E-cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers' views

Objective: Concerns exist that e-cigarettes may be a gateway to traditional cigarettes and/or (re)normalise teenage smoking. This qualitative study explores how teenagers in the UK currently perceive e-cigarettes and how and why they do or do not use them. Design: 16 focus groups were conducted across the UK between November 2014 and February 2015, with 83 teenagers aged 14–17. All discussions were digitally recorded, transcribed verbatim, imported into NVivo 10 and thematically analysed. Results: Teenagers generally agreed that e-cigarettes are useful products for smokers, including teenage smokers, to quit or reduce traditional cigarette use. Concerns were expressed about lack of information on their precise ingredients and any unknown risks for users and bystanders. However, teenagers typically viewed e-cigarettes as substantially less harmful than traditional cigarettes. They perceived e-cigarettes as attractive, with products described as ‘fun’ and having ‘great flavourings’. Seeing websites or social media featuring e-cigarettes, especially YouTube ‘vaping tricks’, prompted some experimentation and imitation. E-cigarettes were used in a variety of situations, including at parties or when they could not smoke traditional cigarettes. A very few participants suggested covert use was a possibility and that e-cigarettes might help maintain a fledgling nicotine habit. Conclusions: Teenagers support the use of e-cigarettes as smoking cessation aids for established adult smokers. However, they engage with these products differently from adults, with the novel hypothesis that covert use could potentially reinforce traditional cigarette smoking requiring further investigation. Policy responses should more clearly meet the needs of young people, as well as helping established adult smokers

Prevalence, Reasons for Use, and Risk Perception of Electronic Cigarettes among Post-Acute Coronary Syndrome Smokers

Purpose—The use of electronic cigarettes (e-cigarettes) has risen dramatically in recent years. However, there is currently no published data on use of e-cigarettes among cardiac patients. The current study reports on the prevalence, reasons for use, and perceived risks of e-cigarettes among post-Acute Coronary Syndrome (ACS) patients. The relationship between e-cigarette use and post- ACS tobacco smoking cessation is also explored. Methods—Participants were drawn from a randomized trial of smoking cessation treatments following hospitalization for ACS. The current study focuses on 49 participants that completed e- cigarette questions at 24 weeks post-ACS. Results—51.0% of participants reported ever use of an e-cigarette and 26.5% reported using an e-cigarette at some time during the 24 weeks post-ACS. Ever use and post-ACS use were both significantly associated with lower rates of abstinence from tobacco cigarettes. Participants perceived e-cigarettes as less harmful to cardiac health than tobacco use and Chantix, and similarly harmful as nicotine replacement therapy. Participant perceived likelihood of experiencing a heart attack in the next year was 34.6% if they were to regularly use e-cigarettes only, significantly lower than perceived risk of recurrence if they were to regularly smoke only tobacco cigarettes (56.2%) and significantly higher than perceived risk of recurrence if they were to use no nicotine (15.2%). Conclusions—A significant minority of patients are using e-cigarettes post-ACS. Providers should be prepared to discuss potential discrepancies between patient beliefs about the safety of e- cigarettes and the current state of the science

Effectively Regulating E-Cigarettes and Their Advertising—and the First Amendment

If tobacco smoking did not exist in the United States, there would be no reason, from a public health perspective, to allow addictive, nicotine-containing e-cigarettes to be marketed and sold. Because e-cigarette use, by itself, is neither beneficial nor benign to users and nonusers, the only public health justification for allowing e-cigarettes in the existing U.S. market would be if doing so would not sustain or increase existing smoking levels but would help smokers quit completely or provide addicted smokers a less harmful way to obtain the nicotine they crave. Yet e-cigarettes are now pervasive in the U.S. market, being sold with unnecessary harmful characteristics and being advertised in ways that encourage youth experimentation and use. Unless effectively regulated, e-cigarette use will be more harmful than necessary and their advertising will work to: (a) increase initiation among both youth and non-tobacco-using adults; (b) prompt former smokers to relapse back into addicted nicotine use; (c) encourage smokers to use e-cigarettes where they cannot smoke; and (d) prompt smokers to switch to e-cigarettes instead of quitting all tobacco and nicotine use. This paper proposes a viable way to regulate e-cigarettes and their advertising both to minimize the health harms they might cause and to allow e-cigarettes to fulfill their potential as cessation aids or harm-reduction products. Normally, any efforts by FDA to establish effective advertising restrictions must accommodate considerable constraints from the First Amendment’s commercial speech protections. However, because of existing text in the Tobacco Control Act, on the effective date of the final FDA deeming rule that puts e-cigarettes under FDA’s active tobacco product jurisdiction all nicotine-containing e-cigarettes will be on the U.S. market illegally until they can obtain permissive orders from FDA. That situation should reduce applicable First Amendment constraints, providing FDA with a tremendous opportunity to place the kinds of substantial restrictions and requirements on e-cigarette advertising necessary to minimize their harmful aspects and maximize their potential to produce substantial net public health benefits

Design and marketing features influencing choice of e-cigarettes and tobacco in the EU

Data were analysed from the 2014 Special Eurobarometer for Tobacco survey. We estimated self-rated importance of various factors in the choice of both tobacco and electronic cigarettes (e-cigarettes) among tobacco smokers who had ever used an e-cigarette. Among ever users of tobacco and e-cigarettes (N = 2430), taste (39.4%), price (39.2%) and amount of nicotine (27.3%) were the most commonly cited reasons for choosing their brand of e-cigarettes. Those aged 15–24 were more likely to cite external packaging [adjusted prevalence ratio (aPR = 2.06, 95% CI 1.00–4.23)] and design features (aPR = 1.99, 1.20–3.29) as important. As further legislation is debated and enacted enhanced regulation of price, design and marketing features of e-cigarettes may help to reduce the appeal of e-cigarettes

Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns.

