Medicalisation of vaping in the UK? E-cigarette users' perspectives on the merging of commercial and medical routes to vaping

Background: In the UK, most smokers choosing e-cigarettes to quit smoking will access vaping via commercial routes. In recent years, however, a shift towards medicalisation of vaping has become apparent, with public health guidance supporting e-cigarettes for smoking cessation and increased partnership working between healthcare professionals and the vaping industry. To achieve the UK’s Smokefree 2030 target, the UK Government has set out measures to utilise e-cigarettes in NHS settings and to move towards streamlining processes to make e-cigarettes available to a million smokers. This paper aims to understand acceptability of different approaches by seeking perspectives of people with lived experience of e-cigarette use for smoking cessation. Methods: Mixed methods data, collected between March 2018 and March 2019 as part of a broader study of e-cigarette use trajectories (ECtra study). Data here relate to views of partnership working and medicalisation of vaping extracted from 136 interviews/extended surveys of people who had used e-cigarettes to try to stop smoking. Qualitative data were thematically analysed. Participant ratings of interventions were presented descriptively and differences in participant characteristics and ratings were reported. Results: Three qualitative themes were identified: pro-partnership, anti-partnership and medicalisation dissonance. Medicalisation was discussed for its potential to reassure smokers about e-cigarette harms and its potential to reach smokers from disadvantaged backgrounds. Concerns were raised about cost-effectiveness, quality of support, conflicts of interest, and limiting product choice. Most participants rated interventions involving partnership working as potentially helpful in switching from smoking to vaping. There were no statistically significant associations between age, gender and socio-economic status and helpfulness ratings. Conclusions: Both commercial and medical routes to vaping offer perceived benefits to vapers and may complement and reinforce each other to support smoking cessation

User pathways of e-cigarette use to support long term tobacco smoking relapse prevention: A qualitative analysis

Background and aims: E-cigarettes are the most popular consumer choice for support with smoking cessation in the United Kingdom. However, there are concerns that long-term e-cigarette use may sustain concurrent tobacco smoking or lead to relapse to smoking in ex-smokers. We aimed to explore vaping trajectories, establishing e-cigarette users' perspectives on continued e-cigarette use in relation to smoking relapse or abstinence. Design: Qualitative longitudinal study collecting detailed subjective data at baseline and ~12 months later. Setting: United Kingdom. Participants: E-cigarette users (n = 37) who self-reported that they had used e-cigarettes to stop smoking at baseline. Measurements: Semi-structured qualitative interviews (face-to-face or telephone) collected self-reported patterns of e-cigarette use. Thematic analysis of transcripts and a mapping approach of individual pathways enabled exploration of self-reported experiences, motives, resources, and environmental and social influences on vaping and any concurrent tobacco smoking. Findings: Three broad participant pathways were identified: ‘maintainer’ (e-cigarette use and not smoking), ‘abstainer’ (neither smoking nor using e-cigarettes), and ‘relapser’ (dual-using, or relapsed back to tobacco smoking only). In each pathway, individual experiences with vaping nicotine appeared to play an important role and appeared to be related to psychological and social factors. A social context supportive of vaping was important for the maintainers, as was a belief in the need to overcome nicotine addiction for the abstainers, and dislike of the ‘vaping culture’ expressed by some in the relapser group. Dual-users held beliefs such as a need for cigarettes at time of acute stress that affirmed dependence on tobacco. Conclusions: In a sample of UK e-cigarette users who report having used e-cigarettes to quit smoking, a social context that supports continued vaping was perceived to be helpful in preventing relapse to smoking

What is the value of peer involvement in advancing tobacco harm reduction?

E-cigarettes are considered a disruptive technology [1], evidencing rapid growth in the financial market and attracting a distinct new customer base of would-be quitters, especially in Great Britain and the USA. Where use is permitted, and regulation is favourable to users [2], e-cigarettes have become the most popular method of smoking cessation [3] and for many are a long-term alternative to smoking [4]. Outside of a medical lens, vaping can be recreational, not just a smoking cessation aid [5]. Simply trying vaping has, for many, had the happy side effect of encouraging smoking cessation through a non-medicalised route. Despite the lack of early research endorsement and the absence of health messaging on e-cigarette use, smokers experimented with them anyway, with many making the switch and quitting smoking completely of their own accord. As the evidence supporting their use as a reduced risk product and a substitute for smoking grew, so too have the endorsements, such that the UK now leads the way in a ‘cautiously permissive’ stance towards the use of e-cigarettes [6, 7]

