; p=0.001) and non-smokers (OR=28.58; 95% CI: 14.03–58.20; p<0.001). University students were easily motivated to use e-cigarettes when their peers also used them, and the risk ratio was 4.15 (95% CI: 2.11–8.19) compared with if their peers never used e-cigarettes. The major factors found to motivate university students to use e-cigarettes were the belief that e-cigarettes were less harmful or not harmful (55.0%) and the perception that e-cigarettes were helpful to quit smoking (37.5%). The survey also indicated that 72.4% of the respondents heard about e-cigarettes from television advertisements, 42.7% from websites online, and 41.2% from their parents and friends.CONCLUSIONSUniversity students who were males, cigarette smokers and whose peers used e-cigarettes were more likely to use e-cigarettes. The use of traditional cigarettes should be controlled strictly in order to reduce the likelihood of e-cigarette use among university students.

E-cigarette use among Canadian Youth: A review of the literature using an interdisciplinary lens

Objective: The increasing use of e-cigarettes among Canadian youth is a concerning population health issue. Vaping, the act of using an e-cigarette, was initially marketed as a healthier alternative to smoking traditional cigarettes, however its use is having unintended negative consequences on those who use them. One of the most concerning consequences is the presence of “e-cigarette, or vaping, product use associated lung injury” (EVALI) which had led to hospitalization. Youth in particular are an overrepresented demographic affected by these negative consequences, likely as a result of both exposure to marketing, which is a well-established determinant of youth behavior as well as inadequate public policy. The purpose of this paper is to present a review of the literature surrounding the issue of e-cigarette use among youth from an interdisciplinary perspective. Method: A narrative review was conducted to summarize the state of e-cigarette use among young Canadians and conceptualize this problem from the perspective of public policy, followed by biomedicine, health economics and education. Results: The results of this review are a summary of the current state of the literature framed with an interdisciplinary perspective. Recommendations for how these interdisciplinary perspectives can be brought together to provide effective solutions for this population health issue are provided. Conclusion: Identifying and understanding this problem through an interdisciplinary approach has the potential to create effective and sustainable solutions. Partnerships between school boards and governmental bodies can enhance educational resource allocation and align messaging to youth through several platforms.

E-cigarettes from the perspective of teenagers – results of focus studies

Abstract Research shows that over 80% of smokers start their habit under the age of 18. A few years ago young people undertook risky behaviors related to nicotine initiation mainly by smoking cigarettes. Today, next to traditional tobacco products, electronic cigarettes are becoming more and more popular. Due to the prevalence of new forms of nicotine addiction, modification of anti-tobacco prevention programs is required. The purpose of the research was exploration - learning the opinions and attitudes of young people towards e-cigarettes. The qualitative study was conducted using the FGI method (focus group interview). The meetings were modereted by specially trained psychologists. 48 students participated in the meetings of six focus groups, divided by gender and smoking status (smokers/non-smokers). The participants are young people aged 15-19, attending high schools in Warsaw, Kielce and Lublin. In conversations, young people emphasized the impact of e-cigarettes in smoking initiation - it usually occurs at the age of 12-14. E-cigarettes are perceived as cigarettes “for younger”, non-addictive, less serious, providing more entertainment. 'Cloud chasing' is particularly popular. They perform social functions - they are helpful in establishing relationships. Teenagers do not see the harmfulness of e-cigarettes. Participants mentioned their advantages over traditional tobacco products - they can be smoked everywhere and do not leave an unpleasant smell. Some of the respondents admit to the simultaneous use of electronic and traditional cigarettes. Moreover, many parents allow children to smoke electronic cigarettes. Vaping have become a natural way to relaxation and socialization for adolescents. E-cigarettes do not have such a negative connotation as traditional tobacco products. Young people do not see them as harmful, which is a challenge for effective preventive measures. Key messages Adolescents do not see e-cigarettes as harmful, which is a challenge for effective preventive measures. Vaping have become more and more popular - it's natural way to relaxation and socialization for young people.

