Physicians’ Attitudes and Use of E-Cigarettes as Cessation Devices, North Carolina, 2013

Electronic cigarettes (e-cigarettes) are not currently approved or recommended by the Food and Drug Administration (FDA) or various medical organizations; yet, they appear to play a substantial role in tobacco users’ cessation attempts. This study reports on a physician survey that measured beliefs, attitudes, and behavior related to e-cigarettes and smoking cessation. To our knowledge this is the first study to measure attitudes toward e-cigarettes among physicians treating adult smokers.

Published: 29 July 2014

Positive:  Yes

Link to publication: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0103462

Authors

Kelly L. Kandra
Leah M. Ranney
Joseph G. L. Lee
Adam O. Goldstein


Summary

Methods

Using a direct marketing company, a random sample of 787 North Carolina physicians were contacted in 2013 through email, with 413 opening the email and 128 responding (response rate = 31%). Physicians’ attitudes towards e-cigarettes were measured through a series of close-ended questions. Recommending e-cigarettes to patients served as the outcome variable for a logistic regression analysis.

Results

Two thirds (67%) of the surveyed physicians indicated e-cigarettes are a helpful aid for smoking cessation, and 35% recommended them to their patients. Physicians were more likely to recommend e-cigarettes when their patients asked about them or when the physician believed e-cigarettes were safer than smoking standard cigarettes.


Conclusion

Many North Carolina physicians are having conversations about e-cigarettes with their patients, and some are recommending them. Future FDA regulation of e-cigarettes may help provide evidence-based guidance to physicians about e-cigarettes and will help ensure that patients receive evidence-based recommendations about the safety and efficacy of e-cigarettes in tobacco cessation.

Continuer la lecture de Physicians’ Attitudes and Use of E-Cigarettes as Cessation Devices, North Carolina, 2013

Cigarettes vs. e-cigarettes: Passive exposure at home measured by means of airborne marker and biomarkers

  • This is the first study of e-cigarette exposure at home under real-use conditions.
  • Airborne nicotine in homes with smokers were 5.7 times higher than in e-cig homes.
  • Cotinine of non-smokers exposed to e-cig and conventional cigarettes was similar.
  • Airborne nicotine in homes with e-cig users was higher than control homes.
  • Cotinine of non-smokers exposed to e-cig users was higher than in those no exposed.

Published:  27 September 2014

Positive: +/-

Link to publication: http://www.sciencedirect.com/science/article/pii/S0013935114003089

Dr Farsalinos comment on the study: http://www.ecigarette-research.com/web/index.php/2013-04-07-09-50-07/2014/184-passive-vape

Authors

Montse Ballbè
Jose M. Martínez-Sánchez
Xisca Sureda
Marcela Fu
Raúl Pérez-Ortuño
José A. Pascual
Esteve Saltó
Esteve Fernández


Summary

Background

There is scarce evidence about passive exposure to the vapour released or exhaled from electronic cigarettes (e-cigarettes) under real conditions. The aim of this study is to characterise passive exposure to nicotine from e-cigarettes׳ vapour and conventional cigarettes׳ smoke at home among non-smokers under real-use conditions.

Methods

We conducted an observational study with 54 non-smoker volunteers from different homes: 25 living at home with conventional smokers, 5 living with nicotine e-cigarette users, and 24 from control homes (not using conventional cigarettes neither e-cigarettes). We measured airborne nicotine at home and biomarkers (cotinine in saliva and urine). We calculated geometric mean (GM) and geometric standard deviations (GSD). We also performed ANOVA and Student׳s t tests for the log-transformed data. We used Bonferroni-corrected t-tests to control the family error rate for multiple comparisons at 5%.

Results

The GMs of airborne nicotine were 0.74 μg/m3 (GSD=4.05) in the smokers’ homes, 0.13 μg/m3 (GSD=2.4) in the e-cigarettes users’ homes, and 0.02 μg/m3 (GSD=3.51) in the control homes. The GMs of salivary cotinine were 0.38 ng/ml (GSD=2.34) in the smokers’ homes, 0.19 ng/ml (GSD=2.17) in the e-cigarettes users’ homes, and 0.07 ng/ml (GSD=1.79) in the control homes. Salivary cotinine concentrations of the non-smokers exposed to e-cigarette׳s vapour at home (all exposed ≥2 h/day) were statistically significant different that those found in non-smokers exposed to second-hand smoke ≥2 h/day and in non-smokers from control homes.


