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.

Prospective longitudinal relations among frequent social media use, nicotine vaping and experiencing internalizing mental health problems.

AIMS: To compare four a priori rival mediated pathways of frequent social media use, electronic nicotine delivery systems (ENDS) use and internalizing mental health (MH) problems across five waves of nationally representative data. DESIGN, SETTING AND PARTICIPANTS: This was a longitudinal study using data drawn from waves 2-5 (October 2014-November 2019) of the Population Assessment of Tobacco and Health Study, a nationally representative cohort study spanning approximately 5 years, conducted in the United States. The analytical sample of participants included those who were aged 12-14 years at wave 2 and who provided data in subsequent waves until wave 4.5 (n = 4627, 69.7% were White and 51.4% were male). MEASUREMENTS: Frequent social media use (several times a day), ENDS use (past 30-day use) and internalizing MH problems (endorsed symptoms on four items in the past year) were dichotomized for analysis. FINDINGS: The weighted proportions of the three key variables increased over time. From wave 2 to wave 5, frequent social media use grew from 56.9 to 77.2%; internalizing MH problems from 18.9 to 29.0%; and ENDS use from 1.4 to 11.4%. In weighted logistic regressions using generalized linear mixed models with random effects, there was a significant within-person association between frequent social media use at time t and greater ENDS use at t + 1 [adjusted odds ratio (aOR) = 1.87; 95% confidence interval (CI) = 1.47, 2.37] and worsened internalizing MH problems at t + 1 (aOR = 1.19; 95% CI = 1.04, 1.37). A model-based causal mediation analysis and marginal structural models were fitted to estimate the average causal mediation effect. Among all four examined mediation pathways throughout the three constructs, partial mediation was observed, and all the pathways were significant for both boys and girls. Sex differences did not emerge in the examined prospective mediated pathways. CONCLUSIONS: Among youth in the United States, frequent social media use appears to mediate the prospective association between experiencing internalizing mental health problems and using electronic nicotine delivery systems.

Packaging of disposable vaping products and e-liquids in England, Canada and the United States: A content analysis.

BACKGROUND AND AIMS: Vaping product packaging is varied and often features bright colours and novel designs, particularly among recently marketed disposable vapes. This study provides an overview of attributes found on the packaging of popular disposable vapes and e-liquid bottles in England, Canada and the United States (US) and assesses compliance with local packaging regulations. DESIGN: Content analysis. SETTING: Brick-and-mortar and online shops in England (London), Canada (Ontario) and the US (New Hampshire and South Carolina). CASES: 108 vaping products (including packaging) from 76 brands in a range of flavours and nicotine levels. Specifically, 48 disposable vapes (15 from England, 16 from Canada, 17 from the US) and 60 e-liquid bottles (20 per country). MEASUREMENTS: Textual and graphic branding and marketing elements, independently coded by two researchers and checked by a third. FINDINGS: Compliance with local packaging regulations varied across countries. Health warnings were present on the packaging of all but one nicotine-containing product, although 33% of disposables and 17% of e-liquids featuring the warning did not adhere to formatting requirements. Leaflets were seldom included with e-liquid bottles, even in England (45%) where mandatory, and omitted elsewhere. Labelling of nicotine type and batch numbers was inconsistent. Vaping product packaging featured claims relating to sensory perceptions (41%), most often flavours, and some (32%) featured youth-appealing content. Common graphic elements included stylised brand fonts (80%), brand logos (54%), product representations on the external packaging (47%) and abstract graphic elements (64%). Colours on packaging, disposable vapes and e-liquid bottles were associated with product flavour. CONCLUSIONS: In England, Canada and the United States, popular disposable vapes and e-liquid bottles appear to have varying compliance with local packaging regulations and inconsistent labelling of nicotine and product characteristics. The use of colourful designs, evocative descriptors and appealing graphics to promote flavours underscores the need for comprehensive packaging regulations and enforcement.

