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.

Cigarros eletrônicos: uma abordagem acerca do conhecimento de jovens adultos e os riscos para o sistema respiratório / Electronic cigarettes: an approach about the knowledge of young adults and the risks to the respiratory system / Cigarrillos electrónicos: una aproximación sobre el conocimiento de los adultos jóvenes y los riesgos para el sistema respiratorio

A presente pesquisa teve o objetivo de avaliar o conhecimento dos jovens adultos sobre os cigarros eletrônicos e os seus efeitos no sistema respiratório. Tratou-se de uma pesquisa transversal, descritiva, com abordagem quantitativa, que foi desenvolvida através da plataforma Google Forms com aplicação de um questionário, contendo dados sociodemográficos e informações acerca do nível de conhecimento sobre os cigarros eletrônicos, divulgado nos grupos de Whatsapp e redes sociais, durante o período de julho a outubro de 2022. A amostra foi composta por adultos jovens, com idade entre 18 e 24 anos, com histórico de tabagismo ou não. Foram respeitadas as normas da Resolução 466/12 do Conselho Nacional de Saúde e a análise foi feita através da estatística descritiva simples. O estudo contou com a participação de 80 indivíduos, com participação homogênea entre os gêneros , sendo 40 do sexo feminino e 40 do masculino, com média de idade dos participantes de 21 anos ± 2,16, no qual, 35% (n=28) utilizam cigarros eletrônicos, 48% (n=38) afirmam ter alto nível de conhecimento sobre os mesmos, 41% (n=33) acreditavam que os dispositivos eletrônicos possuíam o mesmo risco que os cigarros convencionais, com isso, 76% (n=61) afirmam que os cigarros eletrônicos podem causar malefícios, mas não especificaram, além disso, observou-se que 25% (n=20) relatam sentir sensação de relaxamento, prazer ao consumir cigarro eletrônico. Dessa forma, pode-se observar que a amostra da pesquisa possui conhecimento sobre os cigarros eletrônicos, assim como os riscos, embora não saibam quais especificamente, bem como sua proporção no sistema respiratório.

This research aimed to evaluate the knowledge of young adults about electronic cigarettes and their effects on the respiratory system. This was a cross- sectional, descriptive research, with quantitative approach, which was developed through the Google Forms platform with application of a questionnaire, containing sociodemographic data and information about the level of knowledge about electronic cigarettes, disclosed in Whatsapp groups and social networks, during the period from July to October 2022. The sample was composed of young adults, aged between 18 and 24 years, with a history of smoking or not. The norms of Resolution 466/12 of the National Health Council were respected and the analysis was done through simple descriptive statistics. The study had the participation of 80 individuals, with homogeneous participation between genders, 40 females and 40 males, with a mean age of 21 years ± 2.16, in which, 35% (n=28) use electronic cigarettes, 48% (n=38) claim to have a high level of knowledge about them, 41% (n=33) believed that electronic devices have the same risk as conventional cigarettes, with this, 76% (n=61) stated that electronic cigarettes can cause harm, but did not specify, in addition, it was observed that 25% (n=20) report feeling a sense of relaxation, pleasure when consuming electronic cigarette. Thus, it can be observed that the research sample has knowledge about electronic cigarettes, as well as the risks, although they do not know which ones specifically, as well as their proportion on the respiratory system.

La presente investigación tuvo como objetivo evaluar el conocimiento de los jóvenes adultos sobre los cigarrillos electrónicos y sus efectos sobre el sistema respiratorio. Se trató de una investigación transversal, descriptiva, con abordaje cuantitativo, que se desarrolló a través de la plataforma Google Forms con aplicación de un cuestionario, conteniendo datos sociodemográficos e informaciones sobre el nivel de conocimiento sobre cigarrillos electrónicos, divulgados en grupos de Whatsapp y redes sociales, durante el período de julio a octubre de 2022. La muestra fue compuesta por jóvenes adultos, con edad entre 18 y 24 años, con historia de fumador o no. Fueron respetadas las normas de la Resolución 466/12 del Consejo Nacional de Salud y el análisis fue hecho a través de estadística descriptiva simple. El estudio contó con la participación de 80 individuos, con participación homogénea entre géneros, siendo 40 mujeres y 40 hombres, con edad media de los participantes de 21 años ± 2,16, en los cuales, 35% (n=28) utilizan cigarrillos electrónicos, 48% (n=38) afirman tener alto nivel de conocimiento sobre los mismos, 41% (n=33) creen que los dispositivos electrónicos tienen el mismo riesgo que los cigarrillos convencionales, con esto, 76% (n=61) afirman que los cigarrillos electrónicos pueden causar daño, pero no especificaron, además, se observó que 25% (n=20) dicen sentir sensación de relajación, placer al consumir cigarrillo electrónico. Por lo tanto, se puede observar que la muestra de la investigación tiene conocimiento sobre los cigarrillos electrónicos, así como los riesgos, aunque no saben cuáles específicamente, así como su proporción en el sistema respiratorio.

