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Current Electronic Cigarette Use Among Adults Aged 18 and Over: United States, 2021
Abstract
Use of electronic cigarettes (e-cigarettes) has increased among some adults (1-3).Reducing the use of any tobacco product, including e-cigarettes, is a Healthy People 2030 objective (4). E-cigarettes have the potential to benefit some adults who smoke and are not pregnant if they are used as a complete substitute for regular cigarettes or other tobacco products (5). However, concerns exist about dual use of e-cigarettes and cigarettes (6-9). Use of e-cigarettes among young adults is also a concern because nicotine adversely impacts brain development, which continues into the early to mid-20s (5,10). This report uses 2021 National Health Interview Survey data to describe the percentage of adults aged 18 and over who currently use e-cigarettes by selected sociodemographic characteristics and dual use of e-cigarettes and cigarettes.
... Increasing use of electronic cigarettes (e-cigarettes), especially among young people, represents a significant public health concern [8,9]. The use of e-cigarettes impacts oral health and the oral microbiota [10] with e-cigarette usage being associated with increased alpha diversity, increased Veillonella and Haemophilus spp. in saliva and the buccal mucosa [11], and a higher abundance of periodontal pathogens such as Porphyromonas gingivalis, Fusobacterium nucleatum, Bacteroidales, and other Gram-negative anaerobes in the subgingival community [12][13][14]. ...
... Although originally touted as a healthier alternative to traditional cigarette smoking, use of e-cigarettes has increasingly been linked to a myriad of negative impacts on health [8,9]. This is particularly concerning given the increase in e-cigarette use, especially among young people [8,9]. ...
... Although originally touted as a healthier alternative to traditional cigarette smoking, use of e-cigarettes has increasingly been linked to a myriad of negative impacts on health [8,9]. This is particularly concerning given the increase in e-cigarette use, especially among young people [8,9]. Research has shown that, in addition to direct negative effects on user health, use of e-cigarettes also impacts the oral microbiome of the user, which may then indirectly affect the health of the user [10]. ...
Background
Although touted as a safer alternative to cigarette smoking, electronic cigarette usage has been increasingly linked to a myriad of health issues and appears to impact the oral microbiome. Meanwhile, nitrate supplementation has shown promise as a prebiotic that induces positive effects on the oral microbiome.
Methods
In this pilot study, the impact of nitrate supplementation as a countermeasure to e-cigarette usage was explored using in vitro growth and 16S rRNA analysis of microcosms derived from e-cigarette users and nonusers and supplementation with nitrate-rich beetroot juice extract.
Results
The impacts of e-cigarette usage and beetroot supplementation were somewhat limited, with beetroot juice extract supplementation having a significant impact on diversity according to some, but not all, diversity metrics examined. The saliva of the e-cigarette users was depleted in nitrate-reducing Neisseria spp. In terms of differentially abundant individual taxa, the addition of beetroot juice extract to the saliva-derived microcosms had a larger impact on the communities derived from the e-cigarette users compared to that of the nonusers.
Conclusions
Overall, this limited pilot study suggests that beetroot juice extract supplementation may impact the microbiota of e-cigarette users and adds to contemporary research paving the way for more in-depth studies examining the role of nitrate-rich supplements as prebiotics to promote oral health.
... Exposure to discrimination, which systemically privileges dominant groups and is directed against the targeted socially non-dominant groups [3,4,5], is associated with an increased risk of poor general self-rated health and physical health [6], cardiovascular-related risks (e.g., high Body Mass Index [BMI], blood pressure) [7][8][9], psychological distress and anxiety [6,10,11], poor sleep health [12], and harmful coping behaviors including cigarette smoking and e-cigarette use [13][14][15][16][17]. Target groups experiencing racism, sexism, heterosexism, cissexism, ageism, and sizeism [1,2,18] respectively include: Black, Indigenous, and other people of color [2,19], women [20], sexual minority (lesbian, gay, bisexual, and other non-heterosexual; LGBQ+) individuals [21,22], transgender and nonbinary people [21,23], people of older ages [24], and individuals who are overweight or obese [25,26]. Many, but not all, of these targeted groups-non-Hispanic people of color in "Other race" groups, LGBQ + individuals, transgender and nonbinary people-also have a higher prevalence of cigarette smoking and/or e-cigarette use (hereafter smoking/vaping) compared to dominant groups [28][29][30][31][32]. ...
... Second, combining smoking and vaping as a single outcome variable may obfuscate important epidemiologic differences relevant to discriminationhealth associations. Both smoking and vaping are concentrated in men, people identifying as non-Hispanic White and non-Hispanic "Other race" groups, those with low levels of education (e.g., high school or some college) and low income, and LGBT-identified people [27][28][29][30]. Yet, smoking prevalence is highest for individuals ages 25-44 and 45-46 years, whereas vaping is highest among those ages 18-24 years [27][28][29][30]. ...
... Both smoking and vaping are concentrated in men, people identifying as non-Hispanic White and non-Hispanic "Other race" groups, those with low levels of education (e.g., high school or some college) and low income, and LGBT-identified people [27][28][29][30]. Yet, smoking prevalence is highest for individuals ages 25-44 and 45-46 years, whereas vaping is highest among those ages 18-24 years [27][28][29][30]. Additional research is warranted to examine the associations of implicit and explicit discrimination with smoking and vaping as disaggregated outcomes. ...
Background
In the United States (U.S.), the physical and mental health sequelae of diverse types of discrimination are far-reaching, severe, and contribute to population health inequities, with this work informing research on discrimination and health in both the Global North and Global South. To date, limited population health research has examined the joint impacts of discrimination measures that are explicit (i.e., self-report) and implicit (i.e., automatic mental representations), both singly and for multiple types of discrimination.
Methods
Between May 28, 2020-August 4, 2022, we conducted Life + Health, a cross-sectional population-based study regarding six types of discrimination—racism, sexism, heterosexism, cissexism, ageism, and sizeism—with 699 participants (US-born, ages 25–64) from three community health centers in Boston, Massachusetts. Participants completed a Brief Implicit Association Test (B-IAT) and self-reported survey. Spearman’s correlation coefficient was estimated to assess the strength and direction of discrimination types across target/dominant groups; logistic regression models were fit to assess the association of each type of discrimination with smoking/vaping following by random-effects meta-regression modeling to pool effects across discrimination types.
Results
Mean age was 37.9 years (SD = 11.2 years). Overall, 31.6% were people of color; 31.8% identified as transgender or nonbinary/genderqueer; 68.6% were sexual minority. For education, 20.5% had some college/vocational school or no college. Current cigarette/vaping was reported by 15.4% of the study population. Implicit and explicit measures were generally correlated with one another, but associations varied across discrimination types and for target/dominant groups. In random-effects meta-regression modeling, explicit compared to implicit discrimination measures were associated with a 1.18 (95% CI = 1.00-1.39) greater odds of smoking/vaping among dominant group members, but no such difference was observed among target group members.
Conclusion
Implicit and explicit discrimination measures yielded distinct yet complementary insights, highlighting the importance of both. Meta-regression provided evidence of health impacts across discrimination types. Future research on discrimination and health, in diverse country contexts, should consider using both implicit and explicit measures to analyze health impacts across multiple types of discrimination.
... Electronic cigarettes (e-cigarettes [EC]) are electronic devices that heat liquid into an aerosol that can be inhaled into the user's lungs. While e-cigarettes may assist established smokers in quit attempts, e-cigarette use is a growing public health concern due to its increasing use among never smokers and vulnerable populations such as youth and young adults (Hajek et al., 2014;Kramarow & Elgaddal, 2023). Most e-cigarettes contain nicotine, the primary addictive substance in traditional combustible cigarettes (CCs; U.S. Department of Health and Human Services, 2016). ...
... One study specifically investigated dual e-cigarette and combustible cigarette use (Stein et al., 2018). Dual use is a public health concern due to increased toxin exposure and detrimental respiratory outcomes compared to sole use of either product (Kramarow & Elgaddal, 2023). Stein et al. (2018) examined the differences in discounting between dual e-cigarette and combustible cigarette users, exclusive e-cigarette users, exclusive combustible cigarette users, and nonusers. ...
... Regarding age, approximately half of the total participants were between 18 and 25 years old, representing young adults. While this is consistent with the findings that people aged 18-25 were most likely to use ECs among all adults (Kramarow & Elgaddal, 2023), previous studies suggested that younger individuals display steeper discounting (Steinberg et al., 2009). To control for potential differences in discounting by age and race, future studies should equate the number of participants in each age and racial group or include a more representative sample to increase the generality of the findings. ...
Delay discounting refers to the devaluation of an outcome as temporal delay increases. Steep discounting is characterized by preferring a smaller, immediate outcome over a larger, delayed outcome and is associated with maladaptive behaviors such as tobacco use. Previous studies have compared delay discounting outcomes between combustible cigarette (CC) smokers and nonusers using various discounting tasks. With the growing use of electronic cigarettes (e-cigarettes [EC]) and various delay discounting tasks available to researchers, we extended previous work in delay discounting and EC use in two ways. The present study assessed delay discounting in a web-based sample of 259 participants to (a) establish convergent validity across four different delay discounting tasks and (b) compare the outcomes between four subgroups: dual users, exclusive EC users, exclusive CC users, and nonusers. The four delay discounting tasks (Monetary Choice Questionnaire, 5-Trial Adjusting Delay Discounting Task [ADT-5], Temporal Discounting Questionnaire, and Brief Intertemporal Choice Task [BRIC Task]) showed moderate to strong convergent validity (p < .001). Further, findings indicated significant differences between all four subgroups across the four different delay discounting tasks (p < .048) with small effect sizes. Pairwise comparisons showed that exclusive EC users exhibited significantly steeper discounting than nonusers in ADT-5 (p = .043) and BRIC Task (p = .029) and dual users exhibited significantly steeper discounting than nonusers on ADT-5 (p = .043) and BRIC Task (p = .030). Our findings replicate previous findings and suggest the potential role of delay discounting in explaining the behavioral mechanism underlying e-cigarette use.
... Current dual use of e-cigarettes and cigarettes was more likely in adults ages 18 to 44 years compared with those ages 45 years and older. 35 Finally, 14.0% of individuals who used tobacco reported using three or more products. ...
... 32 In adults, e-cigarette use was highest among those ages 18 to 24 years (11.0%) compared with those ages 25 to 44 years (6.5%) and 45 years and older (2.0%). 35 Interestingly, in 2021, most individuals (61.4%) ages 18 to 24 years who used e-cigarettes had never smoked cigarettes. 36 Generally, e-cigarette use in adults was found to decrease as family income increased, although for adults ages 18 to 24 years, the diff erence among those with family incomes of less than 200% of the federal poverty level was not signifi cantly diff erent from those with higher incomes. ...
... 36 Generally, e-cigarette use in adults was found to decrease as family income increased, although for adults ages 18 to 24 years, the diff erence among those with family incomes of less than 200% of the federal poverty level was not signifi cantly diff erent from those with higher incomes. 35 Geographically, e-cigarette use was higher in rural areas (5.3%) compared with urban areas (4.4%), which was similar to use of two or more tobacco products (5.1% in rural areas versus 3.1% in urban areas). 32 Individuals identifying as lesbian, gay, or bisexual had higher use rates of e-cigarettes (13.2% versus 4.1% of individuals identifying as heterosexual) and higher use of two or more tobacco products (7.2% versus 3.2% of the comparator). ...
The emergence and subsequent surge in popularity of electronic nicotine delivery systems (ENDS), especially among adolescents and young adults, have reshaped the landscape of tobacco consumption, including use patterns and beliefs as well as therapeutic approaches to the condition. The health implications of ENDS are a cause for concern among NPs, as they include severe nicotine dependence, mental health consequences, and adverse effects on respiratory and cardiac systems, among other issues. This article focuses on the health implications of vaping across the lifespan and emphasizes the need for NPs to evaluate ENDS use consistently across age groups and offer age-appropriate treatment within the clinical setting. Importantly, although vaping is prevalent among various age groups, most tobacco use, including vaping, begins and becomes established during adolescence. This back-to-school season therefore marks an ideal time for NPs to educate their pediatric patients, along with their parents or caregivers, about the widespread effects of vaping on health, and it also serves as a reminder to screen for the condition in adults, regardless of smoking history. To combat this trend on a larger scale, NPs can further advocate for community health by promoting youth prevention programs and supporting policy initiatives aimed at curbing ENDS use.
