Traditional Combustible Cigarettes Research Articles

Short‐term e‐cigarette vapor exposure causes vascular oxidative stress and dysfunction ‐ evidence for a close connection to brain damage and a key role of the phagocytic NADPH oxidase (NOX‐2)

BackgroundElectronic (e)‐cigarettes have been marketed as a “healthy” alternative to traditional combustible cigarettes and as an effective method of smoking cessation. There are, however, a paucity of data to support these claims. In fact, e‐cigarettes are implicated in endothelial dysfunction and oxidative stress in the vasculature and the lungs. The mechanisms underlying these side effects remain unclear. Here, we investigated the effects of e‐cigarette vapor on vascular function in smokers and experimental animals to determine the underlying mechanisms.Methods and ResultsAcute e‐cigarette smoking produced a marked impairment of endothelial function in chronic smokers determined by flow‐mediated dilation. In mice, e‐cigarette vapor without nicotine had more detrimental effects on endothelial function, markers of oxidative stress, inflammation and lipid peroxidation than vapor containing nicotine. These effects of e‐cigarette vapor were largely absent in mice lacking phagocytic NADPH oxidase (NOX‐2) or upon treatment with the endothelin receptor blocker macitentan or the FOXO3 activator bepridil. We also established that the e‐cigarette product acrolein, a reactive aldehyde, recapitulated many of the NOX‐2‐dependent effects of e‐cigarette vapor using in vitro blood vessel incubation.ConclusionsE‐cigarette vapor exposure increases vascular, cerebral and pulmonary oxidative stress via a NOX‐2‐dependent mechanism. Our study identifies the toxic aldehyde acrolein as a key mediator of the observed adverse vascular consequences. Thus, e‐cigarettes have the potential to induce marked adverse cardiovascular, pulmonary and cerebrovascular consequences. Since e‐cigarette use is increasing, particularly amongst youth, our data suggest that aggressive steps are warranted to limit the health risks of e‐cigarettes.Support or Funding InformationThe present work was supported by a vascular biology research grant from the Foundation Heart of Mainz and by a vascular biology research grant from the Boehringer Ingelheim Foundation for the collaborative research group „Novel and neglected cardiovascular risk factors: molecular mechanisms and therapeutic implications" to study the effects of environmental risk factors on vascular function and oxidative stress. R. H. holds a PhD stipend of the Max Planck Graduate Center with the Johannes Gutenberg University Mainz. T.M. is PI of the DZHK (German Center for Cardiovascular Research), Partner Site Rhine‐Main, Mainz, Germany.Central scheme: Proposed mechanisms of E‐cigarette mediated cerebro/cardiovascular complications from studies in mice.The described adverse effects are also operative in the disease development and progression of classical cerebro/cardiovascular disease such as stroke, atherosclerosis, hypertension and coronary artery disease. Light blue color items represent pharmacological/genetic interventions.Figure 1

Profiling the Acute Effects of Modified Risk Products: Evidence from the SUR-VAPES (Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking) Cluster Study.

Modified risk products (MRP) are promoted as a safer alternative to traditional combustion cigarettes (TCC) in chronic smokers. Evidence for their lower hazardous profile is building, despite several controversies. Yet, it is unclear whether individual responses to MRP differ among consumers. We hypothesized that different clusters of subjects exist in terms of acute effects of MRP. Pooling data from a total of 60 individuals, cluster analysis identified at least three clusters (labelled 1 to 3) of subjects with different electronic vaping cigarettes (EVC) effects and at least two clusters (labelled 4 to 5) of subjects with different heat-not-burn cigarettes (HNBC) effects. Specifically, oxidative stress, platelet aggregation, and endothelial dysfunction after EVC were significantly different cluster-wise (all p < 0.05), and oxidative stress and platelet aggregation after HNBC were significantly different (all p < 0.05). In particular, subjects belonging to Cluster 1 appeared to have less detrimental responses to EVC usage than subjects in Cluster 2 and 3, as shown by non-significant changes in flow-mediated dilation (FMD) and less marked increase in Nox2-derived peptide (NOX). Conversely, those assigned to Cluster 3 had the worst reaction in terms of changes in FMD, NOX, and P-selectin. Furthermore, individuals belonging to Cluster 4 responded unfavorably to both HNBC and EVC, whereas those in Cluster 5 interestingly showed less adverse results after using HNBC than EVC. Results for main analyses were consistent employing different clusters, tests, and bootstrap. Individual responses to MRP differ and smokers aiming at using EVC or HNBC as a risk reduction strategy should consider trying different MRP aiming at finding the one which is less detrimental, with subjects resembling those in Cluster 1 preferably using EVC and those resembling Cluster 5 preferably using HNBC.