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.

Extraction and Characterisation of Flavoured Tobacco by GC-MS Studies and Validation of Results by GC-FID to Investigate Hazardous Flavour Ingredients

Flavoured tobacco is mainly consumed in India and neighbouring countries like Pakistan, Afghanistan, and Nepal and the hazards are known. Considering the need to identify such flavouring ingredients and a simple analytical method was required to quantify such favouring ingredients and hazardous / allergens, we selected top brands available in India for investigation. We simply extracted the ingredients by triturating with Diethyl Ether, evaporating solvent ether and reconstituting the extract in Acetone & Ethanol for GC-MS & GC-FID work respectively. The flavour ingredients were identified, and hazardous ingredients, viz. Diethyl Phthalate was identified. It was found around 2.5% to 3.0%. The GC-MS method was validated with GC-FID analysis with Linearity, LOD & LOQ study.

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

Injuria pulmonar por vapeo / Vaping-induced lung injury

Resumen Se considera vapeo a la inhalación de aerosoles generados por el calentamiento de líquidos. Existen dispositivos que se comercializan libremente para realizar vapeo, siendo los cigarrillos electrónicos los más frecuentes. Estos productos están asociados a la aparición de injuria pulmonar, ya sea injuria pulmonar inducida por vapeo (VAPI), o injuria pulmonar asociada a vapeo y cigarrillos electrónicos (EVALI). Se presenta el caso de una mujer de 54 años con antecedentes de vapeo en los últimos 9 meses. Consultó por disnea clase funcional IV asociada a náuseas y vómitos de 18 h de evolución. Al ingreso presentó insuficiencia respiratoria. Se realizó intubación orotraqueal con asistencia ventilatoria mecánica; la tomografía de tórax evidenció infiltrados alveolares difusos bilaterales. Se interpretó el cuadro clínico como VAPI/EVALI. Aún se desconoce la fisiopato genia exacta de la injuria pulmonar inducida por vapeo; la disnea y tos son los síntomas más frecuentes. Todos los pacientes tienen imágenes radiológicas patológicas. El soporte respiratorio y los corticoides sistémicos son el tratamiento de elección.

Abstract Vaping is considered to be the inhalation of aerosols generated by heating liquids. There are devices freely marketed for vaping, with electronic cigarettes being the most common. These products are associated with the appearance of lung injury, either vaping-induced lung injury (VAPI), or lung injury associated with vaping and electronic cigarettes (EVALI). We presented the case of a 54-year-old woman with a history of vaping in the last 9 months. She consulted for acute dyspnea (class IV) associated with nausea and vomiting of 18 hours of evolution. Upon admission, she presented respiratory failure. Orotracheal intubation was performed with mechanical ventilatory assistance. A chest tomography revealed bi lateral diffuse alveolar infiltrates. The clinical picture was interpreted as VAPI/EVALI. The exact pathophysiology of vaping-induced lung injury is still unknown; dyspnea and cough are the most frequent symptoms. All patients have pathological radiological images. Respiratory support and systemic corticosteroids are the treatment of choice.

Public′s online attention to information about quitting smoking before and during COVID-19 pandemic: an analysis based on Baidu Index / 中华健康管理学杂志

Objective:To explore the hotspots of the public concerns about quitting smoking before and during the coronavirus disease 2019 (COVID-19) pandemic.Methods:The monthly search index data of four key words, “the harm of smoking”，“quitting smoking”，“passive smoking” and “electronic cigarette” before the COVID-19 (from January, 2016 to December, 2019) and during the COVID-19 (from January, 2020 to December, 2020) pandemic were manually collected from the Baidu Index platform. The one-way ANOVA was used to compare the differences among annual search indexes of four keywords. The linear regression model was used to test the annual linear trend of search index of each keyword before the COVID-19, and the one-sample t-test was used to analyze the differences of the search indexes during the COVID-19 and the means before the COVID-19. Results:During 2016—2020, the annual average search index of “electronic cigarette” was the highest (1.465 million), followed by “the harm of smoking” (0.884 million) and “quitting smoking” (0.780 million), while “passive smoking” was the lowest (0.171 million). Before the COVID-19 (2016—2019), the search index of each keyword had positive cumulative growth, but there was no significant linear trend of annual change ( P>0.05). During the COVID-19 period (2020), the search index of “the harm of smoking” decreased significantly (0.794 million vs 0.907 million, P=0.011), and “quitting smoking” (0.591 million vs 0.827 million, P=0.172) and “passive smoking” (0.164 million vs 0.172 million, P=0.257) showed a downward trend, while the search index of “electronic cigarettes” bucked the trend and increased significantly (1.825 million vs 1.375 million, P=0.010). Conclusions:The public′s online attention to “electronic cigarette” increases dramatically during COVID-19 along with other information about quitting smoking decreases. There are urgent needs for strengthening regulation and monitoring of electronic cigarettes and carrying out more effective publicity of scientific methods to help quit smoking.