... 13 Although White young adults remain the highest users of e-cigarettes, e-cigarette use is also common among young adults of color, including Black and Hispanic individuals. 6 Emerging evidence has shown that sexual minority youth of color, particularly Black sexual minority girls, showed elevated levels of e-cigarette use compared to their heterosexual peers. 14,15 Similarly, another study indicated that sexual minority adults in underrepresented race/ethnic groups reported high levels of cigarette smoking. ...
... For example, sociodemographic factors are associated with e-cigarette use (e.g., males and those who have low family income are more likely to use e-cigarettes among young adults). 6 Furthermore, other tobacco and substance use in addition to e-cigarette use is common among young adults. 24 ...
Background
E-cigarettes are commonly used tobacco products by young adults, including sexual minority individuals and racial/ethnic marginalized individuals. This study examines the prevalence of e-cigarette use at the intersections of sexual identity and race/ethnicity among U.S. young adults because of previous research indicating high levels of e-cigarette use among the sexual minority youth of color.
Methods
This study used the public adult dataset from Wave 6 of the Population Assessment of Tobacco and Health (PATH) Study (2021) and included young adults aged 18–24 years (N=10,633). The association between past-30-day e-cigarette use (yes, no), sexual identity (straight/heterosexual, gay/lesbian/bisexual/something else [LGB+]), race (White, Black, others), ethnicity (non-Hispanic, Hispanic), interactions between sexual identity and race, and interactions between sexual identity and ethnicity were analyzed, using adjusted binomial logistic regressions. These analyses were further stratified by sex and presented as adjusted predicted margins.
Results
The analysis showed that the adjusted predicted margin of past-30-day e-cigarette use between heterosexual versus LGB+ Black young adult females (4% versus 12%) is significantly different, while predicted margins between heterosexual versus LGB+ Black young adult males are not significantly different. There were no significant interactions between sexual identity and ethnicity in predicting e-cigarette use.
Conclusions
This study highlights that LGB+ Black young adult females may be at increased risk for e-cigarette use than heterosexual Black young adult females. The findings call for research on the reasons for the heterogeneity of e-cigarette use according to sex, sexual identity, and race.
... Kramarow & Elgaddal, 2023). This is concerning because e-cigarette use (vaping) is associated with health risks, including heavy metal exposure, lung injury, and death (Centers for Disease Control and Prevention, 2021; Kalininskiy et al., 2019; Rubinstein, Delucchi, Benowitz, & Ramo, 2018). ...
... Moreover, vaping has been associated with co-use of marijuana and alcohol (Grant et al., 2019). In 2021, 11.0% of young adults living in the U.S. were currently vaping (Kramarow & Elgaddal, 2023). While the prevalence of current vaping among Latino young adults was lower (7.6%), ...
... The first parameter tested was carotid pulse wave velocity, an indicator of arterial stiffness and CVD [60], which was found to be significantly increased in all exposure groups to the same degree. Of note, while similar results were previously reported with direct e-cigarette exposure in both human and mouse studies [61][62][63], it is rather more alarming to observe such effects even under in utero Content courtesy of Springer Nature, terms of use apply. Rights reserved. ...
Novel tobacco products (NTPs) have recently been on the rise appealing to a variety of users, including pregnant women and women of childbearing age, who deem these products to be a safe/safer alternative to traditional smoking. To this end, several studies have made advances toward proving the invalidity of these claims, especially in the context of cardiovascular disease. However, an area that has yet to be extensively explored is maternal/in utero exposure to these devices and the cardiovascular health outcomes on the offspring into their adult life. Herein, our aim is to critically assess the literature to identify and discuss the cardiovascular health risks that the offspring exhibits as a result of in utero exposure to NTPs. These studies have been summarized as a comprehensive review.
... Considering that some individuals smoke cigarettes and vape, the combination of vaping and smoking policies is also important for clinicians to consider. 39,56 This study found that even compared to models that examined the state percentage of adults who vape and state laws on indoor vaping, a SUD treatment facility's smoking policy had the largest effect size on their vaping policy with odds ratios as large as 320 and 899 (as seen in Table 3). A facility's vaping policy largely corresponds with their smoking policy. ...
Background
Unlike combustible cigarettes, vaping does not produce smoke, creating ambiguity around indoor vaping policies. Vaping policies in substance use disorder treatment facilities may directly impact how an individual engages with treatment.
Objective
To examine associated factors with vaping policies within substance use disorder treatment facilities in the United States.
Design
This cross-sectional study used data from the National Substance Use and Mental Health Services Survey to examine data from substance use disorder treatment facilities. Other data included the state percentage of adults who use e-cigarettes from the Behavioral Risk Factor Surveillance System, and state-level indoor e-cigarette restriction policies from the State Tobacco Activity Tracking and Evaluations System.
Methods
A total of N = 16 042 substance use disorder treatment facilities in 2022 were included. Factors that were examined include [a] state percentages of adults who vape, [b] state indoor vaping restrictions, [c] tobacco use screening in facilities, [d] smoking/tobacco education and counseling in facilities, [e] availability of nicotine pharmacotherapies in facilities, [f] facility smoking policies, [g] availability of outpatient or non-hospital residential treatment, and [h] availability of a treatment program specifically for adolescents or young adults. Facility vaping policies is the outcome variable in this study with three values: [a] vaping is restricted, [b] vaping in designated outdoor area(s), and [c] permissive vaping policies (anywhere outside, designated indoor areas, anywhere inside, anywhere without restriction).
Results
Vaping policies across all treatment facilities include 45.9% restricted vaping, 45.9% permitted vaping in designated outdoor area(s), and 8.2% had a permissive vaping policy. State-level percentage of adults who use e-cigarettes, state indoor e-cigarette restrictions, facility smoking policies, and services provided by facilities were associated with different vaping policies, ranging from restrictive to permissive policies.
Conclusions
Various vaping policies exist in substance use disorder treatment facilities. Different vaping policies may have varied impacts on individuals’ treatment goals.
... Prenatal nicotine exposure, resulting from maternal smoking during pregnancy, has been shown to cause a range of long-term neurodevelopmental defects in children (Crane et al., 2009;Ghanizadeh, 2011;Katbamna et al., 2013;King et al., 2018;Marco et al., 2011), including attention-deficit disorder and learning disabilities, which are shown to be comorbid with sensory processing deficits (Crane et al., 2009;Ghanizadeh, 2011;Marco et al., 2011). Due to the increased prevalence of electronic cigarettes, this requires the need for investigation into the effects of prenatal exposure to nicotine alone on fetal health and development (Kramarow & Elgaddal, 2023). In utero nicotine exposure can cause hearing impairments and auditory processing disorders leading to speech and language delays, poor sound localization and difficulty understanding speech in noisy environments (King et al., 2018). ...
In utero nicotine exposure from maternal smoking is linked to increased risk of auditory processing deficits. This study investigated the impact of developmental nicotine exposure during the critical period on nicotinic acetylcholine receptor (nAChR) functional expression, glutamatergic synaptic transmission and auditory processing in the mouse auditory brainstem. We assessed nAChR function at a central synapse and the consequences of perinatal nicotine exposure (PNE) on synaptic currents and auditory brainstem responses (ABRs) in mice. Our results indicate developmentally regulated changes in nAChR expression in medial nucleus of the trapezoid body (MNTB) neurons and presynaptic calyx of Held terminals. PNE led to increased ACh‐evoked postsynaptic currents and impaired glutamatergic neurotransmission, underscoring the importance of nAChR activity in early auditory synaptic development. PNE also increased ABR thresholds and reduced ABR peak amplitudes, indicating impaired central auditory processing without cochlear dysfunction. Our study provides new insights into the synaptic disruptions underlying auditory deficits from prenatal nicotine exposure. image
Key points
In utero nicotine exposure leads to increased risk of sensory processing deficits and elevated expression of nicotinic acetylcholine receptors (nAChRs).
nAChRs are essential for auditory processing and are present in the auditory brainstem.
Within the medial nucleus of the trapezoid body in the auditory brainstem, the patterning of nicotinic receptor expression during development and how nicotine exposure might affect this are unknown.
Nicotinic receptors are expressed postsynaptically before hearing onset and switch to presynaptic expression after hearing onset.
Perinatal nicotine exposure disrupts physiological nicotinic receptor patterning and impairs synaptic transmission at the calyx of Held.
... Furthermore, we did not include daily cigarette consumption (i.e., smoking intensity) among current smokers into the study. Similarly, we investigated combustible tobacco cigarette smoking trends among American adults and, due to NHANES data constraints, were unable to include e-cigarette use in our analyses, even though 4.5% of adults aged 18 and over were current e-cigarette users in 2021, and e-cigarette use is associated with quitting combustible cigarette smoking 63,64 . Additionally, all APC models have pros and cons 65 . ...
The rates of cigarette use among American adults have dropped substantially throughout the last six decades, yet smoking remains the leading cause of preventable disease and death in the United States. It is crucial to identify the putative time-varying population-level factors of age, period, and cohort that influenced the decrease in smoking prevalence so we can maintain the downward trend. We used 49 years of data from the National Health and Nutrition Examination Survey (NHANES) and hierarchical age–period–cohort (HAPC) analysis to examine lifecycle, historical, and generational distribution of smoking among Americans aged 18–74 years old. The prevalence of smoking has declined tremendously from 1971 to 2020 because American adults over the age of ~ 27 had a lower probability of cigarette use, but the rates of decrease have been unequal among birth cohorts. We uncovered the putative temporal contributors to population-level decreases in the prevalence of current smoking among American adults over the last nearly fifty years. Policy-makers ought to prioritize tobacco control efforts that focus on young adults, and should address the cohort-specific challenges in order to maintain the downward trend in smoking prevalence and further reduce the number of preventable premature deaths due to cigarette use.
... 33 White respondents in the current study were more likely to indicate intent to switch to non-combustible tobacco products, consistent with literature that electronic nicotine delivery systems (ENDS) product users are predominantly White. 34 Interest in non-menthol synthetic cooling agent products (i.e., WS-3, WS-23) as a substitute for menthol cigarettes was low (11.1%), but higher among Blacks (11.8%) than Whites (9.8%) and is a trend worth monitoring as the tobacco industry seeks regulatory loopholes to a MC/FC product standard. 35 Limitations include use of MTURK as a crowdsourcing tool for participant recruitment. ...
Objectives: Menthol flavoring is a critical public health issue, but prior work has largely represented the voices of White adults who smoke (AWS) menthol cigarettes who comprise a small subset of AWS menthol cigarettes in the US. This study compared perceptions of a hypothetical MC/FC ban among Black and White AWS menthol cigarettes.
Methods: Participants were a convenience sample of 2,113 Black and 1,087 White AWS menthol cigarettes collected through Amazon Mechanical Turk between July 2023 and January 2024. Participants reported opinions about a MC/FC ban, likely public health outcomes, and hypothetical impact of the ban on their smoking behavior. Stepwise logistic regression modeled factors associated with ban opposition/ambivalence.
Results: Over one-third of menthol cigarette users supported a MC/FC ban (Black, 37.2% vs White, 34.5%, p=.13], but Black AWS were more likely to endorse public health benefits of a ban assessed via agreement with 5 statements of FDA rationale [3.0 (SD=1.7) versus 2.4 (SD=1.8), p<.001]. Smoking more cigarettes per day, belief that menthol cigarettes are more addictive/harder to quit, and intent to continue using nicotine under a ban increased odd of opposition/ambivalence.
Conclusions: Compared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. Targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users.
