Should clinicians recommend e-cigarettes to their patients who smoke? No

Clinicians should not routinely recommend electronic nicotine delivery devices (ENDS), such as e-cigarettes, to their patients who smoke. The wisdom of this evidenced-based recommendation stems from 4 key issues: inadequate safety, poor effectiveness, little regulation, and an ethical framework to do no harm

Provider satisfaction with an inpatient tobacco treatment program: results from an inpatient provider survey

Background: Hospitalization offers an optimal environment for ensuring that patients receive evidence-based treatment. An inpatient tobacco treatment program can deliver interventions broadly, but minimal research has examined the impacts of a consult program on inpatient providers. The Nicotine Dependence Program at the University of North Carolina has provided an inpatient tobacco treatment consult service since 2010. Objective: The program sought feedback from inpatient providers to examine factors that prompted tobacco treatment consult orders, the impact on provider counseling behavior, provider satisfaction, and suggested program improvements. Design: Providers who had ordered a tobacco treatment consult received an online anonymous survey. Setting: The University of North Carolina Hospital is an academic medical facility with 803 beds and over 37,000 inpatient admissions annually from all 100 counties in North Carolina. Approximately 20% of these inpatients report current use of any tobacco product. Patients/participants: Medical providers who ordered inpatient tobacco treatment consults from July 2012 to June 2013 (n=265) received the survey, with 118 providers responding (44.5% response rate). Results: Almost all providers reported being satisfied with the consult program and believed it was effective. Key factors in provider satisfaction included ease of accessing the service, saving provider time, and offering patients evidence-based tobacco use treatment. The consult program increased the likelihood of providers prescribing tobacco cessation medications at discharge, as well as following up at post-discharge appointments. Conclusion: This is some of the first research to show provider satisfaction, program usage, and outcomes with an inpatient tobacco treatment program and demonstrates the important impact of implementing tobacco treatment services within hospitals

The tobacco 21 movement and electronic nicotine delivery system use among youth

Cigarette smoking prevalence in the United States has significantly decreased over the past few decades to 15.1% among adults 1 and 9.3% among high school students. Declines are a result of a variety of tobacco control initiatives, including limits on tobacco marketing, higher per-unit cost of tobacco products, clean air legislation, mass media campaigns, and reductions in youth access. At the same time, use of electronic nicotine delivery systems (ENDS) has rapidly increased. The role of ENDS in reducing or exacerbating population-level morbidity and mortality from tobacco products remains hotly contested. The increased use of ENDS, and the fact that smoking remains the leading cause of preventable death in the United States indicate that additional policy interventions are needed to work toward the tobacco “endgame.” One such intervention is raising the minimum legal sales age (MLSA) to 21 years. As more states and localities enact Tobacco 21 laws, it is important to consider how such policies, initially designed to decrease combustible cigarette and other tobacco use, will interact with ENDS use patterns among youth

Provider satisfaction with an inpatient tobacco treatment program: Results from an inpatient provider survey

Background: Hospitalization offers an optimal environment for ensuring that patients receive evidence-based treatment. An inpatient tobacco treatment program can deliver interventions broadly, but minimal research has examined the impacts of a consult program on inpatient providers. The Nicotine Dependence Program at the University of North Carolina has provided an inpatient tobacco treatment consult service since 2010. Objective: The program sought feedback from inpatient providers to examine factors that prompted tobacco treatment consult orders, the impact on provider counseling behavior, provider satisfaction, and suggested program improvements. Design: Providers who had ordered a tobacco treatment consult received an online anonymous survey. Setting: The University of North Carolina Hospital is an academic medical facility with 803 beds and over 37,000 inpatient admissions annually from all 100 counties in North Carolina. Approximately 20% of these inpatients report current use of any tobacco product. Patients/participants: Medical providers who ordered inpatient tobacco treatment consults from July 2012 to June 2013 (n=265) received the survey, with 118 providers responding (44.5% response rate). Results: Almost all providers reported being satisfied with the consult program and believed it was effective. Key factors in provider satisfaction included ease of accessing the service, saving provider time, and offering patients evidence-based tobacco use treatment. The consult program increased the likelihood of providers prescribing tobacco cessation medications at discharge, as well as following up at post-discharge appointments. Conclusion: This is some of the first research to show provider satisfaction, program usage, and outcomes with an inpatient tobacco treatment program and demonstrates the important impact of implementing tobacco treatment services within hospitals

Case Study: Use of Electronic Nicotine Delivery Systems (ENDS) By a Pregnant Woman

