Research Library
Published Year: 2023. Publication Type: Journal Article
Publication Title: Nicotine & Tobacco Research.
A Qualitative Analysis of the Experiences of People Who Resumed Smoking Following Exclusive Electronic Nicotine Delivery Systems Use
Authors: Hoek, Janet, Waa, Anaru, Sanford, Kealey-Rei, Robertson, Lindsay
ISBN/ISSN: 1469-994X. DOI: 10.1093/ntr/ntac157.
Website/Url: https://academic.oup.com/ntr/article/25/3/470/6855023
Abstract:
Introduction
For electronic nicotine delivery systems (ENDS) to reduce harms caused by smoking, people who smoke must be able to switch to exclusive ENDS use without subsequently returning to smoking. Identifying factors prompting a return to smoking among former exclusive ENDS users is crucial, yet few qualitative studies have probed experiences of this process.
Aims and Methods
We conducted in-depth, semi-structured interviews with 20 people (seven indigenous Māori and 13 non-Māori) who smoked tobacco at least weekly, had smoked at least 100 cigarettes in their lifetime, and reported using ENDS to stop smoking cigarettes for at least 30 days (ideally, within the preceding 6 months). We explored their experiences of ENDS use, probed critical return-to-smoking settings and triggers, and analyzed strategies that could promote sustained smoking abstinence. We managed data using NVivo12 and used a reflexive thematic analysis approach to interpret the transcripts.
Results
We identified three themes that explained participants’ experiences. ENDS performed a functional role by mimicking some aspects of smoking. Yet participants experienced ENDS as inauthentic and unsatisfying across physical, social, and affectual domains, including in the most common return-to-smoking situations. Furthermore, fewer constraints on ENDS usage led participants to feel they could perpetuate addiction and risk of harm.
Conclusions
Return to smoking reflected two factors: ENDS’ failure to replicate core smoking attributes that remained appealing, and the burden of self-regulation required when using ENDS. Understanding and informing people about the challenges involved in transitioning to ENDS, beyond obtaining sufficient nicotine, could help support informed ENDS use and may potentially prevent people returning to smoking.
Tag: Relapse, Cessation
Key: P7S98YFB
Published Year: 2023. Publication Type: Journal Article
Publication Title: Addiction.
A critique of the Australian National Health and Medical Research Council CEO statement on electronic cigarettes
Authors: Rigotti, Nancy A., McNeill, Ann, Bullen, Chris, Britton, John, Benowitz, Neal L., Beaglehole, Robert, Wodak, Alex, Mendelsohn, Colin P., Borland, Ron, Hall, Wayne
ISBN/ISSN: 0965-2140, 1360-0443. DOI: 10.1111/add.16143.
Website/Url: https://onlinelibrary.wiley.com/doi/10.1111/add.16143
Abstract:
This paper critically analyses a statement by Australia’s National Health and Medical Research Council (NHMRC) on e-cigarettes in May 2022 that will be used to guide national policy. We reviewed the evidence and the conclusions drawn in the NHMRC Statement. In our view, the Statement is not a balanced reflection of the benefits and risks of vaping because it exaggerates the risks of vaping and fails to compare them to the far greater risks of smoking; it uncritically accepts evidence of harms from e-cigarettes while adopting a highly sceptical attitude towards evidence of their benefits; it incorrectly claims that the association between adolescent vaping and subsequent smoking is causal; and it understates the evidence of the benefits of e-cigarettes in assisting smokers to quit. The Statement dismisses the evidence that vaping is probably already having a positive net public health effect and misapplies the precautionary principle. Several sources of evidence supporting our assessment were published after the NHMRC Statement’s publication and are also referenced. The NHMRC Statement on e-cigarettes does not present a balanced assessment of the available scientific literature and fails to meet the standard expected of a leading national scientific body.
Tag: Critique, Position Statement, Communication
Key: ZXUSZM4A
Published Year: 2023. Publication Type: Journal Article
Publication Title: Addiction.
Biomarkers of potential harm in people switching from smoking tobacco to exclusive e_cigarette use, dual use or abstinence: secondary analysis of Cochrane systematic review of trials of e_cigarettes for smoking cessation
Authors: Lindson, Nicola, Rigotti, Nancy A., Hartmann_Boyce, Jamie, Butler, Ailsa R., Bullen, Chris, Hajek, Peter, Onakpoya, Igho J., Theodoulou, Annika
ISBN/ISSN: 0965-2140, 1360-0443. DOI: 10.1111/add.16063.
