Smoking, e-cigarettes and the effect on respiratory symptoms among a population sample of youth: Retrospective cohort study.

INTRODUCTION: E-cigarettes have been steadily increasing in popularity, both as cessation methods for smoking and for recreational and social reasons. This increase in vaping may pose cardiovascular and respiratory risks. We aimed to assess respiratory symptoms in youth users of e-cigarettes and cigarettes. METHODS: A retrospective survey design was utilized to assess Canadian youth aged 16-25 years. Participants were recruited from the Ontario Tobacco Research Unit Youth and Young Adult Research Registration Panel November 2020 to March 2021. A total of 3082 subjects completed the baseline survey. Of these, 2660 individuals who did not have asthma were included in the analysis. The exposure of interest was pack-equivalent years, a novel measure of vaping exposure equivalent conceptually to cigarette pack years incorporating number of puffs per day, number of days vaped per month, and number of years vaped. Respiratory symptoms were measured using the five-item Canadian Lung Health Test. Poisson regression analyses were performed while adjusting for demographic confounders, stratified by smoking status. A non-stratified model tested the interaction of status and vaping dose and the effect of vaping device used was assessed among ever vapers. Analyses controlled for demographic characteristics, use of cannabis and alcohol, and survey date. RESULTS: Each additional puff year increased the rate ratio (RR) of respiratory symptoms by a factor of 11.36 (95% CI: 4.61-28.00; p<0.001) for never smokers, but among current daily smokers higher pack-equivalent years were not associated with more respiratory symptoms (RR=0.83; 95% CI: 0.23-3.11). Among current vapers, those using pod-style devices were more likely to have more respiratory symptoms (RR=1.25; 95% CI: 1.08-1.45) after adjusting for dose. CONCLUSIONS: Vaping is associated with an increased risk of reporting respiratory symptoms among never smoking youth and non-daily ever cigarette smokers. Use of e-cigarettes among non-smokers should be discouraged.

Access to Mental Health and Substance Use Resources for 2SLGBTQ+ Youth during the COVID-19 Pandemic.

Previous research has established that gender and sexual minority (2SLGBTQ+) youth experience worse mental health and substance use outcomes than their heterosexual and cisgender counterparts. Research suggests that mental health and substance use concerns have been exacerbated by the COVID-19 pandemic. The current study used self-reported online survey responses from 1404 Canadian 2SLGBTQ+ youth which included, but were not limited to, questions regarding previous mental health experiences, diagnoses, and substance use. Additional questions assessed whether participants had expressed a need for mental health and/or substance use resources since the beginning of the COVID-19 pandemic (March 2020) and whether they had experienced barriers when accessing this care. Bivariate and multinomial logistic regression analyses were conducted to determine associations between variables and expressing a need for resources as well as experiencing barriers to accessing these resources. Bivariate analyses revealed multiple sociodemographic, mental health, and substance use variables significantly associated with both expressing a need for and experiencing barriers to care. Multinomial regression analysis revealed gender identity, sexual orientation, ethnicity, and level of educational attainment to be significantly correlated with both cases. This study supports growing research on the mental health-related harms that have been experienced during the COVID-19 pandemic and could be used to inform tailored intervention plans for the 2SLGBTQ+ youth population.

A systematic review of addiction substitution in recovery: Clinical lore or empirically-based?

This systematic review synthesized the literature examining addiction substitution during recovery from substance use or behavioral addictions. A total of 96 studies were included with sample sizes ranging from 6 to 14,885. The most common recovery addictions were opioids (30.21%), followed by cannabis (20.83%), unspecified use (17.71%), nicotine (12.50%), alcohol (12.50%), cocaine (4.17%), and gambling (2.08%). Statistical results were provided by 70.83% of the studies. Of these, 17.65% found support for addiction substitution, whereas 52.94% found support for concurrent recovery. A total of 19.12% found no statistical changes and 10.29% found both significant increases and decreases. The remaining 29.17% of studies provided descriptive data, without statistical tests. Predictors of addiction substitution were provided by 22.92% of the studies and 11.46% included information on impact of addiction substitution on treatment outcomes. Overall, male gender, younger age, greater substance use severity, and presence of mental health disorders were associated with addiction substitution. Addiction substitution was associated with poorer treatment outcomes. A limitation of the present systematic review is the use of significance counting for the quantitative synthesis. More research examining changes in addiction during recovery would aid in the development of more effective treatments for addictive disorders and prevent addiction substitution.