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.

Características de consumo de tabaco en jóvenes estudiantes en Paraguay / Characteristics of tobacco use in young students in Paraguay

Introducción: Actualmente el tabaquismo es una de las mayores amenazas para la salud pública a nivel mundial. La muerte atribuida al tabaco en Paraguay representa el 12,2% de todas las muertes y el costo de la enfermedad asociada al consumo de tabaco en el sistema de salud es elevado. Objetivos: El objetivo de este estudio es describir las características del consumo de tabaco en jóvenes en Paraguay. Materiales y métodos: Se realizó un estudio descriptivo transversal no probabilístico de muestreo estandarizado con representatividad nacional en estudiantes matriculados del 7° al 9° grado de la educación escolar básica, de 13 a 15 años de ambos sexos que incluyo a 6.518 estudiantes, correspondiente a 25 escuelas de la capital y 25 escuelas en el resto del país. Resultados: La prevalencia actual de consumo de productos de tabaco fue del 7%, fumadores actuales de 3,9% y fumadores de cigarrillos electrónicos de 3,7%. La prevalencia de fumadores de segunda mano fue más del 20% en todos los escenarios estudiados. Alto porcentaje de adolescentes con acceso fácil a la compra de cigarrillos sin verificación de la edad. Más del 50% con acceso a mensajes publicitarios sobre tabaco. Casi un 30% tenían conocimiento del efecto dañino del tabaco y más del 80% se manifiestan favorables a la prohibición de fumar en espacios cerrados y abiertos. Conclusión: Aunque la prevalencia de fumadores en adolescentes no es muy elevada, es un problema de salud pública creciente. Se requiere fortalecer las medidas de prevención y control.

Introduction: Currently, smoking is one of the greatest threats to public health worldwide. Death attributed to tobacco in Paraguay represents 12.2% of all deaths and the cost of the disease associated with tobacco consumption in the health system is high. Objectives: The objective of this study is to describe the characteristics of tobacco consumption in young people in Paraguay. Materials and methods: A non-probabilistic descriptive cross-sectional study of standardized sampling was carried out with national representativeness in students enrolled from 7th to 9th grade of basic school education, from 13 to 15 years old of both sexes that included 6,518 students, corresponding to 25 schools in the capital and 25 schools in the rest of the country. Results: The current prevalence of tobacco product use was 7%, current smokers 3.9%, and electronic cigarette smokers 3.7%. The prevalence of second-hand smokers was more than 20% in all the scenarios studied. High percentage of adolescents with easy access to the purchase of cigarettes without age verification. More than 50% with access to advertising messages about tobacco. Almost 30% were aware of the harmful effect of tobacco and more than 80% are in favor of the prohibition of smoking in closed and open spaces. Conclusion: Although the prevalence of smoking in adolescents is not very high, it is a growing public health problem. It is necessary to strengthen prevention and control measures.

Contrapublicidad del cigarrillo y actitudes de los adolescentes hacia su consumo / Against tobacco advertising and attitudes towardstobacco use in adolescents

Resumen: Objetivo: Comparar las actitudes hacia el consumo de cigarrillos en adolescentes de secundaria, después de la exposición a tres pósters de contrapublicidad. Materiales y métodos: Diseño pre experimental por comparación de grupos no equivalentes; muestra de 50 adolescentes seleccionados mediante muestreo no probabilístico y asignados a un grupo expuesto a contrapublicidad (n = 25) y un grupo de comparación (n = 25) que permaneció en lista de espera. La estrategia de contrapublicidad consistió en tres pósters administrados por internet. Los pósters incluyeron imágenes y mensajes sobre consecuencias del consumo de cigarrillos. La recolección de datos se efectuó en línea mediante Google Forms. Se utilizó una cédula sociodemográfica y la escala de actitudes hacia el tabaco. Los datos obtenidos fueron procesados a través del paquete estadístico SPSS versión 24.0, mediante análisis inferencial no paramétrico (prueba U de Mann-Whitney). Resultados: Se encontraron diferencias estadísticamente significativas entre ambos grupos (U = 145.0, p < 0.001), donde los estudiantes expuestos a la contrapublicidad mostraron menor mediana de actitudes favorables hacia el cigarrillo (Med = 17.0, DE = 5.11) en comparación con los participantes no expuestos (Med = 25.0, DE = 7.91). En particular, la dimensión del índice de desagrado hacia el consumo de cigarrillos mostró diferencias significativas entre el grupo expuesto y el de comparación (U = 127.5, p < .001). Conclusiones: Los resultados sugieren que los adolescentes que recibieron la contrapublicidad, mostraron menos actitudes favorables hacia los cigarrillos. La información emitida a través de los pósters sobre las consecuencias del consumo de cigarrillos, inclusive al ser administrada por internet, podría beneficiar en la modificación de las actitudes hacia el consumo de este producto en adolescentes mexicanos. Con base en esto, la contrapublicidad puede ser una estrategia útil para el personal sanitario de prevención primaria contra el consumo de cigarrillos.