... 18-25 comprised the highest percentage of people (24% or 8.3 million people) who used e-cigarettes or other devices to vape nicotine in 2022 (2). Since the risk of e-cigarette use increases at the age of 18, raising awareness of e-cigarette education before the age of 18 may perhaps be necessary to reduce the risk (3). Additionally, due to the overall lack of education related to opioid and e-cigarette misuse, engaging youth populations in interactive educational interventions was of the utmost importance to bolster their knowledge (4,5). ...
Introduction
Substance use epidemics, particularly opioids and e-cigarettes, pose a significant public health crisis, especially among minors. To address opioid and e-cigarette epidemics among young individuals, the Substance Use Prevention (SUP) program educated high school students in southeast Michigan. Through a medical student-led intervention, we implemented interactive educational methods to deliver evidence-based information on the risks associated with these substances.
Methods
A non-randomized pre- and post-test quasi-experimental study design assessed the impact of the SUP interventions on the high school students' understanding of addiction mechanisms, health consequences, and prevention strategies. We assessed baseline knowledge (pre-intervention questionnaires), demographic factors, and post-intervention knowledge.
Results
Data analysis among 100 students from four high schools revealed that while students started with varied levels of baseline knowledge, they reported significantly higher confidence in their opioid (p < 0.0001) and e-cigarette (p < 0.0001) knowledge after the intervention. Students significantly (p < 0.05) improved their ability to recognize causes of overdose (scoring 65% vs. 78%), risk factors (21%–84%), and naloxone as emergency treatment (38%–80%) after the intervention.
Discussion
Subjects showed no changes in individual knowledge of e-cigarettes, which we attribute to school-specific variances and/or high baseline knowledge. The difference in knowledge among schools may be due to disparities in race and differences in socioeconomic status, as shown by the increased poverty level. This study evidenced the importance of raising awareness among adolescents to improve their learning and comprehension of the causes and consequences of substance misuse by sharing medically focused explanations of substances as well as the economic and societal impact.
... In this place, we showed that the prevalence of vaping women in Jordan was 12.4%. This percentage is higher than that in the United States, which was 10.3% [22], but lower than it in Saudi Arabia Al-Ahsa small community, which was 17.5% [23]. Nevertheless, the prevalence of women who vape in Saudi community as a hall was about 8% [19], which is still considered lower than what we found in our community. ...
Vaping has become very popular among young generations in Jordan. However, less is known about women's awareness and intention to vape. The aim of this study is to assess women’s knowledge and beliefs about vaping, with a focus on vaping women’s attitudes and practices. This is an observational cross-sectional study. Data were collected from January through March 2024, by using a self-administrated survey inspired from the WHO GATS questionnaire. Among the 923 participating women, 12.4% were vaping. We observed significant variations in knowledge and beliefs among women. Vaping women have a substantially younger age than non-vaping. 57% of vaping women think that vape is safer to use than cigarettes compared to 14% of non-vaping. 61% of vaping women believed that vaping helps to quit cigarette smoking compared to 24% of non-vaping. Vaping women tended to underestimate the health risks associated with it compared to non-vaping women. They are also supporting legislations that allow vaping indoors and in public places. Women vape primarily for enjoyment, to cope with stress, to pass free time, and to hang out with friends. Luckily, many of them believed that smoking increases the risk of cardiovascular and respiratory ailments and limited life expectancy, which supports their future quitting plans. This study revealed misconceptions and knowledge gaps around vaping among women. Emotional demands and social interactions influenced women's vaping use in Jordan, highlighting the need for targeted public health education and legislative measures to promote women's health.
... Electronic cigarettes (e-cigarettes or e-cigs) are a diverse class of tobacco products that have increased in popularity in the USA and have continued to evolve rapidly since their introduction in 2007. 1 E-cigarettes are currently the second most popular tobacco products among US adults (18 years and older) after combustible cigarettes, with 4.5% reporting current (past-30 day) use in 2021 2 ; among young adults (ages [18][19][20][21][22][23][24], however, the prevalence of e-cigarette use was as high as 18.3% in 2021. 2 Although rates of e-cigarette use among youth (ages [12][13][14][15][16][17] have declined from epidemic levels (in 2019, 27.5% of high school students reported using e-cigarettes 3 down to 10% of high school students in 2023), 4 youth e-cigarette use remains a concern. ...
The population-level health consequences of electronic cigarette (e-cigarette) use are heavily debated. This special communication provides updated evidence and identifies knowledge gaps across domains including: (1) health-related outcomes associated with e-cigarette use; (2) initiation and use of e-cigarettes among youth and young adults; (3) concurrent use of electronic and combustible cigarettes; (4) transitions from combustible cigarette use to exclusive e-cigarette use among adults who currently smoke cigarettes and (5) existing e-cigarette-related policy interventions. Literature was searched through PubMed and Medline for systematic reviews, scoping reviews, meta-analyses and primary research articles including emerging topics not covered in reviews published between 1 January 2017 and 1 January 2024. E-cigarette use is associated with several adverse acute health outcomes; there is currently insufficient longitudinal evidence to predict chronic health outcomes. Prevalence of e-cigarette use among youth is considerable and may be associated with subsequent combustible cigarette smoking. Evidence for the health and behavioural impact of dual use of e-cigarettes and combustible cigarettes is limited by imprecise measurement of exposure. Evidence on adults completely substituting combustible cigarettes for e-cigarettes is strong in clinical trials; observational studies do not show complete substitution. Finally, the effects of e-cigarette-related policy interventions to restrict e-cigarette consumption are currently limited in scope and too short-lived to draw causal inferences. Substantial evidence gaps related to the use, associated health impacts and regulation of e-cigarettes in the USA are identified, and we suggest key areas for future research to address that are crucial for informing the public health approach to e-cigarettes.
... Thus, ENDS use is associated with respiratory morbidity in adolescent and adult populations [14][15][16][17][18][19][20][21]. In the United States, 4.5% of American adults [22] and 7.7% of high school students use ENDS [23]. Collectively, these data reinforce the need to study how the inhalation of ENDS aerosols, particularly menthol-flavored ENDS aerosols, affect asthma exacerbation. ...
Background
Little is known regarding the pulmonary effects induced by the inhalation of menthol-flavored e-cigarette aerosols on asthma exacerbation, despite the popularity of these devices and flavors among youth and young adults. In the lungs, matrix metalloproteinase 12 (MMP12) expressed and secreted by both alveolar macrophages and bronchial epithelial cells plays an essential role in airway remodeling, a key feature of severe asthma. In this study, we investigated the role of MMP12 in menthol-flavored e-cigarette aerosol exposures plus house-dust mite (HDM)-induced asthmatic responses.
Methods
We exposed wild-type (WT) and MMP12 knockout (KO) juvenile female mice to well-characterized menthol-flavored e-cigarette aerosols followed by either PBS or HDM treatment, and evaluated pulmonary outcomes in terms of iron metabolism, oxidative stress responses and pulmonary inflammation.
Results
We found high levels of iron in the menthol-flavored e-cigarette aerosol. This correlated with e-cigarette + HDM WT mice exhibiting disruption of pulmonary iron metabolism, suggesting a defense mechanism against iron-mediated toxicity. This was evidenced by altered lung protein concentrations of ferroportin, ferritin, lactoferrin, and transferrin, activation of the antioxidant response element (ARE) pathway and up-regulated expression of NQO1 in e-cigarette + HDM WT mice. Further, despite decreased neutrophilic inflammation, MUC5AC, an oxidative stress inducible mucin, was increased in the e-cigarette + HDM WT mice. In contrast, MMP12 KO mice were protected against iron-induced oxidative stress responses, highlighting a crucial role of MMP12 in this model.
Conclusion
These findings revealed in vivo evidence supporting a crucial role for iron metabolism in nicotine salt iron-rich ENDS aerosol toxicity.
... Despite numerous studies suggesting potential links between tobacco usage and disrupted sleep patterns, few have investigated the impact of combined cigarette and e-cigarette consumption on sleep quality, quantity, and overall sleep parameters [16][17][18][19][20][21][22][23]. According to the Centers for Disease Control and Prevention's National Center for Health Statistics (CDC NCHS), adults aged 18-24 and 25-44 are more likely to be dual users of e-cigarettes and cigarettes compared to adults aged 45 and over, with e-cigarette use being highest among adults aged 18-24 [24]. This demographic trend underscores the importance of studying this population, This study aims to address this critical gap by delving into the intricate relationship between dual cigarette and e-cigarette usage and its potential effects on sleep patterns and quality. ...
Background
The increasing use of conventional cigarettes and e-cigarettes among young adults (18-35 years) in the US raises significant health concerns, including impacts on sleep. While smoking’s adverse health effects are well-documented, the combined effects of conventional cigarette and e-cigarette use on sleep remain under explored, particularly in young adults. This study investigates the association between dual cigarette and e-cigarette use and sleep outcomes in a nationally representative US sample.
Methods
We utilized self-reported data from the 2020 National Health Interview Survey (NHIS) on young adults (N = 6128, Unweighted). Descriptive statistics and chi-squared tests and t-tests, where appropriate, compared socio-demographic, clinical, behavioral, and sleep-related characteristics by conventional cigarette/e-cigarette use status. Multinomial logistic regression estimated the odds of reporting short (<7 hours) or long sleep ( ≥ 9 hours) compared to normal sleep (7-8 hours) across different smoking categories.
Result
Of the total sample, 51.0% were females, mean age: 26.6 years (SD = 4.8). Cigarette smokers were the oldest (mean age 29.2 years), while e-cigarette users were the youngest (mean age 24.7 years) (p < .0001). Poor or long sleep was reported by 72.8% of cigarette smokers, 69.4% of e-cigarette users, and 71.9% of dual users (p < 0.001). Trouble falling asleep daily, or most days was reported by 49.9% of cigarette smokers, 63.6% of e-cigarette users, and 58.5% of dual users (p < 0.001). Difficulty staying asleep daily for most days was reported by 38.0% of cigarette smokers, 45.0% of e-cigarette users, and 44.6% of dual users (p < 0.0001). Furthermore, 13.7% of cigarette smokers, 5.9% of e-cigarette users, and 12.3% of dual users reported never waking up well-rested (p < 0.001). Multinomial logistic regression revealed that cigarette-only users (aOR:1.40, 95%CI:1.06-1.85), e-cigarette users (aOR:1.32, 95%CI:1.06-1.66), and dual users (aOR:1.81, 95%CI:1.46-2.24) had 40%, 32%, and 81% higher odds, respectively, of having poor sleep compared to non-users.
Conclusion
Cigarette and e-cigarette use is associated with poor sleep patterns and quality, with dual users having the greatest odds of having poor sleep outcomes among young adults.
... Tobacco use, including combustible products like cigarettes and cigars, is a century-long epidemic that has caused tens of millions of premature deaths. 1 Despite numerous successful programmes and policies to reduce the health burden of tobacco, tobacco use continues to be a prevalent health issue. 1 A relatively new form of tobacco use, electronic cigarettes, has increased in recent years among US adults, 2 with its use being highest among young adults aged 18-24 years old. 3 Overall, 5%-18% of young adults use e-cigarettes 4-7 compared with less than 5% of adults, 2 making young adults a crucial focus for tobacco product research. Tobacco use is the primary cause of preventable death in the USA, and binge drinking is just one of its many health risks. 1 Binge drinking is defined by theCenters for Disease Control and Prevention (CDC) as 'the consumption of five or more drinks for men, or four or more drinks for women, in the span of 2 hours.' 8 This behaviour is most common among young adults, with one in four young adults engaging in binge drinking compared with one in six adults. ...
Background
Tobacco use is a long-standing epidemic that has caused millions of premature deaths. Electronic cigarette use is rising among young adults, yet few studies have included combustible tobacco, e-cigarettes and their dual use in an analysis of binge drinking among college students. This study aims to calculate the associations between these three forms of tobacco use and binge drinking among college students.
Methods
This cross-sectional study used data from 332 721 college students from the American College Health Association-National College Health Assessment survey. Tobacco use was organised into four groups: no tobacco use, e-cigarette use only, combustible tobacco use only and dual use of e-cigarettes and combustible tobacco. Binge drinking was a binary indication of whether students had engaged in binge drinking in the last 2 weeks. Multiple logistic regression was employed to examine the relationship between tobacco use and binge drinking, adjusting for demographic factors and constructs of the integrated behavioural model.
