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'''Studies, Surveys, Papers, and Case Studies''' | '''Studies, Surveys, Papers, and Case Studies''' | ||
*Sometimes it's necessary to view the PDF version to access the full study. | *Sometimes it's necessary to view the PDF version to access the full study. | ||
*This page is for referencing the possible benefits of [[Abbreviations|'''ENDS''']] products vs. smoking cigarettes from a Public Health standpoint. (Electronic Nicotine Delivery Systems are also known as vapor technology, | *This page is for referencing the possible benefits of [[Abbreviations|'''ENDS''']] products vs. smoking cigarettes from a Public Health standpoint. (Electronic Nicotine Delivery Systems are also known as vapor technology, e-cigarettes, ecigs, EVP, etc.) | ||
*If you'd prefer someone else to add a study to a topic, there is a subject section called "Suggested studies to add to this page". You may put the link in that section for one of the regular page editors to address. | *If you'd prefer someone else to add a study to a topic, there is a subject section called "Suggested studies to add to this page". You may put the link in that section for one of the regular page editors to address. | ||
*If you'd like to help add content to this page, please see the directions at the bottom of the page. | *If you'd like to help add content to this page, please see the directions at the bottom of the page. | ||
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=Continuum of Risk= | =Continuum of Risk= | ||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37085311/ Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study.] === | |||
* Conclusions: We found that smoking increased the risk of self-reported hypertension, but ENDS use did not. These results highlight the importance of using prospective longitudinal data to examine the health effects of ENDS use. | |||
* Like the previous paper on asthma, the analysis is carefully designed to avoid bias/confounding from smoking history, and to avoid errors of temporal sequence (allowing data points where the outcome could have occurred prior to the exposure). This is especially valuable because of the concern that nicotine has direct cardiovascular effects – the evidence for which is mostly at a physiological level rather than a human clinical level. While this analysis does not prove the absence of an effect, it’s important nonetheless in raising doubts that ENDS have a clinically-meaningful cardiovascular effect at the population level. | |||
* Cook S, Hirschtick JL, Barnes G, Arenberg D, Bondarenko I, Patel A, Jiminez Mendoza E, Jeon J, Levy D, Meza R, Fleischer NL. BMJ Open. 2023 Apr 21;13(4):e062297. doi: 10.1136/bmjopen-2022-062297. PMID: 37085311 Free PMC article. | |||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37061812/ Nicotine - friend or foe? The complex interplay between its role in dependence, harm reduction and risk communication.] === | === 2023: [https://pubmed.ncbi.nlm.nih.gov/37061812/ Nicotine - friend or foe? The complex interplay between its role in dependence, harm reduction and risk communication.] === | ||
* So, how should we communicate the risks of nicotine? The quixotic attitude towards nicotine in our field has unintended consequences elsewhere. O’Brien et al.’s study of adolescents in the PATH study confirms findings in adults, including medical professionals, that nicotine is believed to cause smoking-related harms beyond addiction, such as cancer. Encouragingly, those having higher risk perceptions were less likely to start using nicotine-containing products a year later. Concerningly, even among adolescent smokers nearly half believed that nicotine in NRT was harmful, which may reduce the use of effective medication to help them stop smoking. | * So, how should we communicate the risks of nicotine? The quixotic attitude towards nicotine in our field has unintended consequences elsewhere. O’Brien et al.’s study of adolescents in the PATH study confirms findings in adults, including medical professionals, that nicotine is believed to cause smoking-related harms beyond addiction, such as cancer. Encouragingly, those having higher risk perceptions were less likely to start using nicotine-containing products a year later. Concerningly, even among adolescent smokers nearly half believed that nicotine in NRT was harmful, which may reduce the use of effective medication to help them stop smoking. | ||