Abstract: Objective: To compare high-school adolescents' attitudes towards cigarettes use after exposure to three counter-advertising posters. Materials and methods: Preexperimental study through static-group comparison; sample of 50 adolescents selected by non-probabilistic sampling and assigned to a group exposed to counter-advertising (n = 25) and a waiting list control group (n = 25). The counter-advertising strategy consisted of three posters delivered through the Internet. The posters included images and messages related to the consequences of cigarettes use. Data collection was conducted online using Google Forms. A sociodemographic card and the scale of attitudes towards tobacco were used. The data were processed through SPSS version 24.0 using non-parametric inferential analysis (Mann-Whitney U test). Results: Statistically significant differences were identified between both groups (U = 145.0, p < 0.001) where students exposed to counter-advertising showed a lower median of favorable attitudes towards cigarettes (Med = 17.0, SD = 5.11) compared to control group (Med = 25.0, SD = 7.91). In particular, there were significant differences in the dimension of dislike towards tobacco consumption between the exposed group and the control group (U = 127.5, p < 0.001). Conclusions: The results suggest that adolescents who received the counter-advertising showed less favorable attitudes towards cigarettes. The information provided through the posters about cigarette related-consequences, even when administered through Internet, could lead to the modification of attitudes towards cigarettes consumption in Mexican adolescents. Therefore, counter-advertising could become a useful strategy for health personnel in primary prevention against cigarette smoking.

Saborizantes y caracteres de diseño en cigarrillos y productos de tabaco disponibles próximos a centros educativos en Montevideo, Uruguay / Flavour additives and design lettering in cigarettes and tobacco products available close to educational centers in Montevideo, Uruguay / Sabores e características das embalagens de cigarros e produtos de tabaco disponíveis próximos a de centros educativos em Montevidéu, Uruguai

Resumen: Introducción: los productos de tabaco están diseñados para ser atractivos, introduciéndose últimamente elementos aditivos y saborizantes. En Uruguay existen normativas que evitan la publicidad en cualquiera de sus formas, por esto, la atracción del propio producto de tabaco a través de su sabor y diseño es un factor importante para la elección por parte de los fumadores, en particular, jóvenes. Es relevante conocer qué productos se encuentran disponibles en nuestro medio y cuáles son accesibles cerca de centros educativos. Material y método: se realizó un estudio descriptivo, observacional, prospectivo de corte transversal. El protocolo de trabajo de campo se adaptó del Sistema de Vigilancia de paquetes de Tabaco de la Universidad de Johns Hopkins. Resultados: se identificaron 23 variedades. El 34,78% de los productos fueron saborizados, estando disponibles en 86,67% de los puntos de venta. Todas las cajas de los saborizados tenían alguna referencia que indicaba su condición. En la mitad, la marca sugería la presencia de sabor o su activación. El 87,5% de los filtros se referían a la activación del sabor y 37,5% agregaban caracteres tecnológicos para éste; 75% tenía sabor a menta y 24% doble sabor. Solo 39,1% tenía información de protección al menor. Conclusiones e implicancias: hay una gran disponibilidad de productos de tabaco saborizados, incrementado la variedad en los últimos años, siendo en Uruguay menor que en otros países. En ausencia de regulación específica sobre aditivos y saborizantes, los países podrían disminuir la oferta implementando presentación única por marca y prohibición total de la publicidad.

Summary: Introduction: tobacco products are designed to be attractive, and recently, flavour additives have been introduced in the market. In Uruguay, regulations in force prohibit all forms of publicity for these products. For this reason, attracting consumers to tobacco products by means of flavour and design constitutes an important factor in smokers' choice, in particular the young. Learning about products available in our market and those that are close to educational centers is relevant. Method: descriptive, observational, prospective and transversal study. The field work protocol was adapted from the Johns Hopkins University Tobacco Pack Surveillance System Project. Results: 23 varieties were identified. 34.78% of the products were flavoured, and they were available in 86,67% points of sale. All flavoured products' packs included a reference to its condition. In 50% of them, the brand suggested the presence or activation of flavour. 87.5% of filters referred to flavor activation and 37.5% added technological traits. 75% were mint flavoured and 24% were double-flavoured. Only 39.1% included minor protection information. Conclusions: there is great availability of flavoured tobacco products, the variety being greater in recent years, although lower in Uruguay if compared to other countries. In the absence of specific regulations on additives and flavouring substances, countries could reduce the offer by implementing a single presentation by brand and the complete banning of publicity.