Short-term e-cigarette vapour exposure causes vascular oxidative stress and dysfunction: evidence for a close connection to brain damage and a key role of the phagocytic NADPH oxidase (NOX-2).

AimsElectronic (e)-cigarettes have been marketed as a ‘healthy’ alternative to traditional combustible cigarettes and as an effective method of smoking cessation. There are, however, a paucity of data to support these claims. In fact, e-cigarettes are implicated in endothelial dysfunction and oxidative stress in the vasculature and the lungs. The mechanisms underlying these side effects remain unclear. Here, we investigated the effects of e-cigarette vapour on vascular function in smokers and experimental animals to determine the underlying mechanisms.Methods and resultsAcute e-cigarette smoking produced a marked impairment of endothelial function in chronic smokers determined by flow-mediated dilation. In mice, e-cigarette vapour without nicotine had more detrimental effects on endothelial function, markers of oxidative stress, inflammation, and lipid peroxidation than vapour containing nicotine. These effects of e-cigarette vapour were largely absent in mice lacking phagocytic NADPH oxidase (NOX-2) or upon treatment with the endothelin receptor blocker macitentan or the FOXO3 activator bepridil. We also established that the e-cigarette product acrolein, a reactive aldehyde, recapitulated many of the NOX-2-dependent effects of e-cigarette vapour using in vitro blood vessel incubation.ConclusionsE-cigarette vapour exposure increases vascular, cerebral, and pulmonary oxidative stress via a NOX-2-dependent mechanism. Our study identifies the toxic aldehyde acrolein as a key mediator of the observed adverse vascular consequences. Thus, e-cigarettes have the potential to induce marked adverse cardiovascular, pulmonary, and cerebrovascular consequences. Since e-cigarette use is increasing, particularly amongst youth, our data suggest that aggressive steps are warranted to limit their health risks.

Testing the Effect of Vapor in ENDS Public Service Announcements on Current Smokers and ENDS Users’ Psychophysiological Responses and Smoking and Vaping Urge

Electronic nicotine delivery systems (ENDS) are increasingly popular, especially among young adults. Many ENDS advertisements and anti-ENDS public service announcements (PSAs) contain portrayals of ENDS use and visible vapor. Though it is plausible that vapor would be processed in similar ways to traditional combustible cigarette smoking cues, this has not been consistently established. In a laboratory session, we assessed cognitive and emotional processing using psychophysiological measures (e.g., facial electromyography, heart rate, and skin conductance) among young participants who were either smokers only (N = 43) or dual users of ENDS and cigarettes (N = 28) as they viewed four anti-vaping PSAs depicting either vapor or no vapor. Self-report urge to smoke traditional cigarettes and urge to vape and recognition (encoding) of information within the PSAs were measured following each PSA. Orbicularis oculi activation (positive emotion), heart rate deceleration (cognitive resource allocation), recognition (encoding), and vaping urge were greater in the vapor-present condition relative to vapor-absent condition. Hence, the presence of vapor in anti-vaping PSAs activates the approach/appetitive motivational system indicated by greater positive emotion, cognitive resource allocation, and memory, but also greater vaping urge compared to PSAs absent in vapor. Recommendations for inclusion of vapor and design of anti-vaping PSAs are discussed.

Acute Effects of Heat-Not-Burn, Electronic Vaping, and Traditional Tobacco Combustion Cigarettes: The Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking ( SUR - VAPES ) 2 Randomized Trial.