Results
Each tobacco use group had significantly higher odds of binge drinking compared with students who did not use tobacco. Students who engaged in dual tobacco use had significantly higher odds of binge drinking compared with exclusive combustible tobacco use (adjusted OR, aOR=2.41, 95% CI: 2.29, 2.53) and exclusive e-cigarette use (aOR=1.79, 95% CI: 1.71, 1.86).
Conclusion
The strong relationship between dual tobacco use and binge drinking among college students warrants further investigation into the aetiology and clinical manifestations of this emerging coupled substance use behaviour among the next generation of adults.
... E-cigarettes have emerged as the most commonly used tobacco product among young individuals [1,2], rapidly becoming a public health concern in the United States, particularly among youth and young adults [3]. Data from the 2021 National Center for Health Statistics reported that e-cigarette use (ie, vaping) was highest among young adults aged 18-24 years, with 11% (approximately 3.4 million people) using e-cigarettes, compared with an overall adult rate of 4.5% [4]. The 2023 National Center for Health Statistics reported an increase in overall adult e-cigarette use to 6.5% [5]. ...
Background
The persistent high prevalence of e-cigarette use among young adults remains a significant public health concern, with limited evidence and guidance on effective vaping cessation programs targeting this population.
Objective
This study aims to outline the study design and protocol of a pilot randomized controlled trial aimed at investigating feasibility and assessing whether media literacy education or financial incentives enhance the effectiveness of evidence-based text message support in promoting vaping abstinence among young adult e-cigarette users.
Methods
The pilot study uses a 4-arm (1:1:1:1) randomized controlled trial design to assess the potential impact of different combinations of media literacy education, financial incentives, and text message support on vaping abstinence over a 3-month period. The first month serves as a preparatory phase for quitting, followed by 2 months focused on abstinence. A total of 80 individuals, aged 19-29 years, who have used e-cigarettes within the past 30 days, have internet access, and express interest in quitting vaping within the next 30 days, will be enrolled. Eligible individuals will be randomized into one of the four study groups: (1) Text Message, (2) Media Literacy, (3) Financial Incentive, and (4) Combined. All participants, regardless of group assignment, will receive text message support. Participants will be followed for 12 weeks, with abstinence status assessed at week 12, as well as during remote check-ins at weeks 6, 8, and 10. Feasibility measures include recruitment rate, reach, engagement, and retention. Other outcomes of interest include self-reported 7-day abstinence and changes in nicotine dependence and media literacy scores. Exit interviews will be conducted with those who complete the study to explore facilitators of and barriers to participation and engagement in vaping cessation, which will inform future program refinement and uptake.
Results
Recruitment for the study commenced in December 2023 and concluded in August 2024. A total of 40 participants were randomized into these groups: 9 for Text Message, 11 for Media Literacy, 10 for Financial Incentive, and 10 for the Combined group. The final assessment was completed in November 2024, and analyses are currently ongoing.
Conclusions
The findings from this trial could provide valuable insights into the design and uptake of vaping cessation strategies among the young adult population.
Trial Registration
ClinicalTrials.gov NCT05586308; https://clinicaltrials.gov/study/NCT05586308
International Registered Report Identifier (IRRID)
DERR1-10.2196/60527
... Smoking continues to be the leading cause of preventable deaths, with 1 in 5 deaths associated with cigarette use 1 . Despite more than 50 years of research confirming the deleterious health risks and consequences of tobacco use, Americans continue to smoke-tobacco and nicotine-containing products, such as electronic cigarettes (e-cigarettes) 1,2 . Additionally, there is strong evidence of the dangerous health effects of secondhand smoke and urgent concern on the potentially harmful effects of secondhand e-cigarette aerosols 1,3 . ...
INTRODUCTION
Implementation of a 100% tobacco-free policy at universities can assist in limiting the potential negative health impacts of tobacco use, such as susceptibility to lung and heart disease, cancer, addiction, and life-long use. This study’s goal was to gain the perspective of students and non-students across a large Midwestern university campus on implementation of a 100% tobacco-free policy.
METHODS
Students, faculty, and staff of a Midwestern university were recruited to complete a 19-question cross-sectional online survey on tobacco use on campus, awareness of the current tobacco-free policy, and their interest in supporting a 100% smoke-free policy on campus. The survey included open- and close-ended questions, and responses were analyzed qualitatively and quantitatively.
RESULTS
A total of 2389 respondents completed the survey, and 291 (12.2%) reported current tobacco use from April to July 2024. Participants with a higher probability of current tobacco use were associated with having a higher degree of exposure to secondhand aerosols (AOR=1.34; 95% CI: 1.10–1.62), more awareness of the current tobacco policy (AOR=1.19; 95% CI: 1.06–1.32), and disagreed with the petition statement in support of a 100% tobacco-free campus policy (AOR=2.47; 95% CI: 1.48–4.12). Participants that reported a higher degree of exposure to secondhand aerosols (AOR=2.18; 95% CI: 1.19–3.99) and agreed with the statement that a 100% smoke-free campus policy would promote a healthier college campus (AOR=2.18; 95% CI: 1.20–3.96) were significantly associated with supporting the petition for a 100% smoke-free policy on this university campus.
CONCLUSIONS
Supporting a 100% tobacco-free policy for a healthier and safer university campus was demonstrated to be associated with secondhand aerosol exposure among survey respondents.
... This is likely a reflection of the novelty of the e-cigarette market and the fact that COPD develops over decades. Given the fact that most people who use e-cigarettes are adolescents and young adults, the implications of exclusive e-cigarette use on COPD risk will likely become more obvious over time [42,43]. Finally, there is no standardized definition of e-cigarette use comparable to cigarette "pack years" in a way that would quantify overall chemical exposure and the NHIS 2020 did not include questions regarding e-cigarette frequency or intensity. ...
Background
Prior research has linked e-cigarette use with chronic obstructive pulmonary disease (COPD). We examined the relationship between e-cigarette use and COPD prevalence in older adults with varying cigarette use status.
Methods
Data from the 2020 National Health Interview Survey were used to estimate the association between each of 9 exposure categories based on cigarette use (never, former, current) and e-cigarette use (never, former, current), with respondent-reported physician-diagnosed COPD prevalence in individuals 40 years and older (N = 22,997). Weighted multivariable analysis accounted for cigarette pack years, age of cigarette smoking onset, race, income-to-poverty ratio, rurality, gender, age, and medical comorbidities. Sensitivity of results was tested in 3 separate models with addition of years since quit cigarettes, smoking intensity and duration.
Results
39.7% of individuals reported ever smoking cigarettes and 10.2% reported ever using e-cigarettes. Among individuals with ever e-cigarette use, 88.5% also reported current or former cigarette smoking. The weighted prevalence of COPD was 7.2%; Among those who reported former cigarette smoking, the highest risk of COPD prevalence compared to never cigarette/never e-cigarette use was in those currently using e-cigarettes (adjusted risk ratio (ARR) 2.82, 95% confidence interval (CI) [1.5, 5.3]). The ARR for former cigarette/current e-cigarette use was significantly larger than the ARR for former cigarette/never e-cigarette use (p < 0.002) in 3 out of 4 models; however, one model had the ARR attenuated to 1.35 (0.67, 2.76) when years since quitting smoking was added to the model. Other cigarette/e-cigarette combinations were also sensitive to how cigarette smoking history was modeled. For example, ARR for former cigarette/former e-cigarette (1.68 [1.00, 2.80] and current cigarette/former e-cigarette (2.50 [1.56,4.02]) were reduced to 1.05 (0.62, 1.77) and 1.04 (0.62, 1.75) respectively, when cigarette smoking duration was substituted for pack-years.
Conclusions
Current e-cigarette use among former cigarette smokers was associated with significantly higher COPD prevalence compared to never e-cigarette use. However, COPD risk for most cigarette/e-cigarette combinations could be greatly attenuated by how cigarette smoking history was modeled, raising questions about the robustness of these associations in prior research and the possibility of reverse causality in prior cross-sectional research.
... Over the last two decades, e-cigarettes (EC) have become widely popular worldwide, including among adolescent populations [1][2][3]. According to the 2024 National Youth Tobacco Survey, 5.9% of middle and high school students (1.63 million) reported using e-cigarettes, with 26.3% of users vaping daily. ...
Electronic cigarettes (EC) have emerged as a popular alternative to traditional tobacco products, but their impact on immune function has raised significant health concerns. This review explores the immunological effects of EC exposure, focusing on innate and adaptive immune responses. Electronic cigarette aerosol (ECA) induces widespread inflammation. These changes compromise immune cell function, impairing neutrophil chemotaxis, phagocytosis, and oxidative burst while increasing macrophage and dendritic cell recruitment and activation. ECA also disrupts epithelial barriers, increasing susceptibility to bacterial and viral infections. Studies show enhanced biofilm formation in bacteria such as Staphylococcus aureus and Streptococcus pneumoniae and impaired antiviral responses against pathogens like influenza A and SARS-CoV-2. Additionally, EC exposure modulates adaptive immunity, affecting T and B cell function and increasing systemic inflammatory markers. The long-term consequences of these immunological disruptions include heightened risks for chronic inflammatory diseases, respiratory infections, and potentially autoimmune conditions. The widespread adoption of EC, particularly among younger users, poses a growing public health challenge. As the popularity of vaping continues to rise, these immunological disruptions could result in increased healthcare burdens in the future, with higher rates of infections, chronic inflammatory diseases, and immune system–related disorders among those who begin using e-cigarettes at a young age. Understanding the full scope of EC-related health risks is essential for informing public health policies and protecting future generations from the potential long-term effects of vaping.
... The prevalence of smoking observed following the introduction of e-cigarettes in the United States in 2007 was lower than expected based on trends between 1990 and 2006, particularly among individuals aged 18-34 (Foxon et al., 2024). Regarding ecigarette use among young adults, the prevalence of current e-cigarette use (defined as occasional or daily use at the time of the survey) among Americans aged 18-24 in 2021 was estimated to be 11 % (Cornelius et al., 2023;Kramarow and Elgaddal, 2023). Exclusive use of e-cigarettes was more common than exclusive use of tobacco cigarettes or concurrent use of tobacco cigarettes and e-cigarettes (dual use). ...
The use of psychoactive products by young adults is usually described as part of their exploratory identity devel-opment. This behavior is facilitated by social and structural contexts where these substances are perceived as legal and easily accessible. While the motivations for initiating and continuing the use of tobacco and alcohol are well-documented, the same cannot be said for e-cigarettes. The primary objective of this systematic review was to describe the reasons for initiation and continuation of e-cigarette use among adults aged 18 to 30. A secondary objective was to categorize these reasons into intrinsic (i.e., personal motivations) and extrinsic factors (i.e., soci-ocultural or structural influences). Searches were conducted in MEDLINE, Scopus, SocINDEX full text, PsycAr-ticles, PsycInfo, Psychology and Behavioral Sciences Collection, Cochrane Library and gray literature. Studies involving humans, published in English or French up to June 2024 were eligible for inclusion. After removing 594 duplicates, 1,123 articles were screened by title and abstract, with 37 articles published between 2015 and 2024 ultimately included in the review. These comprised 21 cross-sectional studies, eight qualitative studies, six cross-sectional analyses of cohort data, one cohort study and one mixed methods study. The appeal of e-liquid flavors emerged as one of the most frequently reported extrinsic factors driving both initiation and continuation of e-cigarette use. Other reasons varied across intrinsic and extrinsic domains: smoking cessation was a commonly cited intrinsic motivation, often reported alongside other factors. Structural extrinsic factors such as regulatory policies appeared to be less recognized by young adults, suggesting a gap in awareness or compliance to such regulations. These findings indicate the need for further research to better understand young adults' perceptions of and interactions with regulatory measures concerning e-cigarette and tobacco use.