Resumo: Introdução: os produtos do tabaco são projetados para serem atraentes, com aditivos e elementos aromatizantes recentemente introduzidos. No Uruguai, existem normas que proíbem a publicidade em qualquer de suas formas, portanto, a atração do próprio produto do tabaco pelo seu sabor e design é um fator importante na escolha dos fumantes, principalmente dos jovens. É importante saber quais produtos estão disponíveis em nosso ambiente e quais estão disponíveis próximos a centros educativos. Material e métodos: foi realizado um estudo transversal descritivo, observacional e prospectivo. O protocolo de trabalho de campo foi adaptado do Sistema de Vigilância de Pacotes de Tabaco da Universidade Johns Hopkins. Resultados: foram identificadas 23 marcas diferentes. 34,78% dos produtos eram aromatizados, estando disponíveis em 86,67% dos pontos de venda. A embalagem de todas as marcas com sabor tinha alguma referência indicando essa característica. A metade delas indicava a presença do sabor ou sua ativação. 87,5% dos filtros referiram-se à ativação do sabor e 37,5% agregaram sus características tecnológicas. 75% tinham sabor mentolado e 24% dois sabores. Apenas 39,1% possuíam informações de proteção à criança. Conclusões e implicações: há uma grande disponibilidade de produtos de tabaco aromatizados, e a variedade tem aumentado nos últimos anos, sendo menor no Uruguai que em outros países. Na ausência de regulamentação específica sobre aditivos e aromatizantes, os países poderiam reduzir a oferta implementando uma apresentação única por marca e a proibição total da publicidade.

Efectos en la salud de los sistemas electrónicos de administración de nicotina (SEAN) / Health Effects of Electronic Nicotine Delivery Systems (SEAN)

Resumen Sin lugar a dudas, el tabaquismo continúa siendo la principal causa de enfermedad, discapacidad y muerte prematura a nivel mundial. Sin embargo, el advenimiento de los nuevos sistemas electrónicos de administración de nicotina (SEAN), entre los que destaca el cigarrillo electrónico, ha tenido un crecimiento explosivo y en algunos países ha desplazado a los cigarrillos de tabaco, especialmente entre los jóvenes que se sienten atraídos por sus llamativos sabores y por el despliegue de tecnología que se utiliza en su diseño y funcionamiento. Los SEAN surgieron inicialmente en 2003 como una supuesta ayuda para dejar de fumar, a 16 años de esta fecha no hay estudios clínicos que confirmen su superioridad sobre los medicamentos existentes para tal fin: terapias de reemplazo de nicotina, bupropión y vareniclina, ni sobre las terapias psicológicas como la racional emotiva y la cognitivo conductual. Por el contrario, se han acumulado gran cantidad de evidencias sobre el efecto deletéreo que tienen sobre la salud de los consumidores, el riesgo que representan es indudable y esto se confirma por reportes recientes de Centros de Control de Enfermedades de los Estados Unidos (CDC) que señalan 2,172 casos hospitalizados con enfermedad pulmonar aguda y 42 muertes por esta causa, siendo el 79% personas menores de 35 años. Este brote de enfermedad pulmonar ha determinado que se plantee la prohibición de los SEAN en Estados Unidos. Asimismo, la Food and Drug Administration (FDA) aprobó la venta de los cigarrillos híbridos o heets que utilizan tabaco calentado, los cuales ya están disponibles en nuestro país. No cabe duda de que como profesionales del área de la salud nuestra obligación es informar con evidencias científicas sobre los riesgos que representan los SEAN para sus consumidores, asimismo debemos aprender de la historia del tabaquismo para poder prevenir la morbimortalidad asociada con estos nuevos productos del tabaco.

Abstract Without a doubt, smoking continues to be the leading cause of disease, disability, and premature death worldwide. However, the advent of the new Electronic Administration Systems of Nicotine (SEAN), among which the electronic cigarette stands out, has had explosive growth and in some countries has depleted tobacco cigarettes, especially among young people who feel attracted by its striking flavors and the deployment of technology that is used in its design and operation. The SEANs initially emerged in 2003 as a supposed help to quit smoking, at 16 years from this date no clinical studies are confirming their superiority over existing medications for this purpose: nicotine, bupropion and varenicline replacement therapies, or over psychological therapies such as emotional and cognitive-behavioral rational. On the other side, a large amount of evidence has been accumulated on the deleterious effect they have on the health of consumers, the risk they represent is unquestionable and this is confirmed by recent reports from the Centers for Disease Control of the United States (CDC) that indicate 2142 hospitalized cases with acute lung disease and 42 deaths from this cause, 79% being people under 35 years. This outbreak of lung disease has determined that the ban on SEAN in the United States will be planted. Also, the Food and Drug Administration (FDA) approved the sale of hybrid cigarettes or "Heets" (Heat-not-burn tobacco products), which uses heated tobacco, and are now available in our country. There is no doubt that as health professionals, we must inform with scientific evidence about the risks that SEANs pose to their consumers, we must also learn from the history of smoking to prevent the morbidity and mortality associated with these new tobacco products.

