Urgent action needed: addressing the regulatory gap in e-cigarette trade and usage.

Tobacco use is associated with serious health problems. Global efforts, such as the World Health Organization's Framework for Tobacco Control, have reduced tobacco use, but challenges remain. Initially perceived as aids for smoking cessation, e-cigarettes have gained popularity among young people and non-smokers. Government approaches to regulating e-cigarettes range from treating them like tobacco, requiring a prescription for their use to outright bans. Although touted as a valuable alternative, evidence suggests that increased e-cigarette use carries potential direct and indirect health risks, necessitating urgent regulatory measures on a global scale. Lack of defined and uniform regulations poses substantial public health risks, compounded by marketing targeting vulnerable groups. Immediate interventions, public awareness, and research are essential to effectively control the current e-cigarette epidemic.

Disposable e-cigarette use: Factors, frequency and cigarette smoking among United States high school students.

BACKGROUND AND AIMS: Disposable e-cigarette use has increased among United States (US) high school students in recent years. However, there is limited research on the profile of these users, how often they use these products, and whether they displace cigarette smoking. This study aimed to measure how disposable e-cigarette use among US youth varies according to demographic characteristics and whether there is any association between e-cigarette use and reduced use of traditional cigarettes. DESIGN: We used cross-sectional data from the 2022 National Youth Tobacco Survey and conducted a multinomial logistic regression to examine factors associated with the types of e-cigarette devices used in the prior 30 days, adjusting for sex, sexual identity, grade level and race/ethnicity. We also used a finite mixture model to account for unobserved differences among users and identify e-cigarette use patterns in different subgroups of users. SETTING: United States. PARTICIPANTS: High school students in grades 9-12 (n = 14 389). MEASUREMENTS: Survey participants self-reported the type of e-cigarette device used, the frequency of e-cigarettes used and cigarettes smoked over the past 30 days. FINDINGS: Disposable e-cigarettes were the most popular e-cigarette type. Sex, sexual orientation, grade level and race/ethnicity were associated with disposable e-cigarette use. The odds of disposable e-cigarette use were lower in male students than in female students (odds ratio [OR] = 0.78, 95% confidence interval [CI] = [0.64-0.96]), and higher in students who identified as gay or lesbian (OR = 1.70, 95% CI = [1.11-2.61]) or bisexual (OR = 1.52, 95% CI = [1.16-1.99]) than in heterosexual students. The odds of disposable use were higher among students in higher grades (10th, 11th and 12th) than in 9th graders (OR = 1.71, 2.24 and 2.52, respectively). Disposable e-cigarette users had a lower frequency of traditional cigarette use than other e-cigarette users, both in the low-frequency class (incidence rate ratio [IRR] = 0.33, 95% CI = [0.12-0.92]) and the high-frequency class (IRR = 0.27, 95% CI = [0.08-0.92]). CONCLUSIONS: Disposable e-cigarette use appears to be higher among United States high school students who are female, older and/or identify as gay, lesbian or bisexual. Disposable e-cigarettes appear to be associated with reduced traditional cigarette use.

Applying Social Network Theory to Vaping in High School: Implications for Person-Centered Intervention.

BACKGROUND: Peer influence on risky behavior is particularly potent in adolescence and varies by gender. Smoking prevention programs focused on peer-group leaders have shown great promise, and a social influence model has proven effective in understanding adult smoking networks but has not been applied to adolescent vaping until 2023. This work aims to apply a social influence model to analyze vaping by gender in a high school network. METHODS: A high school's student body was emailed an online survey asking for gender, age, grade level, vape status, and the names of three friends. Custom Java and MATLAB scripts were written to create a directed graph, compute centrality measures, and perform Fisher's exact tests to compare centrality measures by demographic variables and vape status. RESULTS: Of 192 students in the school, 102 students responded. Students who vape were in closer-knit friend groups than students who do not vape (p < .05). Compared to males who vape, females who vape had more social ties to other students who vape, exhibiting greater homophily (p < .01). Compared to females who do not vape, females who vape were in closer-knit friend groups (p < .05) and had more ties to other students who vape (p < .01). CONCLUSION: Differences in vaping by social connectedness and gender necessitate school and state policies incorporating the social aspect of vaping in public health initiatives. Large-scale research should determine if trends can be generalized across student bodies, and more granular studies should investigate differences in motivations and social influence by demographic variables to individualize cessation strategies.

