Vaping Products Research Articles

Abstract 13408: Vaping Realities: Views From Youth

Introduction: Youth e-cigarette use is a pressing public health issue. To better understand the landscape of youth e-cigarette use, we engaged middle and high schoolers (N=37) in a photovoice project and focus group interviews. Methods: Members of the VAPERACE Center’s Youth Advisory Council documented experiences with vaping through photographs from October 2021-April 2022. A question was posted each month (e.g. Where do you see vaping?), and participants recorded responses through photographs and then discussed these with the group, focusing on how the photographs conveyed the reality of vaping in their lives. They also participated in focus groups with open-ended questions designed to spur conversation about direct experiences with vaping and their related perceptions, attitudes, and beliefs. Using the constant comparative method, participant responses were analyzed for key themes. Results: Overwhelmingly, the photographs and focus group responses indicate that these youth have considerable exposure to vaping. Their photos documented that vaping pervades many aspects of their lives (e.g. in cars and school bathrooms, at parties and sporting events). Comments such as, “It’s everywhere. Everywhere you go. Everywhere you look.” underscore the degree to which youth confront vaping. Additionally, participants said that promotion of vape products was common, from the stores they entered to their social media feeds, and agreed on the power of social media influencers, which were paid more attention than PSAs. Because one “can’t hide from vapes,” one needs strategies to resist use, and these youth emphasized that “exit strategies” and face-saving approaches (e.g. “Thanks, but I’ve got a tennis match.”) worked better than strong, direct messages (e.g. ”No!”). They also expressed concerns about health effects, including CVD, and negative environmental impacts from trash produced by disposable e-cigarettes. Conclusions: The photovoice and focus groups revealed considerable exposure to vaping. Because these youth perceive that exposure cannot be avoided, they emphasized strategies to decline use. Thus, health advocates should consider strengthening educational programming to assist youth in honing refusal skills, especially indirect ones.

Trends and Socio-Demographic Differences of Cannabis Vaping in the USA and Canada.

Given the rise in cannabis vaping, it is important to highlight the heterogeneity in vaping different cannabis product because of the potential differences in their health risks. This study aims to estimate the trends and socio-demographic correlates of the use of various cannabis vaping products across jurisdiction with different legal status. Data from the 2018 (n = 27,169) and 2019 (n = 47,747) waves of the International Cannabis Policy Study (ICPS) were used. Respondents aged 16-65 completed web-based surveys. In 2019, proportions of past year vaping of cannabis oil, dried flower and concentrates in the overall sample were highest in U.S. jurisdictions where cannabis was legalized for non-medical use (17.4%, 6.0%, 4.9%), followed by U.S. jurisdiction where non-medical cannabis use is illegal (13.7%, 5.8%, 2.9%), and lowest in Canada (8.1%, 4.4%, 2.1%). Vaping dried flower decreased from 2019 to 2018 in U.S. legal jurisdictions and Canada, while vaping cannabis oil and concentrates increased in all jurisdictions (p < 0.001). The odds of vaping all forms of products were higher among younger respondents (16-55 years), males, respondents with some college education, and persons with low-risk perceptions on daily cannabis vaping. In both ICPS surveys (2018 and 2019), cannabis oil was the most frequently vaped products, followed by dried flower, and concentrates. Detailed measures of product forms for cannabis vaping should be considered in future surveys.

Subculture wars: The struggle for the vape industry.

Drawing on a 2-year study, I argue that the UK vape industry is engaged in a classificatory struggle between a subcultural industry and its "other", the mainstream industry. I build on Thornton's analysis of club culture to characterize the subcultural vape industry as a community of taste built round a masculine aesthetic and a commitment to authenticity and DIY practice. Its attachment to complex systems and masculine spaces risked excluding customers without specialist knowledge or interest. The mainstream industry included tobacco companies which promoted vaping as a complementary category to smoking, linking their own vaping products to historic meanings of the cigarette as a lifestyle product. This task was hampered by the toxic legacy of combusted tobacco and its increasing reversion to a generic category rather than a branded product. Finally, the success of the price-focused vaping industry has been largely overlooked, but suggests that for most consumers, electronic cigarettes are still a contrasting category to combusted tobacco and are purchased largely on price. I conclude that the exclusion of a feminized, classed "other" is a defining element of subcultural formation, itself an overwhelmingly male mechanism of group identity construction.

Changes in product labelling practices and the use of flavouring chemical additives in vaping products after enactment of statewide flavour legislation

IntroductionOn 18 May 2020, New York State enacted legislation banning the sale of vaping products with distinguishable flavours (other than tobacco). According to this new statute, vaping products are deemed...