* Clearly, no one wants to see a generation of nicotine-dependent youth, and more effective measures to limit access to nicotine, especially combustible nicotine, are needed. But when it comes to communicating research to the wider public, we must avoid conflating the relatively limited harm of nicotine dependence with its effects on maintaining tobacco addiction, and therefore well-established tobacco-related harm, not least because of the impact this has on risk perceptions of those most in need of nicotine-based treatment: Tobacco users. | * Clearly, no one wants to see a generation of nicotine-dependent youth, and more effective measures to limit access to nicotine, especially combustible nicotine, are needed. But when it comes to communicating research to the wider public, we must avoid conflating the relatively limited harm of nicotine dependence with its effects on maintaining tobacco addiction, and therefore well-established tobacco-related harm, not least because of the impact this has on risk perceptions of those most in need of nicotine-based treatment: Tobacco users. | ||
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=Dependence (Addiction, Abuse) vs Harm / Harm Reduction - Ecigs and Nicotine= | =Dependence (Addiction, Abuse) vs Harm / Harm Reduction - Ecigs and Nicotine= | ||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37195899/ Individual and conjoint factors associated with beliefs about the harmfulness of nicotine replacement therapies relative to combustible cigarettes among people who smoke: Findings from the 2020 ITC Four Country Smoking and Vaping Survey.] === | |||
* An analysis of risk perceptions of NRT vs cigarettes among adults (18+) in ITC data: | |||
* Results: Percentages believing that NRTs are much less harmful than CCs were 29.7% (95% CI:26.2-33.5%) in Australia, 27.4% (95% CI=25.1-29.8%) in England, 26.4% (95% CI=24.4-28.4%) in Canada and 21.7% (95% CI=19.2-24.3%) in the US. | |||
* Another data point confirming the abysmal risk perceptions around nicotine products. Since these data were from 2020, it’s likely that things have gotten even worse since then. As the analysis goes on to show, different variations on nicotine misperceptions are correlated with each other: | |||
** Across all countries, believing nicotine is not at all/slightly harmful to health (aOR=1.53-2.27), endorsing nicotine vaping products as less harmful than CCs (much less harmful: aOR=7.24-14.27; somewhat less harmful: aOR=1.97-3.23), and possessing higher knowledge of smoking harms (aOR=1.23-1.88) were individual factors associated with increased odds of believing NRTs are much less harmful than CCs. | |||
* Echoing comments from the E-Cig Summit last week, this calls for some much-needed communication from government health agencies around authorized nicotine products to better inform adults who smoke about less-harmful alternatives. | |||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37094934/ 2013-2017: a multistate Markov transition analysis] === | |||
* Results: Sole cigarette and SLT use were persistent, with 77% and 78% of adults continuing use after one wave. Other use states were more transient, with 29%–48% of adults reporting the same pattern after one wave. If single-product users transitioned, it was most likely to non-current use while dual or poly cigarette users were most likely to transition to exclusive cigarette use. | |||
* It's notable that e-cigarette use was more transient (~46%), which corroborates other evidence that much of e-cigarette use was experimental in nature and did not lead to regular or long-term use. Even more notable is that this was during a period of continually rising e-cigarette use (2013-2017); since youth e-cigarette use has declined again in more recent years, I would expect later waves of data to show even less persistence of use. | |||
* Review of PATH Waves 1-4 | |||
* Shafie Khorassani F, Brouwer AF, Hirschtick JL, Jeon J, Jimenez-Mendoza E, Meza R, Fleischer NL. Tob Control. 2023 Apr 24:tc-2022-057822. doi: 10.1136/tc-2022-057822. Online ahead of print. PMID: 37094934<br /> | |||
===2020: [https://pubmed.ncbi.nlm.nih.gov/32196810/ Dependence on e‐cigarettes and cigarettes in a cross‐sectional study of US adults]=== | ===2020: [https://pubmed.ncbi.nlm.nih.gov/32196810/ Dependence on e‐cigarettes and cigarettes in a cross‐sectional study of US adults]=== | ||
