Is it safe to vape? Analyzing online forums discussing e-cigarette use during pregnancy

Introduction Electronic cigarette (e-cigarette) use, or vaping, is increasing against a backdrop of declining smoking rates. E-cigarettes contain fewer toxicants than cigarettes, but their appearance and mode of use has the potential to satisfy the habitual aspects of smoking. To date, we know little about lay perceptions of the safety of using e-cigarettes in pregnancy. Methods We conducted a thematic discourse analysis of 13 online discussion forum threads that discussed e-cigarette use during pregnancy. We focused on the major discursive strategies that forum posters used to debate the safety of e-cigarette use during pregnancy. Results We identified three distinct ways in which forum posters debated the safety of using e-cigarettes during pregnancy: 1) quitting (nicotine) cold turkey is unsafe, 2) vaping is the lesser of two evils, and 3) vaping is not worth the risk. Conclusions Discussions about the safety of e-cigarettes drew on the premise that 1) immediate cessation of nicotine was potentially harmful and unsafe, 2) e-cigarettes were a harm reduction tool, or 3) vaping could be dangerous and should be avoided. Although these arguments are not necessarily specific to pregnancy (beside mentions of fetal-specific risks), this analysis points to the need to educate and support women about harm reduction options. Implications Health professionals should be aware that some women may be currently using or considering using e-cigarettes in an effort to quit or reduce smoking. It is important that health professionals are equipped to educate women with accurate, up-to-date, and balanced information about the risks and benefits of e-cigarette use during pregnancy

Is it the nicotine? Australian smokers’ accounts of nicotine addiction and the implications for smoking cessation

Since the 1980s, it has been widely accepted that nicotine is an addictive drug. While discussions of smoking inevitably lead smokers to reflect on their addiction, smokers’ perceptions of nicotine addiction specifically are rarely studied. Smokers’ understandings of nicotine addiction are increasingly relevant in light of the emergence of electronic cigarettes and other cessation aids containing nicotine, and their potential use as long-term replacements for cigarettes. This article is based on a thematic discourse analysis of interviews with 29 smokers from a large metropolitan city in Australia. We explore how smokers negotiate the concept of nicotine addiction in relation to themselves and other smokers, and how this influences their views of smoking cessation methods. Starting with the image of a nicotine addict, we show how participants accept or distance themselves from this image by re-framing the source of their addiction as habit-addicted, rather than nicotine-addicted. We also discuss the function of ‘habit talk’ as a way of contextualising their addiction, and report on how notions of addiction shape participants' views of cessation methods. Finally, we discuss the implications of these findings for future research and for health professionals working with smokers

Differential access to health care and support? A qualitative analysis of how Australian smokers conceptualise and respond to stigma

Scholarship on stigma, originally theorised as a ‘mark’ of social disgrace or difference, has since moved away from individual-level analyses to consider the socio-cultural context in the ‘marking’ of groups of people. In response to this theoretical shift, scholars have demonstrated how extensive tobacco denormalisation policies have contributed to the stigmatisation of smokers, documenting smokers’ experiences of stigma across a number of developed countries. We extend this analysis to the Australian context, examining smokers’ constructions of stigma and their reactions to policies that would give smokers differential access to healthcare. Based on 29 interviews with Australian smokers, we focus on what constitutes evidence of stigma and how participants use social comparisons to respond to stigma. We then explore an assumption underpinning participants’ accounts of stigma: that only smokers committed to cessation are ‘deserving’ of treatment. We close by discussing theoretical perspectives and opportunities in stigma research and the need to extend a stigma lens to study emerging public health issues, such as electronic cigarettes

Smokers' understandings of addiction to nicotine and tobacco: a systematic review and interpretive synthesis of quantitative and qualitative research

Despite the centrality of addiction in academic accounts of smoking, there is little research on smokers' beliefs about addiction to smoking, and the role of nicotine in tobacco dependence. Smokers' perspectives on nicotine's role in addiction are important given the increasing prevalence of non-tobacco nicotine products such as e-cigarettes. We conducted a systematic review of studies investigating smokers' understandings and lay beliefs about addiction to smoking and nicotine.We searched PubMed, Embase, CINAHL and PsycINFO for studies investigating lay beliefs about addiction to smoking. Twenty two quantitative and 24 qualitative studies met inclusion criteria. Critical interpretive synthesis was used to analyse the results.Very few studies asked about addiction to nicotine. Quantitative studies that asked about addiction to smoking showed that most smokers believe that cigarettes are an addictive product, and that they are addicted to smoking. Across qualitative studies, nicotine was not often mentioned by participants. Addiction to smoking was most often characterised as a feeling of "need" for cigarettes resulting from an interplay between physical, mental and social processes. Overall, we found that understandings of smoking were more consistent with the biopsychosocial model of addiction than with more recent models that emphasise the biological aspects of addiction.Researchers should not treat perceptions of addiction to smoking interchangeably with perceptions of addiction to nicotine. More research on lay beliefs about nicotine is required, particularly considering the increasing use of e-cigarettes and their potential for long-term nicotine maintenance for harm reduction

Hartz IV and the Decline of German Unemployment: A Macroeconomic Evaluation

This paper proposes a new approach to evaluate the macroeconomic effects of the “Hartz IV” reform, which reduced the generosity of long-term unemployment benefits. We propose a model with different unemployment durations, where the reform initiates both a partial effect and an equilibrium effect. We estimate the relative importance of these two effects and the size of the partial effect based on the IAB Job Vacancy Survey. Our approach does not hinge on an external source for the decline in the replacement rate for long-term unemployed. We find that Hartz IV was a major driver for the decline of Germany’s steady state unemployment and that partial and equilibrium effect were nearly of equal importance. In addition, we provide direct empirical evidence on labor selection, one potential dimension of recruiting intensity

Motivations and limitations associated with vaping among people with mental illness: a qualitative analysis of Reddit discussions

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes

Lasting immune memory against hepatitis B in children after primary immunization with 4 doses of DTPa-HBV-IPV/Hib in the first and 2^ndyear of life

Abstract Background Few studies have assessed long term persisting immunity against hepatitis B virus (HBV) in children vaccinated during infancy with combined vaccines containing recombinant HBV surface antigen (HBs). We assessed antibody persistence and immune memory in children 4-5 years of age, previously vaccinated with four doses of combined hexavalent DTPa-HBV-IPV/Hib vaccine (Infanrix hexa™). Methods Immune memory was assessed in 301 children through administration of a challenge dose of monovalent HBV vaccine. Results At 4-5 years of age, 85.3% of subjects had persisting anti-HBs antibody concentrations ≥ 10 mIU/mL, rising to 98.6% after the HBV challenge dose. All but 12 subjects (95.8%) achieved post-challenge anti-HBs concentrations ≥ 100 mIU/mL. The post-challenge anti-HBs GMC rose by 100-fold compared to pre-challenge concentrations. An anamnestic response to the HBV vaccine challenge was observed in 96.8% of subjects, including 17/21 (81.0%) of children with initially undetectable antibodies ( Conclusion The combined DTPa-HBV-IPV/Hib vaccine induced lasting immune memory against hepatitis B. Long term protection afforded by DTPa-HBV-IPV/Hib is likely to be similar to that observed following priming with monovalent HBV vaccines. Trial registration http://www.clinicaltrials.gov 106789 NCT00411697</p