Co-substance use of nicotine vaping and non-cigarette tobacco products among U.S. grade 12 students from 2017-2019

BackgroundNicotine vaping among U.S. adolescents has risen rapidly over the past decade, particularly for youth in grade 12. While previous studies examined the relationship between nicotine vaping and combustible cigarette use, less is known about the co-occurrence between vaping and other tobacco products. MethodsUsing Monitoring the Future grade 12 data (2017-2019), we investigated associations between past 30-day nicotine vaping and non-vaping, non-cigarette tobacco use (smokeless tobacco, large cigars, cigarillos, hookah). Population prevalences of four categories were assessed: neither, vaping only, non-vaping of non-cigarette tobacco only, or both. We further investigated these relationships with logistic regressions accounting for the complex survey design (unadjusted, demographic-adjusted, and further adjusted for other substance use). Finally, analyses were stratified by combustible cigarette use. ResultsDepending on the non-cigarette tobacco product, 2.5% to 5.4% of grade 12 students vaped nicotine and used a non-cigarette tobacco product. Controlling for demographics, cigarillo use was associated with nicotine vaping (adjusted RR = 3.44, 95% CI: 3.08, 3.84), as was hookah use (aRR = 3.51, 95% CI: 2.92, 4.23), smokeless tobacco (aRR = 2.97, 95% CI: 2.51, 3.52), and cigar use (aRR = 2.90, 95% CI: 2.49, 3.37). Controlling for cannabis and all non-cigarette tobacco products simultaneously attenuated associations. Associations were stronger among students who did not use cigarettes. DiscussionNicotine vaping is associated with use of many non-cigarette tobacco products, including smokeless tobacco, cigarillos, cigars, and hookah. As prevalence of nicotine vaping remains high among adolescents, we should monitor co-use of vaping and other tobacco products.

Electronic cigarette vaping product use is associated with lung injury in a 15-year-old adolescent.

A 15-year-2-month-old boy presented with progressive and persistent upper abdominal pain and productive cough for 3 days before admission. A physical examination revealed crackles in the right lung, a distended abdomen, and tenderness over the upper abdomen. A chest radiograph (Fig. S1a) and chest computed tomography scan revealed blunting of bilateral costophrenic angles and multiple infiltrative nodules in both lungs with sparing of the left upper lobe (Fig. S1b and c). Laboratory tests showed leukocytosis and an elevated C-reactive protein level.

E-cigarette or vaping product use-associated lung injury: A review of clinico-radio-pathological characteristics.

Aggressive, albeit false marketing of electronic nicotine delivery systems (ENDS) or vaping devices as safer alternatives to cigarette smoking, combined with lack of regulations, has led to its mass adoption, especially among youth. A sudden increase in acute lung injuries was noted in 2019 which was linked to ENDS. It was termed by the Centers for Disease Control and Prevention (CDC) as electronic cigarette or vaping product use-associated lung injury (EVALI). Analysis of bronchoalveolar lavage fluid samples linked EVALI to vitamin E acetate (VEA), which is used as a diluting agent for marijuana oils. Patients with EVALI present with a combination of non-specific respiratory, gastrointestinal, and systemic symptoms. Laboratory results may show elevated inflammatory biomarkers. EVALI is a diagnosis of exclusion and must meet the following criteria: i) history of vaping within last 90 days, ii) abnormal chest imaging, iii) negative evaluation for infection, and iv) no other plausible diagnosis. A spectrum of computed tomography (CT) chest findings has been reported in EVALI, ranging from diffuse alveolar damage to organizing pneumonia, characterized by bilateral ground-glass opacities, consolidation, and septal thickening. A similar spectrum is seen on histopathology, characterized by lipid-laden alveolar macrophages, with varying degrees of infiltrative inflammatory cells and fibrin deposition. Early and accurate identification of the EVALI pattern can help optimize patient care. For example, in diffuse alveolar damage (DAD), a lower threshold for ventilation support and corticosteroid may improve outcomes. Here, we review the etiopathogenesis, clinical management, histopathology, and imaging features of EVALI.

Illegal Experimental Tobacco Marketplace II: effects of vaping product bans — findings from the 2020 International Tobacco Control Project

SignificanceRestrictive e-cigarette policies may increase purchases from illegal sources. The Illegal Experimental Tobacco Marketplace (IETM) allows examination of how restrictions impact illegal purchases. We investigated (1) the effect of a...

Do Current Smokers and Ex-Smokers Who Use Nicotine Vaping Products Daily Versus Weekly Differ on Their Reasons for Vaping? Findings from the 2020 ITC Four Country Smoking and Vaping Survey.