Use of disposable e-cigarettes among youth who vape in Canada, England and the United States: Repeat cross-sectional surveys, 2017-2023.

AIMS: To measure changes over time (between 2017 and 2023) in disposable e-cigarette use and popular brands among youth in Canada, England and the United States (US) who vaped. DESIGN: Nine waves of repeat cross-sectional data from the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey. SETTING: Online surveys conducted in Canada, England and the US between 2017 and 2023. PARTICIPANTS: Youth aged 16 to 19 years who had vaped in the past 30 days (n = 19 710). MEASUREMENTS: Usual type (disposable, cartridge/pod, tank) and brand of e-cigarette used; covariates sex at birth, age, race/ethnicity, cigarette smoking status, vaping on ≥20 of the past 30 days. FINDINGS: In 2017, the majority of youth who vaped in the past 30 days reported using refillable tank e-cigarettes, whereas disposable e-cigarettes were the least commonly used product type in Canada (10.0%), England (8.6%) and the US (14.4%). Cartridge/pods overtook tank devices in Canada and the US by 2020; however, by 2023, disposables were the leading type of e-cigarette used by youth who vaped in all three countries (Canada = 58.5%; England = 83.2%; US = 67.3%). The shift to disposables occurred among all socio-demographic groups, with few differences by vaping and smoking status. The percentage of youth who vaped that reported 'no usual' brand also decreased substantially from 2017 (29% to 42%) to 2023 (11% to 17%). The rise of disposable e-cigarettes appeared to be driven primarily by individual brands in the US (Puff Bar in 2020/2021, Elf Bar in 2022/2023) and England (Elf Bar in 2022/2023). CONCLUSIONS: The e-cigarette market has evolved rapidly with notable shifts in the types of e-cigarettes used by youth who vape in Canada, England and the United States. Although the timing differed across countries, major shifts in device types appear to be driven by individual brands and were often accompanied by increases in vaping prevalence among youth.

Tobacco and Nicotine Product Use Transitions by Race and Ethnicity: Results from a Latent Transition Analysis Using Data from the Truth Longitudinal Cohort (2020-2022).

OBJECTIVE: To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigars, and cigarillos (LCCs) over time and determine whether patterns differ by race and ethnicity. METHODS: Data was obtained from the Truth Longitudinal Cohort of youth and young adults between September 2020 and June 2022. Latent class and transition analyses were used to classify participants (N = 4448) into subgroups, based on frequency of tobacco product use in the past 30 days, and to estimate the probability of use pattern transitions by race and ethnicity, adjusted for the effects of gender, financial situation, parental education, household tobacco use, and sensation seeking. RESULTS: Four latent classes were identified: former/noncurrent users, predominantly frequent to daily (FTD) e-cigarette users, predominantly FTD e-cigarette and LCC users, and predominantly FTD cigarette with polytobacco users. Use trajectories differed by race and ethnicity. A lower proportion of those who identified as non-Hispanic Black (60.0%) remained e-cigarette and LCC users, relative to those who identified as non-Hispanic White (86.0%), Hispanic or Latino (86.0%), and another race and ethnicity (79.0%). A lower proportion of those who identified as Hispanic or Latino (54.0%) and another race and ethnicity (59.9%) remained cigarette with polytobacco users, relative to those who identified as non-Hispanic White (76.0%) and non-Hispanic Black (72.0%). A greater proportion of non-Hispanic Black respondents transitioned from e-cigarette and LCC user to former/noncurrent user (40.0%) and polytobacco user to e-cigarette and LCC user (11.0%), relative to other racial/ethnic groups. CONCLUSION: More research is needed to determine why tobacco use trajectories differ by race and ethnicity. Such research will be important in informing comprehensive approaches that promote evidence-based prevention policies and programs.

Evaluation of Dry Eye Parameters Among Electronic Cigarette Smokers.