Conclusion

The airborne markers were statistically higher in conventional cigarette homes than in e-cigarettes homes (5.7 times higher). However, concentrations of both biomarkers among non-smokers exposed to conventional cigarettes and e-cigarettes’ vapour were statistically similar (only 2 and 1.4 times higher, respectively). The levels of airborne nicotine and cotinine concentrations in the homes with e-cigarette users were higher than control homes (differences statistically significant). Our results show that non-smokers passively exposed to e-cigarettes absorb nicotine.

Continuer la lecture de Cigarettes vs. e-cigarettes: Passive exposure at home measured by means of airborne marker and biomarkers

Do Electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes?: Review on e-cigarette vapor versus tobacco smoke.

Development and utilization of electronic cigarettes (ECs) resulted from the search for healthier alternatives to conventional tobacco cigarettes (TCs) and the search for alternative methods for quitting TCs. This review compares the potential disease burden presented by TC smoke to that of EC vapor.

Published: 09 October 2014

Positive: Yes

Link to publication:

Authors

Oh AY
Kacker A.


Summary

Methods

Potential disease burden of EC vapor versus TC smoke was assessed by reviewing clinical studies that measured inhaled components. Chemicals and carcinogens produced by vapor versus smoke were compared.

Results

Studies show that EC vapors contain far less carcinogenic particles than TC smoke. Whereas ECs have the ability to reach peak serum cotinine/nicotine levels comparable to that of TCs, ECs do not cause an increase in total white blood cell count; thus, ECs have the potential to lower the risk of atherosclerosis and systemic inflammation. Use of ECs has been shown to improve indoor air quality in a home exposed to TC smoke. This reduces secondhand smoke exposure, thus having the potential to decrease respiratory illness/asthma, middle-ear disease, sudden infant death syndrome, and more. However, some studies claim that propylene glycol (PG) vapor can induce respiratory irritation and increase chances for asthma. To minimize risks, EC manufacturers are replacing PG with distilled water and glycerin for vapor production.


Conclusion

Based on the comparison of the chemical analysis of EC and TC carcinogenic profiles and association with health-indicating parameters, ECs impart a lower potential disease burden than conventional TCs. Laryngoscope, 2014.

Continuer la lecture de Do Electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes?: Review on e-cigarette vapor versus tobacco smoke.

Reasons for Starting and Stopping Electronic Cigarette Use

The aim of our study was to explore reasons for starting and then stopping electronic cigarette (e-cigarette) use.

Published: 3 October 2014

Positive: N/A

Link to publication: http://www.mdpi.com/1660-4601/11/10/10345

Authors

Jessica K. Pepper
Kurt M. Ribisl
Sherry L. Emery
Noel T. Brewer


Summary

Among a national sample of 3878 U.S. adults who reported ever trying e-cigarettes, the most common reasons for trying were curiosity (53%); because a friend or family member used, gave, or offered e-cigarettes (34%); and quitting or reducing smoking (30%). Nearly two-thirds (65%) of people who started using e-cigarettes later stopped using them. Discontinuation was more common among those whose main reason for trying was not goal-oriented (e.g., curiosity) than goal-oriented (e.g., quitting smoking) (81% vs. 45%, p < 0.001). The most common reasons for stopping e-cigarette use were that respondents were just experimenting (49%), using e-cigarettes did not feel like smoking cigarettes (15%), and users did not like the taste (14%).

Conclusion

Our results suggest there are two categories of e-cigarette users: those who try for goal-oriented reasons and typically continue using and those who try for non-goal-oriented reasons and then typically stop using. Research should distinguish e-cigarette experimenters from motivated users whose decisions to discontinue relate to the utility or experience of use. Depending on whether e-cigarettes prove to be effective smoking cessation tools or whether they deter cessation, public health programs may need distinct strategies to reach and influence different types of users.

Continuer la lecture de Reasons for Starting and Stopping Electronic Cigarette Use

Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices

A wide range of electronic cigarette (EC) devices, from small cigarette-like (first-generation) to new-generation high-capacity batteries with electronic circuits that provide high energy to a refillable atomizer, are available for smokers to substitute smoking. Nicotine delivery to the bloodstream is important in determining the addictiveness of ECs, but also their efficacy as smoking substitutes. In this study, plasma nicotine levels were measured in experienced users using a first- vs. new-generation EC device for 1 hour with an 18 mg/ml nicotine-containing liquid. Plasma nicotine levels were higher by 35–72% when using the new- compared to the first-generation device. Compared to smoking one tobacco cigarette, the EC devices and liquid used in this study delivered one-third to one-fourth the amount of nicotine after 5 minutes of use. New-generation EC devices were more efficient in nicotine delivery, but still delivered nicotine much slower compared to tobacco cigarettes. The use of 18 mg/ml nicotine-concentration liquid probably compromises ECs’ effectiveness as smoking substitutes; this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes.