Among current users, dependence on e‐cigarettes was significantly lower than dependence on cigarettes, in within‐subjects comparisons among dual users of both e‐cigarettes and cigarettes, and in separate groups of e‐cigarette users and cigarette smokers, and among both daily and non‐daily users of each product. | Among current users, dependence on e‐cigarettes was significantly lower than dependence on cigarettes, in within‐subjects comparisons among dual users of both e‐cigarettes and cigarettes, and in separate groups of e‐cigarette users and cigarette smokers, and among both daily and non‐daily users of each product. | ||
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= Ethics = | |||
=== 2021: [https://academic.oup.com/ntr/issue/23/1 Ethics and Harm Reduction Approaches in Tobacco Control] (Special journal edition) === | |||
* This special issue of ''Nicotine and Tobacco Research'' focuses on the ethical aspects of tobacco harm reduction as a strategy in tobacco control. Several of the papers arise from presentations given in May 2018 at a Summer Academy on population-level bioethics hosted by the Brocher Foundation, organized by Samia Hurst, Dan Wikler, Nir Eyal, and Monica Magalhaes, specifically focusing on tobacco control. This event led to a call for papers for this journal. | |||
* The polarization of this debate and the impact this has on trainees and early career researchers and professionals in the field of nicotine and tobacco is discussed in the commentary by Carroll and colleagues. | |||
* This further motivates the search for ethical principles, which can explain why participants in these debates take the positions they do, and assist us to find an ethical position that can clarify and guide policy choice. | |||
* Thomas and colleagues consider the debate from the point of view of three major analytical approaches in bioethics—utilitarianism, (individual oriented) bioethics, and public health ethics—arguing that the first is not adequate to tackle the problems, but that the latter approaches are in fact complementary and draw to similar conclusions. | |||
* The papers in this issue consider what may be familiar problems to most readers of this journal, but in possibly unfamiliar ways drawing from the discipline of philosophy. | |||
=== 2019: [https://doi.org/10.1007/s12152-019-09402-x A critical analysis of Australia’s ban on the sale of electronic nicotine delivery systems] === | |||
* Australia does not allow adult smokers to buy or use electronic nicotine delivery systems (ENDS) that contain nicotine without a prescription. This paper critically evaluates the empirical and ethical justifications provided for the policy by Federal and State governments, public health advocates and health organisations. | |||
* We also argue that even if the evidence were stronger, it would not justify denying adult smokers the right to use ENDS either to quit smoking or as a long-term alternative to smoking cigarettes. | |||
* We outline ENDS policies that would more ethically address the public health concerns that motivated the current policy by allowing adult smokers to access ENDS for smoking cessation or tobacco harm reduction under tight regulations that discourage commercial promotion and adolescent use. | |||
* Hall, W., Morphett, K. & Gartner, C. A ''Neuroethics'' '''14''' (Suppl 3), 323–331 (2021). <nowiki>https://doi.org/10.1007/s12152-019-09402-x</nowiki> | |||
=Mental Health= | =Mental Health= | ||
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===See Also=== | ===See Also=== | ||
*[[ | *[[Nicotine therapeutic benefits|Mental Health under: Nicotine Therapeutic Benefits]] | ||
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=Perception - safety vs harm - effects on use= | =Perception - safety vs harm - effects on use= | ||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37544328/ Medicalisation of vaping in the UK? E-cigarette users' perspectives on the merging of commercial and medical routes to vaping.] === | |||
* An important paper, investigates the co-existence, synergies and tensions between the two models of vaping for public health - the medicalised and consumer-based approaches - drawing on the insights of users. Great subject, because these two models have entirely different modes of engagement and action. We would ideally like both to work, but it could be problematic if one compromised the impact of the other. | |||