... 1−3 The National Health Interview Survey data in 2021 revealed that 4.5% of adults aged 18 and over were actively using e-cigs. 4 Given the increasing popularity of e-cigs and the absence of stringent emission regulations, these products are continuously developing and emerging as novel sources of indoor air contaminants. The vaping process transforms eliquids into aerosols that users inhale, and the exhaled aerosols can persist in the surrounding atmosphere. ...
E-cigarette emissions, which contain a variety of hazardous compounds, contribute significantly to indoor air pollution and raise concerns about secondhand exposure to vaping byproducts. Compared to fresh vape emissions, our understanding of chemically aged products in indoor environments remains incomplete. Terpenes are commonly used as flavoring agents in e-liquids, which have the ability to react with the dominant indoor oxidant ozone (O3) to produce reactive oxygenated byproducts and result in new particle formation. In this study, mixtures of propylene glycol (PG), vegetable glycerin (VG), and terpenes as e-liquids were injected into a 2 m³ FEP chamber to simulate the indoor aging process. 100 ppbv O3 was introduced into the chamber and allowed to react with the fresh vape emissions for 1 h. Complementary online and offline analytical techniques were used to characterize the changes in the aerosol size distribution and chemical composition during the aging processes. We observed more ultrafine particles and a greater abundance of highly oxygenated species, such as carbonyls, in aged e-cigarette aerosols. Compared with their fresh counterparts, the aged emissions exhibited greater cytotoxic potential, which can be attributed to the formation of these highly oxygenated compounds that are not present in the fresh emissions. This work highlights the dynamic chemistry and toxicity of e-cigarette aerosols in the indoor environment as well as the indirect risks of secondhand exposure.
... In none of the studies, a long-term biomarker for CC use was applied, such as for example the hemoglobin adduct CEVal (2-cyanoethyl valine, a longterm biomarker for exposure to acrylonitrile) [125]. Among adults (18 + years) who use ECs in the US in 2021 (about 11.6 million persons), almost 30% were DU (using CCs and ECs) [126]. It has to be assumed that it is quite likely that the EC groups in the evaluated studies contain considerable numbers of un-assessed DU, which might constitute a potential risk of bias for elevated deterimental oral health effects in the EC groups. ...
Background
Use of combustible cigarettes (CCs) and smokeless oral tobacco products are well documented risk factors for a variety of oral diseases. However, the potential oral health risks of using recently introduced (since about 2000) non-combustible tobacco/nicotine products (NCPs: electronic cigarettes (ECs), heated tobacco products (HTPs) and oral nicotine pouches (ONPs), remain poorly established.
Methods
This review evaluates published human studies on detrimental oral health effects in people who use NCPs compared to those smoking cigarettes and those not using any tobacco/nicotine product (NU). We identified 52 studies, predominantly focusing on adults who used electronic cigarettes as an NCP. The studies exhibited significant heterogeneity regarding design, populations, endpoints and quality. Reported outcomes, based on both single and grouped endpoints were qualitatively evaluated by comparing people who use NCPs with NU and with people smoking CCs. Significant increases (indicating a worsening in oral health), significant decreases (indicating a lower level of detrimental effects) and no significant difference between groups were assigned scores of + 1, -1 and 0, respectively. Scores from studies belonging to the same single or grouped endpoints were averaged to a summary score ranging from − 1 to + 1.
Results
The qualitative meta-analysis revealed that comparisons of EC versus NU groups yielded mean scores of 0.29 for pre-cancerous lesions (N = 14 observations), 0.27 for inflammatory processes (N = 83), 0.43 for oral clinical parameters (N = 93) and 0.70 for shifts in the oral microbiome (N = 10). The corresponding values for the EC versus CC group comparisons amounted to -0.33 (N = 15), -0.14 (N = 76), -0.27 (N = 78) and 0.57 (N = 7). Most studies had significant limitations regarding group sizes, duration of NCP use (mostly only a few years) and validity of self-reported exclusive NCP use. Notably, the implications of dual use (EC + CC) and prior CC use were often not adequately considered.
Conclusions
The evaluated studies suggest that use of ECs is associated with relatively fewer detrimental oral health effects compared to smoking, yet oral health status remains poorer compared to not using any tobacco/nicotine products. These results have to be interpreted with caution due to a number of limitations and uncertainties in the underlying studies, particularly the potential biases and confounding factors inherent in cross-sectional study designs.
... Electronic cigarettes (e-cigarettes) have become popular over the past decade to quit or reduce cigarette smoking (9). In 2021, 4.5% of US adults aged 18 years and older currently used e-cigarettes, and e-cigarette use varied by race/ethnicity (10). The prevalence of e-cigarette use among NHW adults (5.2%) was higher than that of Asian adults (2.9%), Black adults (2.4%), and Hispanic (3.3%) adults (9). ...
Background
Chronic Obstructive Pulmonary Disease (COPD), mainly caused by cigarette smoking, is one of the leading causes of death in the United States (US) and frequent asthma attacks are often exacerbated by cigarette use. Electronic cigarettes (e-cigarettes) are often used to quit cigarette smoking. Prevalence of COPD, asthma, cigarette use, and e-cigarette use differs between racial/ethnic groups. The overall objective was to assess the associations between e-cigarette use and COPD and asthma and how race/ethnicity and cigarette smoking modifies these associations.
Methods
Data were retrieved from the 2016–2018 and 2020–2021 Behavioral Risk Factor Surveillance System datasets, a national annual health survey representing the US general adult population. Frequency and weighted percentages or means and standard deviations were obtained. Rao-Scott Chi-square test, two-sample t tests, and logistic regression were used to evaluate binary associations between current e-cigarette use and lifetime diagnosis of COPD and asthma. Multivariable analyses using logistic regression were conducted to assess associations between variables. Interaction effects between e-cigarette use and race/ethnicity were assessed and stratified analyses were performed as indicated. All multivariate analyses were stratified by cigarette smoking status.
Results
Prevalence of e-cigarette use was 5.1%, COPD was 6.7%, and asthma was 9.2%. Individuals who currently smoked cigarettes among all racial/ethnic groups, excluding non-Hispanic (NH) American Indian/Alaska Native individuals, were more likely to report current asthma if using e-cigarettes compared to non-use (p < 0.05). Among individuals who never smoked, Non-Hispanic White (NHW), NH-Black and Hispanic individuals using e-cigarettes had greater odds of COPD compared to NHW, NH-Black and Hispanic individuals who did not use these products, respectively (p < 0.05). Among NHW, Hispanic, and NH-Other persons who currently used cigarettes, individuals currently using e-cigarettes had greater odds of COPD compared to NHW, Hispanic, and NH-Hispanic individuals who did not use e-cigarettes, respectively (p < 0.05). Among individuals who formerly used cigarettes, current e-cigarette use was associated with COPD and asthma. Among individuals who never used cigarettes, current e-cigarette use was associated with reporting current asthma.
Conclusion
The association between e-cigarette use and COPD and asthma was dependent on smoking status and racial/ethnic groups. Further studies should be conducted to explore this association.
... However, this study did not specify the temporal changes and specific correlates of e-cigarettes among Albanian adolescents. Evidence suggests e-cigarettes are contributing to increased nicotine exposure and are associated with initiating combustible cigarette use among adolescents [23][24][25]. This raises urgent questions about trends, correlates, and broader implications for public health and policy in Albania, particularly regarding taxation, law enforcement, cessation services, and youth-focused public education campaigns. ...
Tobacco use often starts during adolescence, with many adults beginning before 21. This study investigated the patterns and factors associated with tobacco and e-cigarette use among school-aged adolescents in Albania. Data were analyzed from two Albania Global Youth Tobacco Surveys (GYTS) conducted in 2015 and 2020. Participants included 7th-10th grade students (ages 12–16) who completed the survey (n = 9985). Descriptive statistics depicted demographic characteristics, tobacco, and e-cigarette use across survey years. Logistic regression assessed temporal changes and the odds of use across independent variables, adjusting for age and sex. From 2015 to 2020, tobacco and e-cigarette use among students aged 13–15 increased from 12.86 to 14.49% and from 6.8 to 8.8%, respectively. Cigarette smoking declined from 8.4 to 4.3%, but the use of other tobacco products nearly doubled, from 6.4 to 12.3%. Higher odds of use were found among males, older students, and those with more pocket money. Environmental factors like family, peer, and media exposure to smoking increased the likelihood of use. Anti-tobacco messages had no significant impact, while advertising strongly influenced usage. Knowledge of tobacco harms and anti-smoking attitudes correlated with lower odds of use. Increased availability of cigarettes near schools was linked to higher odds of tobacco use. The study highlights gaps in anti-tobacco messaging and the strong influence of advertising, underscoring the need for targeted and effective tobacco control strategies in Albania.
... Given that more young Americans are enrolling in higher education, with approximately 62.0% of high school graduates pursuing college as of October 2022 (U.S. Bureau of Labor Statistics, 2022), understanding the patterns of e-cigarette use among college students has become crucial (Lanza et al., 2020). In 2021, there was a significant increase in e-cigarette use among young adults aged 18 to 24 years, constituting about 11% or roughly 3.4 million people, compared to adults aged 25 to 44 years (6.5%) and those aged 45 years and older (2.0%) (Kramarow & Elgaddal, 2023). About 15.6% of 18-20-year-olds and 14.5% of 21-24-year-olds have reported using e-cigarettes within the past 30 days (Boakye et al., 2022). ...
Background:
Given that college life is a major life-changing and stressful event for many young adults, they may use e-cigarettes to manage their stress, which in the long run could be detrimental to their health. Furthermore, perceived social support and self-esteem are important factors that might influence young adults' e-cigarette use behavior. This cross-sectional study examines the associations of perceived stress, social support, and self-esteem with e-cigarette use among U.S. college-aged young adults.
Methods:
Students (aged 18-24 years, n = 220) attending Slippery Rock University of Pennsylvania between February-May 2023 were recruited to complete an online survey. The outcome variables were current (past 30 days) and ever e-cigarette users, while the explanatory variables were perceived stress, perceived social support, self-esteem, and socio-demographics. Data was analyzed using bivariate and multivariable logistic regression models.
Results:
About 30.1% and 55.0% of participants were current users and ever users of e-cigarettes, respectively. Participants who perceived high stress (vs. low stress) were 12.4 (Adjusted Odds ratio (aOR) = 12.39, p = 0.02) and 7.4 (aOR = 7.37, p = 0.04) times more likely to be current users and ever users of e-cigarettes, respectively. For every one-unit increase in self-esteem score, the likelihood of participants being current e-cigarette users decreased by 7% (OR = 0.93, p = 0.01).
Conclusion:
Perceived stress and self-esteem are significantly associated with e-cigarette use among college-aged young adults. Public health efforts should focus on stress reduction, healthy coping strategies, and improving self-esteem in order to prevent e-cigarette use among this population.
... Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among US young adults; in 2021, current use of e-cigarettes among adults aged 18-24 years (11.0%) was greater than among adults aged 25-44 (6.5%) and 45 and older (2.0%). 1 Although e-cigarette use among high school students declined from 10.0% in 2023 to 7.8% in 2024, 2,3 e-cigarette use among youth and young adults remains a public health concern because nicotine is addictive, harms the adolescent brain (the development of which occurs through approximately age 25), and may prime the brain for addiction to other substances. 4 Nicotine withdrawal symptoms are psychologically and physically uncomfortable and include feelings of sadness, anxiety, and depression; irritability; urges or cravings to use tobacco; and difficulty concentrating and sleeping; temporary relief of these symptoms drives continued use. 5 Furthermore, e-cigarette aerosol can contain harmful substances in addition to nicotine, including heavy metals and carcinogens; the long-term respiratory effects of e-cigarette use are unknown. ...
Introduction
Since 2016, the U.S. Food and Drug Administration (FDA) has required e-cigarette packaging and advertising to bear the warning: “WARNING: THIS PRODUCT CONTAINS NICOTINE. NICOTINE IS AN ADDICTIVE CHEMICAL.” Nicotine has numerous adverse consequences besides addiction, including increased anxiety and depression symptoms that arise from nicotine withdrawal. We tested the effects of exposure to text-only e-cigarette package labels about the psychological consequences of nicotine withdrawal.