Thermal Pharyngeal Injury Resulting From Vaping: A Case Report.

Thermal injury to the pharyngeal structures is uncommon, and clinicians generally attribute these injuries to consuming hot foods or liquids. While thermal injuries have been reported with the ingestion of hot substances, thermal injuries from vape pens have not been widely described in the literature. We present a case of a 35-year-old male who presented to the emergency department (ED) with oropharyngeal burns after utilizing a vape pen that malfunctioned. The patient had visible burns on his uvula, as well as on the soft and hard palate. Additionally, he had symptoms of difficulty swallowing and a hoarse voice, which raised concerns about a possible deeper airway or lung injury. The patient required a flexible nasopharyngolaryngoscopy by a head and neck surgeon, which revealed mild edema and erythema of the epiglottis and the arytenoids. The patient was admitted to the hospital overnight for observation and treatment with analgesia and dexamethasone. The following morning, the patient's symptoms had improved. The repeat nasopharyngolaryngoscopy showed improvement in the swelling of the epiglottis and arytenoids, and the patient was deemed stable for discharge. This case brings attention to the variety of injuries possible from e-cigarette use and the importance of prompt management of oropharyngeal thermal injuries.

Health literacy and adolescents' substance use behaviors and correlates: a scoping review.

From 2011 to 2023, substance use increased by 23% worldwide. Given that substance use initiation is highest during adolescence, it is crucial to identify amenable correlates of substance use prevention [e.g. health literacy (HL)], which, if embedded in interventions, may improve uptake and outcomes. Hence, this study conducted a scoping review to answer the question: What is known from the existing literature about the relationship between HL and substance use correlates and behaviors in adolescents? Five electronic databases and the bibliography of review articles were searched and a total of 1770 records were identified. After removing duplicates and engaging in three levels of screening to identify studies that included adolescents ≤ 25 years old and assessed the relationship between general HL (vs. behavior/disease-specific health knowledge) and substance use behaviors and correlates, 16 studies were retained. Studies assessed alcohol-related (n = 11), tobacco-related (n = 12), electronic vapor product use-related (n = 4), cannabis-related (n = 1), and amphetamines/methamphetamines-related (n = 1) outcomes. Studies spanned Africa, Asia, Europe, and North and Central America. Most studies included substance use as an outcome and found an inverse relationship between HL and use. Few studies examined substance use correlates (e.g. risk perception). There were no longitudinal or intervention studies. This review highlighted that the topic of adolescent HL and its relationship with substance use remains inadequately researched. Notable gaps for future studies include intervention and longitudinal designs, expansion of outcomes (e.g. more studies on marijuana, prescription drug misuse, vaping, substance use-related correlates), and examining HL as a mediator or moderator of substance use and its correlates.

Electronic Vapor Products: Alarming Trends in United States Adolescents.

Background: The use of electronic vapor products (EVPs) increases the risks of nicotine addiction, drug-seeking behavior, mood disorders, and avoidable premature morbidities and mortality. We explored temporal trends in EVP use among US adolescents. Methods: We used data from the Youth Risk Behavior Survey for school grades 9 through 12 from 2015 (earliest available data) to 2021 (the most recently available data) from the US Centers for Disease Control and Prevention (n=57,006). Results: Daily use of EVPs increased from 2.0% in 2015 to 7.2% in 2019, a greater than 3.5-fold increase. Although the percentage decreased to 5.0% in 2021, it was still a >2.5-fold increase since 2015. In 2015, the percentage of EVP use was significantly higher in boys (2.8%) than girls (1.1%). By 2021, the percentage of EVP use was higher in girls (5.6%) than boys (4.5%), a 1.24-fold increase. In addition, the percentage of EVP use in 2021 was higher in White youth (6.5%) vs Black (3.1%), Asian (1.2%), and Hispanic/Latino (3.4%) youth compared to 2015, but White and Black adolescents had the highest increases of approximately 3.0-fold between 2015 and 2021. Adolescents in grade 12 had the highest percentages of EVP use at all periods. Conclusion: These data show alarming statistically significant and clinically important increases in EVP use in US adolescents in school grades 9 through 12. The magnitude of the increases may have been blunted by coronavirus disease 2019, a hypothesis that requires direct testing in analytic studies. These trends create clinical and public health challenges that require targeted interventions such as mass media campaigns and peer interventions to combat the influences of social norms that promote the adoption of risky health behaviors during adolescence.