** Three qualitative themes were identified: pro-partnership, anti-partnership and medicalisation dissonance. Medicalisation was discussed for its potential to reassure smokers about e-cigarette harms and its potential to reach smokers from disadvantaged backgrounds. Concerns were raised about cost-effectiveness, quality of support, conflicts of interest and limiting product choice. Most participants rated interventions involving partnership working as potentially helpful in switching from smoking to vaping. There were no statistically significant associations between age, gender and socioeconomic status, and helpfulness ratings. | |||
* Being qualitative, the paper is sprinkled with revealing quotes from vapers... e.g. | |||
** [Millions of] people are now using e-cigarettes in the UK and that this change came about with no involvement of any health professionals whatever. My guess is that the best thing would be for health professionals to leave things as they are, while doing everything they can to counteract adverse media reportage and trumpet the benefits of switching from smoking to e-cigarette use. (Survey participant 21) | |||
* The authors see complementary benefits in pursuing both models... | |||
** Conclusion: Both commercial and medical routes to vaping offer perceived benefits to vapers and may complement and reinforce each other to support smoking cessation. | |||
* Ward E, Dawkins L, Holland R, Pope I, Notley C. Perspect Public Health. 2023 Aug 6:17579139231185481. doi: 10.1177/17579139231185481. Online ahead of print. PMID: 37544328 | |||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37182238/ Awareness and beliefs about FDA e-cigarette regulation in the premarket application review era.] === | |||
* A survey of awareness and attitudes about regulation of e-cigarettes, among adults who smoke and youth (15-20): | |||
* Awareness that FDA regulates e-cigarettes was low among adults who smoke (25.4 %) and youth (18.5 %). Awareness that FDA authorizes e-cigarettes was also low among adults who smoke (10.8 %) and youth (12.7 %). | |||
* Additionally, participants were asked about two positive beliefs regarding regulation (“agree that FDA regulation makes e-cigarettes safer”, ~40%; “agree that FDA regulation helps prevent youth uptake”, ~25%), and two negative beliefs (“agree that FDA regulation takes away freedom to choose”, ~20%; “agree that FDA regulation limits choices”, ~40%). Current e-cigarette use was associated with higher odds of agreeing to each item (both positive and negative beliefs). | |||
* Seems to indicate a lot of confusion about regulation, and responses that are not always consistent (e.g. the two negative beliefs are both about choice, but have very different rates of endorsement). | |||
* Again this is very timely considering conversations during this week’s E-Cig Summit: given the low awareness of e-cigarettes among the population who would benefit most from them (adults who smoke), seems like a prime opportunity for some communication from FDA about authorized e-cigarette products. | |||
* Weiger C, Chen-Sankey J, Jeong M, Delnevo C, Wackowski O. Addict Behav. 2023 May 9;144:107748. doi: 10.1016/j.addbeh.2023.107748. Online ahead of print. PMID: 37182238 | |||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37191964/ US Physicians' Self-reported Discussions About Tobacco-Free Nicotine Pouches During Clinical Encounters With Patients in 2021.] === | |||
* This survey asked US physicians whether patients have asked them about nicotine pouches, and some characteristics about those conversations: | |||
** Results: Of 745 participating physicians, 63 (9.7%) reported being asked by patients about tobacco-free nicotine pouches… Fifty respondents described patient discussions about nicotine pouches, which clustered into 3 themes: discouraging use of pouches (20 [40.0%]), learning about nicotine pouches from patients or neutral communication (19 [38.0%]), and communicating to patients that they were open to pouch use for cessation or harm reduction (11 [22.0%]). | |||
* These numbers are remarkably similar to risk perceptions overall in the US if you map the physician response categories onto different risk perception categories: the largest group incorrectly thinks that noncombustible nicotine products are harmful and should be discouraged, followed by a large minority who doesn’t know one way or another, and only ~20% viewing noncombustible nicotine products as ''less'' risky. In other words, doctors are just as confused and misinformed about nicotine as most of the rest of us. | |||