Methods
We randomized 1919 U.S. young adults aged 18–24 years to view one of four warning label conditions: a no-message control, the current FDA warning, a message that “nicotine addiction can worsen depression and anxiety symptoms,” and a message that “nicotine addiction is a source of stress.” We explored associations between condition and intentions to use or quit e-cigarettes and perceived message effectiveness.
Results
Label condition was not associated with intentions to use or quit e-cigarettes. Intentions were equivalent among those who viewed the FDA label and those who viewed the no-message control. Compared with the FDA label, the depression/anxiety label and the stress label produced greater agreement among participants that the message “makes me concerned about nicotine addiction” after adjustment for sociodemographic characteristics; those who viewed the depression/anxiety label had greater agreement that the message “discourages me from wanting to use nicotine.”
Conclusions
While brief exposure to the warnings tested may not impact young adults’ intentions to use or quit vaping, messages about stress, depression, and anxiety arising from nicotine addiction had higher perceived effectiveness among young adults than the FDA’s current message about addictiveness.
Implications
Findings from this randomized controlled experiment among U.S. young adults suggest that warnings about the mental health consequences of nicotine addiction might be one type of message to consider including in a suite of required e-cigarette warnings and as part of a comprehensive effort to educate the public about the risks of commercial tobacco products.
... The normalization of smoking behavior is one of the most alarming social issues associated with the use of e-cigarettes by young people (Kramarow & Elgaddal, 2023). E-cigarettes are frequently marketed as socially acceptable and fashionable, which may make them more appealing to young people who may otherwise be discouraged by the stigma associated with traditional smoking Wang et al., 2024;Zavala-Arciniega et al., 2024). ...
E-cigarettes have gained notable popularity among youth in recent years, posing a serious societal issue that has elicited much concern from public health professionals and legislators. The increase in e-cigarette consumption among adolescents can be ascribed to assertive marketing strategies employed by corporations that focus on appealing to young consumers through flavored offerings and aesthetically pleasing designs. This rise is concerning because of the possible long-term health ramifications linked to vaping, such as nicotine addiction and exposure to hazardous chemicals found in numerous e-cigarette formulations. The normalization of e-cigarette usage in social contexts may result in heightened peer pressure and the endorsement of detrimental conduct. To properly address this issue, government agencies must enforce stronger rules on e-cigarette sales and marketing directed at minors, while schools and community organizations should educate youth about the risks of vaping.
... Use of e-cigarettes and ACEs may also vary across race/ethnicity and sex [31][32][33]. Studies on adult e-cigarette use have shown the highest e-cigarette use among those who are non-Hispanic White and non-Hispanic American Indian/Alaskan Native (AIAN) [34,35]. ...
Introduction
The use of e-cigarettes or other electronic vaping products (EOEVP) has been on the rise since their introduction. Concurrently, Adverse Childhood Experiences (ACEs) have been linked to various negative behavioral health outcomes. We explore the association between ACEs and current EOEVP use, with a focus on variations across sex, race/ethnicity, and age.
Methods
Utilizing data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2020–2022, we analyzed responses from 202,126 adults in the United States in a cross-sectional study. Multivariable logistic regression models were used to evaluate the adjusted odds ratios (aORs) of current EOEVP use for different levels of ACEs. Stratified and interaction analyses were used to examine potential effect modification.
Results
Among adults 54 years of age and younger, even a lower number of ACEs [1 (aOR 1.52), 2 (aOR 2.01), and 3 (aOR 1.51)] was associated with higher odds of current EOEVP use. Stratified analyses revealed significant differences in the odds of current EOEVP use among Non-Hispanic White adults between 1 ACE (95% CI 1.75–2.28) and 4 ACEs (2.34–3.17). Hispanic adults with ≥ 1 ACEs (p-value 0.001) and 8 ACEs (p-value 0.005) showed strong associations compared to Non-Hispanic White adults. The influence of ACEs on current EOEVP use was observed to decrease with age, particularly in older adults with fewer ACEs. The aORs did not very by sex.
Conclusion
The findings emphasize the importance of considering any number of ACEs in public health strategies targeting current EOEVP use, especially among younger adults and specific minority groups. These insights are crucial for tailoring interventions and policies to address the nuanced impacts of early life adversities on health risk behaviors.
... Specifically, we included the nonproportional quota sampling goals related to history of cigarette smoking to align with characteristics of adult e-cigarette users in the United States who are not current cigarette smokers-approximately 60% are former smokers, and 40% are never smokers [16,17]. Targeting no more than 60% of participants from any self-identified gender group was to align with the gender breakdown of American adults and prevalence of e-cigarette use among these gender groups [18,19]. Pursuing <50% of participants in any particular decade-spanning age group was arbitrary and an attempt to avoid overrepresentation of any age group. ...
Background
In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app–based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data.
Objective
This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design.
Methods
American adults aged ≥21 years who vaped daily, reported ≥5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ≥7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback.
Results
In total, 73 participants onboarded (intention-to-treat sample); 68 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks—4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P<.001 in both cases). Most participants (64/73, 88%) made ≥1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48% (35/73), 45% (33/73), and 30% (22/73), respectively. In total, 45% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change –3.2, SD 3.9; P<.001); 48% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79% (55/70) reported using Pivot decreased the amount they vaped per day.
Conclusions
In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements.
... E-cigarette use is high in the U.S. across all age groups, exposing millions of people to harmful toxins and chemicals including nicotine. In 2021, the Centers for Disease Control and Prevention (CDC) found that 14% of adolescents (grades 6-12), 11% of young adults (age 18-24), and 7% of adults (age 25 and older) used a nicotine e-cigarette in the past 30-days (Kramarow, 2023;Park-Lee et al., 2022). Adolescent use of nicotine e-cigarettes has recently decreased, yet in 2023, 10% of high-school students reported past 30-day use (Birdsey et al., 2023). ...
... In the United States, the prevalence of e-cigarette use within the past 30 days among high school students has risen from 1.5% in 2011 to a staggering 20.8% in 2018. 2 The situation is equally concerning in Mexico, where the prevalence of e-cigarette use reached a high of 22% in a sample of middle school students. According to US statistics, the number of e-cigarette consumers has doubled annually since 2008, reflecting the product's sustained popularity as a trendy device promoted for smoking cessation, often as an alternative to traditional nicotine replacement therapies such as snuff and patches. ...
Objective: This study examined perceptions and attitudes toward electronic cigarettes (e-cigarettes) among young adults aged 15-20 years in Samut Songkhram Province, Thailand, and their relationship.
Materials and Methods: A descriptive cross-sectional study was conducted between July and October 2023. The study included 328 young adults aged 15-20 selected from an educational institution in Samut Songkhram Province using simple random sampling. Data were collected using a self-administered questionnaire and analyzed using descriptive statistics and Pearson's correlation coefficient.
Results: The participants had a good level of knowledge about e-cigarettes. They exhibited a positive attitude towards electronic cigarettes regarding health aspects (M=3.05, SD=0.97) and a positive attitude towards the legal dimensions of e-cigarettes (M=3.12, SD=0.80). However, no statistically significant correlation was found between the perception of e-cigarettes and health-related attitudes toward them (r=0.013, p=0.820). On the other hand, there was a statistically significant positive correlation between the perception of e-cigarettes and legally oriented attitudes (r=0.192, p<0.001). Furthermore, a borderline positive correlation emerged between the perception of electronic cigarettes and the general attitudes toward them (r=0.102, p=0.065).
Conclusion: Young adults in rural Thailand have a good knowledge of e-cigarettes. However, they exhibit positive attitudes towards the health aspects and legal dimensions of e-cigarettes. Moreover, no significant relationship exists between perceptions and health-related attitudes. These insights emphasize the need for targeted strategies to address misperceptions and raise awareness about the health risks of e-cigarette use among rural youth.
... From 2011 and onward, e-cigs have been massively adopted by teens and youth who have wished to experiment with tobacco products [10]. In 2021, 4.5% of U.S. adults aged 18 and over were current e-cig users, with those between the ages of 18 and 24 having the highest rate of use (11.0%) [11]. Since 2014, e-cigs have been the most commonly used tobacco product by U.S. youth [10]. ...
Despite the popularity of electronic cigarettes (e-cigs) among adolescent never-smokers and adult smokers seeking a less pernicious substitute for tobacco cigarettes, the long-term health impact of vaping is largely unknown. Like cigarette smoke, e-cig vapor contains harmful and potentially harmful compounds, although in fewer numbers and at substantially lower concentrations. Many of the same constituents of e-cig vapor and cigarette smoke induce epigenetic changes that can lead to the dysregulation of disease-related genes. MicroRNAs (MiRNAs) are key regulators of gene expression in health and disease states. Extensive research has shown that miRNAs play a prominent role in the regulation of genes involved in the pathogenesis of smoking-related diseases. However, the use of miRNAs for investigating the disease-causing potential of vaping has not been fully explored. This review article provides an overview of e-cigs as a highly consequential electronic nicotine delivery system, describes trends in e-cig use among adolescents and adults, and discusses the ongoing debate on the public health impact of vaping. Highlighting the significance of miRNAs in cell biology and disease, it summarizes the published and ongoing research on miRNAs in relation to gene regulation and disease pathogenesis in e-cig users and in vitro experimental settings. It identifies gaps in knowledge and priorities for future research while underscoring the need for empirical evidence that can inform the regulation of tobacco products to protect youth and promote public health.
... It was reported that in 2021, 4.5% of adults aged 18 and over were current e-cigarette users. 3 As an increase of their use, there are growing researches focusing on the impacts of e-cigarette to the oral health. Therefore, a well-organized review of associated researches on the impacts of e-cigarette to the oral health is important and of great value. ...
Many people have associated e-cigarettes with adjectives such as trendy and cool, and regarded vaping as “a safer alternative to cigarette smoking”. Compared with the conventional cigarettes, the public is less familiar with the dangers of e-cigarettes. E-cigarettes produce an aerosol by heating the e-liquid (usually comprising nicotine, flavorings, propylene glycol, vegetable glycerin, and other additives). Harmful substances are generated during the vaporization, such as formaldehyde. Cellular damages and DNA hypermethylation are also found to be associated with vaping. We reviewed the clinical neoplastic cases of patients with vaping history (three oral squamous cell carcinomas, one conjunctival squamous intraepithelial neoplasia, and one thoracic NUT-midline carcinoma). These patients tend to be younger than the average cancer patients. Although the exact relations between the cellular damages or DNA hypermethylation and vaping still need further investigations, we should be very careful about the dangers of using e-cigarettes as aids for cigarette smoking cessation.
... Electronic cigarettes (Ecigs) are most popular among youth of reproductive age. A recent CDC survey found more than 1 in 10 young adults (18-24 years old) use vaping-related products daily, and over 2 million middle and high school students reported using Ecigs in 2016 (Gentzke et al., 2022;Kramarow & Elgaddal, 2023). Despite the lack of evidence to substantiate claims of harm reduction from long-term use, Ecigs are being marketed as safer than cigarettes and even being promoted as an alternative to smoking during pregnancy (Lerner et al., 2015;McNeill, 2015). ...
Studies have shown cerebrovascular dysfunction in offspring with full‐gestational electronic cigarette (Ecig) exposure, but little is known about how individual trimester exposure impacts offspring health. This study aimed to determine if there is a critical window during gestation that contributes to vascular and anxiety‐like behavioural changes seen with full‐term exposure. To test this, rats were time‐mated, and the pregnant dams were randomly assigned to Ecig exposure during first trimester (gestational day, GD2–7), second trimester (GD8–14), third trimester (GD15–21) or full‐term gestation (GD2–21). We also assessed the effect of maternal preconception exposure. Both male and female offspring from all maternal exposure conditions were compared to offspring from dams under ambient air (control) conditions. Ecig exposure consisted of 60‐puffs/day (5 days/week) using either 5 or 30 watts for each respective exposure group. We found that maternal exposure to Ecig in the second and third trimesters resulted in a decrease (23–38%) in vascular reactivity of the middle cerebral artery (MCA) reactivity in 3‐ and 6‐month‐old offspring compared to Air offspring. Further, the severity of impairment was comparable to the full‐term exposure (31–46%). Offspring also displayed changes in body composition, body mass, anxiety‐like behaviour and locomotor activity, indicating that Ecigs influence neurodevelopment and metabolism. Maternal preconception exposure showed no impact on offspring body mass, anxiety‐like behaviour, or vascular function. Thus, the critical exposure window where Ecig affects vascular development in offspring occurs during mid‐ to late‐gestation in pregnancy, and both 5 W and 30 W exposure produce significant vascular dysfunction compared to Air. image
Key points
Exposure to electronic cigarettes (Ecigs) is known to increase risk factors for cardiovascular disease in both animals and humans.
