Current Impactful Studies

From Safer nicotine wiki
Jump to navigation Jump to search

These studies will have been recently published in the last few months, and rightly or wrongly receiving media attention. Negative media attention is by its very nature, vastly more common, as 'bad news travels or sells'. Some may be described as junk studies, but we must demonstrate why that is the the case in a Scientific logical manner,not just simply dismiss. Please consult E-Cigarette Research Forum that may well have examined and assessed a study you may have an interest in.

NEW:,Heated debates on regulations of heated tobacco products in South Korea: the news valence, source and framing of relative risk/benefit

  • This poor study learns nothing new, by surveying TV and media.

NEW:,Electronic Cigarette Solvents, Pulmonary Irritation and Endothelial Dysfunction:Role of Acetaldehyde and Formaldehyde

  • This poor study compares ECig aerosol to filtered air, not to tobacco smoke.

NEW:,E-cigarette or vaping product use-associated lung injury and state-level cannabis policies

  • Conclusions: Estimates suggest there may have been a protective effect of state-level, recreational adult-use cannabis policies on incident EVALI. Effects of specific state-level regulations (e.g., laboratory testing, product quality standards, tracking systems) should be considered alongside additional geographic indices in future assessments of EVALI causes.

NEW:,The role of vaping nicotine in psychiatry practice

  • People with mental illness have higher smoking rates, smoke more heavily, are more nicotine dependent and have lower quit rates than the general population. As a result, smoking prevalence is declining more slowly than in the wider community, especially among people with serious mental illness (SMI).
  • For smokers who are unable to quit with first line treatments and would otherwise continue to smoke tobacco, long-term substitution with a safer nicotine product could reduce tobacco-related harm.

NEW:,An Open-Label, Randomised, Controlled, Crossover Study to Assess Nicotine Pharmacokinetics and Subjective Effects of the JUUL System with Three Nicotine Concentrations Relative to Combustible Cigarettes in Adult Smokers

  • This randomised, openlabel, crossover clinical study evaluated nicotine pharmacokinetics (PK) and subjective effects of the JUUL System (JS; Juul Labs, Inc.) with three nicotine concentrations compared to usual brand (UB) cigarettes in 24 adult smokers.
  • Conclusions: Nicotine exposure and subjective relief were directly related to JS nicotine concentration: higher nicotine concentrations gave rise to significantly greater plasma nicotine levels and relief from craving. Heavier and more dependent smokers may require the greater nicotine delivery of JS 59 mg/mL to successfully transition away from cigarettes.

NEW:, Characterizing and assessing compliance of online vendors to the state of Massachusetts ENDS product sales ban


Simulated online purchases from 50 identified ENDS vendors yielded 72% (n=36) stores that were non-compliant and allowed placement of ENDS product orders, without restrictions, to a Massachusetts address. The remaining 14 websites had processes in place to prevent orders from buyers located in Massachusetts. Other characteristics of interest, including use of age verification, location data, and web registrar/registrant data were collected and reported.

NEW:,E-Cigarettes, Harm Reduction, and Tobacco Control A Path Forward?

NEW:, Article Rating 0 Votes Review Article Article Jan 15, 2021 Qeios ID: W0GEL2 Open Access Text messages to support e-cigarette use for smoking cessation: a tool for researchers

  • "Satisfaction: According to the cross sectional survey by Action on Smoking and Health (ASH)[10], of those who currently vape and do not smoke, two-thirds find vaping equally or more satisfying than smoking. However, for dual product users, around two thirds do not find vaping as satisfying. For those smokers who have tried an e-cigarette but discontinued use 80% report satisfaction as key reason for stopping vaping."

NEW:,The temporary ban on tobacco sales in South Africa: lessons for endgame strategies

  • "Results: About 9% of prelockdown smokers in the sample successfully quit smoking. 93% of continuing smokers purchased cigarettes despite the sales ban. The average price of cigarettes increased by 250% relative to prelockdown prices. Most respondents purchased cigarettes through informal channels."

