UKECRF Research Roundup
The UK Electronic Cigarette Research Forum has published its latest monthly roundup of vaping and harm reduction related research and picked four for comment
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by Dave Cross
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A Qualitative Exploration of Consumers’ Perceived Impacts, Behavioural Reactions, and Future Reflections of the EU Tobacco Products Directive (2017) as Applied to Electronic Cigarettes – Ward et al. – [link]
The study was conducted by Emma Ward, Claudia Anholt, Sarah Gentry, and Caitlin Notley from the University of East Anglia, London South Bank’s Lynne Dawkins, and Richard Holland at the Leicester Medical School.
The authors found: “Awareness of the TPD among consumers was not universal. Participants’ smoking behaviour did not appear to be influenced by the legislation. Participants were reassured by manufacturing regulations and requirements for ingredients labels. Participants responded negatively to changes perceived to cause inconvenience and extra plastic waste. The product restrictions prompted some participants to purchase non-compliant products illegally, potentially putting their safety at risk.”
They concluded: “E-cigarette regulation should focus on ensuring product safety. Raising awareness of the TPD among consumers and smokers could be beneficial.”
UKECRF commented: “Participants were predominantly white males meaning the results may not be representative of the wider population. They were also mostly from the UK, meaning the findings might not be relevant to other EU member states. Most participants had successfully quit smoking using e-cigarettes so the findings might not be relevant to other e-cigarette users who had relapsed and current smokers.”
It also thinks that due to the nature of recruitment and over-recruitment, there was a disparity between how people were interviewed, and that selection bias may have impacted the findings.
“Healthcare professionals’ beliefs, attitudes, knowledge and behaviour around vaping in pregnancy and postpartum: A qualitative study” by Hunter et al. – [link]
The research team was made up of a number of established experts in tobacco harm reduction. They found, “discussing vaping as a tool for quitting smoking in pregnancy was prevented by a lack of capability (limited knowledge of ECs, lack of training in smoking cessation); lack of opportunity (restricted by organisational policies and guidelines, lack of time and financial issues impacting on training), and negative social influences (sensationalist media and stigma associated with vaping in pregnancy); and lack of motivation (fear of future litigation and comebacks should adverse effects from vaping arise).”
They concluded: “Factors related to capability, opportunity and motivation were identified that influence HCPs attitudes and behaviours towards vaping in pregnancy. Gaps in knowledge and training needs were identified, which could inform the development of targeted vaping training.”
UKECRF warned that the sample of healthcare professionals who took part was “opportunistic” and the participants “may” have been more motivated to talk about vaping and therefore unrepresentative of the attitudes of the wider healthcare population.
“Investigating the added value of biomarkers compared with self-reported smoking in predicting future e-cigarette use: Evidence from a longitudinal UK cohort study” by Khouja et al. – [link]
The team was mainly made up of researchers at the University of Bristol, an establishment that receives millions of pounds from anti-vape billionaire Michael Bloomberg.
They concluded: “Cotinine levels consistent with active smoking in adolescence are associated with later e-cigarette use even after adjusting for some measures of self-reported smoking behaviour. This could have implications for studies assessing the gateway hypothesis that rely on self-report measures of smoking behaviour. Future studies investigating prediction of e-cigarette use should investigate use of more detailed self-report and objective measures.”
From a non-scientific perspective, it is a struggle to hold any store in a paper that cites work by Jessica Barrington-Trimis to support its conclusion. Barrington-Trimis has been behind some of the shoddiest studies looking at vaping, flavours, and teen use.
UKECRF pointed out: “The study cannot determine causality between smoking at 15 years and e-cigarette use at 22 years for both cotinine determined and self-reported smoking status. E-cigarette and tobacco landscapes have changed significantly since 2006-2008 when participants were initially approached, so the association observed may not apply to young people today.
“Measurement error may explain the residual association between continue determined smoking and later e-cigarette use after adjusting for self-reported smoking status. Self-reported and cotinine determined smoking status were recorded an average of 15 months apart. This time gap was adjusted for in a sensitivity analysis and was found to be unlikely to have an effect. However, this may have resulted in measurement error.”