This study examined reasons why adults who currently smoke or formerly smoked cigarettes use nicotine vaping products (NVPs) by vaping frequency (daily vs. weekly) stratified by smoking status. This cross-sectional study included 3070 adults from the 2020 ITC Four Country Smoking and Vaping Survey (Australia, Canada, England, United States) who reported using a NVP (vaping) at least weekly and who either currently smoke (n = 2467) or formerly smoked (n = 603). Respondents were asked to select the reason(s) they use NVPs, including to manage their smoking (reduce/quit or remain quit) and/or for reasons unrelated to managing smoking (e.g., to save money, enjoyment, flavours). We found that both current and former smokers endorsed an average of six reasons for vaping, with those vaping daily reporting significantly more reasons than those vaping weekly. Among current smokers, 72.8% reported vaping may help them quit smoking, 13.0% reported vaping to reduce smoking but not to quit, and 14.2% reported vaping only for reasons other than to reduce or quit smoking. The most common reason for vaping among current smokers was to reduce smoking (81.3%). Current smokers vaping daily were significantly more likely than those vaping weekly to report using a NVP to reduce smoking, for enjoyment, to reduce harm to themselves and others, to quit smoking, likeable flavours, and to save money. The most common reason cited for vaping by respondents who formerly smoked was enjoyment, with those who vaped daily more likely than those who vaped weekly to report vaping for enjoyment and to reduce harm to themselves. Nearly all reported vaping to help stay abstinent from smoking (92.3%), with no significant difference by vaping frequency. In conclusion, a majority of respondents reported using NVPs to manage their smoking (reduce/quit smoking or remain quit), particularly those vaping daily. Those who were vaping daily also endorsed a greater number of reasons other than managing smoking relative to those who were vaping weekly.

The Knowledge and Attitude about New Generation Tobacco Products among Physicians.

Health hazards of e-cigarettes including "e-cigarette or vaping product use-associated lung injury" are better understood today. Just as e-cigarettes, heated tobacco products release toxic emissions. We aimed to determine the knowledge and attitude about new generation tobacco products among physicians who were the members of an organization for health care professionals, the majority of whom are pulmonologists. In this cross-sectional study, a self-administered online questionnaire-based survey was conducted among the physicians from April to October 2019. The survey included questions about demographics (gender, age, graduation date from medical institution, and academic title), their smoking status, their knowledge and attitudes toward new generation tobacco products, and additionally about whether new generation tobacco products can be used to aid in smoking cessation. Among the 506 members who responded to the survey, 56.7 % were female; the mean age was 42.4 ± 10.9 years (20-74). About 74.5% were pulmonologists, 5.5% were thoracic surgeons, and 20% were other physicians. Among the responders, the frequency of those who have not heard of new generation tobacco products before was determined as 9.5%, 24.5%, and 41.3%. At least 58.9% of participants lacked the knowledge necessary to discuss these products with their patients and the rate reached 76.7% for the heated tobacco product. To the question of whether new generation tobacco products can be used in smoking cessation, 68.4% responded "I never agree that they can be used." Non-current smokers (P = .003), elders (P = .001), those who had training on smoking cessation assistance (P = .001), and those who had experience in smoking cessation assistance (P = .009) were significantly more prevalent in the group who answered: "I never agree that they can be used." Physicians must become considerably more knowledgeable about the new generation tobacco products and hazards. Otherwise, these new tobacco products may pose new threats to national and global tobacco control efforts.

Association between use of electronic vaping products and insufficient sleep among adolescents: Findings from the 2017 and 2019 YRBS

Background and objectiveAlthough studies have investigated the association between cigarette smoking and sleep outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) use and insufficient sleep among adolescents. The objective of this study was to investigate the cross-sectional association between the use of EVPs and insufficient sleep among adolescents. MethodsData were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The dependent variable investigated was insufficient sleep, and the main independent variable was the use of EVPs. ResultsOf the 28,135 adolescents, 22.6%, 19.2%, and 58.2% were current, former, and never users of EVPs, respectively. More than three in four adolescents (76.5%) did not obtain the recommended 8 h of sleep on an average school night. Controlling for demographic factors and other covariates, adolescents who currently used EVPs had 1.33 times higher odds of having insufficient sleep (AOR = 1.33, p < .001, 95% CI = 1.16–1.52), and adolescents who previously used EVPs had 1.29 times higher odds of having insufficient sleep (AOR = 1.29, p < .001, 95% CI = 1.15–1.44) when compared to adolescents who had never used EVPs. Adolescents were more likely to get insufficient sleep if they were older, non-Hispanic Black, had symptoms of depression, experienced suicidal ideation, engaged in excessive screen-time behaviors, or currently used alcohol. Physical activity had a protective effect on insufficient sleep. ConclusionThis study found that EVPs use was associated with insufficient sleep among adolescents over and above demographic and other covariates. As EVP use increases among adolescents, it is important to consider the potential impact on multiple domains, including sleep. Future studies that employ longitudinal designs may offer additional insight into the mechanisms underlying the association between EVPs use and insufficient sleep.