Introduction  The emergence of electronic cigarettes as the "healthier" version of smoking has been popular, especially among young adults. However, knowledge about the potential effects of e-cigarettes on ocular structures is scarce. Objective  To compare the mean change in dry eye parameters between e-cigarette smokers and non-smokers and to correlate between dry eye parameters with device power output. Methodology A cross-sectional, single-visit study was conducted involving 85 e-cigarette smokers and 85 non-smokers. All participants were evaluated on dry eye parameters, including the Ocular Surface Disease Index (OSDI) score, tear meniscus height (TMH), tear break-up time (TBUT), cornea fluorescein staining, and Schirmer's I test. The mean change in dry eye parameters was compared between e-cigarette smokers and non-smokers. The correlation between dry eye parameters with device power output was analyzed. Results Specifically, 32.94% of e-cigarette smokers were found to have a TMH <0.2 mm, compared to only 5.88% of non-smokers (p<0.001). A significant change in mean TBUT was found between the e-cigarette smokers (10.41+2.65 seconds) and non-smokers (12.66+3.14 seconds, p<0.001). The lower mean Schirmer's I test was found among e-cigarette smokers (12.75+7.24 mm, p<0.001). No significant change in the median OSDI score and corneal fluorescein staining. The OSDI score and device power output were found to have a significant positive correlation (p=0.003). There was a significant association between dry eye signs and device power output, including TMH (p=0.047), TBUT (p=0.002), Schirmer's I test (p<0.001), and corneal fluorescein staining (p<0.001). Conclusion Electronic cigarette smokers are prone to develop dry eyes. Concern should be raised on the risk of electronic cigarette use on ocular health, and regulation on e-cigarette ban should be revisited.

Risk Factors for E-Cigarette Ban Relaxation in Homes With Adolescents.

PURPOSE: To identify risk factors for relaxing a strict e-cigarette ban in households with adolescents. METHODS: Youth (ages 12-17) in the Population Assessment of Tobacco and Health (PATH) Study whose parents held a strict vaping ban in 2016 (n = 6,514; 51.5% male) and their parents provided follow-up data on up to four occasions through 2020 on whether the ban was relaxed. RESULTS: 13.5% of households with strict vaping bans relaxed them in a subsequent wave. Results from a logistic regression model showed that the odds of relaxing strict bans were higher if, at baseline, parents vaped (OR = 2.20; 95% CI: 1.22-3.97; p < .01), parents smoked tobacco (OR = 2.55; CI: 2.00-3.26; p < .001), youth smoked tobacco (OR = 2.27; CI: 1.29-4.00; p < .01), parents reported no smoking ban (OR = 2.68; CI: 1.88-3.81; p < .001), youth did not know that their household had a vaping ban (OR = 1.95; CI: 1.50-2.54; p < .001), and parents perceived low harm from vaping (OR = 1.60; CI: 1.16-2.19; p < .01). Although most sociodemographic controls were not independently associated, parents were less likely to relax bans if they had a college degree (OR = 0.71; CI: 0.51-0.998; p < .05), graduate degree (OR = 0.50; CI: 0.43-0.72; p < .001), or children who were non-Hispanic Black (OR = 0.69; CI: 0.49-0.96; p < .05) or Hispanic (OR = 0.62; CI: 0.47-0.81; p < .001). DISCUSSION: While most households with adolescents prohibited e-cigarette use indoors, nearly one in seven relaxed prior strict vaping bans. Parents need support to maintain clear, consistent, and continuous restrictions that communicate that vaping is not safe or permissible for youth.

Different Lengths of Gestational Exposure to Secondhand Smoke or e-Cigarette Vapor Induce the Development of Placental Disease Symptoms.

