Tag: vaping

How Do You Do, Fellow Kids? Making Anti-vaping Messaging Work

Vaping with an e-cigarette
Photo by Toan Nguyen on Unsplash

Effective anti-vaping advertisements geared to teens have the greatest impact when they emphasise the adverse consequences and harms of vaping e-cigarettes, use negative imagery, and avoid memes, hashtags and other ‘teen-centric’ communication styles, according to a first-of-its-kind study by researchers in the journal Tobacco Control.

The researchers also found that certain messaging content currently being used, especially sweets and flavour-related imagery, increases the appeal of vaping and should be avoided when designing prevention messages.

“E-cigarettes and vaping have become a major public health concern, with nicotine addiction and other harmful outcomes looming large for youth,” said Seth M. Noar, PhD, the paper’s corresponding author and UNC Lineberger professor. “The percentage of teens vaping increased from about 5% in 2011 to over 25% in 2019,” Prof Noar said. “That is an alarming trend, making an understanding of effective vaping prevention messages especially urgent.”

Since the introduction of e-cigarettes, numerous US health departments have created their own anti-vaping messaging geared to teens, as have national health organisations such as the US Food and Drug Administration and Centers for Disease Control and Prevention.

The online study asked 1501 teens to rate seven randomly selected vaping prevention ads from a pool of more than 200 ads. Vaping prevention ads that clearly communicated the health harms of vaping, or compared vaping to cigarette smoking, were comparatively more effective. Neutral or less personally relevant content, such as referencing the environmental impact of vaping or the targeting of youth by the tobacco industry, was less impactful.

“Although we anticipated that vaping prevention ads with neutral or pleasant imagery would not be as effective, we were alarmed to find that flavour-related messages actually heightened the attractiveness of vaping,” said Marcella H. Boynton, PhD, first author

“In retrospect, it stands to reason that by reminding teens about pleasurable aspects of e-cigarettes, even within the context of a prevention ad, we run the risk of doing harm. Notably, we found that flavour-related prevention ad content was associated with vaping appeal among both users and non-users of e-cigarettes, which is a good reminder of how much candy and fruit flavours in e-cigarettes have driven the youth vaping epidemic.”

The researchers hope to next investigate the effects of other types of anti-vaping ads on a wide range of audiences. They also are developing a series of messages and a companion website to test the ability of a text message-driven intervention to reduce youth vaping. In that regard, Prof Noar noted that “We have been developing our own evidence-based messages based on the latest science about the harms of vaping. Our messaging approach has been greatly influenced by the insights generated by this study.”

The study used UNC’s Vaping Prevention Resource, a website designed to provide practitioners, researchers and communities with vaping prevention media content from around the world, as well as strategies and resources for youth vaping prevention. It is the largest repository of free, open-access vaping prevention materials, all available for download at https://vapingprevention.org/.

Source: UNC Lineberger Comprehensive Cancer Center

Use of e-cigarettes Associated With Prediabetes Risk

Vaping with an e-cigarette
Photo by Toan Nguyen on Unsplash

Analysis of a large representative database shows that e-cigarette use is associated with an increased risk of prediabetes, posing a new concern for public health.

“Our study demonstrated a clear association of prediabetes risk with the use of e-cigarettes,” explained lead researcher Shyam Biswal, PhD, at Johns Hopkins Bloomberg School of Public Health. “With both e-cigarette use and prevalence of prediabetes dramatically on the rise in the past decade, our discovery that e-cigarettes carry a similar risk to traditional cigarettes with respect to diabetes is important for understanding and treating vulnerable individuals.”

According to the Centers for Disease Control and Prevention (CDC), traditional cigarette smokers are 30% to 40% more likely than non-smokers to develop type 2 diabetes, which increases their risk for cardiovascular diseases. e-cigarettes are sometimes promoted as a healthier option for cigarette smokers, and e-cigarettes use is rising among younger demographics.

The study analysed 2016–2018 data from the Behavioral Risk Factor Surveillance System (BRFSS), the largest annual nationally representative health survey of US adults. Among the 600 046 respondents, 9% were current e-cigarette users who self-reported prediabetes diagnoses. The data also showed that e-cigarette users have a higher prevalence of high-risk lifestyle factors and worse self-related mental and physical health status than non-smokers.

In this representative sample of US adults, e-cigarette use was associated with greater odds of prediabetes compared to those who did not use e-cigarettes or traditional cigarettes – a worrying link from a public health standpoint.

