Progress on toxicity of co-exposure to ambient fine particulate matter and e-cigarettes / 环境与职业医学

Ambient fine particulate matter (PM2.5) is particulate matter with an aerodynamic diameter less than 2.5 μm, and has an extremely wide range of sources. It affects the environmental quality in many cities and regions around the world, and associates with lots of negative effects on public health. E-cigarettes, a group of products that atomize e-liquid by an atomizer and then deliver nicotine and/or other substances to the respiratory system, have been introduced as smoking cessation products or replacement of tobacco cigarettes in recent years. The usage rate of e-cigarettes has grown rapidly all over the world. When these two pollutants coexist in the same atmosphere, they would induce certain adverse health effects not only on the e-cigarette users, but also on the people around them. Besides causing cardiopulmonary toxicity, the co-existing pollutants may associate with higher risks of developmental toxicity and carcinogenicity. In addition, the combined exposure may be related with the occurrence of depression. Therefore, there is an urgent need to conduct studies on the toxic potential of the combined exposure to PM2.5 and e-cigarettes, which is also important for the evaluation and control of the atmospheric compound pollution associated health risk. This paper reviewed the current situation of PM2.5 pollution and e-cigarettes use, introduced the epidemiological studies of PM2.5 and e-cigarette combined exposure, their toxic effects in vivo and in vitro, and possible mechanisms, aiming to provide a reference for subsequent toxicity studies.

Estudio cualitativo del uso de los cigarrillos electrónicos en los estudiantes universitarios / Qualitative Study of E-Cigarette Use in College Students

Objetivos: El propósito de esta investigación fue determinar el nivel de conocimiento, creencias, percepción y practicas asociadas al consumo de cigarrillos electrónicos en los estudiantes universitarios (UASD), recinto Santiago, República Dominicana. Cada estudiante firmó un consentimiento informado certificando que éste respondió cada pregunta realizada por el entrevistador de manera voluntaria. El método de recolección de los datos fue mediante entrevistas, las cuales fueron grabadas por los entrevistadores. La muestra fue de 53 entrevistas, 48 individuales y 5 grupos focales, la misma se tomó hasta alcanzar el punto de saturación de cada pregunta, es decir cuando todas las respuestas se tornaron repetitivas. Materiales y métodos: Se realizó un estudio cualitativo de tipo fenomenológico y de fuentes primarias en el período mayo-agosto del año 2019 en la universidad privada Pontificia Universidad Católica Madre y Maestra (PUCMM) y la universidad pública Universidad Autónoma de Santo Domingo. (UASD), campus Santiago, República Dominicana. El método de recolección de datos se realizó a través de entrevistas, las cuales fueron grabadas por los entrevistadores. Cada estudiante entrevistado firmó un consentimiento informado certificando que respondió voluntariamente a cada pregunta formulada por el entrevistador. La muestra estuvo compuesta por 53 entrevistas, 48 personas y cinco grupos focales. Las entrevistas se realizaron hasta llegar al punto de saturación de cada pregunta, que es cuando todas las respuestas se volvieron repetitivas. Resultados: El conocimiento que tiene los estudiantes universitarios sobre cigarrillo electrónico (CE), es pobre, desde su funcionamiento, partes, sustancias e incluso las posibles complicaciones que puede traer a la salud, tanto en la Pontificia Universidad Católica Madre y Maestra (PUCMM) como en la Universidad Autónoma de Santo Domingo (UASD), pero es más notable en la universidad pública. Por otro lado, muchos perciben el CE, como una alternativa del uso de tabaco, que posee diversidad de sabores, olor agradable, atractivo, práctico y capaz de ofrecer relajación. En cuanto a la actitud hacia el dispositivo, en PUCMM exhibe un mayor nivel de rechazo con respecto al uso. Es importante mencionar, que mayoría de los entrevistados son o alguna vez fueron usuarios de este, no obstante, no lo recomiendan en gran medida, ya que asumen que puede causar daño y ser adictivo, aunque en menor medida al cigarrillo convencional. La población más susceptible a su uso, son los jóvenes y el sexo masculino, aunque las féminas se han ido sumando de manera significativa. De igual modo, se logró apreciar las grandes influencias que mueven a los jóvenes a su consumo, incluyendo, las redes sociales, familia, amigos, en general el entorno en que se rodean. Conclusión: Concluimos que los estudiantes universitarios carecen de conocimiento con respecto al cigarrillo electrónico, tanto en el funcionamiento, sustancias y complicaciones para la salud. Muchos observan al cigarrillo electrónico como un dispositivo para fumar con un olor agradable, por lo cual puede ser muy atractivo para los usuarios. Se logró apreciar el importante papel que juegan las influencias sociales para el uso del dispositivo, promovido por las redes sociales y relaciones cercanas. Otro problema en la sociedad actual es el uso de CE en menores de edad. Según los resultados existe una gran necesidad de intervención y educación, principalmente en los jóvenes.