Published: 26 February 2014

Positive: Yes

Link to publication:

Authors

  • Konstantinos E. Farsalinos,
  • Alketa Spyrou,
  • Kalliroi Tsimopoulou,
  • Christos Stefopoulos,
  • Giorgio Romagna
  • Vassilis Voudris

Summary

Electronic cigarettes (ECs) have been introduced to the market in recent years as alternatives to smoking. They are considered part of tobacco harm reduction, a strategy of reducing adverse health effects by providing low-risk nicotine products to substitute smoking1. They deal with both the psycho-behavioral (through motor simulation and sensory stimulation) and the chemical (through delivery of nicotine) aspects of smoking addiction2. ECs mainly consist of a lithium battery and a part called atomizer, where the liquid is stored and evaporated by applying electrical current to a resistance and wick setup. There is a substantial variability of devices; small devices, looking similar to tobacco cigarettes (commonly referred as first-generation), consist of a low-capacity batteries and polyfil-filled atomizers, while new-generation devices consist of larger-capacity batteries, larger atomizers and electronic circuits providing the ability to set the power delivery to the atomizer.

The growing popularity of ECs3, 4 has raised significant controversy in public health authorities. Organizations such as the World Health Organization and Food and Drug Administration have expressed concerns about the safety of e-cigarettes and the effects of nicotine intake. Recently, European Union has developed a new regulation which implements an upper limit of 20 mg/ml nicotine concentration in liquids that are used with ECs5. The decision was based on a study from our group, in which nicotine consumption and delivery to the user was evaluated6, 7. However, the route, speed and amount of nicotine absorption (and subsequent nicotine levels in plasma) are important determinants of the efficacy of ECs to serve as smoking substitutes and of any concerns about nicotine overdose or intoxication. Data on nicotine absorption are scarce. Initially, EC use (commonly called vaping) was found to deliver minimal amounts of nicotine to the user as measured by plasma nicotine levels8, 9. However, there has been a fast evolution of new, more efficient devices, and devices used at the time of those experiments are currently outdated and off the market. Surveys have shown that new-generation devices are more popular in dedicated EC users and a significant proportion of these users report complete smoking cessation10, 11. However, no study has evaluated nicotine absorption from such devices. Therefore, the purpose of this study was to compare the nicotine absorption from a first- vs. a new-generation device in experienced vapers.

Results

The use of 18 mg/ml nicotine-concentration liquid probably compromises ECs’ effectiveness as smoking substitutes; this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes.

Continuer la lecture de Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices

Prospective Cohort Study of the Effectiveness of Smoking Cessation Treatments Used in the “Real World”

NOT Vape-related

To estimate the “real-world” effectiveness of commonly used aids to smoking cessation in England by using longitudinal data.

Published: October 2014

Positive: N/A

Link to publication: http://www.mayoclinicproceedings.org/article/S0025-6196(14)00629-6/fulltext

Authors

Daniel Kotz, PhD
Jamie Brown, PhD
Robert West, PhD


Summary

Patients and Methods

We conducted a prospective cohort study in 1560 adult smokers who participated in an English national household survey in the period from November 2006 to March 2012, responded to a 6-month follow-up survey, and made at least 1 quit attempt between the 2 measurements. The quitting method was classified as follows: (1) prescription medication (nicotine replacement therapy [NRT], bupropion, or varenicline) in combination with specialist behavioral support delivered by a National Health Service Stop Smoking Service; (2) prescription medication with brief advice; (3) NRT bought over the counter; (4) none of these. The primary outcome measure was self-reported abstinence up to the time of the 6-month follow-up survey, adjusted for key potential confounders including cigarette dependence.

Results

Compared with smokers using none of the cessation aids, the adjusted odds of remaining abstinent up to the time of the 6-month follow-up survey were 2.58 (95% CI, 1.48-4.52) times higher in users of prescription medication in combination with specialist behavioral support and 1.55 (95% CI, 1.11-2.16) times higher in users of prescription medication with brief advice. The use of NRT bought over the counter was associated with a lower odds of abstinence (odds ratio, 0.68; 95% CI, 0.49-0.94).


Conclusions

Prescription medication offered with specialist behavioral support and that offered with minimal behavioral support are successful methods of stopping cigarette smoking in England.

Continuer la lecture de Prospective Cohort Study of the Effectiveness of Smoking Cessation Treatments Used in the “Real World”

Portrayal of electronic cigarettes on YouTube

As the most popular video sharing website in the world, YouTube has the potential to reach and influence a huge audience. This study aims to gain a systematic understanding of what e-cigarette messages people are being exposed to on YouTube by assessing the quantity, portrayal and reach of e-cigarette videos.