A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products.

Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.

Cue Reactivity Effects of Heated Tobacco Product Use in Current, Former, and Never Smokers in the United States.

Heated tobacco products (HTPs) share similar characteristics as combustible cigarettes and electronic nicotine delivery systems (ENDS) and thus may serve as cues for smoking and vaping. While HTP familiarity is low in the United States, HTPs may be perceived as a less harmful alternative to cigarettes. The present study examined if visual exposure to HTP use influenced cigarette and e-cigarette craving in a large national sample of adults with varied smoking patterns. Current, former, and never cigarette smokers (N = 515; Mage = 40) were recruited from online crowd-sourcing panels throughout the United States from January to April 2020. Participants completed surveys before and after watching a video depicting the use of an HTP, cigarette, or bottled water. Main outcomes were changes in cigarette craving after exposure to the video cue. Secondary outcomes included changes in e-cigarette craving. Relative to the water cue, the HTP and cigarette cues increased cigarette craving in current smokers. The HTP cue also increased e-cigarette craving (desire for a mod or vape pen and JUUL) across all subgroups. Current smokers demonstrated cue reactivity to the use of an HTP as they reported increases in both cigarette and e-cigarette craving after exposure. All smoking groups reported e-cigarette reactivity to the HTP cue. As HTPs gain traction globally, it is crucial to consider how their use may influence active users and passive viewers to inform future health policies. Noncombustible nicotine delivery systems are known cues for cigarette smoking and e-cigarette vaping, and this study examined whether relatively novel heated tobacco products (HTPs) may also act as a smoking or vaping cue in adults across varied smoking backgrounds. Results showed that passive exposure to HTP use increased desire for both a cigarette and an e-cigarette in current smokers and also increased desire for an e-cigarette in former and nonsmokers. Thus given its similarity to smoking and vaping, HTP use may affect passive observers and could play a role in perpetuating the dual use of cigarettes and vape products.

Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak

IntroductionIn August 2019, an outbreak of “e-cigarette or vaping product use-associated lung injury” (EVALI) prompted many states and health organizations to warn against the use of electronic cigarettes, or e-cigarettes, due to the presumed link between e-cigarette use and the illness. However, it was later shown that vitamin E acetate, a component of some illicit vaporizable THC products, was the causative agent in this outbreak.MethodsWe conducted a series of cross-sectional surveys of the websites of all state departments of health to determine how they communicated the risk of e-cigarette use during and after the EVALI outbreak. We then paired this analysis with data from the 2016 through 2020 Behavioral Risk Factor Surveillance System to measure changes in cigarette and e-cigarette use.ResultsWebsite data from 24 states was available for analysis at all three time points of interest, and BRFSS data was only available for 8 of these states. We found that by January 2020, a majority of the states surveyed did not list vaporizable THC use as a cause of EVALI; however, differences in state messaging did not appear to be associated with changes in e-cigarette and cigarette use.ConclusionsGiven the number of states that did not appear to update their messaging regarding the cause of EVALI, we believe that states should re-evaluate this messaging to accurately communicate the risks of e-cigarette use.