Cotinine’s half-life is very short, UKECRF adds, which would impact on smoking status measurements. Not just that, but passive smoke exposure could have introduced further errors and was not accounted for.
UKECRF goes on to add that they failed to account for the use of other tobacco products, “therefore, adjusting for ever smoking or smoking transitions may not be expected to attenuate the association.”
“Association of the US Outbreak of Vaping-Associated Lung Injury With Perceived Harm of e-Cigarettes Compared With Cigarettes” by Tattan-Birch, Brown, Shahab, and Jackson – [link]
The authors said: “After the US outbreak of vaping-associated lung injury, views on e-cigarettes among smokers in England deteriorated. The proportion perceiving e-cigarette use as less harmful than cigarette smoking decreased, and the proportion perceiving e-cigarette use as more harmful increased by over one-third.”
They went on to warn: “The effects that these worsened harm perceptions will have on population health is unclear. It is possible that people who had quit smoking cigarettes through vaping might now return to smoking, and cigarette smokers might be deterred from using e-cigarette devices to help them quit. On the other hand, young people who have never smoked may be dissuaded from ever trying e-cigarettes.”
While the UKECRF said, “the study examined an association rather than a causal link,” any findings demonstrating a worsening of attitudes towards vaping and tobacco harm reduction is troubling and worthy of monitoring on an ongoing basis.
Vaping and harm reduction studies this month:
Patterns of use
- Tobacco-use behavior and toxicant exposure among current dual users of electronic cigarettes and tobacco cigarettes.
- Comparing the Characteristics of Cigarette Smoking and e-Cigarette and IQOS Use among Adolescents in Taiwan.
- Perceived harms of and exposure to tobacco use and current tobacco use among reproductive-aged women from the PATH study.
- Associations of home and workplace vaping restrictions with e-cigarette use among U.S. adults.
- Increasing Prevalence of Electronic Cigarette Use among Medical Students. Repeated Cross-Sectional Multicenter Surveys in Germany and Hungary, 2016-2018.
- How Is Use of Electronic Cigarettes Related to Conventional Cigarette Use? A Qualitative Study among Korean American Young Adults.
- The impact of cigarette and e-cigarette use history on transition patterns: a longitudinal analysis of the population assessment of tobacco and health (PATH) study, 2013-2015.
- Prevalence, Trends, and Distribution of Nicotine and Marijuana use in E-cigarettes among US adults: The Behavioral Risk Factor Surveillance System 2016-2018.
- A Retrospective Cross-Sectional Study on the Prevalence of E-cigarette Use Among College Students.
- Prevalence of Vaping and Behavioral Associations of Vaping Among a Community of College Students in the United States.
- Electronic cigarette use among university students aged 18-24 years in New Zealand: results of a 2018 national cross-sectional survey.
- Changes from 2017 to 2018 in e-cigarette use and in ever marijuana use with e-cigarettes among US adolescennts: analysis of the National Youth Tobacco Survey.
- What influences adolescents to continuously use e-cigarettes?
- How and Why California Young Adults Are Using Different Brands of Pod-Type Electronic Cigarettes in 2019: Implications for Researchers and Regulators.
- The Effects of Cannabis Use: A Test Among Dual Electronic and Combustible Cigarette Users.
- E-cigarette use is prospectively associated with initiation of cannabis among college students.
Perception
- Social Media Message Designs to Educate Adolescents About E-Cigarettes.
- Harm Perceptions of the JUUL E-Cigarette in a Sample of Ever Users.
- Young Adult JUUL Users' Beliefs About JUUL.
- A Qualitative Exploration of Consumers' Perceived Impacts, Behavioural Reactions, and Future Reflections of the EU Tobacco Products Directive (2017) as Applied to Electronic Cigarettes.
- User Perceptions of Different Electronic Cigarette Flavors on Social Media: Observational Study.
- A Social Media Study on the Associations of Flavored Electronic Cigarettes With Health Symptoms: Observational Study.
- Perceived risk of electronic cigarettes compared with combustible cigarettes: direct versus indirect questioning.
- An investigation of racial and ethnic differences in e-cigarette beliefs and use characteristics.