Responsibility, normalisation and negotiations of harm: E-cigarette users opinions and experiences of vaping around children

Background: Concern about youth uptake of vaping is widespread. Regulation and education campaigns aim to protect children from initiating use, yet it is likely that children will be primarily influenced by the behaviour of people in their immediate environment. This is the first known study exploring e-cigarette users’ views and reported experiences of vaping around children. Methods: Following informed consent, semi-structured qualitative interviews were conducted with 40 adults who had attempted to give up smoking by vaping. Participants were recruited from England as part of a wider study into e-cigarette use trajectories and smoking relapse (ECtra study). Data were extracted from 28 interviews where participants had spontaneously discussed vaping around children. Extracted data were analysed thematically and situated in previous analysis of vaping identity which distinguished between recreational and medicinal vapers. Results: Vaping behaviour around children was in part a habituated replication of smoking norms but also guided by broad vaping identity; recreational users were more permissive and medicinal users more secretive. Vaping in the home appeared to be determined by caregivers’ need to reconcile vaping behaviour so that it was congruent with parental identity as a responsible caregiver. Participant perspectives reflected existing moral discourses applied to e-cigarettes around the use of “harm reduction for smokers” and “potential for youth harm”. Conclusion: Vaping is likely to be role modelled within the community and home despite attempts by e-cigarette users to conceal the behaviour. The ambivalent contextualisation of e-cigarettes means that e-cigarette users may lack a clear narrative to draw on when discussing vaping with children. Public health guidance for vaping around children could be helpful, but to be most effective, should take into consideration users’ vaping identity

Migration routes of the Grant's Zebra

This is where the abstract of this record would appear. This is only demonstration data

Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study.

SMS text messages are affordable, scalable, and effective smoking cessation interventions. However, there is little research on SMS text message interventions specifically designed to support people who smoke to quit by switching to vaping. Over 3 phases, with vapers and smokers, we codeveloped and coproduced a mobile phone SMS text message program. The coproduction paradigm allowed us to collaborate with researchers and the community to develop a more relevant, acceptable, and equitable SMS text message program. In phase 1, we engaged people who vape via Twitter and received 167 responses to our request to write SMS text messages for people who wish to quit smoking by switching to vaping. We screened, adjusted, refined, and themed the messages, resulting in a set of 95 that were mapped against the Capability, Opportunity, and Motivation-Behavior constructs. In phase 2, we evaluated the 95 messages from phase 1 via a web survey where participants (66/202, 32.7% woman) rated up to 20 messages on 7-point Likert scales on 9 constructs: being understandable, clear, believable, helpful, interesting, inoffensive, positive, and enthusiastic and how happy they would be to receive the messages. In phase 3, we implemented the final set of SMS text messages as part of a larger randomized optimization trial, in which 603 participants (mean age 38.33, SD 12.88 years; n=369, 61.2% woman) received SMS text message support and then rated their usefulness and frequency and provided free-text comments at the 12-week follow-up. For phase 2, means and SDs were calculated for each message across the 9 constructs. Those with means below the neutral anchor of 4 or with unfavorable comments were discussed with vapers and further refined or removed. This resulted in a final set of 78 that were mapped against early, mid-, or late stages of quitting to create an order for the messages. For phase 3, a total of 38.5% (232/603) of the participants provided ratings at the 12-week follow-up. In total, 69.8% (162/232) reported that the SMS text messages had been useful, and a significant association between quit rates and usefulness ratings was found (χ =9.6; P=.002). A content analysis of free-text comments revealed that the 2 most common positive themes were helpful (13/47, 28%) and encouraging (6/47, 13%) and the 2 most common negative themes were too frequent (9/47, 19%) and annoying (4/47, 9%). In this paper, we describe the initial coproduction and codevelopment of a set of SMS text messages to help smokers stop smoking by transitioning to vaping. We encourage researchers to use, further develop, and evaluate the set of SMS text messages and adapt it to target populations and relevant contexts. [Abstract copyright: ©Vassilis Sideropoulos, Eleni Vangeli, Felix Naughton, Sharon Cox, Daniel Frings, Caitlin Notley, Jamie Brown, Catherine Kimber, Lynne Dawkins. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.09.2023.