Maternal Ecig use during pregnancy in rodents is found to impair the vascular health of adolescent and adult offspring, but the critical gestation window for Ecig‐induced vascular impairment is not known.
This study demonstrates Ecig exposure during mid‐ and late‐gestation (i.e. second or third trimester) results in impaired endothelial cell‐mediated dilatation (i.e. middle cerebral artery reactivity) and alters anxiety‐like behaviour in offspring.
Maternal exposure prior to conception did not impact offspring's vascular or anxiety‐like behavioural outcomes.
Rodent models have been a reliable and useful predictor of inhalation‐induced harm to humans. These data indicate maternal use of Ecigs during pregnancy should not be considered safe, and begin to inform clinicians and women about potential long‐term harm to their offspring.
Despite a documented decline in conventional cigarette smoking ((CDC, Health effects of cigarette smoking. Centers for Disease Control and Prevention, 2021)) there has been a surge in electronic cigarette (e-cigarette) use (Surgeon General’s report, 2016). Approximately half of current e-cigarette users reported never being conventional cigarette smokers (King et al., 2013), underscoring the necessity of comprehending both conventional and e-cigarette usage patterns distinctively. While examining smoking patterns and disparities in the risk of conventional cigarette smoking across different population groups is crucial, equal attention must be given to understanding smoking cessation patterns. Using an intersectional framework, we generated exploratory statistics to examine smoking behavior and cessation patterns across sexuality and gender identity. Using three sets of multi-year data (2016–2021) from the Behavioral Risk Factor Surveillance System (BRFSS), we highlight three key findings. First, our data indicate that sexual minorities exhibit higher percentages of both e-cigarette and conventional cigarette usage. Second, we find evidence of high percentages of smoking cessation attempts regardless of sexual identity for both conventional and e-cigarettes. Finally, in our sample we find that regardless of sexual identity, e-cigarette smokers were younger, male, and economically disadvantaged. We also find evidence of more casual e-cigarette use across sexual identity. More work should examine additional factors that are significant predictors of e-cigarette use.
Approximately 4.6 % of U.S. adults over the age of 18 use e-cigarettes, which are a type of electronic nicotine delivery system (ENDS). Over 2.5 million U.S. middle and high school students also use both disposable and/or flavored ENDS products. The health impacts of ENDS use by adults and adolescents are considered a controversial topic in the social media partially due to misperceptions surrounding ENDS toxicity compared to that of combustible cigarettes. There is growing evidence that ENDS, particularly their product composition and design, individual and combined ingredients, and produced aerosols, are toxic to human health. Animal studies have been critical for defining the pathophysiologic outcomes resulting from ENDS use. However, in vitro approaches using human cells can measure the potential toxicity of ENDS e-liquids and aerosols on a shorter timeline and are in keeping with recent statements to replace, reduce and refine the use of animals in biomedical research and regulatory decision making. This review examines current research related to cell culture models of the respiratory tract and exposure methodologies for ENDS use and compares known in vivo parameters of injury and inflammation associated with ENDS to different in vitro systems developed to replicate the inhaled toxicant outcomes. The design and interpretation of exposure methodologies and technological gaps in the evaluation of ENDS aerosols are also discussed. Given the ongoing evolution and popularity of ENDS products, in vitro assessments for measuring respiratory tract injury and inflammation resulting from ENDS use provide a critical scientific platform for rapid evaluation of potential inhalation toxicity in tobacco regulatory science.
Despite the rise in electronic cigarette use in recent years, the neurobiological effects of daily e-cigarette use versus smoking cigarettes in young adults remains unknown. This study aimed to investigate the impact of regular, exclusive e-cigarette use on grey matter morphometry in young adults, age 18-25. Structural MRI data were collected from 3 distinct groups of participants (n = 78): daily, exclusive e-cigarette users; tobacco cigarette users; and non-using controls, to assess grey matter volume (GMV) differences. Voxel-based morphometry revealed significant GMV reductions in tobacco cigarette users in the left fusiform gyrus (FG), left and right inferior temporal gyrus (IFG), right middle temporal gyri, and right middle cingulate gyrus (MCG), compared to controls, as well as the anterior cingulate cortex (ACC), compared to both e-cigarette users and controls, even after adjusting for nicotine exposure history. Partial correlation analyses revealed that in tobacco cigarette users, GMV in the FG, ITG, MTG, and MCG displayed a strong, negative association with exposure history but not with nicotine dependence. GMV of the ACC was not associated with duration of use or nicotine dependence score, suggesting distinct relationships between ACC volume and smoking status and FG/ITG/MTG/MCG volume and smoking status. This indicates a distinct difference between regular tobacco cigarette and e-cigarette use, perhaps a relatively safer profile of e-cigarette use on GMV. These findings suggest that factors beyond nicotine, such as other toxicants in tobacco cigarette smoke, may contribute to the observed brain atrophy, or imply potential pre-existing vulnerabilities that might predispose individuals to take up smoking.
Background: The current study examined how the interplay between message frame and vaping norms impacted college students' responses to vaping prevention messages, from the lens of deviance regulation theory. Objectives: College students (N = 231) were randomly assigned to one of seven conditions in a 2 (message frame: positive, negative) by 3 (manipulated vaping norm: high, low, none) + 1 control (recycling) between-subjects experiment. Participants' preconceived vaping norms, vaping history, and health harm and addiction beliefs in vaping were also measured. Results: Results showed a main effect of message frame and an interaction effect between message frame and preconceived vaping norms in a way that is consistent with DRT prediction. A positive frame led to less freedom threat and negative cognition, and more favorable message attitudes, compared to a negative frame. Moreover, participants who had a low preconceived vaping norm and viewed a negative frame reported more favorable attitudes than those who had a low preconceived vaping norm and viewed a positive frame. Similarly, participants who had a high preconceived vaping norm and viewed a positive frame reported more favorable attitudes than those who had a low preconceived vaping norm and viewed a positive frame. No significant interaction between message frame and manipulated vaping norms was found. Conclusions: Findings of the study suggested that in using DRT-based interventions, utilizing preconceived norms provides a better approach than manipulated norms for producing more favorable message responses.
Background
Smoking among adults in substance use disorder (SUD) treatment programs is common with limited success in quitting. Given e-cigarettes’ potential for smoking harm reduction, it is important to examine e-cigarette use among people in SUD treatment.
Methods
We analyzed data from adults who have received SUD treatment in the past year, from the 2020–2021 National Survey on Drug Use and Health (N = 1,246). We delineated correlates of lifetime and current (past-month) use e-cigarette use.
Results
Among adults receiving SUD treatment, an estimated 39.4 % (95 % CI: 34.1, 45.1) have used e-cigarettes in their lifetime and 19.5 % (95 % CI: 16.1, 23.6) of those currently vape. Among those reporting current vaping, an estimated 57.3 % (95 % CI: 44.9–68.8) currently smoke cigarettes and half (54.2 % [95 % CI: 41.1–66.7]) currently use cannabis. Compared to those who only received treatment for alcohol use disorder, those receiving treatment for drug use (aPR = 1.47, 95 % CI: 1.09–1.99) and alcohol and drug use (aPR = 1.60, 95 % CI: 1.16–2.22) had higher prevalence of lifetime e-cigarette use, and those reporting treatment for drug use only (aPR = 2.60, 95 % CI: 1.52–4.46) and alcohol and drug use (aPR = 2.82, 95 % CI: 1.63–4.87) also had higher prevalence of current e-cigarette use.
Conclusions
The prevalence of e-cigarette use was higher among those in treatment for both drug or alcohol and drugs only than those receiving treatment for only alcohol use. Smoking harm reduction interventions can potentially include e-cigarette among those receiving drug treatment. There is also a need to address challenges of dual e-cigarette and cigarette use, as well as dual e-cigarette use with cannabis.
Background:
Since their inception, electronic nicotine delivery systems (ENDS) have gained increasing popularity, sparking a vaping epidemic among adolescents in the US and globally. Several ENDS safety concerns have emerged as device features and formats that contribute to heavy metal exposure and toxicity continue to evolve and outpace regulatory efforts.
Objectives:
Our objective was to integrate ENDS emission profiles with salivary proteome and metabolome data to characterize exposure factors that may influence adverse vaping-mediated health outcomes.
Methods:
A total of 56 participants (38 exclusive ENDS users and 18 non-ENDS users) were recruited. A subset of 15 exclusive ENDS users completed puffing topography assessments to obtain individual vaping behavior patterns using each participant's ENDS device. Inductively coupled plasma mass spectrometry was used to determine the metal content of emissions (12 ENDS devices) generated using a programmable ENDS aerosol generation system and saliva (15 exclusive ENDS users and 5 non-ENDS users). Saliva samples from 10 exclusive ENDS users and 5 non-ENDS users were analyzed for proteomic, metabolomic, inflammatory, and oxidative stress/damage biomarkers.
Results:
A linear puff volume-dependent increase in particle emissions and heavy metals was observed in ENDS aerosols and saliva of exclusive ENDS users. Elevated puff volume-dependent levels of salivary cytokines, including tumor necrosis factor-alpha (TNFα), interleukin-1 beta (IL-1β), and IL-6, were observed alongside the oxidative damage indicators malondialdehyde (MDA), superoxide dismutase (SOD), and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Proteome-metabolome network analysis showed a higher risk of potentially developing neurological and respiratory diseases in ENDS users compared with non-ENDS users. Integrated salivary proteome-metabolome-metallome network analysis further demonstrated that heavy metals were associated with proteomic and metabolomic perturbations, with notable alterations in inflammatory response, immune function, and disease-related pathways.
Discussion:
A significant correlation between heavy metals, cytokines, and oxidative stress markers reveals a potential role of vaping behavior in exposure to metals and changes in markers associated with DNA damage and inflammation. Our study demonstrates the importance of characterizing vaping behavior and puffing topography when examining the human health implications of ENDS use. https://doi.org/10.1289/EHP14321.
Introduction
Despite limited knowledge of its potential health effects, electronic cigarette (e-cigarette) use has become increasingly popular in the United States (US). Cigarette smoking is linked to a higher risk of asthma, and e-cigarettes may have similar effects. This study’s aim was to examine the association between e-cigarette use and asthma exacerbations in US adults with known asthma.
Methods
The 2018 Asthma Call Back Survey (ACBS), paired with corresponding data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), was utilized for this analysis. Individuals were divided into the following categories: exclusive e-cigarette users, exclusive cigarette users, dual e-cigarette and cigarette users, and never users. A multivariable logistic regression model utilizing a complex survey design was completed after applying weights for population representation and adjusting for potential confounders.
Results
Of the 11,598 adults in the study, 453 (3.9%) were exclusive e-cigarette users, 3,735 (32.2%) were exclusive cigarette users, 1,484 (12.8%) were dual users, and 5,926 (51.1%) were never users. There was no statistically significant association between asthma exacerbations and exclusive e-cigarette use (OR: 0.88; 95% CI: 0.56-1.38), exclusive cigarette use (OR: 0.80; 95% CI: 0.60-1.05), or dual-use (OR: 0.98; 95% CI: 0.68-1.41).
Conclusion
There was no association among the categories of exclusive e-cigarette users, exclusive cigarette users, and dual users with asthma exacerbations among adults 18+ with asthma. The results emphasize a need to continue e-cigarette use research to assess future health effects and formulate appropriate public health recommendations.