NEW:,A first pass, using pre‐history and contemporary history, at understanding why Australia and England have such different policies towards electronic nicotine delivery systems, 1970s–c. 2018

  • "An understanding of the different policy responses to electronic nicotine delivery systems (ENDS) in England and Australia requires an appreciation of how actors within the different policy structures, scientific networks and activist organizations in each country and region have interpreted the evidence and the priority that policymakers have given to the competing goals of preventing adolescent uptake and encouraging smokers to use ENDS to quit smoking."

NEW:,User pathways of e‐cigarette use to support long term tobacco smoking relapse prevention: a qualitative analysis

  • 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.

NEW:,Risk perception of cigarette and e-cigarette use during pregnancy: A qualitative postpartum perspective

  • This wins our award for shockingly bad paper of the week.

NEW:,Trends in Electronic Cigarette Use and Conventional Smoking: Quantifying a Possible "Diversion" Effect among U.S. Adolescents

  • Conclusions: A simulation model shows that a substantial diversion effect is needed to explain observed nicotine use trends among US adolescents, and it must be larger than any possible opposing catalyst effect, if present.

NEW:,ENDS Flavor Preference by Menthol Cigarette Smoking Status among US Adults, 2018-2019

  • "Approximately 60% of dual users and “switchers” used fruit or other e-cigarette flavors, regardless of menthol cigarette preference. Exclusive use of these flavors was highest among “switchers” who had used nonmenthol cigarettes at 52.0% and lowest among dual users who used menthol cigarettes at 34.5%."

NEW:,Response to Flavored Cartridge/Pod-Based Product Ban among Adult JUUL Users: "You Get Nicotine However You Can Get It"

  • The title says it all, if you ban flavours users simply re-adjust to the flavours that are available. We note no mention of the black market, or grey market sources that some users will have turned too.

NEW:,Dependence on nicotine in US high school students in the context of changing patterns of tobacco product use

  • Findings: Between 2012 and 2019 there was a marked decline in past-30-day cigarette smoking and a surge in use of e-cigarettes. Different products were associated with differing levels of nicotine dependence, with cigarettes characterised by highest dependence (strong craving 42%, wanting to use within 30 minutes 17% among exclusive users in 2019) and e-cigarettes in otherwise tobacco-naïve students by low dependence (16% and 9% in 2019). The overall 34% increase in population use of nicotine products between 2012 and 2019 (from 23.2% to 31.2%) was not accompanied by an equivalent increase in overall population burden of dependence (percentage reporting craving 10.9% [95% CI 9.8-12.2%] in 2012 and 9.5% [7.5-12.0%] in 2019; wanting to use within 30 minutes 4.7% [4.0-5.5%] in 2012, 5.4% [4.0-7.2%] in 2019).
  • Conclusions: Among US high school students, increases in the prevalence of nicotine product use from 2012 to 2019 do not appear to have been accompanied by a similar increase in the population burden of nicotine dependence. This may be at least partly attributable to a shift in the most common product of choice from cigarettes (on which users are most dependent) to e-cigarettes (on which users are least dependent).

NEW:,Association of Cigarette and Electronic Cigarette Use Patterns With Levels of Inflammatory and Oxidative Stress Biomarkers Among US Adults: Population Assessment of Tobacco and Health Study

  • "Our analysis was restricted to Wave 1 adults ≥18 years of age with nonmissing data on biomarkers and cigarette/e-cigarette use. Analytic sample sizes were dependent on the respective biomarker considered."
  • "...we observed no difference in inflammatory and oxidative stress biomarkers between exclusive e-cigarette users and nonusers (no cigarettes or vaping), and levels were lower in exclusive e-cigarette users relative to exclusive smokers."