Factors associated with intentions to quit vaping and quit attempts among Adolescents: A structural equation modeling approach.

OBJECTIVES: Previous youth tobacco research has identified multiple factors relating to intentions to quit vaping and quit attempts among current e-cigarette users in adolescents. The pathways in the complex associations with vaping cessation behaviors remain unclear. METHODS: Using data from the 2022 National Youth Tobacco Survey (NYTS) (grades 6-12), structural equation models (SEMs) are developed to examine the associations of social environment, vaping risk perceptions, e-cigarette marketing, vaping characteristics, and demographics with two outcome measures - intentions to quit vaping and past year quit attempts among current e-cigarette users. RESULTS: The national sample of current e-cigarette users (n = 2,701) consisted of 52.7 % females, 47.0 % non-Hispanic Whites, 80.1 % high school students, and 56.2 % heterosexual individuals. Among them, 70.2 % reported intentions to quit vaping and 66.3 % reported past year quit attempts. The protective factor for quit intentions was vaping risk perceptions (p < 0.001). Risk factors included e-cigarette marketing (p = 0.04), dual use of e-cigarettes and other tobacco products (p = 0.003), vaping due to feeling anxious or stressed (p = 0.01), vaping for nicotine buzz (p = 0.002), nicotine dependence (p = 0.02), identifying as Gay or Lesbian (p < 0.001), bisexual (p = 0.03), or Hispanic (p = 0.04). Similar associations were observed with quit attempts except that e-cigarette marketing, vaping due to feeling anxious or stressed, vaping dependence, and identifying as Hispanic were not significant. Besides, high vaping frequency (p < 0.001), grade level (p < 0.001) and not sure about sexual orientation (p = 0.01) were also negatively associated with quit attempts. CONCLUSIONS: This study provided insights into factors influencing vaping cessation outcomes among adolescent current e-cigarette users. Developing tailored vaping cessation programs based on these findings could enhance quit success.

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 Moderating Role of Health Status on the Association Between Depressive Symptoms and Cannabis Vaping.

Objective: Cannabis vaping is increasing among college students. There is little information on risk factors for vaping cannabis. Consistent with the self-medication hypothesis, experiencing depressive symptoms and having a chronic medical condition (CMC) are associated with cannabis use among young adults. Individuals who experience both risk factors may be at higher risk for cannabis vaping. This study examined cross-sectional associations between depressive symptoms, CMC status, and cannabis vaping, and identified the moderating role of CMC status on depressive symptoms and cannabis vaping. Method: College students (N = 3,742) self-reported on depressive symptoms, CMC status, and lifetime and current cannabis vaping (i.e., cannabis vaporizers; electronic nicotine devices to use cannabis). Data were collected Fall 2017 until Spring 2021. The sample was predominantly female (70.9%) and White (75.4%). Regression analyses were used. Results: Greater depressive symptoms were related to increased likelihood of cannabis vaping across outcomes. Having a CMC was related to lifetime history of cannabis vaporizing. CMC status moderated the associations between depressive symptoms and lifetime cannabis vaporizing. Depressive symptoms were only a risk factor for cannabis vaporizing among college students without a CMC, not those with a CMC. Conclusions: Interventions that teach adaptive ways of coping with depressive symptoms and the potential demands of managing a CMC in college are needed. Comprehensive programs for college students, with and without CMCs, are needed to support those with comorbid depression and cannabis vaping use.