Recent changes in smoking habits in France

Abstract Background In 2018, smoking rate among French adults was 32.0%. This rate has been slowly decreasing over the past years but remains high compared to other European countries. In addition, smoking habits have changed over time and for instance roll-your-own tobacco (RYO) is both cheaper and seen as less dangerous. It is crucial to keep an eye on these changes in order for public health actors to adapt their actions in the fight against smoking. Methods Data come from the Santé publique France health Barometer, a national representative phone survey. In the 2005, 2010, 2014, 2017 and 2018 editions, respectively 28,224, 25,034, 15,186, 25,319 and 9,074 adults where asked about their smoking habits. Results In 2018, three quarters of smokers smoked cigarettes, over a third smoked RYO and about ten percent smoked hookahs. The proportion of smokers using exclusively RYO tobacco has more than doubled in recent years (from 8.1% in 2010 to 20.5% in 2018). Since 2010, RYO tobacco is taking shares over traditional cigarettes especially among the poorest smokers. In 2018, RYO tobacco users were more often young men or deprived individuals. Conclusions The share of cigarette smokers switching to RYO has increased over the past years. It seems to be both a result of changes in trends and a way for deprived smoker to cope with higher prices for cigarettes. Key messages Public health actions need to take into account the recent increase of popularity of RYO tobacco in France. taxes need to be adjusted in order to level up RYO tobacco prices compared to traditional cigarettes.

Exposure to tobacco smoke among pupils from Sopot primary schools. SOPKARD study results

Abstract Background The problem of tobacco use among minors and in their immediate environment remains a significant challenge in Poland. Although Poland has passed smoke free law children are still being exposed to tobacco smoke. The purpose of this study was to analyze the phenomenon of tobacco use by children in City of Sopot and in their surroundings. Methods The cross-sectional study was conducted as part of the SOPKARD program for early detection of risk factors for civilization diseases in children and adolescents. A limited GYTS questionnaire was utilized to conduct the study. Data was collected from all the fifth grade students (9-11 yo) attending to Sopot primary schools in 2017 and 2018. Results The study involved 385 students (161 in 2017 and 224 in 2018). Only few students tried to smoke traditional cigarettes (3%) or use electronic e-cigarettes (2%). Despite the legal ban, 24% of students saw smokers in the school premises. In addition, 34% of children said that one or both of their parents smokes and that in only slightly more than ¾ of the houses smoking is completely prohibited. As many as 66% of students reported smoking incidents in the cars they travel. There were 16% students who think they could start smoking in the future. Conclusions The results suggest that Sopot children are still exposed to tobacco smoke inhalation. It happens in private, non-smoking areas (homes and family cars). It is worth conducting educational activities and considering legislative initiatives such as smoking ban in vehicles carrying children to stimulate parents to take care more of the health of their children. Key messages Although tobacco legislation in Poland protects people from passive smoking in public places children are still exposed in private premises. Ban on smoking should be extended to privates cars at minimum.

Discoveries in Aerosol Science: Characterization of Nanoparticles Emitted From Metallic Coils in Electronic Cigarettes

Electronic (e-) cigarettes, also known as electronic nicotine delivery systems, are battery-operated devices that are growing in popularity worldwide. Although e-cigarettes are known to be safer than traditional cigarettes, their potential health risks have not been extensively reviewed yet. In this study, aerosol nanoparticles generated from e-cigarette heaters were characterized. Kanthal A1 (iron + chromium + aluminum) coils, without nicotine solution or a wick, were installed in an e-cigarette atomizer. The operating conditions were varied coil resistances (0.1–1.0 Ω), a set applied power (10 W), and a stable duty cycle (50%: 5 s on, 5 s off ). The size distribution and morphology of particles were collected by a scanning mobility particle sizer and evaluated by transmission electron microscopy, respectively. From an applied power of 10 W and a 50% duty cycle, the size and total number concentration (TNC) of particles emitted increased with greater coil resistances. Within these operating conditions, the average TNC of particles generated exhibited a steep decrease during the first 15 minutes of each trial. The TNC of particles decreased over time because surface oxidation (iron oxide layer) prevented further nanoparticle emission. As a result, a used coil may reduce the risk of the metal exposure from e-cigarettes. The results indicate that our designed and tested e-cigarette generation system is useful for future research that aims to investigate the health impacts of metallic particle inhalation on e-cigarette users.

A scoping review of sources of mercury and its health effects among Pakistan's most vulnerable population.