High-Resolution Mutation Mapping Reveals Parallel Experimental Evolution in Yeast

Understanding the genetic basis of evolutionary adaptation is limited by our ability to efficiently identify the genomic locations of adaptive mutations. Here we describe a method that can quickly and precisely map the genetic basis of naturally and experimentally evolved complex traits using linkage analysis. A yeast strain that expresses the evolved trait is crossed to a distinct strain background and DNA from a large pool of progeny that express the trait of interest is hybridized to oligonucleotide microarrays that detect thousands of polymorphisms between the two strains. Adaptive mutations are detected by linkage to the polymorphisms from the evolved parent. We successfully tested our method by mapping five known genes to a precision of 0.2–24 kb (0.1–10 cM), and developed computer simulations to test the effect of different factors on mapping precision. We then applied this method to four yeast strains that had independently adapted to a fluctuating glucose–galactose environment. All four strains had acquired one or more missense mutations in GAL80, the repressor of the galactose utilization pathway. When transferred into the ancestral strain, the gal80 mutations conferred the fitness advantage that the evolved strains show in the transition from glucose to galactose. Our results show an example of parallel adaptation caused by mutations in the same gene

Text messages to support e-cigarette use for smoking cessation: a tool for researchers

E-cigarettes are now the most popular quit aid chosen by smokers in England. Mobile phone text messages have been shown to be a useful tool in facilitating smoking cessation attempts by providing behaviour change support. To date, no published examples of text messages exist specifically aimed at smokers attempting to quit with e-cigarettes (vaping). As part of a parent study, we led an online call to vapers asking what advice and information they would give, in the form of a text message, to smokers wishing to quit smoking by vaping. We received 102 initial suggestions. Alongside behaviour change and smoking cessation experts, we checked the messages for readability and scientific accuracy, removed inappropriate messages, refined and edited others, and added additional messages. Messages were also grouped by theme and relevance to the stage of quitting. 95 messages were taken forward for further evaluation by 376 smokers, ex-smokers and vapers. Here we present the full set of 95 messages along with a final set of 78 that were selected and ordered for our parent study by two members of the research team along with four vapers. We encourage engagement with this resource and further validation from researchers interested in smoking cessation with e-cigarettes

Selective Deuterium Ion Acceleration Using the Vulcan PW Laser

We report on the successful demonstration of selective acceleration of deuterium ions by target-normal sheath acceleration (TNSA) with a high-energy petawatt laser. TNSA typically produces a multi-species ion beam that originates from the intrinsic hydrocarbon and water vapor contaminants on the target surface. Using the method first developed by Morrison, et al.,$^{1}$ an ion beam with $>$99$\%$ deuterium ions and peak energy 14 MeV/nucleon is produced with a 200 J, 700 fs, $>10^{20} W/cm^{2}$ laser pulse by cryogenically freezing heavy water (D$_{2}$O) vapor onto the rear surface of the target prior to the shot. Within the range of our detectors (0-8.5$^{\circ}$), we find laser-to-deuterium-ion energy conversion efficiency of 4.3$\%$ above 0.7 MeV/nucleon while a conservative estimate of the total beam gives a conversion efficiency of 9.4$\%$.Comment: 5 pages, 5 figure

Comparison of time-gated surface-enhanced raman spectroscopy (TG-SERS) and classical SERS based monitoring of Escherichia coli cultivation samples

The application of Raman spectroscopy as a monitoring technique for bioprocesses is severely limited by a large background signal originating from fluorescing compounds in the culture media. Here, we compare time-gated Raman (TG-Raman)-, continuous wave NIR-process Raman (NIR-Raman), and continuous wave micro-Raman (micro-Raman) approaches in combination with surface enhanced Raman spectroscopy (SERS) for their potential to overcome this limit. For that purpose, we monitored metabolite concentrations of Escherichia coli bioreactor cultivations in cell-free supernatant samples. We investigated concentration transients of glucose, acetate, AMP, and cAMP at alternating substrate availability, from deficiency to excess. Raman and SERS signals were compared to off-line metabolite analysis of carbohydrates, carboxylic acids, and nucleotides. Results demonstrate that SERS, in almost all cases, led to a higher number of identifiable signals and better resolved spectra. Spectra derived from the TG-Raman were comparable to those of micro-Raman resulting in well-discernable Raman peaks, which allowed for the identification of a higher number of compounds. In contrast, NIR-Raman provided a superior performance for the quantitative evaluation of analytes, both with and without SERS nanoparticles when using multivariate data analysis. (c) 2018 American Institute of Chemical EngineersPeer reviewe