Frecuencia y perfil del uso de cigarrillos electrónicos en estudiantes de una Universidad Pública / Frequency and profile of the electronic cigarettes use in students of a Public University

Introducción: El consumo de Cigarrillos electrónicos (CE) ha aumentado considerablemente en los últimos años. Estos productos son ahora los más comúnmente utilizados por la juventud en diversos países del mundo y nuestro país no está exento de su utilización. En este contexto se ha realizado el presente estudio; cuyo objetivo fue conocer la frecuencia de uso de cigarrillo electrónico y otras características del consumo de CE en universitarios. Materiales y Métodos: Estudio observacional, descriptivo. Se procesaron datos de 1500 estudiantes de diferentes Unidades Académicas de la UNA que respondieron a la encuesta electrónica. Se determinaron variables demográficas como sexo y edad, particularidades sobre los CE relacionadas a la preferencia por determinado dispositivo, motivaciones para el consumo, simultaneidad de consumo de cigarrillo común, así como la percepción de riesgo con respecto al mismo y las molestias ocasionadas por vapear. La encuesta fue anónima y realizada entre los meses de junio y julio del año 2019 mediante la plataforma libre Google Form. Para el procesamiento de datos se utilizó la planilla Excel. Los estudiantes recibieron vía aplicación de mensajería instantánea un link para responder el cuestionario, el mismo fue distribuido por grupos de docentes y delegados de los cursos de cada unidad académica. Resultados: Respondieron a la encuesta un total de 1500 alumnos, 502 hombres (33,5%) y 998 mujeres (66,5%). El promedio de edad fue de 24 años (DE: ± 3.2), con edades comprendidas entre los 17 y 62 años. Al preguntar sobre el hábito de fumar o vapear los estudiantes respondieron: No fuma ninguno 1222 (81 %), consume cigarrillos electrónicos: 74(5 %), 146 (10%) consumen cigarrillo común y un total de 58(4%) consumen ambos productos. Considerando el total de consumidores de CE y aquellos que utilizan ambos (CE y Cigarrillo común), tenemos una frecuencia de 132 consumidores de CE (9%). Percepción de riesgo con respecto a cigarrillos comunes: Ningún riesgo 32 (24%), pequeño riesgo: 54 (41%), riesgo moderado: 34 (26%), alto riesgo: 9 (7%) e igual riesgo: 3 (2%). Entre las molestias más frecuentes: tos 27 (20%), irritación de garganta 20 (15%), dolor de cabeza 6 (5 %) y malestar general 4 (3%). Conclusión: El uso de CE se aproxima al consumo de cigarrillo común y los universitarios no son conscientes sobre los daños potenciales que confiere el uso de estos dispositivos. Para prevenir y reducir el uso de cigarrillos electrónicos por los jóvenes y los adultos jóvenes debemos poner en práctica estrategias de prevención efectivas.

Introduction: The consumption of Electronic Cigarettes (EC) has increased considerably in recent years. These products are now the most commonly used by youth in various countries of the world and our country is not exempt from their use. In this context, the present study has been carried out; whose objective was to know the frequency of use of electronic cigarettes and other characteristics of CE consumption in university students. Materials and methods: Observational, descriptive study. Data from 1500 students from different UNA Academic Units that responded to the electronic survey were processed. Demographic variables such as sex and age, peculiarities on EC related to the preference for a certain device, motivations for consumption, simultaneity of consumption of common cigarettes, as well as the perception of risk with respect to it and the discomfort caused by vaping were determined. The survey was anonymous and carried out between the months of June and July of the year 2019 through the free platform Google Forms. The Excel spreadsheet was used for data processing. The students received a link via instant messaging application to answer the questionnaire, it was distributed by groups of teachers and delegates of the courses of each academic unit. Results: A total of 1500 students answered the survey, 502 men (33.5%) and 998 women (66.5%). The average age was 24 years (SD: ±16), with ages between 17 and 62 years. When asked about the habit of smoking or vaping, the students answered: 1222 (81%) do not smoke, use electronic cigarettes: 74 (5%), 146 (10%) use a regular cigarette and a total of 58 (4%) use both products. Considering the total of EC consumers and those who use both (EC and Common Cigarette), we have a frequency of 132 EC consumers (9%). Perception of risk with respect to common cigarettes: No risk 32 (24%), small risk: 54 (41%), moderate risk: 34 (26%), high risk: 9 (7%) and equal risk: 3 (2 %). Among the most frequent complaints: cough 27 (20%), throat irritation 20 (15%), headache 6 (5%) and general discomfort 4 (3%). Conclusion: The use of EC is close to the consumption of common cigarettes and the university students are not aware of the potential damage that the use of these devices confers. To prevent and reduce the use of electronic cigarettes by youth and young adults, we must implement effective prevention strategies.