BackgroundLittle clinical research on new‐generation heat‐not‐burn cigarettes (HNBC) in comparison with electronic vaping cigarettes (EVC) and traditional tobacco combustion cigarettes (TC) has been reported. We aimed to appraise the acute effects of single use of HNBC, EVC, and TC in healthy smokers.Methods and ResultsThis was an independent, cross‐over, randomized trial in 20 TC smokers, with allocation to different cycles of HNBC, EVC, and TC. All participants used all types of products, with an intercycle washout of 1 week. End points were oxidative stress, antioxidant reserve, platelet activation, flow‐mediated dilation, blood pressure, and satisfaction scores. Single use of any product led to an adverse impact on oxidative stress, antioxidant reserve, platelet function, flow‐mediated dilation, and blood pressure. HNBC had less impact than EVC and TC on soluble Nox2‐derived peptide (respectively, P=0.004 and 0.001), 8‐iso‐prostaglandin F2α‐III (P=0.004 and <0.001), and vitamin E (P=0.018 and 0.044). HNBC and EVC were equally less impactful than TCs on flow‐mediated dilation (P=0.872 for HNBC versus EVC), H2O2 (P=0.522), H2O2 breakdown activity (P=0.091), soluble CD40 ligand (P=0.849), and soluble P‐selectin (P=0.821). The effect of HNBC and, to a lesser extent EVC, on blood pressure was less evident than that of TC, whereas HNBC appeared more satisfying than EVC (all P<0.05).ConclusionsAcute effects of HNBC, EVC, and TC are different on several oxidative stress, antioxidant reserve, platelet function, cardiovascular, and satisfaction dimensions, with TCs showing the most detrimental changes in clinically relevant features.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03301129.

Experts Call For More Action to Thwart Youth Vaping ‘Epidemic’

Experts Call For More Action to Thwart Youth Vaping ‘Epidemic’

Evolution of Electronic Cigarette Brands From 2013-2014 to 2016-2017: Analysis of Brand Websites.

BackgroundThe electronic cigarette (e-cigarette) industry has grown in size and organizational complexity in recent years, most notably with the entry of major tobacco companies in 2012 and the proliferation of vape shops. Many brands maintain retail websites that present e-cigarette marketing claims and sell directly to consumers. Understanding of the evolving composition of different types of e-cigarette brand websites is currently underdeveloped.ObjectiveThis paper presents how e-cigarette brand websites surveyed in 2013-2014 evolved by 2016-2017, and how the websites run by different types of e-cigarette producers currently differ.MethodsIn 2016-2017, we revisited 466 e-cigarette brand websites surveyed in 2013-2014, 288 of which were extant, and identified 145 new English-language websites. We compared product designs, marketing claims, and age-based warnings presented by types of e-cigarette producers: major tobacco companies, independent vape shops, and independent internet-only companies.ResultsAmong the 433 websites examined in 2016-2017, 12 were owned by major tobacco companies, 162 operated a physical vape shop, and 259 were internet-only operations. Closed-system product designs were sold by 83% (10/12) of tobacco-owned brands. In comparison, 29.0% (47/162, P<.001) of vape shop and 55.2% (143/259, P=.06) of internet-only brands sold closed-system designs. Compared with vape shop and internet-only brands, tobacco-owned brands offered a smaller set of product models (P values <.001) and a narrower range of flavors (P values <.01), with greater emphasis on the traditional combustible cigarette flavors of tobacco and menthol (P values <.001). Tobacco-owned brands also offered a narrower range of nicotine options than the vape shops (P=.002) and were less likely to offer nicotine-free e-liquid compared with internet-only and vape shop brands (P values <.001). Finally, 83% (10/12) of tobacco-owned brand websites featured age verification pop-up windows. In comparison, only 50.2% (130/259) of internet-only brands (P=.01) and 60.5% (98/162) of vape shop brands (P=.06) featured age verification windows. Websites surveyed in both 2013-2014 and 2016-2017 became more likely to sell open-system mods (P<.001) and sold an increased number of product models (P<.001), flavors (P<.001), and nicotine options (P<.001). Prevalence of several types of claims decreased significantly, including indirect claims regarding smoking cessation (P<.001), claims regarding e-cigarettes as healthier (P<.001), less expensive (P<.001), and usable in more places (P<.001) compared with combustible cigarettes.ConclusionsThe number of e-cigarette brands has not appeared to increase since 2014, even as website messaging evolved, with brands owned by tobacco companies and vape shops pulling in opposite directions. Brands owned by tobacco companies offered a limited range of e-cigarette products, whereas brands owned by vape shops emphasized a panoply of flavor and nicotine options. Furthermore, the Food and Drug Administration’s regulatory action may influence the types of e-cigarette products offered and the market shares of various companies.

E-Cigarettes: A 1-Way Street to Traditional Smoking and Nicotine Addiction for Youth.