NEW: Associations of Socioeconomic Status, Parental Smoking and Parental E-Cigarette Use with 10–11-Year-Old Children’s Perceptions of Tobacco Cigarettes and E-Cigarettes: Cross Sectional Analysis of the CHETS Wales 3 Survey

  • In total, 186 primary schools were invited to take part. Despite multiple contact attempts 36 schools did not respond, 73 schools declined, and 77 agreed to take part in principle, with four dropping out due to time/scheduling constraints. Overall, 73 schools took part in the study; a school-level response rate of 39.3%. Of 2514 pupils within sampled classes, 2218 (88.2%) took part in the survey, with 53 (2.1%) opted out by parents and 58 (2.3%) declining to participate, but most non-participation was due to absence on the day of the data collection visit (n = 185; 7.4%). Sample characteristics are described in Table 1.
  • Table 2 presents frequencies and percentages of children reporting awareness of, exposure to and a range of perceptions of, e-cigarettes and tobacco overall, by parental smoking, parental vaping and family affluence level. For each of these associations odds ratios and 95% confidence intervals are presented in Table 3
  • Unsurprisingly children of smokers and vapers where more likely to know about e-cigs, but it appears from the results they are less likely to go on to become smokers. They also possibly paradoxically reported as being less likley to go on to become vapers, maybe in part due to education from the vaping parent(s)?
  • The number of children who reported vaping or smoking was small, and some of the results were thrown out due to insufficient numbers.
  • Hence, our study provides no evidence to support a view that if parent figures fully switch from tobacco smoking to e-cigarettes, the use of devices which ‘mimic’ the act of smoking will maintain positive perceptions of smoking among their children. This adds to prior evidence that, in the UK at least, the presence of e-cigarettes in the lives of children who have grown up in a context of comprehensive tobacco control, has not led them to perceive tobacco cigarettes more positively.

See Also:Looks like smoking, is it smoking?: Children’s perceptions of cigarette-like nicotine delivery systems, smoking and cessation

  • Children did not recognise the inhaler or electronic cigarette. Some children did however notice anomalies in the ‘smoking’ behaviour. Once told about the products the children were mostly positive about the potential of the inhaler and electronic cigarette to assist smokers to quit. Negative perceptions were expressed, including views about the ill health effects associated with continued nicotine intake and the smoker’s inability to quit.

New:Switching from smoking to Electronic Delivery Systems: Changing practices and identities

  • Electronic nicotine delivery systems (ENDS) – commonly known as E-cigarettes or vapes - could potentially support the smokefree 2025 goal, but switching from smoking to ENDS involves more than replacing one nicotine source with another
  • Researchers from the University of Otago, led by Professor Janet Hoek and Ms Mei-Ling Blank, have theorised that people may seek more than a physical re-creation of smoking. Gathering together a multi-disciplinary team comprising public health researchers, health psychologists, consumer behaviour theorists and biostatisticians, their Marsden Fund project explores how people move from identifying as smokers and attempt to negotiate new identity positions as ENDS users. The study involved researchers buying study participants an ENDS device, then meeting with them up to five times over an 18-20 week period and asking them to record their daily smoking and ENDS use. Participants also recorded their mood states and recorded their smoking and ENDS use in a daily diary.

Ongoing Australian TGA to make Vaping prescription only

  • We have to wonder given the enquiry into vaping products this happened? Australia is indeed a THR backwater, compared with New Zealand especially

  • Konstantinos Farsalinos Accused of being in the employ of big tobacco, accused of trying to make smoking out as protective against COVID-19
  • Our initial findings would seem to be in favour of Dr Farsalinos, he was indeed researching nothing whatsoever to do with smoking, but instead using NRT products in COVID-19 research, as was indicated by the paradoxical lower instance of hospitalisation in nicotine users.


  • Thread on twitter on COVID-19 and Smoking / Vaping

2019 E-cigarettes and Primary Care. A cross-sectional survey of nurses and GPs across the UK

  • Key findings
  • E-cigarettes are frequently brought up in conversations between clinicians and patients who smoke
  • 3 in 10 clinicians say that the topic of ecigarettes is raised in the majority of conversations about smoking.
  • Beliefs: Clinicians are often unsure in their beliefs around e-cigarettes
  • Over 1 in 3 clinicians are unsure if ecigarettes are safe enough to recommendas a quit tool to patients who smoke.
  • 1 in 3 are unsure whether e-cigarettes areaddictive.
  • Advice: Many clinicians are reluctant tosuggest e-cigarettes as a tool to quit smoking
  • When asked what advice they would give patients on e-cigarettes, 3 in 5 clinicianssaid “we do not know enough about themso I don’t endorse them”.
  • 2 in 5 said they would feel uncomfortable recommending e-cigarettes to theirpatients who smoke.
  • 1 in 6 clinicians said they would neverrecommend using e-cigarettes topatients who smoke.
  • There was no clear agreement as to whether clinicians would primarily recommend e-cigarettes as a first line or last resort therapy.