Awareness about cigarettes and other tobacco products act and impact of health warnings on smokers in a North Indian city

Background: Tobacco use is a major preventable cause of morbidity as well as mortality worldwide. To combat the increasing trend of this problem, Government of India formulated the COTPA (Cigarettes and Other Tobacco Products Act) in 2003. The study aimed to assess the awareness about COTPA and impact of pictorial warnings among smokers attending outpatient services in a tertiary care hospital in Jammu.Method: The present study was conducted among 320 patients attending the outpatient department of Internal Medicine, Government Medical College, Jammu who happened to be cigarette smokers. The questionnaire was developed by authors with the help of literature review and pilot tested before its final use. Information was elicited about demographic details, awareness about COTPA and impact of pictorial warnings on quitting of smoking.Results: More than half of the respondents were in 30-50-year age group and were urban residents. Awareness about COTPA was good on some parameters but was relatively low on other parameters. Despite all, the respondents noticing pictorial warnings on tobacco packages, only 69.37% of them were contemplating to quit. About half of them were of the view that warning statements preferably be written in local languages.Conclusion: Health and pictorial warnings on tobacco packages remain an important pillar in filling the gap of knowledge and communicating the health risks of tobacco use to the consumers. Only 69.3% of the respondents were planning to quit and awareness levels about COTPA were mixed.

Compliance and awareness of Cigarettes and Other Tobacco Products Act among tobacco sellers in urban Ludhiana

Background: Tobacco use is one of the major preventable causes of deaths globally. Although India responded early to combat this global problem by implementing Cigarettes and Other Tobacco Products Act (COTPA), there is a need to evaluate its implementation. Objective: The objective of this study was to assess the compliance and awareness of the tobacco vendors to Section 5 (Point of sale advertisements of Cigarettes and Other Tobacco Products) and Section 6 (Prohibition on sale to minors and within 100 yards of educational institutes) of COTPA. Materials and Methods: The present study was a community-based cross-sectional study. All tobacco selling stores located within 100 yards distance from 58 educational institutes in urban Ludhiana were assessed for compliance to Section 5 and 6 provisions of COTPA. The study also assessed awareness regarding COTPA legislation among the tobacco vendors available in these tobacco selling stores. Data were collected using a semi-structured questionnaire. The questions were asked to determine the level of awareness of COTPA among the tobacco vendors. Results: Around 42.0% of the educational institutes had tobacco stores located within 100 yards and only around 25.0% of educational institutes had mandatory signage prohibiting ban on selling tobacco products displayed outside institutions. Most of the tobacco outlets (77.7%) were permanent, exclusive tobacco sellers (72%) and had displayed the products enabling easy access to minors. Majority (89%) of the vendors knew about an act regarding tobacco products. However, only 19.4% and 25% of vendors were aware of ban on selling tobacco products within the radius of 100 yards of educational institutions and to minors, respectively. Conclusion: Strict enforcement of the provisions of COTPA around educational institutes to reduce easy access of tobacco products to minors and strengthening awareness generation activities by involving key stakeholders is needed.

Cuestionario de Clasificación de Consumidores de Cigarrillos. Resultados de su aplicación en Cuba, 2017 / Questionnaire for classification of cigarette consumers. Results obtained from its implementation in Cuba, 2017

RESUMEN Introducción: El consumo de tabaco deviene un trastorno adictivo que pone en peligro la salud tanto de los fumadores como de los que lo rodean. Su evaluación adecuada requiere contemplar los factores psicológicos y sociales que lo propician. Objetivo: Describir el proceso de adaptación al contexto cubano del Cuestionario de clasificación de consumidores de cigarrillos y caracterizar la muestra de fumadores estudiada para ello. Material y métodos: La investigación desarrollada incluye dos etapas. La primera, clasifica como un estudio de desarrollo tecnológico y la segunda, consiste en un estudio descriptivo de corte transversal con un diseño cuantitativo. Participaron 5 expertos y 205 fumadores activos seleccionados a partir de un muestreo intencional procedentes de áreas de salud de La Habana y Santiago de Cuba. Resultados: Se desarrolló una versión válida para la población cubana del cuestionario, que contiene las recomendaciones realizadas por los expertos y obtuvo una consistencia interna de 0,7005. El 49.7% de los participantes clasificó como fumadores fuertes y 48.3% como fumadores moderados (de riesgo). Por otra parte 60% de ellos son hombres, 32,7% son jóvenes y 65% son trabajadores. Conclusiones: Se realizó la adaptación lingüística y cultural al contexto cubano del Cuestionario de clasificación de consumidores de cigarrillos, la cual cuenta con un nivel de fiabilidad adecuado. La mayor parte de los sujetos estudiados clasificaron como fumadores fuertes o moderados. Predominaron los del sexo masculino, jóvenes y trabajadores.