Introduction: The use of electronic nicotine delivery systems (ENDS) such as electronic cigarettes, vapour cigarettes, and vapour/hookah pens is rapidly increasing. The effectiveness of ENDS for smoking cessation and their safety, particularly amongst pregnant women, is largely unknown. Some women who use tobacco products in pregnancy, such as the one described in this case study, switch to ENDS assuming they are a safer alternative to smoking traditional cigarettes. Many obstetric providers do not screen for ENDS use and may miss an opportunity to counsel their patients about ENDS usage, side effects, or alternatives. Case Description: Motivated by concern for her baby's health, a 28-year-old patient reduced consumption of traditional cigarettes and began using ENDS shortly after learning she was pregnant. Her obstetric team did not screen for ENDS use and was unaware that she had started using ENDS. During the postpartum period, her providers ordered a tobacco cessation consult and the tobacco treatment specialist (TTS) discovered the patient's ENDS use as well as her desire to quit. Conclusions: In the absence of consistent screening by providers and a lack of safety data regarding ENDS use during pregnancy, women are often given little guidance in deciphering the potential risks and benefits of ENDS use. In this case, the patient turned to ENDS because she thought it was safer than smoking tobacco cigarettes and was unaware that there is limited research on ENDS safety. This case highlights the importance of updating clinical screening tools to include ENDS and the need for further research investigating the safety of ENDS use during pregnancy

Evaluation of Community-Based Cessation Programs: How Do Smokers with Behavioral Health Conditions Fare?

Though persons with behavioral health conditions experience large disparities in tobacco use, questions about the efficacy of evidence-based tobacco use treatment remain understudied in community health settings. This evaluation examined outcomes from eight community-based tobacco cessation programs for participants with and without behavioral health conditions (n = 974 participants). The majority (64.8%) of participants reported one or more current behavioral health conditions, including mental illness and/or substance abuse. Participants who used cessation medication during the program and who attended more counseling sessions had an increased likelihood of being quit at 4-month follow-up. Quit rates were between 9.8% (intent-to-treat rate) and 30.6% (responder rate); behavioral health status did not negatively affect reported quit rates. Findings add to the growing literature evaluating community-based interventions within the behavioral health population

Impact of non-menthol flavours in e-cigarettes on perceptions and use: an updated systematic review

Objectives Given the exponential increase in the use of e-cigarettes among younger age groups and in the growth in research on e-cigarette flavours, we conducted a systematic review examining the impact of non-menthol flavoured e-cigarettes on e-cigarette perceptions and use among youth and adults. Design PubMed, Embase, PyscINFO and CINAHL were systematically searched for studies published and indexed through March 2018. Eligibility criteria Quantitative observational and experimental studies that assessed the effect of non-menthol flavours in e-cigarettes on perceptions and use behaviours were included. Specific outcome measures assessed are appeal, reasons for use, risk perceptions, susceptibility, intention to try, initiation, preference, current use, quit intentions and cessation. Data extraction and synthesis Three authors independently extracted data related to the impact of flavours in tobacco products. Data from a previous review were then combined with those from the updated review for final analysis. Results were then grouped and analysed by outcome measure. Results The review included 51 articles for synthesis, including 17 published up to 2016 and an additional 34 published between 2016 and 2018. Results indicate that non-menthol flavours in e-cigarettes decrease harm perceptions (five studies) and increase willingness to try and initiation of e-cigarettes (six studies). Among adults, e-cigarette flavours increase product appeal (seven studies) and are a primary reason many adults use the product (five studies). The role of flavoured e-cigarettes on smoking cessation remains unclear (six studies). Conclusion This review provides summary data on the role of non-menthol flavours in e-cigarette perceptions and use. Consistent evidence shows that flavours attract both youth and adults to use e-cigarettes. Given the clear findings that such flavours increase product appeal, willingness to try and initiation among youth, banning non-menthol flavours in e-cigarettes may reduce youth e-cigarette use. Longitudinal research is needed to examine any role flavours may play in quit behaviours among adults

Burns from e-cigarettes and other electronic nicotine delivery systems

With increasing use of electronic cigarettes (e-cigarettes) and other electronic nicotine delivery systems (ENDS) globally, the debate surrounding the potential harms or benefits may shift to ensuring that the devices are manufactured, marketed, and sold according to standards that reduce harm and promote health

Outcomes after assisted reproductive technology in women with cancer: A systematic review and meta-Analysis