E-CIGARETTE OR VAPING PRODUCT USE ASSOCIATED LUNG INJURY: A DIAGNOSTIC DILEMMA

E-CIGARETTE OR VAPING PRODUCT USE ASSOCIATED LUNG INJURY: A DIAGNOSTIC DILEMMA

S2567 Vaping-Induced Duodenal Ulcer

Introduction: Vaping, or electronic cigarette use has tremendously increased. It is estimated a population of five million is involved in vaping each year. While lung injury associated with vaping has gained national attention, the systemic burden of vaping has not been established. To date, there is no current report on the prevalence of gastrointestinal symptoms alone in association with vaping, yet it has been reported that 90% of patients who present with lung injury also have gastrointestinal symptoms. This raises the concern that vaping may also result in gastrointestinal injury such as seen with tobacco smoking and use of nicotine products. To our knowledge, vaping has not been shown to be associated with gastrointestinal ulcers or peptic ulcer disease. Case Description/Methods: We report a case of a 19-year-old male who was admitted to the intensive care unit for concern of hemorrhagic shock after presenting with hematemesis from a duodenal ulcer. The patient had no other medical history or known risk factors for peptic ulcer disease. However, he did report a seven-month history of vaping marijuana and THC products through a vaping pen for several hours per day prior to his onset of gastrointestinal symptoms and eventual hematemesis. Patient gastrin levels were normal. Gastric biopsies were negative for H Pylori. He denied using NSAIDS, including BC powders and goody powders. Discussion: This case emphasizes the need for clinicians to obtain a medical history of vaping when assessing patients with gastrointestinal symptoms. Future research in vaping should evaluate if the various compounds in vaping products or if the different methods of vaping can cause adverse gastrointestinal side effects such as ulcers.

Thermodynamic behaviour of an e-cigarette: Investigation of nicotine delivery consistency using nicotine yield

In 2014, the Tobacco Product Directive imposed a regulatory framework to protect the users of vaping products. One of the items requires that vaping devices shall deliver nicotine doses at consistent levels. However, this item is not evident to grasp and results from a lack of understanding of the physical behaviour of a vaping device. This publication aims to provide a physical explanation of ”nicotine doses at a consistent levels”. Numerical and an experimental approaches are developed in parallel. The first is based on the Rayleigh distillation model to describe the vaporisation of a volume initially in liquid phase under vapour–liquid equilibrium conditions. The second generates emissions using in-lab or commercial e-liquids under standardised conditions (AFNOR XP-D90-300-3) and the Cubis atomiser with a 1Ω coil. The comparison is focused on the nicotine delivery efficiency obtained with these two approaches. Emissions are collected using a cold trap. The results show a mean nicotine recovery that is around 93% with a standard deviation of 12% over more 1000 tested e-liquids. A comparison of these results with simulation, allow assuming a complete vaporisation rather than a partial one. Therefore, the nicotine’s consistency postponed the problem of the consistency of the mass of e-the vaporised liquid. This consistency is verified under laboratory conditions (with a controlled and regulated power supply). In real life, the power units that are used in vaping products are discharging devices, and therefore the consistency will depend on the number of puffs expected, the power set-up and the battery’s characteristics.

Erratum: "On Target: Environmental Health Messaging That Hits the Mark".

Vol. 130, No. 10 ErratumOpen AccessErratum: “On Target: Environmental Health Messaging That Hits the Mark”is correction ofOn Target: Environmental Health Messaging That Hits the Mark Wendee Nicole Wendee Nicole Search for more papers by this author Published:5 October 2022CID: 109001https://doi.org/10.1289/EHP12138AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Environ Health Perspect. 130(7): 072001 (2022), https://doi.org/10.1289/EHP9272This article stated, “Although the U.S. Food and Drug Administration has authorized companies to market specific vaping products as smoking cessation devices,50 several studies have found evidence that vaping is far from a public health boon.51–55”That is partially incorrect. The sentence and updated reference 50 should read, “However, the U.S. Food and Drug Administration has not authorized any company to market specific vaping products as smoking cessation devices,50 and several studies have found evidence that vaping is far from a public health boon.51–55”50. U.S. Food and Drug Administration. 2019. Fact or Fiction: What to Know About Smoking Cessation and Medications. [Website.] Updated 28 March 2019. https://www.fda.gov/consumers/consumer-updates/fact-or-fiction-what-know-about-smoking-cessation-and-medications [accessed 21 September 2022].EHP regrets the error.FiguresReferencesRelatedDetailsRelated articlesOn Target: Environmental Health Messaging That Hits the Mark29 July 2022Environmental Health Perspectives Vol. 130, No. 10 October 2022Metrics About Article Metrics Publication History Manuscript received12 September 2022Manuscript accepted16 September 2022Originally published5 October 2022 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

E-CIGARETTE OR VAPING USE-ASSOCIATED LUNG INJURY (EVALI): EFFECTS OF VAPING OR COVID-19?

E-CIGARETTE OR VAPING USE-ASSOCIATED LUNG INJURY (EVALI): EFFECTS OF VAPING OR COVID-19?

LEFT SIDE PREDOMINANT E-CIGARETTE OR VAPING USE-ASSOCIATED LUNG INJURY (EVALI): A CHALLENGING DIAGNOSIS OF EXCLUSION

LEFT SIDE PREDOMINANT E-CIGARETTE OR VAPING USE-ASSOCIATED LUNG INJURY (EVALI): A CHALLENGING DIAGNOSIS OF EXCLUSION