* Abbreviation: E-cigarette — : electronic cigarette In a longitudinal study in this month’s issue of Pediatrics , Bold et al1 examined past-month cigarette and electronic cigarette (e-cigarette) use in high school students from 2013 to 2015 in Connecticut. They found that having used an e-cigarette in the past month significantly and strongly predicted combustible cigarette use. The odds of e-cigarette use at each wave predicting future cigarette use was 7.08 from wave 1 to 2 and 3.87 from wave 2 to 3. Not surprisingly, e-cigarette use leads to traditional product use. In contrast, traditional combustible cigarette use did not predict future e-cigarette use. And a substantial proportion of both cigarette and e-cigarette users progressed to heavy use, reporting that they smoked 21 to 30 days in the past month at the 2-year follow-up. This is consistent with patterns of use seen with young people’s increasing addiction to nicotine in numerous studies.2 E-cigarette products were not part of … Address correspondence to Jonathan D. Klein, MD, MPH, Pediatrics, University of Illinois at Chicago, 820 S. Wood St, Chicago, IL 60612. E-mail: jonklein{at}uic.edu

Emissions from Electronic Cigarettes: Assessing Vapers' Intake of Toxic Compounds, Secondhand Exposures, and the Associated Health Impacts.

E-cigarettes likely represent a lower risk to health than traditional combustion cigarettes, but they are not innocuous. Recently reported emission rates of potentially harmful compounds were used to assess intake and predict health impacts for vapers and bystanders exposed passively. Vapers' toxicant intake was calculated for scenarios in which different e-liquids were used with various vaporizers, battery power settings and vaping regimes. For a high rate of 250 puff day-1 using a typical vaping regime and popular tank devices with battery voltages from 3.8 to 4.8 V, users were predicted to inhale formaldehyde (up to 49 mg day-1), acrolein (up to 10 mg day-1) and diacetyl (up to 0.5 mg day-1), at levels that exceeded U.S. occupational limits. Formaldehyde intake from 100 daily puffs was higher than the amount inhaled by a smoker consuming 10 conventional cigarettes per day. Secondhand exposures were predicted for two typical indoor scenarios: a home and a bar. Contributions from vaping to air pollutant concentrations in the home did not exceed the California OEHHA 8-h reference exposure levels (RELs), except when a high emitting device was used at 4.8 V. In that extreme scenario, the contributions from vaping amounted to as much as 12 μg m-3 formaldehyde and 2.6 μg m-3 acrolein. Pollutant concentrations in bars were modeled using indoor volumes, air exchange rates and the number of hourly users reported in the literature for U.S. bars in which smoking was allowed. Predicted contributions to indoor air levels were higher than those in the residential scenario. Formaldehyde (on average 135 μg m-3) and acrolein (28 μg m-3) exceeded the acute 1-h exposure REL for the highest emitting vaporizer/voltage combination. Predictions for these compounds also exceeded the 8-h REL in several bars when less intense vaping conditions were considered. Benzene concentrations in a few bars approached the 8-h REL, and diacetyl levels were close to the lower limit for occupational exposures. The integrated health damage from passive vaping was derived by computing disability-adjusted life years (DALYs) lost due to exposure to secondhand vapor. Acrolein was the dominant contributor to the aggregate harm. DALYs for the various device/voltage combinations were lower than-or comparable to-those estimated for exposures to secondhand and thirdhand tobacco smoke.

Bans on electronic cigarette sales to minors and smoking among high school students

Many states have banned electronic cigarette sales to minors under the rationale that using e-cigarettes leads to smoking traditional combustion cigarettes. Such sales bans would be counterproductive, however, if e-cigarettes and traditional cigarettes are substitutes, as bans might push teenagers back to smoking the more dangerous combustion cigarettes. We provide evidence that these sales bans reduce the incidence of smoking conventional cigarettes among high school seniors. Moreover, we provide evidence suggesting that sales bans reduced e-cigarette usage as well. This evidence suggests that not only are e-cigarettes and smoking regular cigarettes positively related and not substitutes for young people, banning retail sales to minors is an effective policy tool in reducing tobacco use.

Second Generation Electronic Nicotine Delivery System Vape Pen Exposure Generalizes as a Smoking Cue.