Introduction
Over 20 states and local jurisdictions in the United States have imposed e-cigarette taxes. It is important to evaluate how adult vapers, including those who also smoke respond to e-cigarette taxation. The purpose of this study is to examine factors associated with adult vapers’ cost comparison between e-cigarettes and cigarettes (ie, which one is perceived to be more expensive) and expenditures (ie, dollars spent) on these two products.
Aims and Methods
We recruited a nationally representative sample of 801 adult e-cigarette users in the United States., who participated in an online survey in April–May 2023. Nested-ordered logit and ordinary least squares regressions were used in the analysis.
Results
On average, adult vapers spent 118.77 per month on cigarettes. More frequent e-cigarette use, lower state-level e-cigarette taxes, age, and exclusive use of rechargeable tank systems with e-liquids were associated with considering e-cigarettes as less expensive than cigarettes. Exclusive use of tank systems was associated with lower e-cigarette spending. Adults who used e-cigarettes more frequently preferred to report weekly (vs. monthly) spending on e-cigarettes; among dual users, everyday smokers were more likely to think of weekly (vs. monthly) spending on cigarettes compared to someday smokers.
Conclusions
Among U.S. adult vapers, tobacco use frequency, and e-cigarette device type are closely related to cost measures; e-cigarette taxes are associated with cost comparison between e-cigarettes and cigarettes, suggesting potential financial disincentive for vaping. Policymakers may consider imposing differential taxes on e-cigarette product types due to their different costs to consumers.
Implications
This study provides supportive evidence that e-cigarette taxes may impact how vapers compare the costs of e-cigarettes relative to cigarettes. Given different expenditures and cost comparisons by e-cigarette device types, tax, and policy design may need to be taken into consideration of e-cigarette device types. We also found that indoor tobacco use restrictions in shared housing may reduce vaping, and future research is needed. The associations between sociodemographics and cost comparison and expenditures reflect known patterns in price responsiveness and vaping prevalence. Cost comparison and expenditures are related measures, which may further reflect product affordability.
There has been an alarming increase in e-cigarette dependence among young adults, many of whom would like to quit vaping nicotine but are finding it difficult to do so. Episodic future thinking (EFT), a cognitive intervention involving imagining future events, has been shown to reduce cigarette craving, demand intensity, and self-administration among cigarette smokers but has not been tested with e-cigarette users. This study tested if a brief EFT intervention decreases delay discounting and smoking choice using a within-subjects experimental design administered via Zoom. Daily young adult e-cigarette users attended a baseline session and two counterbalanced experimental sessions: (a) EFT in which participants preexperienced and described positive future events and (b) standardized episodic thinking, a control intervention in which participants described their experiences watching three short videos. Measures of craving, mood, and delay discounting across three commodities: Money, e-cigarette products, and food were completed pre- and postmanipulation. As predicted, monetary delay discounting showed a greater decrease following EFT relative to standardized episodic thinking (p = .006; ηp² = .229). There were no effects on craving or mood. Participants also completed a 40-min vaping versus money choice task. Approximately 70% of participants chose to abstain for the full 40 min after EFT compared to 60% after the control condition, a nonsignificant difference (p = .184). Additional research is needed to support the efficacy of EFT as an intervention for helping e-cigarette users increase their ability to abstain. The study demonstrates the feasibility of conducting experimental research on e-cigarettes in a virtual setting.
Importance
Use of electronic cigarettes (e-cigarettes) is increasing. Measures of exposure to known tobacco-related toxicants among e-cigarette users will inform potential health risks to individual product users.
Objectives
To estimate concentrations of tobacco-related toxicants among e-cigarette users and compare these biomarker concentrations with those observed in combustible cigarette users, dual users, and never tobacco users.
Design, Setting, and Participants
A population-based, longitudinal cohort study was conducted in the United States in 2013-2014. Cross-sectional analysis was performed between November 4, 2016, and October 5, 2017, of biomarkers of exposure to tobacco-related toxicants collected by the Population Assessment of Tobacco and Health Study. Participants included adults who provided a urine sample and data on tobacco use (N = 5105).
Exposures
The primary exposure was tobacco use, including current exclusive e-cigarette users (n = 247), current exclusive cigarette smokers (n = 2411), and users of both products (dual users) (n = 792) compared with never tobacco users (n = 1655).
Main Outcomes and Measures
Geometric mean concentrations of 50 individual biomarkers from 5 major classes of tobacco product constituents were measured: nicotine, tobacco-specific nitrosamines (TSNAs), metals, polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs).
Results
Of the 5105 participants, most were aged 35 to 54 years (weighted percentage, 38%; 95% CI, 35%-40%), women (60%; 95% CI, 59%-62%), and non-Hispanic white (61%; 95% CI, 58%-64%). Compared with exclusive e-cigarette users, never users had 19% to 81% significantly lower concentrations of biomarkers of exposure to nicotine, TSNAs, some metals (eg, cadmium and lead), and some VOCs (including acrylonitrile). Exclusive e-cigarette users showed 10% to 98% significantly lower concentrations of biomarkers of exposure, including TSNAs, PAHs, most VOCs, and nicotine, compared with exclusive cigarette smokers; concentrations were comparable for metals and 3 VOCs. Exclusive cigarette users showed 10% to 36% lower concentrations of several biomarkers than dual users. Frequency of cigarette use among dual users was positively correlated with nicotine and toxicant exposure.
Conclusions and Relevance
Exclusive use of e-cigarettes appears to result in measurable exposure to known tobacco-related toxicants, generally at lower levels than cigarette smoking. Toxicant exposure is greatest among dual users, and frequency of combustible cigarette use is positively correlated with tobacco toxicant concentration. These findings provide evidence that using combusted tobacco cigarettes alone or in combination with e-cigarettes is associated with higher concentrations of potentially harmful tobacco constituents in comparison with using e-cigarettes alone.
Background The National Center for Health Statistics (NCHS) disseminates information on a broad range of health topics through diverse publications. These publications must rely on clear and transparent presentation standards that can be broadly and efficiently applied. Standards are particularly important for large, cross-cutting reports where estimates cannot be individually evaluated and indicators of precision cannot be included alongside the estimates. Objective This report describes the NCHS Data Presentation Standards for Proportions. Results The multistep NCHS Data Presentation Standards for Proportions are based on a minimum denominator sample size and on the absolute and relative widths of a confidence interval calculated using the Clopper-Pearson method. Proportions (usually multiplied by 100 and expressed as percentages) are the most commonly reported estimates in NCHS reports. Conclusions The NCHS Data Presentation Standards for Proportions will be applied to all NCHS publications. Using these Standards, some estimates will be identified as unreliable and suppressed and some estimates will be flagged for statistical review. For reports where estimates are evaluated individually, a particular proportion not meeting the NCHS Data Presentation Standards could be identified as unreliable but not be suppressed if it can be interpreted appropriately in the context of subject-specific factors and report objectives. © 2017, National Center for Health Statistics. All Rights Reserved.
Introduction:
Concurrent use of tobacco cigarettes and e-cigarettes ("dual use") is common among tobacco users. Little is known about differences in demographics and toxicant exposure among subsets of dual users.
Aims and methods:
We analyzed data from adult dual users (current every/some day users of tobacco cigarettes and e-cigarettes, n = 792) included in the PATH Study Wave 1 (2013-2014) and provided urine samples. Samples were analyzed for biomarkers of exposure to nicotine and selected toxicants (tobacco-specific nitrosamine NNK [NNAL], lead, cadmium, naphthalene [2-naphthol], pyrene [1-hydroxypyrene], acrylonitrile [CYMA], acrolein [CEMA], and acrylamide [AAMA]). Subsets of dual users were compared on demographic, behavioral, and biomarker measures to exclusive cigarette smokers (n = 2411) and exclusive e-cigarette users (n = 247).
Results:
Most dual users were predominant cigarette smokers (70%), followed by daily dual users (13%), non-daily concurrent dual users (10%), and predominant vapers (7%). Dual users who smoked daily showed significantly higher biomarker concentrations compared with those who did not smoke daily. Patterns of e-cigarette use had little effect on toxicant exposure. Dual users with high toxicant exposure were generally older, female, and smoked more cigarettes per day. Dual users who had low levels of biomarkers of exposure were generally younger, male, and smoked non-daily.
Conclusions:
In 2013-2014, most dual users smoked cigarettes daily and used e-cigarettes occasionally. Cigarette smoking appears to be the primary driver of toxicant exposure among dual users, with little-to-no effect of e-cigarette use on biomarker levels. Results reinforce the need for dual users to stop smoking tobacco cigarettes to reduce toxicant exposure.
Implications:
With considerable dual use of tobacco cigarettes and e-cigarettes in the United States, it is important to understand differences in toxicant exposure among subsets of dual users, and how these differences align with user demographics. Findings suggest most dual users smoke daily and use e-cigarettes intermittently. Low exposure to toxicants was most common among younger users, males, and intermittent smokers; high exposure to toxicants was most common among older users, females, and heavier cigarette smokers. Results underscore the heterogeneity occurring within dual users, and the need to quit smoking cigarettes completely in order to reduce toxicant exposure.
Introduction:
The trends in e-cigarette prevalence and population count of users according to cigarette smoking histories are unknown. These data are needed to inform public health actions against a rapidly changing U.S. e-cigarette market.
Methods:
Data collected between 2014 and 2018 (analyzed in 2020) from cross-sectional, nationally representative National Health Interview Surveys were used to estimate current e-cigarette prevalence, adjusted prevalence differences (percentage points), and population counts of users. Analyses were stratified by age group (younger, 18-29 years, n=25,445; middle age, 30-49 years, n=47,745; older, ≥50 years, n=79,517) and cigarette smoking histories (current smokers, recent quitters [quit <1 year ago], near-term quitters [quit 1-8 years ago], long-term quitters [quit >8 years ago], never smokers).
Results:
Among younger adults, e-cigarette use increased in all groups of smokers, with notable increases between 2014 and 2018 among never smokers (1.3%-3.3%, adjusted prevalence difference=2%, p<0.001) and near-term quitters (9.1%-19.2%, adjusted prevalence difference=8.8%, p=0.024). Conversely, the only substantial increase in e-cigarette use between 2014 and 2018 among middle-aged (5.8%-14.4%, adjusted prevalence difference=8.2%, p<0.001) and older (6.3%-9.5%, adjusted prevalence difference=3.3%, p=0.045) adults was among near-term quitters. The largest absolute population increase in e-cigarette users between 2014 and 2018 was among younger-adult never smokers (0.49-1.35 million), followed by near-term quitters among middle-aged (0.36-0.95 million), younger (0.23-0.57 million), and older (0.35-0.50 million) adults.
Conclusions:
The continuous increase among younger-adult never smokers suggests a rise in primary nicotine initiation with e-cigarettes. The concomitant increase among near-term quitters of all age groups suggests continuing e-cigarette use among smokers who may have switched from cigarettes previously.
e-Cigarettes are generally perceived to be less harmful than traditional cigarettes.¹ A considerable public health challenge is their use among young adults who have never smoked and among vulnerable subgroups, including individuals with mental health conditions and pregnant women.²⁻⁴ The rapidly evolving e-cigarette market, outdated tobacco laws and regulations, and the recent outbreak of e-cigarette or vaping product use–associated lung injuries highlight the need for up-to-date data on e-cigarette use.
About electronic cigarettes (e-cigarettes)
Centers for Disease Control and Prevention. About electronic cigarettes (e-cigarettes). 2023.
Available from: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.
html.
Dual use of tobacco products
Centers for Disease Control and Prevention. Dual use of tobacco products. 2022. Available
from: https://www.cdc.gov/tobacco/campaign/tips/diseases/dual-tobacco-use.html.
QuickStats: Percentage distribution of cigarette smoking status among current adult e-cigarette users, by age group-National Health Interview Survey
National Center for Health Statistics. QuickStats: Percentage distribution of cigarette
smoking status among current adult e-cigarette users, by age group-National Health Interview
Survey, United States, 2021. MMWR Morb Mortal Wkly Rep 72:270. 2023. DOI:
https://dx.doi.org/10.15585/mmwr.mm7210a7.