Exposure to cigarette smoke is known to induce disease during pregnancy. Recent evidence showed that exposure to secondhand smoke (SHS) negatively impacts fetal and placental weights, leading to the development of intrauterine growth restriction (IUGR). Electronic cigarettes (eCigs) represent a phenomenon that has recently emerged, and their use is also steadily rising. Even so, the effects of SHS or eCigs during gestation remain limited. In the present study, we wanted to characterize the effects of SHS or eCig exposure at two different important gestational points during mouse pregnancy. C57/Bl6 mice were exposed to SHS or eCigs via a nose-only delivery system for 4 days (from 14.5 to 17.5 gestational days (dGA) or for 6 days (from 12.5 dGA to 17.5 dGA)). At the time of necropsy (18.5 dGA), placental and fetal weights were recorded, maternal blood pressure was determined, and a dipstick test to measure proteinuria was performed. Placental tissues were collected, and inflammatory molecules in the placenta were identified. Treatment with SHS showed the following: (1) a significant decrease in placental and fetal weights following four days of exposure, (2) higher systolic and diastolic blood pressure following six days of exposure, and (3) increased proteinuria after six days of exposure. Treatment with eCigs showed the following: (1) a significant decrease in placental weight and fetal weight following four or six days of exposure, (2) higher systolic and diastolic blood pressure following six days of exposure, and (3) increased proteinuria after six days of exposure. We also observed different inflammatory markers associated with the development of IUGR or PE. We conclude that the detrimental effects of SHS or eCig treatment coincide with the length of maternal exposure. These results could be beneficial in understanding the long-term effects of SHS or eCig exposure in the development of placental diseases.

Depression screening outcomes among adolescents, young adults, and adults reporting past 30-day tobacco and cannabis use.

BACKGROUND: Few studies examine the relationship between depression and use of specific tobacco and/or cannabis products among adolescents, young adults, and adults. We determined whether the odds of depression are greater among those who used specific tobacco and/or cannabis products and among co-users of tobacco and cannabis. METHOD: Cross-sectional online survey of a national convenience sample of 13-40-year-olds (N = 6,038). The survey included depression screening and past 30-day use of specific tobacco and cannabis products (cigarettes; e-cigarettes, vaped cannabis, little cigars, cigarillos, cigars, hookah, chewing tobacco, smoked cannabis, edible cannabis, blunts). Analyses correspond to the total sample, and 13-17-, 18-24-, and 25-40-year-olds. RESULTS: Among 5,281 individuals who responded to the depression screener and nine product use questions, 1,803 (34.1 %) reported co-use of at least one tobacco product and one cannabis product in the past 30 days. Past 30-day co-use was associated with higher likelihood of screening positive for depression compared to past 30-day use of tobacco-only (aOR = 1.32, 1.06-1.65; 0.006) or cannabis-only (aOR = 1.94, 1.28-2.94; <0.001). Screening positive for depression was more likely among those who reported past 30-day use of e-cigarettes (aOR = 1.56; 1.35-1.80; <0.001), cigarettes (aOR = 1.24, 1.04-1.48; 0.016), chewed tobacco (aOR = 1.91, 1.51-2.42; <0.001), and blunts (aOR = 1.22, 1.00-1.48; 0.053) compared to those who did not report past 30-day use of these products. Among the 2,223 individuals who screened positive for depression, the most used two-product combination was nicotine e-cigarettes and smoked cannabis (614 individuals, 27.6 %). CONCLUSIONS: Screening positive for depression was more likely among past 30-day co-users versus past 30-day users of tobacco-only or cannabis-only. Findings suggest that prevention programs for depression and substance use address tobacco and cannabis co-use.

Vaping as a Risk Factor for Oral Erythema Multiforme: A Case Report and Literature Review.

Introduction: Erythema multiforme is a hypersensitivity reaction caused by various factors, such as viruses, chemicals, and drugs. Electronic cigarettes (e-cigarettes) or vape is a battery-powered nicotine delivery device that substitutes for traditional cigarettes. The chemical components of vaping, including propylene glycol and nicotine, can cause hypersensitivity reactions. Objective: To report a case of oral erythema multiforme in an e-cigarettes user, treatment, and review the literature regarding the impact of these devices on oral health. Clinical Case: A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy. Conclusion: Erythema multiforme restricted to the mouth is rare, especially associated with electronic cigarettes. Early identification of oral ulcerative disorders is crucial for accurate diagnosis and treatment, where clinicians should consider oral erythema multiforme as a possible diagnosis.

Interpersonal communication and perceived norms as social influence mechanisms of e-cigarette use among adults: a systematic review.