“We were surprised by the findings associating prediabetes with e-cigarettes because they are touted as a safer alternative, which we now know is not the case,” commented Dr Biswal. “In the case of cigarette smoking, nicotine has a detrimental effect on insulin action, and it appears that e-cigarettes may also have the same effect.”

Prediabetes is fortunately a reversible condition, given appropriate lifestyle management. The authors make a compelling recommendation for targeting the reduction in e-cigarette use and education of young adults to reduce diabetes risk.

“Our effort for smoking cessation has led to a decrease in smoking traditional cigarettes. With this information, it is time for us to ramp up our public health efforts to promote the cessation of e-cigarettes,” cautioned Dr Biswal.

The researchers published their findings in the American Journal of Preventive Medicine.

The World Health Organization (WHO) defines prediabetes as a state of intermediate hyperglycaemia using impaired fasting glucose, defined as fasting plasma glucose of 6.1–6.9 mmol/L (110 to 125 mg/dL) and impaired glucose tolerance defined as 2h plasma glucose of 7.8–11.0mmol/L (140–200 mg/dL) after ingestion of 75g of oral glucose or a combination of the two based on a 2h oral glucose tolerance test. It is estimated that by 2030, more than 470 million people worldwide will be diagnosed with prediabetes.

Source: EurekAlert!

Investigating Vaping’s Impact on Gum Disease

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A series of new studies investigates how e-cigarettes alter oral health and may be contributing to gum disease. The latest, published in mBio, finds that e-cigarette users have a distinctive oral microbiome that is less healthy than nonsmokers but potentially healthier than cigarette smokers, and measures worsening gum disease over time.

“To our knowledge, this is the first longitudinal study of oral health and e-cigarette use. We are now beginning to understand how e-cigarettes and the chemicals they contain are changing the oral microbiome and disrupting the balance of bacteria,” said co-lead researcher Prof Deepak Saxena.

While cigarette smoking is known to increase gum disease risk, much less is known about the impact of e-cigarette use on oral health, especially in the long term.

The researchers studied the oral health of 84 adults from three groups: cigarette smokers, e-cigarette users, and people who have never smoked. Gum disease was assessed through two dental exams six months apart, during which plaque samples were taken to analyse the bacteria present.

Gum health changes
All participants had some gum disease at the start of the study, with cigarette smokers having the most severe disease, followed by e-cigarette users. After six months, the researchers observed that gum disease had worsened in some participants in each group, including several e-cigarette users.

Clinical attachment loss is a key indicator of gum disease, measured by gum ligament and tissue separating from a tooth’s surface, leading the gum to recede and form pockets. These pockets are bacterial breeding grounds and can lead to worsening gum disease. In a study of the same participants published in Frontiers in Oral Health, the research team found that clinical attachment loss was significantly worse only in the e-cigarette smokers after six months.

A unique microbiome
Analysis of the bacteria in plaque samples showed that e-cigarette users had a different oral microbiome than smokers and nonsmokers, in line with their earlier results.

While all groups shared roughly a fifth of the types of bacteria, the bacterial makeup for e-cigarette users had strikingly more in common with cigarette smokers than nonsmokers. Several types of bacteria, including Selenomonas, Leptotrichia, and Saccharibacteria, were abundant in both smokers and vapers compared to nonsmokers. Several other bacteria – including Fusobacterium and Bacteroidales, linked to gum disease – were particularly dominant in the mouths of e-cigarette users.

When plaque samples were gathered and analysed in the six-month follow-up, the researchers found greater diversity in bacteria for all groups studied, yet each group maintained its own distinct microbiome.

“Vaping appears to be driving unique patterns in bacteria and influencing the growth of some bacteria in a manner akin to cigarette smoking, but with its own profile and risks to oral health,” said Fangxi Xu, study co-first author.

An altered immune response
The researchers found that the distinct microbiome in e-cigarette users was correlated with clinical measures of gum disease and changes to the host immune environment. In particular, vaping was associated with different levels of cytokines. Certain cytokines are linked to an imbalance in oral bacteria and can worsen gum disease by making people prone to inflammation and infection.

TNFα, a cytokine that causes inflammation, was significantly elevated among e-cigarette users. In contrast, cytokines IL-4 and IL-1β were lower among e-cigarette users; because IL-4 tends to be reduced in people with gum disease and increases after treatment, it suggests that certain bacteria in the mouths of e-cigarette users are worsening inflammation.