Website/Url: https://onlinelibrary.wiley.com/doi/10.1111/add.16063
Abstract:
This study aims to compare biomarkers of potential harm between people switching from smoking combustible cigarettes (CC) completely to electronic cigarettes (EC), continuing to smoke CC, using both EC and CC (dual users) and using neither (abstainers), based on behaviour during EC intervention studies.Secondary analysis following systematic review, incorporating inverse variance random-effects meta-analysis and effect direction plots.This study was conducted in Greece, Italy, Poland, the United Kingdom and the United States.A total of 1299 adults smoking CC (nine studies) and provided EC.Measurements were conducted using carbon monoxide (CO) and 26 other biomarkers.In pooled analyses, exhaled CO (eCO) was lower in EC versus EC + CC [mean difference (MD) = -4.40 parts per million (p.p.m.), 95% confidence interval (CI) = -12.04 to 3.24, two studies] and CC (MD = -9.57 p.p.m., 95% CI = -17.30 to -1.83, three studies). eCO was lower in dual users versus CC only (MD = -1.91 p.p.m., 95% CI = -3.38 to -0.45, two studies). Magnitude rather than direction of effect drove substantial statistical heterogeneity. Effect direction plots were used for other biomarkers. Comparing EC with CC, 12 of 13 biomarkers were significantly lower in EC users, with no difference for the 13th. Comparing EC with dual users, 12 of the 25 biomarkers were lower for EC, and five were lower for dual use. For the remaining eight measures, single studies did not detect statistically significant differences, or the multiple studies contributing to the outcome had inconsistent results. Only one study provided data comparing dual use with CC; of the 13 biomarkers measured, 12 were significantly lower in the dual use group, with no statistically significant difference detected for the 13th. Only one study provided data on abstainers.Switching from smoking to vaping or dual use appears to reduce levels of biomarkers of potential harm significantly.
Tag: Dual Use, Biomarkers, Toxicity
Key: RH22IGCW
Published Year: 2023. Publication Type: Journal Article
Publication Title: Addictive Behaviors.
Association of psychological distress with smoking cessation, duration of abstinence from smoking, and use of non-combustible nicotine-containing products: A cross-sectional population survey in Great Britain
Authors: Brose, Leonie S., Tattan-Birch, Harry, Shahab, Lion, Robson, Debbie, McNeill, Ann, Cox, Sharon, Brown, Jamie, Kock, Loren
ISBN/ISSN: 3064603. DOI: 10.1016/j.addbeh.2022.107570.
Website/Url: https://linkinghub.elsevier.com/retrieve/pii/S0306460322003367
Abstract:
Background
Tobacco smoking cessation is associated with improvements in mental health. This study assessed psychological distress, using the K6 non-specific screening tool ((items cover feelings of nervousness, hopelessness, restlessness, depression, ‘everything an effort’ and worthlessness), by smoking status, time since quit, and use of a non-combustible nicotine product.
Methods
Monthly repeat cross-sectional household survey of adults (18 + ) from October 2020–February 2022 in Great Britain (N = 32,727). Using unadjusted and adjusted logistic regression (adjusted models included socio-demographic characteristics and ever diagnosis with a mental health condition), we assessed: associations between any/serious past-month psychological distress and smoking status and time since quit, whether these relationships were moderated by ever diagnosis with a mental health condition, and associations between distress and use of a nicotine product by people who formerly smoked.
Results
In the unadjusted model, those who had not smoked for > 1y and who had never smoked had lower odds of any distress (OR = 0·42, 95 % CI 0·39-0·45; OR = 0·44, 0·41-0·47) compared with those who currently smoked. Moreover, the association of lower distress in those who had not smoked for > 1y and never smoked compared with those who currently smoked was more pronounced among those who had ever been diagnosed with a mental health condition (AOR = 0·58, 0·51-0·66; AOR = 0·60, 0·53-0·67) than among those who had not (AOR = 0·86, 0·76-0·98; AOR = 0·72, 0·65-0·81). In adjusted models of people who formerly smoked, current use of any nicotine product was associated with higher odds of distress compared with not using any nicotine product (AOR 1·23, 1·06-1·42).
Conclusion
People who had never smoked, or had not smoked for > 1y had lower levels of distress than those who currently smoked. The lower odds of distress among people who had not smoked for > 1y was more pronounced among those with an ever (vs never) diagnosis of a mental health condition. Nicotine product use among those who formerly smoked was associated with greater distress. Due to potential residual confounding and selection bias more research is needed to determine causality.
Tag: Metal Health, Comparison
Key: A43FXRBY
Published Year: 2023. Publication Type: Journal Article
Publication Title: Journal of Consumer Policy.