Mercury and methyl mercury are poisonous to human body. In the recent times, exposure to mercury has been anthropogenic in nature. Within the past several decades, many incidences of mercury poisoning have been documented in several countries including Pakistan. Mercury has been ingested where it has been used to preserve crops, through the point and non-point source discharge into the surface water, and consequently entering the food chain. We conducted this scoping review of mercury and its health effects in Pakistan in order to raise the flag to a silent ongoing Minamata disease in the country. We conducted a systematic search of the available literature in Google Scholar, PubMed, and grey literature of unpublished theses and reports of various universities across the country. We found that in the northern Pakistan, suspended sediments were the major pathway of the riverine mercury transport. Sediments of Hunza and Gilgit River were found high in mercury concentrations. Gold mining leads to an increase in mercury concentration in soil and river waters flowing in this region. High concentrations up to 108ng/L were found in Shimsal River. It is suspected that that high level of mercury transport may be leading to accumulation of mercury in major water bodies and lakes downstream. Occupational exposure to mercury and other heavy metals is common in an unregulated private sector of the country. Goldsmiths burn the amalgamated gold without personal protective measures. Direct exposure to the fumes of mercury leads to respiratory, dermatological, systemic and neurological ailments specific to mercury poisoning. We found good evidence of bioaccumulation of mercury in fish and fish products in Pakistan. The untreated waste water discharge is responsible to not only afflicted the fish but also the birds which feed on this fish. Further, the same untreated waste water from factories and agriculture runoffs affect vegetables grown in it. Studies looking at the biomarkers for mercury in humans have shown increased and even toxic levels of mercury among the most vulnerable populations of the country. Other sources of mercury exposure included mercury in traditional medicines and cigarette products. Though no evidence was found for its presence in drinking water, its existence in the food chain and occupational exposure pose great threat to the humans as well as animals.

Comparative Indoor Pollution from Glo, Iqos, and Juul, Using Traditional Combustion Cigarettes as Benchmark: Evidence from the Randomized SUR-VAPES AIR Trial.

Modified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) are appealing alternatives to combustion cigarettes. Limited between- and within-device comparative data are available on MRP. We aimed at comparing indoor particulate matter (PM) emissions measured in a randomized trial enforcing standardized smoking sessions, testing different devices and flavors of MRP, using traditional combustion cigarettes (TCC) as benchmark. Overall, MRP yielded significantly lower levels of indoor PM in comparison to TCC (with median PM levels during smoking for MRP < 100 μg/m3, and for TCC > 1000 μg/m3). Despite this, significant differences among MRP were found, with Iqos appearing associated with a significantly lower burden of emissions for all the monitored fractions of PM, including total PM (all p < 0.05). Precisely, during use, PM ≤1 µm (PM1) emissions were 28 (16; 28) μg/m3 for Glo, 25 (15; 57) μg/m3 for Iqos, and 73 (15; 559) μg/m3 for Juul (p < 0.001 for Glo vs. Iqos, p < 0.001 for Glo vs. Juul, and p = 0.045 for Iqos vs. Juul). Exploratory within-MRP analyses suggested significant differences between flavors, favoring, for instance, Ultramarine for Glo, Bronze for Iqos, and Mango for Juul, even if results varied substantially according to individual smoker. In conclusion, leading MRP have significantly less intense and persistent effects on indoor pollution in comparison to TCC. Yet, when focusing solely on MRP, between-product and between-flavor differences appear, with quantitative estimates suggesting lower polluting effects with Iqos. These results, if confirmed externally, could be used to individualize product and flavor choice to minimize the untoward effects of EVC and HNBC on indoor pollution.

Vaping and oral health

Electronic cigarettes also known as e-cigarettes, which deliver a vaporised smoke of nicotine and promise less toxicants than conventional cigarette smoke. However, studies suggest e-cigarettes are not completely harmless but are less dangerous than traditional cigarettes. The promise of help in smoking cessation effectiveness is still unproven and requires further evidence and studies. There are ongoing studies on deleterious oral and systemic health effects. Because of the rising popularity of vaping, it is absolutely vital that dental professionals must stay informed to provide patients truthful information as new data emerge. Keywords: Ecigarette, Vaping, Smoke, Cigarette, Oral health, Effect.

Electronic Cigarettes Prevalence and Awareness Among Jordanian Individuals.

The general awareness regarding E-smoking is varying from country to other depending on multivariable factors. We try to investigate the prevalence of E-Cigarette Awareness, Perceived Harmfulness, Prevalence, and Associations with Smoking-Cessation Outcomes among different age groups and different sex in Jordanian individuals. The study element shaped by data gathered from various questionnaire surveys. The questionnaire was of our own design the method of data collection was through online surveys Different applications were used to distributing the questionnaire including; Whatsapp, Facebook, Instagram, other social applications. The study included 1536 participants. The prevalence of E-smoking is 18% among Jordanian individuals where it is 24.9% in males and 3.5% in females. 47.3% of participants believe that E-smoking has less harmful effects than traditional cigarette smoking while 46.7% believe that E-smoking has the same risk of cigarette smoking. 56% of participants believe the E-smoking can lead to addiction. E-smoking is considered an emerging modality of smoking with limited data regarding its long term impact regarding its addictive behavior and toxic effect. Awareness program regarding E-smoking is mandatory especially for the nontraditional smoker and young people.