IntroductionSecond generation electronic nicotine delivery systems (ENDS; also known as e-cigarettes, vaporizers or vape pens) are designed for a customized nicotine delivery experience and have less resemblance to regular cigarettes than first generation “cigalikes.” The present study examined whether they generalize as a conditioned cue and evoke smoking urges or behavior in persons exposed to their use.MethodsData were analyzed inN = 108 young adult smokers (≥5 cigarettes per week) randomized to either a traditional combustible cigarette smoking cue or a second generation ENDS vaping cue in a controlled laboratory setting. Cigarette and e-cigarette urge and desire were assessed pre- and post-cue exposure. Smoking behavior was also explored in a subsample undergoing a smoking latency phase after cue exposure (N = 26).ResultsThe ENDS vape pen cue evoked both urge and desire for a regular cigarette to a similar extent as that produced by the combustible cigarette cue. Both cues produced similar time to initiate smoking during the smoking latency phase. The ENDS vape pen cue elicited smoking urge and desire regardless of ENDS use history, that is, across ENDS naїve, lifetime or current users. Inclusion of past ENDS or cigarette use as covariates did not significantly alter the results.ConclusionsThese findings demonstrate that observation of vape pen ENDS use generalizes as a conditioned cue to produce smoking urge, desire, and behavior in young adult smokers. As the popularity of these devices may eventually overtake those of first generation ENDS cigalikes, exposure effects will be of increasing importance.ImplicationsThis study shows that passive exposure to a second generation ENDS vape pen cue evoked smoking urge, desire, and behavior across a range of daily and non-daily young adult smokers. Smoking urge and desire increases after vape pen exposure were similar to those produced by exposure to a first generation ENDS cigalike and a combustible cigarette, a known potent cue. Given the increasing popularity of ENDS tank system products, passive exposures to these devices will no doubt increase, and may contribute to tobacco use in young adult smokers.

Unicorns cartoons: marketing sweet and creamy e-juice to youth

In 2009, the Food and Drug Administration (FDA) banned characterising flavours for cigarettes with the exception of menthol and tobacco.1 New regulations, released in May 2016, deemed electronic cigarettes to...

Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults.

Electronic cigarettes (e-cigarettes) may help smokers reduce the use of traditional combustible cigarettes. However, adolescents and young adults who have never smoked traditional cigarettes are now using e-cigarettes, and these individuals may be at risk for subsequent progression to traditional cigarette smoking. To determine whether baseline use of e-cigarettes among nonsmoking and nonsusceptible adolescents and young adults is associated with subsequent progression along an established trajectory to traditional cigarette smoking. In this longitudinal cohort study, a national US sample of 694 participants aged 16 to 26 years who were never cigarette smokers and were attitudinally nonsusceptible to smoking cigarettes completed baseline surveys from October 1, 2012, to May 1, 2014, regarding smoking in 2012-2013. They were reassessed 1 year later. Analysis was conducted from July 1, 2014, to March 1, 2015. Multinomial logistic regression was used to assess the independent association between baseline e-cigarette use and cigarette smoking, controlling for sex, age, race/ethnicity, maternal educational level, sensation-seeking tendency, parental cigarette smoking, and cigarette smoking among friends. Sensitivity analyses were performed, with varying approaches to missing data and recanting. Use of e-cigarettes at baseline. Progression to cigarette smoking, defined using 3 specific states along a trajectory: nonsusceptible nonsmokers, susceptible nonsmokers, and smokers. Individuals who could not rule out smoking in the future were defined as susceptible. Among the 694 respondents, 374 (53.9%) were female and 531 (76.5%) were non-Hispanic white. At baseline, 16 participants (2.3%) used e-cigarettes. Over the 1-year follow-up, 11 of 16 e-cigarette users and 128 of 678 of those who had not used e-cigarettes (18.9%) progressed toward cigarette smoking. In the primary fully adjusted models, baseline e-cigarette use was independently associated with progression to smoking (adjusted odds ratio [AOR], 8.3; 95% CI, 1.2-58.6) and to susceptibility among nonsmokers (AOR, 8.5; 95% CI, 1.3-57.2). Sensitivity analyses showed consistent results in the level of significance and slightly larger magnitude of AORs. In this national sample of US adolescents and young adults, use of e-cigarettes at baseline was associated with progression to traditional cigarette smoking. These findings support regulations to limit sales and decrease the appeal of e-cigarettes to adolescents and young adults.