Sales of Electronic Nicotine Delivery Systems (ENDS) and Cigarette Sales in the USA: A Trend Break Analysis
Authors: Kim, S., Joselow, J., Selya, A., Sembower, M., Chandra, S., Shiffman, S., Wissmann, R.
ISBN/ISSN: 0168-7034, 1573-0700. DOI: 10.1007/s10603-022-09533-4.
Website/Url: https://link.springer.com/10.1007/s10603-022-09533-4
Abstract:
Electronic nicotine delivery systems (ENDS) are a potentially lower-risk tobacco product which could help smokers switch completely away from cigarettes. However, the lack of strong evidence to date of a measurable, population-level effect on reducing smoking has generated skepticism about ENDS’ potential benefits. This study examines whether increased US ENDS sales have been associated with reduced cigarette sales. Retail data on weekly per-capita cigarette and ENDS purchases in the USA during 2014–2019 were obtained from a national sample of brick-and-mortar retail outlets. Trends in cigarette sales were modeled before (2014–2016) ENDS had a substantial market share, and, after adjusting for macroeconomic factors, projected into the post-period (2017–2019). Actual cigarette sales were lower than projected sales (by up to 16% across the post-period), indicating a substantial “cigarette shortfall” in the post-period. To explore whether general (i.e., inclusive of potentially many mechanisms) substitution by ENDS can explain the cigarette shortfall, its association with per-capita ENDS volume sales was examined. Higher ENDS sales were significantly associated with a greater cigarette shortfall: for every additional per-capita ENDS unit, cigarette sales were 1.4 packs-per-capita lower than expected (B = 1.4, p < .0001). Error correction models which account for spurious correlation yielded similar results. These findings support ENDS serving as a substitute for cigarettes (through potentially many mechanisms including cigarette price), causing cigarette consumption to decline. Since ENDS potentially pose lower risk than cigarettes, this general substitution effect suggests that risk-proportionate tobacco regulation could mitigate the tobacco-related health burden.
Tag: Sales, Trends, Industry
Key: DY24JW5X
Published Year: 2023. Publication Type: Journal Article
Publication Title: BMC Chemistry.
Harmful and potentially harmful constituents (HPHCs) in two novel nicotine pouch products in comparison with regular smokeless tobacco products and pharmaceutical nicotine replacement therapy products (NRTs)
Authors: Lindholm, Johan, Rutqvist, Lars E., Masser, Anna E., Back, Susanne
ISBN/ISSN: 2661-801X. DOI: 10.1186/s13065-023-00918-1.
Website/Url: https://bmcchem.biomedcentral.com/articles/10.1186/s13065-023-00918-1
Abstract:
Background
Tobacco-free nicotine pouches is a novel category of oral nicotine-delivery products. Among current tobacco users such pouches may serve as a low-risk alternative to cigarettes or conventional, tobacco-based oral products e.g., snus and moist snuff. In the United States (U.S.), the market leading nicotine-pouch brand is ZYN®. However, no data on the chemical characteristics of ZYN have been published.
Methods
We screened for 43 compounds potentially present in tobacco products in seven oral nicotine-delivery products: ZYN (dry and moist), snus (General®), moist snuff (CRP2.1 and Grizzly Pouches Wintergreen), and two pharmaceutical, nicotine replacement therapy products (NRTs, Nicorette® lozenge and Nicotinell® gum). Thirty-six of the tested compounds are classified as harmful and potentially harmful constituents (HPHCs) by the Center for Tobacco Products at the U.S. Food and Drug Administration (FDA-CTP). Five additional compounds were included to cover the GOTHIATEK® product standard for Swedish snus and the last two compounds were chosen to include the four primary tobacco specific nitrosamines (TSNAs).
Results
The tested products contained nicotine at varying levels. The two ZYN products contained no nitrosamines or polycyclic aromatic hydrocarbons (PAHs) but low levels of ammonia, chromium, formaldehyde, and nickel. In the NRT products we quantified low levels of acetaldehyde, ammonia, cadmium, chromium, lead, nickel, uranium-235, and uranium-238. The largest number (27) and generally the highest levels of HPHCs were quantified in the moist snuff products. For example, they contained six out of seven tested PAHs, and seven out of ten nitrosamines (including NNN and NNK). A total of 19 compounds, none of which were PAHs, were quantified at low levels in the snus product. NNN and NNK levels were five to 12-fold lower in snus compared to the moist snuff products.