** ''Discussion: Previous guidance on e-cigarettes may be helpful to inform physicians’ approach to nicotine pouches—in a discussion of cigarette substitutes, clinicians should urge patients to quit or reduce combustible tobacco use, and while the effects of long-term nicotine pouch use remain unknown, such products are likely less harmful than combustible tobacco.'' | |||
* Hrywna M, Bover-Manderski MT, Wackowski OA, Steinberg MB, Delnevo CD. JAMA Netw Open. 2023 May 1;6(5):e2313583. doi: 10.1001/jamanetworkopen.2023.13583. PMID: 37191964 Free PMC article. | |||
===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501702/ Perception of the relative harm of electronic cigarettes compared to cigarettes amongst US adults from 2013 to 2016: analysis of the Population Assessment of Tobacco and Health (PATH) study data]=== | ===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501702/ Perception of the relative harm of electronic cigarettes compared to cigarettes amongst US adults from 2013 to 2016: analysis of the Population Assessment of Tobacco and Health (PATH) study data]=== | ||
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The researchers also found that "the propylene glycol itself was a potent germicide. One part of glycol in 2,000,000 parts of air would--within a few seconds--kill concentrations of air-suspended pneumococci, streptococci and other bacteria numbering millions to the cubic foot." | The researchers also found that "the propylene glycol itself was a potent germicide. One part of glycol in 2,000,000 parts of air would--within a few seconds--kill concentrations of air-suspended pneumococci, streptococci and other bacteria numbering millions to the cubic foot." | ||
=== 1947: [https://jpet.aspetjournals.org/content/91/1/52 TESTS FOR THE CHRONIC TOXICITY OF PROPYLEXE GLYCOL AND TRIETHYLENE GLYCOL ON MONKEYS AND RATS BY VAPOR INHALATION AND ORAL ADMINISTRATION] === | |||
===1942: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2135271/ | * Comparative observations on the growth rates, blood counts, urine examinations, kidney function tests, fertility and general condition of the test and control groups, exhibited no essential differences between them with the exception that the rats in the glycol atmospheres exhibited consistently higher weight gains. Some drying of the skin of the monkeys' faces occurred after several months continuous exposure to a heavy fog of triethylene glycol. However, when the vapor concentration was maintained just below saturation by means of the glycostat this effect did not occur. | ||
* Examination at autopsy likewise failed to reveal any differences between the animals kept in glycolized air and those living in the ordinary room atmosphere. Extensive histological study of the lungs was made to ascertain whether the glycol had produced any generalized or local irritation. None was found. The kidneys, liver, spleen and bone marrow also were normal. | |||
* The results of these experiments in conjunction with the absence of any observed ill effects in patients exposed to both triethylene glycol and propylene glycol vapors for months at a time, provide assurance that air containing these vapors in amounts up to the saturation point is completely harmless. | |||
* Animal study | |||
* O. H. ROBERTSON, CLAYTON G. LOOSLI, THEODORE T. PUCK, HENRY WISE, HENRY M. LEMON and WILLIAM LESTER JR. Journal of Pharmacology and Experimental Therapeutics September 1947, 91 (1) 52-76; | |||
=== 1942: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2135271/ THE BACTERICIDAL ACTION OF PROPYLENE GLYCOL VAPOR ON MICROORGANISMS SUSPENDED IN AIR.] === | |||
It has been found that propylene glycol vapor dispersed into the air of an enclosed space produces a marked and rapid bactericidal effect on microorganisms introduced into such an atmosphere in droplet form. Concentrations of 1 gm. of propylene glycol vapor in two to four million cc. of air produced immediate and complete sterilization of air into which pneumococci, streptococci, staphylococci, H. influenzae, and other microorganisms as well as influenza virus had been sprayed…. | It has been found that propylene glycol vapor dispersed into the air of an enclosed space produces a marked and rapid bactericidal effect on microorganisms introduced into such an atmosphere in droplet form. Concentrations of 1 gm. of propylene glycol vapor in two to four million cc. of air produced immediate and complete sterilization of air into which pneumococci, streptococci, staphylococci, H. influenzae, and other microorganisms as well as influenza virus had been sprayed…. | ||