Background: Given the increasing popularity of e-cigarette use among adults and the ongoing debate about the benefits and the potential adverse health risks associated with e-cigarette use, it is critical to identify the correlates of e-cigarette use. Prior research has found associations between interpersonal communication, perceived norms, and adults' e-cigarette use, but the evidence has yet to be summarized and synthesized.Objectives: This paper reviewed empirical studies examining the relationship between interpersonal communication, perceived norms, and e-cigarette use among adults.Methods: Following PRISMA guidelines, articles were searched on DOAJ, EMBASE, Europe PubMed Central, Google Scholar, PsychINFO, PubMed, Web of Science, and the reference list of the retrieved studies for studies that examined social influence on e-cigarette use. Three reviewers independently screened 1,713 non-duplicate papers and further screened the full text of 195 articles for inclusion.Results: Thirty studies (30), consisting of quantitative (n = 25) and qualitative (n = 5) data, were included in this review. The twenty-five (25) quantitative studies consisted of both cross-sectional (n = 20) and longitudinal (n = 5) studies. Interpersonal communication portraying e-cigarettes as beneficial or harmful was found to increase e-cigarette use and quit attempts, respectively. Across study designs, greater perceptions of others' e-cigarette use or approval were related to more frequent e-cigarette use.Conclusions: The findings highlight that e-cigarette-related interpersonal communication and perceived norms are associated with e-cigarette use. These factors may be useful targets in brief interventions. However, most of the included studies were cross-sectional, limiting the ability to establish clear cause-and-effect relationships; therefore, more longitudinal studies are needed.

E-cigarette Use and Severe Coronavirus Disease 2019 (COVID-19) Outcomes: A Meta-Analysis.

E-cigarettes have been known to cause varied poor health outcomes prior to coronavirus disease 2019 (COVID-19), but after the impact of COVID-19, evidence came out that was, in some instances, not as expected regarding the severity of COVID-19 among e-cigarette users (vapers). A meta-analysis was performed on the available evidence to comprehensively find the effect of COVID-19 on existing or past e-cigarette users (vapers). The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were used to perform this meta-analysis. PubMed was searched for observational studies that described outcomes after COVID-19 positivity from December 1, 2019, to December 2023. Medical Subject Headings (MeSH) keywords were used for searching the relevant studies highlighting the relationship between COVID-19 and e-cigarette users. Calculations for pooled prevalence, 95% confidence interval (95% CI), weights for current e-cigarette users and vapers, and outcomes (events) were made. To analyze the data, Review Manager V.5.4 was used. The I² statistic was used to assess statistical heterogeneity. The I² statistic of >50% was considered significant heterogeneity. The "leave-one-out" method was used for sensitivity analysis. Out of 3231 studies, four studies reported data on vaping and non-vaping status and composite outcomes, resulting in a sample size of 653 COVID-19-positive cases. The pooled prevalence of being COVID-19 positive, having symptoms, or visiting an emergency room was 7.78% (653/8392). COVID-19 patients with current vaping status had decreased odds of poor outcomes compared to non-smokers, with a pooled odds ratio (OR) of 0.09 (95% CI 0.00-2.42; p>0.05) with heterogeneity between studies (I²=99%, p=0.15). Because of difficulties related to data collection and other factors, this meta-analysis was unable to conclusively establish the correlation between e-cigarette usage and severe COVID-19 outcomes such as hospitalization, admission to the intensive care unit, and fatality. Additional research using more detailed data is necessary to fully understand this correlation.

Knowledge of Tunisian physicians about electronic cigarettes.

INTRODUCTION: The electronic cigarette is a new-generation smoking product whose mechanism of use could, in theory, minimize adverse health effects. AIM: Determine the knowledge and perceptions of a sample of Tunisian doctors regarding electronic cigarettes. METHODS: We conducted a descriptive cross-sectional study over a two-month period with a sample of Tunisian doctors. We used an online self-questionnaire on physicians' knowledge and perceptions of e-cigarettes. RESULTS: Data were obtained from 216 physicians. Of the participants, 97.2% were familiar with e-cigarettes, 56.5% reported low knowledge, and 83.4% expressed motivation to learn more about e-cigarettes. Overall, 83.8% of doctors felt that electronic cigarettes are harmful to the user's health. Use of this product would increase the risk of cancer according to 73.1% of participants, the risk of cardiovascular disease according to 68.5% of participants, and the risk of chronic lung disease according to 79.2% of participants. The perception of e-cigarettes as harmful to the user's health was associated with the physicians' medical specialty (p=0.032). The recommendation of e-cigarettes as a smoking cessation tool was negatively correlated with addictology training (p=0.027). CONCLUSIONS: Physicians' knowledge of electronic cigarettes is heterogeneous, reflecting the current lack of information and consensus.