Objective: The purpose of this research was to determine the level of knowledge, beliefs, perception, and practices associated with consuming electronic cigarettes among university students. Materials and methods: A qualitative study of phenome-nological type and from primary sources was carried out in the period of May-August of the year 2019 at the private university Pontificia Universidad Católica Madre y Mae-stra (PUCMM) and the public university Universidad Autónoma de Santo Domingo (UASD), Santiago campus, Dominican Republic. The data collection method was done through interviews, which the interviewers recorded. Each student interviewed signed an informed consent cer-tifying that they answered voluntarily each question asked by the interviewer. The sample consisted of 53 interviews, 48 individuals, and five focus groups. Interviews were done until reaching the saturation point of each question, which is when all the answers became repetitive. Results: University students' knowledge regarding elec-tronic cigarettes (EC) is poor. Knowledge regarding its mechanism, parts, substances, and possible complications to one's health, is scarce both in PUCMM and the UASD, but this is more notable at the public university. Addition-ally, many perceive EC as an alternative to tobacco use, the former, as per our study population, having a variety of fla-vors, a pleasant smell, being attractive, practical, and capa-ble of offering relaxation. Regarding the attitude towards the device, PUCMM exhibits a higher level of rejection regarding its use. It is essential to mention that most inter-viewees were once users of EC. However, they do not rec-ommend it to a great extent since they assume that it can cause harm and be addictive, although to a lesser extent than conventional cigarettes. The population most suscep-tible to its use are young people, including minors and the male gender, although females have been significantly increasing its use. Similarly, it was possible to appreciate the influences that greatly evoke the younger population's consumption, including social networks, family, friends, and the surrounding environment. Conclusion: We concluded that university students have insufficient knowledge regarding electronic cigarettes, both in their mechanism, substances, and health compli-cations. Most see electronic cigarettes as smoking devices with a pleasant smell, which can be very attractive to users. It was possible to observe the critical role played by social influences on the use of the device, promoted by social networks and close relationships. Another problem in cur-rent society is the use of CE in minors. According to the results, there is a great need for intervention and educa-tion, mainly among the younger generation.

Vaping - A Precipitating Factor of Pneumothorax in A Smoker?

@#A 24 years old man who was a dual user of tobacco smoke and e-cigarette presented with one month history of right sided pleuritic chest pain, associated with cough and shortness of breath a week prior to the admission. He was diagnosed with a right primary spontaneous pneumothorax. A right pleural catheter was inserted after a failed simple needle aspiration. He recovered uneventfully. Advice on quitting smoking and vaping was given prior to discharge. This case highlights the importance of obtaining a thorough history including vaping from every patient who experiences pneumothorax.

Ethical issues for e-cigarette control policies in Australia

Although tobacco smoking in Australia is at a historical low, electronic cigarette (e-cigarette) use, especially among the youth is increasing. Policies around e-cigarette control in Australia are currently evolving, even during the pandemic, thus demonstrating its priority status. The current article discusses ethical issues for e-cigarette control policies in Australia using a public health ethics framework. The article is structured using the domains of the WHO-MPOWER framework of tobacco control to enable a comprehensive coverage of all elements of e-cigarette control policies in Australia. It highlights several ethical issues, from different stakeholder perspectives, and indicates moral and ethical tensions in different public health actions that might be considered in framing policies around e-cigarette control. Keywords: Electronic nicotine delivery systems, e-cigarettes, Australia,, smoke-free policy, public health ethics

Electronic cigarette use among junior high school students of health promotion schools in Xihu District / 预防医学

Objective@#To investigate electronic cigarette (e-cigarette) use and its influencing factors among junior high school students of health promotion schools in Xihu District, Hangzhou City, so as to provide insights into school-based tobacco control.@*Methods@#Grade 1 to 3 junior high school students of health promotion schools in Xihu District were recruited using a multi-stage stratified cluster sampling method from September to December, 2021. The participants' demographic features, e-cigarette use and exposure to tobacco advertising were collected using the Chinese version of the Global Youth Tobacco Survey, and the factors affecting the intention to use e-cigarettes were identified using a multivariable logistic regression model.@*Results@#The 1 677 respondents included 875 boys (52.18%) and 802 girls (47.82%), and grade 1 to 3 junior high school students consisted of 33.93%, 35.00% and 31.07% of all respondents, respectively. There were 1 461 students that had heard of e-cigarettes (87.12%), 101 students with intention to use e-cigarettes (6.02%), and 24 current users (1.43%). Multivariable logistic regression analysis identified living in rural areas (OR=2.364, 95%CI: 1.442-3.875), having close friends that were smokers (OR=5.614, 95%CI: 3.404-9.258), having seen smoking via TV, video or movie in the past 30 days (OR=2.106, 95%CI: 1.259-3.523), having received free tobacco products (OR=3.887, 95%CI: 1.172-12.894), considering e-cigarettes as nicotine-free (OR=208.442, 95%CI: 55.713-779.856), and considering smoking making comfortable at party (OR=4.534, 95%CI: 1.853-11.090) as factors affecting intention to use e-cigarettes. There were 38.04% (638/1 677) of junior high school students with exposure to advertisements for e-cigarettes and related products, and stores, supermarkets, convenience stores, grocery, e-cigarette experience stores or offline retail stores were the primary places to contact e-cigarettes and related products.@*Conclusions@#The percentage of intention to use e-cigarettes was low among junior high school students of health promotion schools in Xihu District in 2021, and their intention to use e-cigarettes was mainly affected by close friends' smoking status and personal recognition.