The researchers concluded that the distinct oral microbiome of e-cigarette users elicits altered immune responses, which along with clinical markers for gum disease illustrate how vaping presents its own challenge to oral health.

“E-cigarette use is a relatively new human habit,” said Scott Thomas, study co-first author. “Unlike smoking, which has been studied extensively for decades, we know little about the health consequences of e-cigarette use and are just starting to understand how the unique microbiome promoted by vaping impacts oral health and disease.”

Source: New York University

National Treasury Proposes e-Cigarette Tax

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The National Treasury is proposing to impose a tax on both the non-nicotine and nicotine solutions in e-cigarettes (EC), and is asking for public comment by 7 February 2022.

The National Treasury published a draft discussion paper in December 2021 on the proposed taxation of e-cigarettes (ECs). The National Treasury defines e-cigarettes as battery powered devices that do not burn or use tobacco leaves but vaporise e-liquid solutions for inhalation.

In its discussion paper, the Treasury notes the uncertainty of e-cigarettes’ health risks, so it seeks stakeholder engagement on its proposal for the taxation of ECs.

The National Treasury proposes to introduce a specific excise tax on both the non-nicotine and nicotine solutions used in ECs and intends to use its existing policy guidelines applicable to other excisable products to do so. For example, traditional tobacco products are subject to excise duties at a rate of 40% of the price of the most popular brand in each tobacco category. 

For EC users, that would mean paying R2.03 per mL of EC solution nicotine-containing nicotine and R0.87 per mL of nicotine-free EC solution, if the draft proposals are accepted and become legislation. It is also proposed that EC products with a higher nicotine content will attract a higher duty rate.
Certain stakeholders may question that the Treasury’s proposed EC tax extends to nicotine-free liquids, as it does not necessarily support the government’s stated policy intention of reducing the consumption of tobacco products. The use of ECs as a means of quitting tobacco products is well established, with a Cochrane review showing that nicotine-containing ECs resulted in increased odds of quitting than nicotine-free ECs. 
It could also generate a knock-on illicit trade in e-cigarettes, as has  already happened in the tobacco sector.

Manufacturers and importers who would be taxed on ECs will need stringent certifications by accredited laboratories, which use either South African National Accreditation or International Laboratory Accreditation Cooperation (ILAC) approved methodologies.  Where such certifications are not available, a penalty rate of duty is being proposed.

Comments on the draft discussion document are due by 7 February 2022.

Source: Webber Wentzel

Paediatricians Can Help Adolescents Quit Vaping

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Even though e-cigarette- or vaping-associated lung injury (EVALI) were “a drop in the bucket” compared with COVID, vaping remains a significant health risk for teens, reported Anne Griffiths, MD, of the Children’s Hospital of Minnesota, during her presentation entitled “Updates on Youth Vaping” at the American Academy of Pediatrics virtual meeting

According to the 2021 National Youth Tobacco Survey, 11.3% (1.72 million) of high school students (ages 16 to 18) and 2.8% (320 000) of middle school students (ages 12 to 15)  reported using e-cigarettes in the past 30 days.
As more than half of youths who tried to stop vaping, there is an opportunity fo paediatricians to intervene, Dr Griffiths said.

Middle school students often start with zero-nicotine, flavour-only products before “they move on to a nicotine-based product and ultimately a THC-based product,” Griffiths noted. Of the middle and high school students who vape, 85% use flavoured products, with sweet and fruity flavours favoured.
Notably, disposable e-cigarettes are now more popular than refillable pods and cartridges this year, with 53.7% of all vaping students reporting use of these products. This comes down to messaging not to reuse vaping products during COVID, Dr Griffiths said.

However, vaping could be a risk factor for COVID, being diagnosed five times more often in vaping adolescents, according to a study in the Journal of Adolescent Health.

E-cigarette flavouring can suppress innate immune function, as demonstrated by studies. Others have shown that e-cigarette vapour may increase ACE2 expression in the lungs, which the receptor that enables entry of SARS-CoV-2 into host cells.

Adolescents presenting with EVALI or COVID (or both) can be differentiated Dr Griffiths said. The patient’s reaction to steroid treatment can be diagnostic: “Unlike SARS-CoV-2 where the [patient’s] improvement might be subtle [with a] gradual response to steroids, in EVALI, one day on high-dose steroids and they feel like a million bucks in comparison.”