Prevalence of Adverse Respiratory Symptoms Among E-Cigarette Users in Saudi Arabia - A Cross-Sectional Study.

Electronic cigarettes, frequently referred to as e-cigarettes, have emerged as a controversial and rapidly growing phenomenon in the realm of tobacco and nicotine consumption worldwide. This study reports the prevalence of respiratory symptoms among e-cigarette users. This study also helps to understand the potential harmful effects and importance of quitting e-cigarette smoking. An observational cross-sectional study was carried out in Saudi Arabia. The study period was from September 2022 to August 2023. The sample size was 447 participants. Among recent e-cigarette users in this Saudi study, usage varied, with 44.1% using 1-5 days, 33.6% using 6-30 days, and 22.4% using e-cigarettes previously but not in the previous month. Vape devices were predominant (42.7%). There were significant associations emerged between e-cigarette use frequency and symptoms such as fatigue, breathlessness, and shortness of breath. E-cigarette use was notably linked to asthma-related symptoms, underscoring its concerning impact on respiratory health (P < 0.05). E-cigarette consumption has a significant impact on respiratory effects and specifically asthma-related symptoms among this Saudi population.

Nicotine or marijuana vaping exposure during pregnancy and altered immune responses in offspring.

Electronic nicotine delivery systems (ENDS) - which include electronic cigarettes or e-cigarettes, or simply e-cigs, and marijuana vaping have become increasingly popular. ENDS devices have been established as one of the tobacco quit methods and promoted to be safer compared to traditional tobacco cigarettes. Emerging evidence demonstrates that e-cigarette and marijuana vape use can be harmful, with potential associations with cancer. Herein, we summarize the level of evidence to date for altered immune response, with a focus on cancer risks in the offspring after maternal use of, or aerosol exposures from, ENDS or marijuana vape during pregnancy. From 27 published articles retrieved from PubMed, we sought to find out identified carcinogens in ENDS aerosols and marijuana vapor, which cross the placental barrier and can increase cancer risk in the offspring. Carcinogens in vaping aerosols include aldehydes, metals, tobacco-specific nitrosamines, tobacco alkaloids, polycyclic aromatic hydrocarbons, and volatile organic compounds. Additionally, there was only one passive vaping exposure case study on a human fetus, which noted that glycerol, aluminum, chromium, nickel, copper, zinc, selenium, and lead crossed from the mother to the offspring's cord blood. The carcinogens (metals) in that study were at lower concentrations compared to the mother's biological matrices. Lastly, we observed that in utero exposures to ENDS-associated chemicals can occur in vital organs such as the lungs, kidneys, brain, bladder, and heart. Any resulting DNA damage increases the risk of tumorigenesis. Future epidemiological studies are needed to examine the effects of passive aerosol exposures from existing and emerging electronic nicotine and marijuana products on developing offspring to cancer.

Young people's use of disposable vapes: A qualitative study.