  • This study is the first to describe the long-term health effects of HTP use in COPD patients. Consistent improvements in respiratory symptoms, exercise tolerance, quality of life, and rate of disease exacerbations were observed in patients with COPD who abstained from smoking or substantially reduced their cigarette consumption by switching to HTP use.

Characteristics and Correlates of Recent Successful Cessation Among Adult Cigarette Smokers, United States,2018

  • What is already known on this topic?
  • Increasing smoking cessation reduces smoking-related disease, death, and economic costs.
  • What is added by this report?
  • In 2018, 7.1% of US adult smokers reported recent successful quitting. However, some groups had less success, including certain demographic groups, and some groups had greater success, including exclusive e-cigarette users, people with smoke-free home rules, and people who received advice to quit from a medical doctor.
  • What are the implications for public health practice?
  • To help more smokers quit, public health practitioners can ensure that evidence-based tobacco control interventions, including barrier-free access to evidence-based cessation treatments, are reaching all tobacco users, especially those who face greater barriers to quitting.

Associations between vaping and Covid-19: cross-sectional findings from the HEBECO study

  • Conclusions Among UK adults, self-reported diagnosed/suspected Covid-19 was not associated with vaping status. Half of current vapers changed their vaping consumption since Covid-19, with the majority reporting an increase, and a minority was motivated to quit due to Covid-19.

Does Nicotine Prevent Cytokine Storms in COVID-19?

  • We discuss how his excessive use of nicotine replacement therapy may have contributed to his emerging unscathed from COVID-19. Nicotine, an α7-nACh receptor agonist, may boost the cholinergic anti-inflammatory pathway and hinder the uncontrolled overproduction of pro-inflammatory cytokines triggered by the SARS-CoV-2 virus, which is understood to be the main pathway to poor outcomes and death in severe COVID-19.

An exploratory non-randomized study of a 3-month electronic nicotine delivery system (ENDS) intervention with people accessing a homeless supported temporary accommodation service (STA) in Ireland accompanying helpful blog here My Study of Providing Vapes to Unhoused Smokers in Ireland

Nicotine delivery and user reactions to Juul EU (20 mg/ml) compared with Juul US (59 mg/ml), cigarettes and other e-cigarette products

  • Juul EU delivers much less nicotine to users than Juul US, and also less than refillable EC products. It may thus have more limited potential to help smokers quit.

What Motivates Smokers to Switch to ENDS? A Qualitative Study of Perceptions and Use

  • Switching completely from cigarettes to electronic nicotine delivery systems (ENDS) may reduce health risks for addicted smokers. This paper provides information about perceptions and other factors that may influence smokers’ ENDS use and substitution for cigarettes.

Socioeconomic distribution of e-cigarette use among recent former regular smokers and current smokers at ages 25-26 in England

  • Among young adult smokers in England, lower status occupational groups were more likely to use e-cigarettes on a non-daily basis than to have never used compared with higher status occupational groups. Compared with people in full-time employment, those without employment were less likely to use e-cigarettes daily than to have never used.

Information and sin goods: Experimental evidence on cigarettesand here]

  • Our findings suggest that information source matters in the context of cigarettes choice for adult smokers. Private companies appear to be an important information source for cigarettes among adult smokers.

A randomised controlled single-centre open-label pharmacokinetic study to examine various approaches of nicotine delivery using electronic cigarettes

  • Smokers who switch completely to e-cigarettes may reduce their relative risk of tobacco-related disease. Effective nicotine delivery from e-cigarettes is important in consumer acceptance. We assessed whether protonated nicotine and e-cigarette devices delivering greater aerosol mass increase nicotine delivery and product liking.