In addition, EVALI may present with leukocytosis and high erythrocyte sedimentation rates and C-reactive protein levels, while COVID patients are more likely to have lymphopenia.

Dr Griffiths that in spite of the risks of vaping, “there’s an entire culture surrounding [kids] that can glamorise vaping life.”

Vaping companies reach out to children using methods such as YouTube vape championships, in which competitors perform various smoke tricks. In addition, vaping companies provide scholarships to students, often requiring them to write an essay on the benefits of vaping.

Source: MedPage Today

Use of Nicotine-containing E-cigarettes Increases Blood Clot Formation

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A new study found the use of e-cigarettes containing nicotine has a number of immediate effects, which include increased blood clot formation, blood vessel dysfunction, as well as raised heart rate and blood pressure.

These effects are similar to smoking traditional cigarettes with heart attack or stroke risk with long-term use, according to researchers. The study was presented at the ERS International Congress by Gustaf Lyytinen, a clinician at Helsingborg Hospital and researcher at the Karolinska Institute in Stockholm, Sweden. 

Each of the 22 occasional smoker volunteers was tested before and after taking 30 puffs from an e-cigarette with nicotine, and before and after 30 puffs from an e-cigarette without nicotine. These two sets of tests were conducted on separate occasions, at least one week apart.

On each occasion, the researchers measured volunteers’ heart rate and blood pressure and took a blood sample before they used the e-cigarettes, then 15 minutes after use and again 60 minutes after use. A laser was used to measure dilation of skin blood vessels before volunteers used e-cigarettes and 30 minutes afterwards.
E-cigarettes with nicotine caused an immediate short-term change: a 23% average increase in blood clots after 15 minutes, that returned to normal levels after 60 minutes. Average heart rates also increased from 66bpm to 73bpm. as did blood pressure from 108mmHg to 117mmHg. Researchers observed temporary narrowing of blood vessels after nicotine-containing e-cigarettes use.

These effects were not observed after volunteers used e-cigarettes without nicotine. Nicotine is known to raise levels of hormones including adrenaline, which can increase blood clot formation.

Dr Lyytinen said: “Our results suggest that using e-cigarettes that contain nicotine have similar impacts on the body as smoking traditional cigarettes. This effect on blood clots is important because we know that in the long-term this can lead to clogged up and narrower blood vessels, and that of course puts people at risk of heart attacks and strokes.”

Source: European Respiratory Society

Vaping Raises Oxidative Stress Levels Even in Nonsmokers

Photo by Toan Nguyen on Unsplash
Photo by Toan Nguyen on Unsplash

In addition to the well-documented risks of smoking and vaping, a new UCLA study has revealed that a short vaping session can affect the cells of even healthy younger nonsmokers.

According to their study, published in JAMA Pediatrics, a single 30-minute vaping session can significantly increase cellular oxidative stress, which occurs when the body has an imbalance between free radicals, and the antioxidants which neutralise them.

“Over time, this imbalance can play a significant role in causing certain illnesses, including cardiovascular, pulmonary and neurological diseases, as well as cancer,” said the study’s senior author, Dr Holly Middlekauff, a professor of cardiology and physiology at the David Geffen School of Medicine at UCLA.

E-cigarettes, devices that deliver nicotine with flavouring and other chemicals in a vapour rather than smoke, are popularly seen as a safer cigarette alternative, but research by Prof Middlekauff and others has demonstrated that vaping is associated with a number of adverse changes in the body that can presage future health problems.

For the present study, 32 male and female study participants, aged 21 to 33, were split into three groups: 11 nonsmokers, nine regular tobacco cigarette smokers and 12 regular e-cigarette smokers. The researchers collected immune cells from each individual before and after a 30-minute vaping session to measure and compare changes in oxidative stress among the groups.

The researchers repeated this with a control session where participants spent 30 minutes “sham-vaping,” or puffing on an empty straw.

In nonsmokers, oxidative stress levels were found to be two to four times higher after the vaping session than before. Among the regular cigarette and e-cigarette smokers, the same 30-minute exposure did not lead to an increase in oxidative stress, the researchers noted, most likely because their baseline levels of oxidative stress were already increased.
“We were surprised by the gravity of the effect that one vaping session can have on healthy young people,” Prof Middlekauff said. “This brief vaping session was not dissimilar to what they may experience at a party, yet the effects were dramatic.”

The researchers noted that these results are especially troubling due to the increasing popularity of vaping, particularly among the youth. In a 2020 study, nearly a third of high school students reported e-cigarette use during the previous month.