STUDY QUESTION: What are the associations between a history of cancer and outcomes after ART? SUMMARY ANSWER: Compared to women without cancer, on average, women with cancer had a lower return for embryo transfer and a lower likelihood of clinical pregnancy and live birth after ART. WHAT IS KNOWN ALREADY: Small, single-institution studies have suggested that cancer and its treatment may negatively affect ART outcomes. STUDY DESIGN, SIZE, DURATION: We conducted a systematic review with meta-Analysis of studies comparing ART outcomes between women with and without cancer. PubMed, Embase and Scopus were searched for original, English-language studies published up to June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Inclusion criteria required reporting of ART outcomes after controlled ovarian stimulation (COS) among women with a history of cancer compared to women without cancer who used ART for any indication. Outcomes of interest ranged from duration of COS to likelihood of live birth after embryo transfer. Random-effects meta-Analysis was used to calculate mean differences and odds ratios (ORs) with 95% CIs and 95% prediction intervals (PIs). We assessed heterogeneity by age-Adjustment, referent group indication for ART, study location and among women with breast cancer and women who initiated ART before cancer treatment. We used visual inspection, Egger's test and the trim-And-fill method to assess funnel plot asymmetry. MAIN RESULTS AND THE ROLE OF CHANCE: Of 6094 unique records identified, 42 studies met inclusion criteria, representing a median per study of 58 women with cancer (interquartile range (IQR) = 159) and 114 women without cancer (IQR = 348). Compared to women without cancer, on average, women with cancer had a lower return for embryo transfer (OR: 0.22; 95% CI: 0.07, 0.74; 95% PI: 0.00, 64.98); lower likelihood of clinical pregnancy (OR: 0.51; 95% CI: 0.35, 0.73; 95% PI: 0.19, 1.35); and lower likelihood of live birth (OR: 0.56; 95% CI: 0.38, 0.83; 95% PI: 0.19, 1.69). Substantial among-study heterogeneity was observed for COS duration, gonadotropin dose, cycle cancellation, total oocytes and mature oocytes. Fertilization percentage showed less heterogeneity, but study-specific estimates were imprecise. Similarly, number of embryos showed less heterogeneity, and most studies estimated minimal differences by cancer history. Funnel plot asymmetry was observed for estradiol peak and oocyte maturation percentage. LIMITATIONS, REASONS FOR CAUTION: Appreciable confounding is possible in 11 studies that lacked adequate control for group differences in age, and among-study heterogeneity was observed for most outcomes. Lack of data limited our ability to assess how cancer clinical factors (e.g. cancers other than breast, cancer stage and treatment) and ART cycle characteristics (e.g. fresh versus frozen embryo transfers and use of gestational carriers) may affect outcomes. WIDER IMPLICATIONS OF THE FINDINGS: Women with cancer may be less likely to achieve pregnancy and live birth after embryo transfer. Further examination of reproductive outcomes and sources of heterogeneity among studies is warranted to improve evidence of the expected success of ART after a cancer diagnosis. STUDY FUNDING/COMPETING INTEREST(S): This research was supported in part by R01 CA211093 and P30 ES010126. C.M. was supported by the University of North Carolina Lineberger Cancer Control Education Program (T32 CA057726) and the National Cancer Institute (F31 CA260787). J.A.R.-H. was supported by the National Cancer Institute (K08 CA234333, P30 CA016672). J.A.R.-H. reports receiving consulting fees from Schlesinger Group and Guidepoint. The remaining authors declare no competing interests. REGISTRATION NUMBER: N/A

Impact and mechanisms of cigarillo flavor descriptors on susceptibility to use among young adult nonusers of tobacco

Evidence suggests that flavoring may impact reactions to tobacco products. In the present research, we tested the impact and mechanisms of cigarillo flavor descriptors on susceptibility to use in order to determine whether exposure to cigarillos with characterizing flavors increases susceptibility in young adult nonusers of tobacco and, if so, why susceptibility increases. Nonsmoking, 18–26 years old U.S. residents were recruited for an online randomized controlled trial with two conditions: cigarillos with characterizing flavors (experimental condition) versus cigarillos with tobacco flavors (control condition). Experimental condition participants (n = 49) were presented with five cigarillo pack images with characterizing flavors (e.g., “Sweet”), whereas control condition participants (n = 53) were presented with five standard, tobacco-flavored images (e.g., “Air-Cured”). Each presented cigarillo image included a description of the pack flavor. Approach bias to the cigarillos was measured using the Implicit Association Test, and participants reported their perceptions of taste, smell, social acceptability, enjoyment, and harm in relation to each cigarillo pack. Finally, participants indicated their susceptibility to using cigarillos. Susceptibility to cigarillo use was significantly greater for participants exposed to the cigarillo packs with characterizing flavors. Taste perceptions both mediated and moderated the relationship between cigarillo flavor descriptors and susceptibility to use. Characterizing flavors increased susceptibility to cigarillo use via two routes: (1) by enhancing perceptions of taste and (2) by increasing the strength of association between perceptions of taste and susceptibility. These findings have implications for public health and policy decisions regarding banning or limiting characterizing flavors in cigarillos