Since the initial marketing in 2005, the use of e-cigarettes has increased exponentially. Nonetheless, accumulating evidence has demonstrated the ineffectiveness of e-cigarettes in leading to smoking cessation, and decreasing the adverse health impacts of cigarette smoking. The number of adolescents adapted to e-cigarettes has been increasing substantially each year, and this adaptation has promoted openness to tobacco smoking. The present review discusses controversies regarding the smoking cessation effects of e-cigarettes, recent governmental policies and regulations of e-cigarette use, toxic components and vaporization products of e-cigarettes, and the novel molecular mechanisms underlying the adverse health impacts of e-cigarettes leading to oxidative stress in target tissues, and consequent development of cardiopulmonary diseases (i.e. COPD), neurodegenerative disorders (i.e. Alzheimer's' disease), and cancer. Health warning signs on the packaging and professional consultation to avoid adaptation in risk groups might be helpful solutions to control negative impacts of e-cigarettes. It is also recommended to further expand basic and clinical investigations to reveal more detailed oxidative stress mechanisms of e-cigarette induced damages, which would ultimately result in more effective protective strategies

E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups.

OBJECTIVE: To assess whether electronic cigarette (e-cigarette) awareness, 'ever use' and current use vary significantly between different sociodemographic groups. DESIGN: Systematic review. DATA SOURCES: Published and unpublished reports identified by searching seven electronic databases (PubMed, MEDLINE, Web of Science, EMBASE, Global Health, PsycINFO, CINAHL Plus) and grey literature sources. STUDY SELECTION: Systematic search for and appraisal of cross-sectional or longitudinal studies that assessed e-cigarette awareness, 'ever use' or current use, and included subgroup analysis of 1 or more PROGRESS Plus sociodemographic groups. No geographical or time restrictions imposed. Assessment by multiple reviewers, with 17% of full articles screened meeting the selection criteria. DATA EXTRACTION: Data extracted and checked by multiple reviewers, with quality assessed using an adapted tool developed by the Joanna Briggs Institute. DATA SYNTHESIS: Results of narrative synthesis suggest broadly that awareness, 'ever use' and current use of e-cigarettes may be particularly prevalent among older adolescents and younger adults, males, people of white ethnicity and-particularly in the case of awareness and 'ever use'-those of intermediate or high levels of education. In some cases, results also varied within and between countries. CONCLUSIONS: E-cigarette awareness, 'ever use' and current use appear to be patterned by a number of sociodemographic factors which vary between different countries and subnational localities. Care will therefore be required to ensure neither the potential benefits nor the potential risks of e-cigarettes exacerbate existing health inequalities

Perceptions of E-Cigarettes among Black Youth in California.

Research suggests that Black youth are less likely to use e-cigarettes than their white counterparts, yet little is known as to why. We examined perceptions of e-cigarettes among Black young adults (ages 18-25) to explore the meanings these youth ascribe to e-cigarettes and the role that identity plays in how these devices are viewed. Analysis of in-depth interviews with 36 Black smokers and non-smokers in the San Francisco Bay Area suggests that Black youth perceive e-cigarettes as serving distinct, yet overlapping roles: a utilitarian function, in that they are recognized as legitimate smoking cessation tools, and a social function, insofar as they serve to mark social identity, specifically a social identity from which our participants disassociated. Participants described e-cigarette users in highly racialized and classed terms and generally expressed disinterest in using e-cigarettes, due in part perhaps to the fact that use of these devices would signal alignment with a middle class, hipster identity. This analysis is discussed within a highly charged political and public health debate about the benefits and harms associated with e-cigarette use

ALTERNATIVE TOBACCO PRODUCTS & DEPRESSIVE SYMPTOMS AMONG YOUNG ADULTS

The association between cigarette use and depression has been documented in many studies. Fewer studies have examined other tobacco products such as electronic cigarettes (e-cigarettes) and hookah that are used by young adults. This study examined whether increased frequency of use of these products was associated with depressive symptoms in a cohort of n=5,236 Texas college students followed from 2014 to 2017. A hierarchical model showed that increased frequency of single product use of cigarettes, refillable e-cigarettes and hookah was associated with depressive symptoms. Refillable and disposable e-cigarettes were examined separately and results did not provide evidence of a different association for each type of e-cigarette when cigarettes were not also used. Dual use of cigarettes with another product was also examined. Dual use was associated with higher depressive symptoms for most product combinations. However, infrequent dual use of disposable e-cigarettes and cigarettes may not be associated with depressive symptoms. Suggestions for further research are included