ABSTRACT Introduction: Tobacco consumption becomes an addictive disorder that endangers the health of both smokers and those around them. Its proper evaluation requires an analysis of the psychological and social factors that favor it. Objective: To describe the adaptation process of the questionnaire for classification of cigarette consumers within the Cuban context and characterize the sample of smokers under study. Material and Methods: The research includes two stages: the first stage that is classified as a technological development study, and the second one which consists of a descriptive cross-sectional study with a quantitative design. Five experts and 205 active smokers selected from an intentional sample from the health areas of Havana and Santiago de Cuba participated in the study. Results: A valid version of the questionnaire for the Cuban population was developed, which contains the recommendations made by the experts and obtained an internal consistency of 0.7005. It was observed that 49.7% of the participants classified as strong smokers and 48.3% as moderate smokers (at risk). On the other hand, 60% of them are men, 32.7% are young and 65% are workers. Conclusions: Linguistic and cultural adaptation to the Cuban context of the questionnaire for classification of cigarette consumers was carried out, which has an adequate level of reliability. Most of the subjects studied were classified as strong or moderate smokers. The male sex, young and workers predominated in the study.

Survey of compliance with the cigarettes and other tobacco products act, 2003 at schools in Mangalore, Dakshina Kannada district, Karnataka

Background: Tobacco use is a major problem of public health significance as the tobacco smoking causes a wide range of diseases and adverse health impacts that affect nearly every organ of the body. The COTPA, 2003 i.e., the Indian smoke-free legislation “Prohibition of smoking in Public places” which forbids smoking in public places, including educational institutions. The main objective of this study is to assess the compliance of Section 4 and Section 6(b) of cigarettes and other tobacco products act (COTPA), 2003 in schools, to observe compliance of smoking ban at public places, to observe compliance of display of signboards at prominent places, to observe for direct and indirect evidence of smoking and other tobacco products used in school buildings and premises, to study the availability of tobacco products within 100 yards of school premises.Methods: A cross sectional survey in 100 schools in Dakshina Kannada district using compliance guide developed by partners of Bloomberg School of Public health to reduce tobacco use.Results: In 100 schools, 55 were rural area and 45 from urban area, further division shows government/semi-government schools were 44 and Private schools were 56. Section 4 for the presence of signboard, there is an association between the Management wise schools and presence of signboards (p=0.001), for section 6(b) of COTPA, there is an association between this Section and type of management (p=0.004).Conclusions: The schools depending upon the location show varied compliance towards the law. The Section 6(b) shows better compliance than Section 4.This study will help to address the implementation issues of C

Estado actual y desafíos emergentes en la prevención y el control del tabaco / Current and emerging issues in tobacco prevention and control

Resumen: Objetivos: Revisar la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas, describir dos estudios de caso nacionales y analizar la evidencia sobre los cigarrillos electrónicos desde la perspectiva de salud pública. Material y métodos: Revisión de la legislación de control de tabaco y la evidencia científica sobre los cigarrillos electrónicos. Resultados: La aplicación de políticas no es homogénea, con avances importantes en ambientes libres de humo, advertencias sanitarias gráficas y vigilancia epidemiológica, pero desafíos pendientes en la prohibición total de la publicidad, incremento de impuestos y cesación tabáquica. La interferencia de la industria tabacalera es uno de los principales obstáculos para avanzar y los nuevos productos crean incertidumbre sobre su regulación. Conclusiones: Se necesita revitalizar la voluntad política para aplicar integralmente el Convenio, tomando decisiones basadas en evidencia ante los nuevos desafíos y defendiendo los logros de la interferencia de la industria.

Abstract: Objectives: To review the implementation of the WHO Framework Convention on Tobacco Control in the Americas, describe two national case studies and analyze the evidence on electronic cigarettes from a public health perspective. Materials and methods: Revision of the tobacco control legislation and the scientific evidence regarding electronic cigarettes. Results: Implementation of tobacco control policies is not homogeneous, with important advances in smoke-free environments, pictorial health warnings, and epidemiological surveillance, but challenges that remain for the implementation of a total ban of tobacco advertising, increases in tobacco taxes, and tobacco cessation programs. Tobacco industry interference is one of the main obstacles for advancing and novel products create uncertainty about their regulation. Conclusion: There is a need for political will for a comprehensive implementation of the Convention, with evidence-based decisions to confront challenges and to defend the achievements from tobacco industry interference.

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.