- Flavour types used by youth and adult tobacco users in wave 2 of the Population Assessment of Tobacco and Health (PATH) Study 2014-2015.
Cessation
- Exploring positive expectancies and quit status among adult electronic cigarette users.
- Healthcare professionals' beliefs, attitudes, knowledge and behaviour around vaping in pregnancy and postpartum: A qualitative study.
- Addressing and Overcoming Barriers to E-Cigarette Use for Smoking Cessation in Pregnancy: A Qualitative Study.
- The role of subjective responses in electronic cigarette uptake and substitution in adult smokers.
Youth
- Electronic Cigarettes Associated With Incident and Polysubstance Use Among Youth.
- E-cigarette devices used on school grounds.
- Ends Device Type and Initiation of Combustible Tobacco Products among Adolescents.
Harms and harm reduction
- Nicotine induces cardiac toxicity through blocking mitophagic clearance in young adult rat.
- Association of electronic cigarette use with lead, cadmium, barium, and antimony body burden: NHANES 2015-2016.
- Electronic nicotine delivery system-induced alterations in oral health via saliva assessment.
- Salivary Biomarker Profiles in E-Cigarette Users and Conventional Smokers: A Cross-Sectional Study.
- Pulmonary Toxicity and Inflammatory Response of E-Cigarette Vape Cartridges Containing Medium-Chain Triglycerides Oil and Vitamin E Acetate: Implications in the Pathogenesis of EVALI.
- A cross-sectional analysis of electronic cigarette use in US adults by asthma status.
- Pulmonary toxicity and inflammatory response of e-cigarettes containing medium-chain triglyceride oil and vitamin E acetate: Implications in the pathogenesis of EVALI but independent of SARS-COV-2 COVID-19 related proteins.
- Voltage and e-liquid composition affect nicotine deposition within the oral cavity and carbonyl formation.
- Acute and chronic sympathomimetic effects of e-cigarette and tobacco cigarette smoking: role of nicotine and non-nicotine constituents.
- The analysis of commercially available natural products recommended for use in electronic cigarettes.
- E-cigarettes damage the liver and alter nutrient metabolism in pregnant mice and their offspring.
- E-cigarette-induced pulmonary inflammation and dysregulated repair are mediated by nAChR α7 receptor: role of nAChR α7 in SARS-CoV-2 Covid-19 ACE2 receptor regulation.
- Comparison of End Tidal Carbon Monoxide Levels between Conventional Cigarette, Electronic Cigarette and Heated Tobacco Product among Asiatic Smokers.
- Validation of a nicotine vapor self-administration model in rats with relevance to electronic cigarette use.
- Impact of E-Cigarette Liquid Flavoring Agents on Activity of Microsomal Recombinant CYP2A6, the Primary Nicotine-Metabolizing Enzyme.
- Comparison of RANKL and osteoprotegerin levels in the gingival crevicular fluid of young cigarette- and waterpipe-smokers and individuals using electronic nicotine delivery systems.
- Association of the US Outbreak of Vaping-Associated Lung Injury With Perceived Harm of e-Cigarettes Compared With Cigarettes
- Short-term e-cigarette vapour exposure causes vascular oxidative stress and dysfunction: evidence for a close connection to brain damage and a key role of the phagocytic NADPH oxidase (NOX-2).
Marketing
- Tactics for drawing youth to vaping: A content analysis of e-cigarette advertisements.
- Characterizing vaping posts on instagram by using unsupervised machine learning.
- E-cigarette Marketing Regulations and Youth Vaping: Cross-Sectional Surveys, 2017-2019.
- Exposure to e-cigarette information and advertising in social media and e-cigarette use in Australia: A mixed methods study.
Misc
- Investigating the added value of biomarkers compared with self-reported smoking in predicting future e-cigarette use: Evidence from a longitudinal UK cohort study.
- Hot wires and film boiling: Another look at carbonyl formation in electronic cigarettes.
- Using Social Media to Recruit Youth Who Use Electronic Cigarettes.
- Transfer of metals in the liquids of electronic cigarettes.
Dave Cross
Journalist at POTVDave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous start-ups to develop content for their websites.
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