Published: 3 October 2014

Positive: No

Link to publication: http://www.biomedcentral.com/1471-2458/14/1028

Authors

Chuan Luo
Xiaolong Zheng
Daniel Dajun Zeng
Scott Leischow


Summary

Methods

Researchers identified the top 20 search results on YouTube by relevance and view count for the following search terms: “electronic cigarettes”, “e-cigarettes”, “ecigarettes”, “ecigs”, “smoking electronic cigarettes”, “smoking e-cigarettes”, “smoking ecigarettes”, “smoking ecigs”. A sample of 196 unique videos was coded for overall portrayal and genre. Main topics covered in e-cigarette videos were recorded and video statistics and viewer demographic information were documented.

Results

Among the 196 unique videos, 94% (n = 185) were “pro” to e-cigarettes and 4% (n = 8) were neutral, while there were only 2% (n = 3) that were “anti” to e-cigarettes. The top 3 most prevalent genres of videos were advertisement, user sharing and product review. 84.3% of “pro” videos contained Web links for e-cigarette purchase. 71.4% of “pro” videos claimed that e-cigarettes were healthier than conventional cigarettes. Audience was primarily from the United States, the United Kingdom and Canada and “pro” e-cigarette videos were watched more frequently and rated much more favorably than “anti” ones.


Conclusions

The vast majority of information on YouTube about e-cigarettes promoted their use and depicted the use of e-cigarettes as socially acceptable. It is critical to develop appropriate health campaigns to inform e-cigarette consumers of potential harms associated with e-cigarette use.

Continuer la lecture de Portrayal of electronic cigarettes on YouTube

Determinants and prevalence of e-cigarette use throughout the European Union: a secondary analysis of 26 566 youth and adults from 27 Countries

This study assessed the prevalence and determinants of e-cigarette use among persons aged ≥15 years in 27 European Union (EU) member countries during 2012.

Published: 16 June 2014

Positive: Yes

Link to publication: http://tobaccocontrol.bmj.com/content/early/2014/04/30/tobaccocontrol-2013-051394.abstract?sid=e065daee-e796-4cd1-8bf5-30ae2696f39f

Authors

Constantine I Vardavas
Filippos T Filippidis
Israel T Agaku


Summary

Abstract

Objective This study assessed the prevalence and determinants of e-cigarette use among persons aged ≥15 years in 27 European Union (EU) member countries during 2012.

Methods The 2012 Eurobarometer 385 (77.1) survey was analysed for n=26 566 respondents. Knowledge, perception of harm, and determinants of e-cigarettes use were assessed, while separate regression analyses among current (n=7352) and former cigarette smokers (n=5782) were performed. National estimates of the number of e-cigarette users were also extrapolated.

Results 20.3% of current smokers, 4.7% of ex-smokers, and 1.2% of never cigarette smokers in the EU reported having ever used an e-cigarette (overall approximately 29.3 million adults). Among smokers, ever e-cigarette use was more likely among 15–24-year-olds (aOR 3.13, 95% CI 2.22 to 4.54) and 25–39-year-olds (aOR 2.00, 95% CI 1.47 to 2.78) in comparison to older smokers, and among those who smoked 6–10 cigarettes/day (aOR 1.53, 95% CI 1.10 to 2.13) or 11–20 cigarettes/day (aOR 2.07, 95% CI 1.52 to 2.81) in comparison to very light smokers (≤5 cigarettes/day). Moreover, e-cigarette use was more likely among smokers who had made a past year quit attempt (aOR 2.08, 95% CI 1.67 to 2.58). E-cigarette use among ex-smokers was associated only with the respondents’ age, with younger ex-smokers being more likely to have ever used an e-cigarette.


Conclusions

A substantial number of EU adults have ever used e-cigarettes. Ever users were more likely to be younger, current smokers, or past-year quit attempters. These findings underscore the need to evaluate the potential long term impact of e-cigarette use on consumer health, cessation and nicotine addiction and formulate a European framework for e-cigarette regulation within the revised EU Tobacco Product Directive.

Continuer la lecture de Determinants and prevalence of e-cigarette use throughout the European Union: a secondary analysis of 26 566 youth and adults from 27 Countries

A Longitudinal Study of Electronic Cigarette Use in a Population-based Sample of Adult Smokers: Association with Smoking Cessation and Motivation to Quit

Increasingly popular electronic cigarettes (e-cigarettes) may be the most promising development yet to end cigarette smoking. However, there is sparse evidence that their use promotes cessation. We investigated whether e-cigarette use increases smoking cessation and/or has a deleterious effect on quitting smoking and motivation to quit.