There is still more to be understood about what exactly causes the changes in oxidative stress levels, whether it is caused by the nicotine or non-nicotine elements in e-cigarettes, which will be the subject of future research.

“While there’s a perception that e-cigarettes are safer than tobacco cigarettes, these findings show clearly and definitively that there is no safe level of vaping,” Prof Middlekauff said. “The results are clear, unambiguous and concerning.”

Source: UCLA

Team Investigates The Hazards of Vaping During Pregnancy

Motivated by widely assumed and unproven presumptions that vaping is safer than cigarette smoking, a team at West Virginia University (WVU) is conducting a three-year study on the effects of vaping during pregnancy.

Smoking during pregnancy continues to be a public health problem. It is estimated that around half of women who smoke before becoming pregnant will continue to smoke during and after the pregnancy. Smoking during pregnancy can lead to preterm birth, birth defects and an increased risk of sudden infant death syndrome. Because of this, an increasing number of women who choose to smoke while pregnant are being encouraged to switch to vaping.

“We know that when someone vapes, their blood vessels react by temporarily constricting – or getting smaller, which affects children while in the womb because their fetal environment is also altered,” said contact principal investigator Mark Olfert, associate professor at WVU.

Altering the blood supply in the foetal environment can create a hostile environment for the foetus, leading to serious issues during child and adult life. A previous study in 2018 showed that vaping induced a similar dysfunctional response in the blood vessels of both male and female animals as did smoking cigarettes. So there is great concern that women who are switching to vaping during pregnancy because they think it is safer than smoking are wrong, and that vaping will result in the same problems and complications for offspring as smoking.

Investigations are underway into the reasons behind the harm, and, importantly, what effect these have on the long-term vascular health beyond childhood in offspring that experienced foetal exposure to maternal vaping.

Source: News-Medical.Net

Smoking Risks for Allergic and Asthmatic Cannabis Users

A survey in the US has shown that cannabis users are often asthmatic, and some have allergies from cannabis smoking or its second-hand smoke.

Cannabis allergies can potentially cause respiratory symptoms, contact urticaria, angioedema, and uncommonly anaphylaxis. Inhalation of cannabis may also manifest in allergic rhinitis, conjunctivitis, wheezing, and throat oedema. Given the widespread legal use of cannabis, more information is needed on the effects of cannabis use, particularly smoking, on individuals with asthma and allergies.

The anonymous survey, conducted in concert with the Allergy & Asthma Network, consisted of 489 participants, 18% of whom reported cannabis use. A surprising 60% were asthmatic, and 40% had uncontrolled asthma. 

Inhalation routes were the most popular way of taking cannabis. About half of users smoked cannabis, while a third vaped it. Only 40% reported being asked by their physician about cannabis use, and about the same proportion of participants were willing to talk to a physician about their cannabis use, said study co-author and cannabis allergy expert, William Silvers, MD.

“In order to more completely manage their allergy/asthma patients, allergists should increase their knowledge about cannabis and inquire about cannabis use including types of cannabinoid, route of use, reasons for use, and adverse effects,” said Dr Silvers. “As with cigarette smoking, efforts should be made to reduce smoking of cannabis, and recommend other potentially safer routes such as edibles and sublingual tinctures.”

Reported positive effects of cannabis use (eg, reduced pain, calm, improved sleep) were more frequent than adverse effects (eg, cough, increased appetite, anxiety). Approximately 20% of survey respondents reported coughing from cannabis, which was associated with smoking cannabis; this was cause for concern as it may indicate smoking risks for cannabis users.

“It surprised me that over half of the cannabis users in this study who have asthma were smoking it,” said principal investigator Joanna Zeiger, PhD. “And further, of those with uncontrolled asthma, half reported smoking cannabis. We also found that people with asthma are not routinely being asked or advised by their physician about cannabis and how they are consuming it.”

The researchers commented that further research into the relationship of cannabis and allergies is warranted.
“We look forward to future studies of larger, more diverse cohorts to better explore more deeply the effect of cannabis use on asthma and other allergic disorders,” said Dr Zeiger.

Source: News-Medical.Net

Journal information: Zeiger, J. S., et al. (2021) Cannabis attitudes and patterns of use among followers of the Allergy & Asthma Network. Annals of Allergy, Asthma & Immunology.doi.org/10.1016/j.anai.2021.01.014.