E-cigarette use and its association with smoking reduction and cessation intentions among Mexican smokers / Uso de cigarros electrónicos y su asociación con la reducción en el consumo de cigarros convencionales y la intención de dejar de fumar entre fumadores mexicanos

Abstract: Objective: Evaluate the patterns of e-cigarette use and their association with smoking behavior. Materials and methods: We analyzed data from a population-based representative cohort of adult smokers who participated in the International Tobacco Control Policy Evaluation Surveys in Mexico. The analytic sample (n=760) was restricted to participants who were followed up from wave 6 (2012) to wave 7 (2014-2015). GEE models regressed e-cigarette use at follow-up and changes in cigarettes per day (CPD) between waves, on baseline sociodemographic variables, smoking status (daily, non-daily, quit), e-cigarette trial, and quit intentions. Results: Smokers who were younger, had a higher income, and had tried e-cigarettes at baseline were more likely to be current e-cigarette users at follow-up. E-cigarette use at follow-up was not associated with a change in CPD over time. Conclusions: E-cigarette use does not appear to have promoted smoking cessation or reduction in this sample of Mexican smokers.

Resumen: Objetivo: Evaluar los patrones de uso de cigarros electrónicos y su asociación con el uso de tabaco. Material y métodos: Se usaron datos de una cohorte de fumadores adultos mexicanos de la Encuesta Internacional de Evaluación de Políticas del Control del Tabaco (n=760) con seguimiento de la ronda 6 (2012) a la 7 (2014-2015). Se usaron modelos GEE para evaluar el uso de cigarros electrónicos y el cambio en el número de cigarros por día (CPD) en variables de la basal sobre características sociodemográficas, consumo del cigarro (diario, no diario, haber dejado de fumar), prueba de cigarros electrónicos e intención de dejar de fumar. Resultados: Fumadores jóvenes, con ingresos altos y que probaron cigarros electrónicos en la medición basal tenían más posibilidad de usar cigarros electrónicos. No se encontró relación entre uso de cigarros electrónicos y cambio en CPD. Conclusiones: Los cigarros electrónicos no parecen promover el abandono ni la reducción del consumo de cigarros en esta muestra de fumadores mexicanos.

Assessment of Knowledge, Attitude and Smoking-Addiction between Students of Medical Sciences Regarding Electron-Cigarettes

Introduction: E-cigarettes or vaping have increased amongthe young generation especially between college students, Ecigarettes are electronic products with a small pump and liquidtank who emerged to the public in the past 20 years. Ecigarettes users can be motivated by their urge for theirnicotine addiction, trying to stop smoking R-cigarettes, practicesmoking in places where R-cigarettes are prohibited, simplypleasures or seeking trying new things.Objectives: A survey study to assess knowledge, attitude andaddiction of E-cigarettes among college of medical sciencesstudents.Methods: This cross-sectional study of a convenient samplecovered 337 students in the four departments nursing,laboratory, radiology and physiotherapy. A web-basedquestioner was distributed to all students. Data collectedincluded age groups, department and smoking status werecollected.Results: The response was 25% of the total students at thecollege, data showed only about 26% of all students aresmokers, ex-smokers and passive smokers. The findings arecuriously different between smokers’ groups. R-cigarettes arethe preferred choice of most of the students. Whole smokersgroup believe that E-cigarettes are more addictive than Rcigarettes.Conclusion: There is a lack of knowledge, also differentopinions emerged between the whole smokers and nonsmokers groups. Whole smokers believe E-cigarettes are moreaddictive while non-smokers have contradictory opinion.