Conclusions
No nitrosamines or PAHs were quantified in the ZYN and NRT products. Overall, the number of quantified HPHCs were similar between ZYN and NRT products and found at low levels.
Tag: Comparison, Nicotine Pouches
Key: RML4WTGW
Published Year: 2023. Publication Type: Journal Article
Publication Title: Drug Testing and Analysis.
Curiosity and intentions to use myblu e-cigarettes and an examination of the ‘gateway’ theory: Data from cross-sectional nationally representative surveys
Authors: Nides, Mitchell, O’Connell, Grant, Nahde, Thomas, Malt, Layla, Verron, Thomas, Cahours, Xavier, Tope, Andrew, Houser, Trisha L., Seltzer, Ryan G. N., Fearon, Ian M.
ISBN/ISSN: 1942-7603, 1942-7611. DOI: 10.1002/dta.3450.
Website/Url: https://onlinelibrary.wiley.com/doi/10.1002/dta.3450
Abstract:
Encouraging adult smokers who are uninterested or unwilling to quit, and would otherwise continue to smoke, to transition to potentially less harmful nicotine products such as electronic nicotine delivery systems (ENDS) may positively impact population health. However, counterbalancing this benefit is the societal concern that ENDS may be used by never smokers and youth and serve as a ‘gateway’ into cigarette smoking. Data were analysed from two independent surveys of the prevalence and perceptions of myblu ENDS use in the United States. Total sample size was 22,232 young adults and 23,264 adults. Being curious to use myblu was 1.6-2.0 times more likely in young adult current smokers than young adult never smokers. This likelihood was 2.8 times greater for adult current smokers compared with adult never smokers in the perceptions survey, while in the prevalence survey, there was no difference between adult current and never smokers. Intentions to use myblu were significantly greater in young adult current smokers compared with young adult never smokers in both surveys and in adults in the prevalence survey. In all surveys and age cohorts, 124 of 45,496 participants (0.1% of the total survey population) reported first using myblu prior to smoking cigarettes and went on to become established smokers. Curiosity and intentions to use myblu were generally higher in current smokers compared with never smokers. There was minimal evidence to suggest the existence of a ‘gateway’ effect to established cigarette smoking among never-smoking myblu users.
Tag: Gateway
Key: 3T9XTVP2
Published Year: 2023. Publication Type: Journal Article
Publication Title: Drug Testing and Analysis.
Behavioral Intentions Assessment of a Disposable E_Cigarette Among Adult Current, Former, and Non_Smokers in the United States
Authors: Fearon, Ian M., McKinney, Willie J., Russell, Christopher
ISBN/ISSN: 1942-7603, 1942-7611. DOI: 10.1002/dta.3467.
Website/Url: https://onlinelibrary.wiley.com/doi/10.1002/dta.3467
Abstract:
Modeling the public health effects of e-cigarettes requires estimates of the likelihood that different individuals and population subgroups will start using e-cigarettes and subsequently transition to and from combustible cigarette use. To begin to generate input values for modeling efforts, this study assessed adults’ behavioral intentions in relation to a disposable e-cigarette, “BIDI® Stick.” An online questionnaire assessed intentions to try and use a BIDI® Stick regularly in 11 flavor variants among United States (U.S.) nationally representative samples of adult (21+ years) non-smokers (n = 2284), current smokers (n = 2391), former smokers (n = 2241), and young adult (21–24 years) non-smokers (n = 1140) of combustible cigarettes following exposure to product information and images. Current smokers rated their intentions to use a BIDI® Stick to partially or completely replace cigarettes. Positive intention to try a BIDI® Stick at least once was, for each flavor variant, highest among current smokers (22.4%–28.1%), lower among former smokers (6.0%–9.7%) and non-smokers (3.4%–5.2%), and lowest among never-smokers (1.0%–2.4%). Among current smokers, former smokers, and non-smokers, trial and regular use intentions were lowest among e-cigarette non-users and e-cigarette never-users. Approximately 23.6% of current smokers reported an intention to use a BIDI® Stick in at least one flavor to completely switch from cigarettes and/or to reduce cigarette consumption. Low trial and regular use intentions suggest that U.S. adults who do not currently smoke cigarettes and/or use e-cigarettes are unlikely to initiate use of the BIDI® Stick e-cigarette. Trial and regular use intentions are highest among adults who currently smoke cigarettes and/or use e-cigarettes. A moderate proportion of current smokers may try using a BIDI® Stick e-cigarette as a partial or complete replacement for combustible cigarettes.
Tag: Disposables, Cessation, Flavours
Key: 2XH2AMWG