Published: 3 June 2014

Positive: Yes

Link to publication: http://ntr.oxfordjournals.org/content/early/2014/10/07/ntr.ntu200.abstract.html

Authors

Lois Biener, Ph.D.
J. Lee Hargraves, Ph.D


Summary

Aims: Increasingly popular electronic cigarettes (e-cigarettes) may be the most promising development yet to end cigarette smoking. However, there is sparse evidence that their use promotes cessation. We investigated whether e-cigarette use increases smoking cessation and/or has a deleterious effect on quitting smoking and motivation to quit.

Methods: Representative samples of adults in two U.S. metropolitan areas were surveyed in 2011/2012 about their use of novel tobacco products. In 2014, follow-up interviews were conducted with 695 of the 1374 baseline cigarette smokers who had agreed to be re-contacted (retention rate: 51%). The follow-up interview assessed their smoking status and history of electronic cigarette usage. Respondents were categorized as intensive users (used e-cigarettes daily for at least one month), intermittent users (used regularly, but not daily for more than one month), and non-users/triers (used ecigarettes at most once or twice).


Conclusions

Results: At follow-up, 23% were intensive users, 29% intermittent users, 18% had used once or twice, and 30% hadn’t tried e-cigarettes. Logistic regression controlling for demographics and tobacco dependence indicated that intensive users of e-cigarettes were 6 times as likely as non-users/triers to report that they quit smoking (O.R. 6.07, 95% C.I. 1.11, 33.2). No such relationship was seen for intermittent users. There was a negative association between intermittent e-cigarette use and one of two indicators of motivation to quit at follow-up.

Conclusions: Daily use of electronic cigarettes for at least one month is strongly associated with quitting smoking at follow up. Further investigation of the underlying reasons for intensive versus intermittent use will help shed light on the mechanisms underlying the associations between e-cigarette use, motivation to quit and smoking cessation.

Continuer la lecture de A Longitudinal Study of Electronic Cigarette Use in a Population-based Sample of Adult Smokers: Association with Smoking Cessation and Motivation to Quit

Comparative In Vitro Toxicity Profile of Electronic and Tobacco Cigarettes, Smokeless Tobacco and Nicotine Replacement Therapy Products: E-Liquids, Extracts and Collected Aerosols

In this study,  an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of certain commercial e-cigs and compared to tobacco burning cigarettes, smokeless tobacco (SLT) products and a nicotine replacement therapy (NRT) product. The toxicity evaluation was performed on e-liquids and pad-collected aerosols of e-cigs, pad-collected smoke condensates of tobacco cigarettes and extracts of SLT and NRT products.

Note that the study is financed by Lorillard (tobacco manufacturer)

Published: 30 October 2014

Positive: Yes

Link to publication: http://www.mdpi.com/1660-4601/11/11/11325

Comments (in French): http://www.ma-cigarette.fr/une-nouvelle-etude-revele-labsence-de-toxines-dans-les-e-cigarettes/

Authors

Manoj Misra
Robert D. Leverette
Bethany T. Cooper
Melanee B. Bennett
Steven E. Brown


Summary

The use of electronic cigarettes (e-cigs) continues to increase worldwide in parallel with accumulating information on their potential toxicity and safety. In this study, an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of certain commercial e-cigs and compared to tobacco burning cigarettes, smokeless tobacco (SLT) products and a nicotine replacement therapy (NRT) product.

The toxicity evaluation was performed on e-liquids and pad-collected aerosols of e-cigs, pad-collected smoke condensates of tobacco cigarettes and extracts of SLT and NRT products. In all assays, exposures with e-cig liquids and collected aerosols, at the doses tested, showed no significant activity when compared to tobacco burning cigarettes.


 

Conclusions

Results for the e-cigs, with and without nicotine in two evaluated flavor variants, were very similar in all assays, indicating that the presence of nicotine and flavors, at the levels tested, did not induce any cytotoxic, genotoxic or inflammatory effects. The present findings indicate that neither the e-cig liquids and collected aerosols, nor the extracts of the SLT and NRT products produce any meaningful toxic effects in four widely-applied in vitro test systems, in which the conventional cigarette smoke preparations, at comparable exposures, are markedly cytotoxic and genotoxic.

Continuer la lecture de Comparative In Vitro Toxicity Profile of Electronic and Tobacco Cigarettes, Smokeless Tobacco and Nicotine Replacement Therapy Products: E-Liquids, Extracts and Collected Aerosols