BACKGROUND AND AIMS: Youth use of disposable vapes has increased markedly in the United Kingdom in recent years, yet little is known about the motivations, experiences and perceptions of young people themselves. This study aimed to explore young people's experiences and use of disposable vapes. METHODS: This was a qualitative study recruiting young people reporting regularly vaping disposables, collecting data via dyad guided, individual and group interviews. Data analysis was theoretically informed by the Social Ecological Model. Inductive and deductive coding approaches were used, with resolution of coded interpretations by consensus. RESULTS: Twenty-nine young people aged 16-20 years participated in qualitative interviews. At the individual level, participants discussed how characteristics of disposable vapes were important to them-particularly price, accessibility and the attractive designs, colours, names and flavours. Young people frequently engaged in both vaping and tobacco smoking, seeing the behaviours as interchangeable dependent on context, and having inaccurate relative harm perceptions of vaping compared with smoking. Experimentation was widespread and many used vapes as a way of managing stress and anxiety. Vaping was positioned as a social behaviour, common among peers. Parental influence on vaping behaviour was minimal, although vaping initiation could be influenced by family vaping norms. Culturally, vaping was a widespread normalized behaviour. Young people were aware of media reports and potential harms, but were less aware of smoking related harms as a consequence. CONCLUSIONS: Disposable vapes appear to be attractive and accessible to young people in the United Kingdom. Vaping is normalized in this population, despite being seen as potentially damaging to health, and vaping and smoking are engaged in interchangeably. Underage sales of vapes are reportedly widespread. Strict regulation, such as banning products or increasing prices, may prompt UK youth to switch from vaping to smoking.

The use of electronic cigarettes and other tobacco products among university students and their potential relationship with oral health: A cross-sectional study.

BACKGROUND: The aim of this study was to evaluate oral alterations among university students and explore possible associations with tobacco consumption in its various forms. METHODS: A cross-sectional study was conducted in 2 phases: the first phase involved administering an electronic questionnaire to participants determine the prevalence of tobacco use and the second phase involved a physical examination of the participants. The participants were grouped on the basis of their reported habits and compared using statistical analysis (P < .05). RESULTS: Of the 620 participants, 57.1% reported using tobacco in some form, with 47.4% reporting electronic cigarette (e-cigarette) use. In the clinical phase, comparing the presence of oral changes in tobacco users vs nonusers, e-cigarette users had a higher proportion of white-spot caries lesions (P = .041) and gingivitis (P = .012). When e-cigarette use was combined with other forms of tobacco use, additional oral changes were more prevalent, including coated tongue and nicotinic stomatitis (P < .05). CONCLUSIONS: The use of alternative forms of tobacco consumption is common among university students, with e-cigarette use being the most prevalent form, and may lead to detrimental effects on the oral cavity, such as caries and gingivitis, particularly when used in conjunction with other tobacco products. PRACTICAL IMPLICATIONS: The use of tobacco in alternative forms, such as e-cigarettes, can affect oral health directly or indirectly. Dentists should be familiar with the characteristics of this population and the potential oral repercussions associated with tobacco use to address the impact on health and raise awareness of the associated risks.

The prospective relationship between a-priori intentions for and patterns of e-cigarette use among adults who smoke cigarettes.

BACKGROUND: Electronic (e-)cigarettes may help adult cigarette smokers achieve cigarette cessation, depending on patterns of e-cigarette use. Among cigarette smokers who do not use e-cigarettes, it is unclear if and how a-priori intentions for use are related to uptake patterns. Longitudinal studies have focused on established e-cigarette users or adolescent and young adult populations exclusively. METHODS: Within a nationwide randomized clinical trial (N = 638), adult cigarette smokers not currently using e-cigarettes were randomized (2:1) to receive (or not) one-month sampling of e-cigarettes. An exploratory factor analysis (EFA) was performed on an established 15-item measure assessing a-priori intentions for e-cigarette use to identify latent variables. Among those receiving e-cigarette products, regression models examined relationships between intentions and: 1) uptake (yes/no), 2) frequency (number of days per week), and 3) amount (puffing episodes per day) of e-cigarette use at one-month follow-up. RESULTS: Two factors emerged from the EFA: 1) cigarette-related intentions (e.g., cigarette cessation, no smell) and 2) novel appeal of e-cigarettes (e.g., flavors). Three items remained and were treated as separate intentions: "feels like cigarette smoking", "curiosity", and "affordability". In the final multivariable models, "feel like cigarette smoking" predicted more frequent e-cigarette use (ß = 0.187, SE = 0.086, p = 0.03); however, none of the five factors/intentions were significantly associated with uptake or amount of use. CONCLUSIONS: For adult cigarette smokers not currently using e-cigarettes, a-priori intentions for using e-cigarettes might not be predictive of if or how these products will be used in the future, suggesting that motives may not drive use behavior.