Commentary on Notley et al. (2020): Understanding transitions in the use of nicotine and tobacco products-the value of qualitative longitudinal research

  • Qualitative longitudinal research is an underused methodology in addiction research, but can provide valuable insights into transitions in the use of addictive substances, including e‐cigarettes and tobacco smoking.

impact of lung diseases, smoking and e-cigarette use on the severity of COVID-19 illness at diagnosis

  • The age distribution and prevalence of lung disease and their risk factors are described in the context of COVID-19 incidence and symptom severity in a whole-nation cohort of Icelanders. The cohort is younger and had less severe symptoms than in many previosly published studies of COVID-19. Interestingly, the prevalences of smoking and e-cigarette use were lower than in the Icelandic general population and they were not associated with symptom severity at diagnosis. To conclude, the results presented here indicate that underlying lung diseases are prevalent among people with severe COVID-19 symptoms but fail to demonstrate an association between cigarette smoking or e-cigarette smoking with COVID-19 severity.

Effects of E-Cigarette Use on Cigarette Smoking among U.S youth, 2014-18

see also accompanying Glantz blog

  • note another paper published 2/12 finds the exact opposite, due to differing frequency of use measures applied, ie one includes ever use as opposed to regular use.
    • Despite its recent increase in popularity, e-cigarette use does not seem to be counteracting the decreases in other tobacco use prevalence.
    • See also Item 1 in the table of contents
  • Further analysis here gives another explanation for the differences.
  • These entries neatly summarise some of the major differences that exist in Tobacco Control, that of data interpretation. We leave it to the readers to decide which is the more plausible

New Lancet Study: vaping is rare among individuals who have never smoked conventional cigarettes.

  • E-cigarette use in China remains low but has increased substantially between 2015 and 2019. Our study identified increased e-cigarette use among subpopulations, and use patterns, that warrant further attention from public health policy makers in China.

see reaction and interpretation of this study via a UK Regional Public Health Director

Effects of tobacco cigarettes,e-cigarettes...on endothelial function reaction from Science Media Centre

  • Prof John Britton, Director of the UK Centre for Tobacco & Alcohol Studies and Consultant in Respiratory Medicine, University of Nottingham, said:
  • “This paper provides an unsystematic overview on evidence relating to the likely relative risks of nicotine use, and of questionable reliability: for example, that e-cigarette use increases the risk of chronic obstructive pulmonary disease by 194% but COPD is a disease with a lead time of decades, so to attribute a risk directly to e-cigarettes – which have been widely used for less than a decade and are almost exclusively used by former smokers – is inappropriate.”

  • Dr Nick Hopkinson, Reader in Respiratory Medicine at Imperial College London, said:
  • More comment at the provided link

E-Cig Experimentation data analysis from France

  • Experimenting with e‐cigarettes first (as opposed to tobacco first) appears to be associated with a reduction in the risk of daily tobacco smoking among French adolescent at ages 17‐18.5, but this risk varies negatively with age at experimentation, and early e‐cigarette experimenters are at higher risk.

E-Cigarette Research Forum

  • For a monthly subscription request ask

Exclusive E-Cigarette Users Report Lower Levels of Respiratory Symptoms Relative to Dual E-Cigarette and Cigarette Users | Nicotine & Tobacco Research | Oxford Academic

  • Findings suggest that differences in respiratory symptoms between dual and exclusive e-cigarette users appear to be attributable to combustible cigarette smoking, rather than more intense or frequent e-cigarette use across groups.

Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19

  • COVID-19 is associated with youth use of e-cigarettes only and dual use of e-cigarettes and cigarettes, suggesting the need for screening and education.
  • See also comment below
E-Cigarette Use and COVID-19: Questioning Data Reliability
  • The authors found a statistically significant association between ever, but not current, e-cigarette use and COVID-19. It is not :biologically plausible that e-cigarette trial or experimentation would cause effects that result in stronger predisposition to :COVID-19 than current/regular use. Therefore, no causal link between e-cigarette use and COVID-19 can be implied.

Statments from NGOs etc

THR Statments from NGOs