Respiratory impact of electronic cigarettes and low-risk tobacco

Abstract Electronic cigarettes, handheld devices that generate an aerosol that may contain nicotine by heating a solution or e-liquid, have been increasingly used especially in the young population. The aerosol's composition is determined by temperature, and by the substances contained in the heated liquid: glycerin, propylene glycol, nicotine in variable concentrations, flavoring agents, and other non-nicotine compounds. >80 compounds (including known toxics, e.g., formaldehyde, acetaldehyde, metallic nanoparticles, and acrolein) have been found in e-liquid and aerosols. Airway irritation, mucus hypersecretion, and inflammatory response, including systemic changes, have been observed after the exposure to e-cigarettes, leading to an increase in respiratory symptoms and changes in respiratory function and the host defense mechanisms. E-cigarette has been linked with an increase of symptoms in individuals with asthma, cystic fibrosis, and chronic obstructive pulmonary disease. One of the major concerns in public health is the rise in e-cigarette experimentation among never-smokers, especially children and adolescents, which leads to nicotine addiction and increases the chances of becoming with time a conventional smoker. There is an urgent need to regulate e-cigarettes and electronic nicotine delivery systems, at least with the same restrictions to those applied to tobacco products, and not to consider them as harmless products.

The Characteristics of Electronic Cigarette User among Korean Smokers: The Sixth Korean National Health and Nutrition Examination Survey, 2013–2015

BACKGROUND: Although the electronic cigarette (e-cigarette) market is growing rapidly, few studies have been conducted on e-cigarettes in South Korea. This study aims to analyze the general characteristics of Korean adult smokers with e-cigarette use.METHODS: This study used data from the 6th National Health and Nutrition Survey (NHANS). Multivariate logistic regression analysis was conducted to examine subjects' general characteristics and a questionnaire related to smoking cessation, stress perception, and depression. A frequency analysis of reasons for using e-cigarettes was conducted of 318 subjects of the 2015 NHANS who were smokers and used e-cigarettes.RESULTS: The study found that smokers with experience using e-cigarettes were younger and had a higher income level (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.03–2.05) than smokers without e-cigarette experience. Professional, management, and office worker groups were associated with e-cigarette use (OR, 1.40; 95% CI, 1.10–1.77). Willingness to quit smoking was also higher in subjects with experience using e-cigarettes (OR, 1.35; 95% CI, 1.09–1.68). The most common reason for smoking cessation in both groups was concern about their own and their family's health. About 50% of smokers with experience using e-cigarettes thought e-cigarettes would be more helpful for smoking cessation than regular cigarettes.CONCLUSION: Although the safety and rationale of using e-cigarettes as a smoking cessation aid are unproven, many smokers consider them a method of smoking cessation. It is necessary to provide correct information on e-cigarettes.

Accidental ingestion of E-cigarette liquid nicotine in a 15-month-old child: an infant mortality case of nicotine intoxication / 소아과

Electronic cigarettes are novel tobacco products that are frequently used these days. The cartridge contains liquid nicotine and accidental poisoning, even with a small oral dose, endangers children. We present here a mortality case of a 15-month-old child who ingested liquid nicotine mistaking it for cold medicine. When the emergency medical technicians arrived, she was found to have pulseless electrical activity. Spontaneous circulation was restored after approximately 40 minutes of cardiopulmonary resuscitation. The cotinine level in her urine was 1,716 ng/mL. Despite intensive supportive care, severe anoxic brain injury was found on computed tomography and the child ultimately died. This fatality highlights the need for public health efforts to minimize such accidents.

E-cigarettes: Facts and legal status

The sale of tobacco-based cigarettes has declined in western countries, and ‘Big Tobacco’ is trying to make up the deficit in profits from the developing world. The recent introduction of e-cigarette, in which they have invested both their hopes and their finances, has been a boon to them as it serves to confuse smokers and non-smokers about the real issues relating to the toxicity, dangers, and the promotion of nicotine addiction especially among youths who have not previously smoked cigarettes. E-cigarettes cause inflammation and damage to epithelial cells in human airways and increased risk of infection. E-cigarette vapour contains more carcinogens like formaldehyde and acetaldehyde compared to a regular cigarette. Longterm vaping is associated with an incremental lifetime cancer risk. E-cigarettes are neither safe nor effective in helping smokers quit; there is enough evidence to caution children, adolescents, pregnant women, and women of reproductive age about e-cigarette’s potential for long term consequences to foetal and adolescent brain development that sub-serve emotional and cognitive functions. The nicotine effects that cause modification of late CNS development constitute a hazard of adolescent nicotine use. The American Heart Association (AHA), Food and Drug Administration (FDA), World Health Organisation (WHO) and twothirds of the major nations in the world discourage the promotion of e-cigarettes as an alternative to proven nicotine-addiction treatments. Doctors, health care workers, and medical students should be armed with the facts about e-cigarettes, its dangers, and the legal status concerning its use, in order to be able to offer proper counselling to patients and adolescents, in particular, with special reference to the Malaysian context.