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===2018: [https://pubmed.ncbi.nlm.nih.gov/29570695/ Lack of Substantial Post-Cessation Weight Increase in Electronic Cigarettes Users]=== | ===2018: [https://pubmed.ncbi.nlm.nih.gov/29570695/ Lack of Substantial Post-Cessation Weight Increase in Electronic Cigarettes Users]=== | ||
“Conclusion: Within the study limitations, EC use may help smokers attenuate cigarette consumption or remain abstinent, as well as reduce their post-cessation weight increase. The potential role of the e-vapour category for harm minimization in relation to tobacco and/or food abuse requires confirmation from larger prospective studies. Moreover, the observed lack of post-cessation weight gain in those who reduced substantially cigarette consumption by switching to ECs (i.e., dual users) is an interesting finding and calls for further research investigating the role of nicotine in weight control. Meanwhile, these preliminary findings should be communicated to smokers and particularly to weight-conscious smokers intending to quit. | *“Conclusion: Within the study limitations, EC use may help smokers attenuate cigarette consumption or remain abstinent, as well as reduce their post-cessation weight increase. The potential role of the e-vapour category for harm minimization in relation to tobacco and/or food abuse requires confirmation from larger prospective studies. Moreover, the observed lack of post-cessation weight gain in those who reduced substantially cigarette consumption by switching to ECs (i.e., dual users) is an interesting finding and calls for further research investigating the role of nicotine in weight control. Meanwhile, these preliminary findings should be communicated to smokers and particularly to weight-conscious smokers intending to quit. | ||
By combining substantial reduction of smoking with prevention of post-cessation weight gain, EC-based interventions may promote an overall improvement in quality of life. Considering that the negative effects of weight increase could overshadow the health benefits of smoking abstinence, it is important to stimulate more research in this area.” | *By combining substantial reduction of smoking with prevention of post-cessation weight gain, EC-based interventions may promote an overall improvement in quality of life. Considering that the negative effects of weight increase could overshadow the health benefits of smoking abstinence, it is important to stimulate more research in this area.” | ||
===2018: [https://pubmed.ncbi.nlm.nih.gov/28525609/ E-cigarettes and Weight Loss—Product Design Innovation Insights From Industry Patents]=== | ===2018: [https://pubmed.ncbi.nlm.nih.gov/28525609/ E-cigarettes and Weight Loss—Product Design Innovation Insights From Industry Patents]=== | ||
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=Suggested studies to add to this page= | =Suggested studies to add to this page= | ||
[[File:Data reliability.png|alt=The data reliability pyramid. Shows the quality of various data from expert opinion at the bottom to systematic review at the top (lowest quality at bottom, highest at top)|center|frame|The data reliability pyramid]] | |||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37041005/ Vaping: Government announces "swap to stop" scheme to cut smoking rates.] === | === 2023: [https://pubmed.ncbi.nlm.nih.gov/37041005/ Vaping: Government announces "swap to stop" scheme to cut smoking rates.] === | ||
* One million smokers in England will be given a free vaping starter kit as part of a government package of measures to get smoking rates below 5% by 2030 | * One million smokers in England will be given a free vaping starter kit as part of a government package of measures to get smoking rates below 5% by 2030 | ||
* Comment and write up in BMJ of UK policy. | * Comment and write up in BMJ of UK policy. | ||
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* ''Baseline e-cigarette use did not increase the odds of having functionally important respiratory symptoms at follow-up regardless of combustible tobacco use status.''<br /> | * ''Baseline e-cigarette use did not increase the odds of having functionally important respiratory symptoms at follow-up regardless of combustible tobacco use status.''<br /> | ||
Click on the category link below for more studies by topic on ENDS and Nicotine. | Click on the category link below for more studies by topic on ENDS and Nicotine. | ||
[[Category:Studies, Surveys, and Papers]] | [[Category:Studies, Surveys, and Papers]] | ||
[[Category:THR Advocacy Group]] | |||
[[Category:Smoking cessation]] | |||
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