Appealing characteristics of E-cigarette marketing in the retail environment among adolescents.

Background: Nearly 3 million U.S. adolescents use e-cigarettes. E-cigarette marketing is associated with adolescent e-cigarette use; however, studies have not asked adolescents their perceptions about whether and which e-cigarette marketing in retail stores influences purchase and use. Methods: Eleven 90-minute focus groups with 12-19-year-olds (mean age 15.7, 46.6 % female) from 11 U.S. states (n = 58) recruited through Instagram and schools (May 2021-Aug 2022). Photographs of e-cigarette marketing in and around retail stores were used to aid discussion. Thematic analysis identified themes related to appealing marketing characteristics. Results: Adolescents indicated that e-cigarette marketing in and around retail stores arouses their curiosity, reminds them to buy, and normalizes using e-cigarettes. Adolescents identified specific e-cigarette marketing characteristics that they believed influence their decision to purchase and use e-cigarettes including the Tobacco Power Wall, free samples and flavor smelling samples, price incentives such as discounts and starter-kits, e-cigarette displays near checkout encouraging grab-and-go, displays near food, snacks or candy, and e-cigarette advertising through posters on store windows and stickers at checkout. Adolescents reported combining online and social media strategies to bypass age verification in retail stores (e.g., buying gift cards online and using them in stores). Adolescents suggested adding warning images on negative health effects of e-cigarettes, increasing prominence of minimum-age-of-tobacco-sale signs, and developing marketing education as counter-marketing strategies. Conclusions: Adolescents indicate that specific e-cigarette marketing characteristics in retail stores influence their purchase and use decisions. Addressing such e-cigarette marketing exposures in retail stores through counter-marketing messages may bolster adolescent e-cigarette prevention efforts.

Investigative analysis of blood-brain barrier penetrating potential of electronic nicotine delivery systems (e-cigarettes) chemicals using predictive computational models.

INTRODUCTION: Seizures are known potential side effects of nicotine toxicity and have been reported in electronic nicotine delivery systems (ENDS, e-cigarettes) users, with the majority involving youth or young adults. AREAS COVERED: Using chemoinformatic computational models, chemicals (including flavors) documented to be present in ENDS were compared to known neuroactive compounds to predict the blood-brain barrier (BBB) penetration potential, central nervous system (CNS) activity, and their structural similarities. The literature search used PubMed/Google Scholar, through September 2023, to identify individual chemicals in ENDS and neuroactive compounds.The results show that ENDS chemicals in this study contain >60% structural similarity to neuroactive compounds based on chemical fingerprint similarity analyses. The majority of ENDS chemicals we studied were predicted to cross the BBB, with approximately 60% confidence, and were also predicted to have CNS activity; those not predicted to passively diffuse through the BBB may be actively transported through the BBB to elicit CNS impacts, although it is currently unknown. EXPERT OPINION: In lieu of in vitro and in vivo testing, this study screens ENDS chemicals for potential CNS activity and predicts BBB penetration potential using computer-based models, allowing for prioritization for further study and potential early identification of CNS toxicity.

A 2024 nationwide cross-sectional survey to assess the prevalence of cigarette smoking, e-cigarette use and heated tobacco use in Poland.

OBJECTIVES: Monitoring tobacco use is one of the most important tobacco control interventions recommended by the World Health Organization. This study aimed to assess the prevalence of cigarette smoking, e-cigarette use, and heated tobacco use in a nationwide sample of adults in Poland, as well as to identify factors associated with smoking, e-cigarette use, and heated tobacco use. MATERIAL AND METHODS: This nationwide crosssectional survey was carried out in February 2-4, 2024 using the computer-assisted web interviewing method. The study questionnaire included 17 closed questions on smoking, e-cigarette use, and heated tobacco use. A sample of 1080 adults was selected using a non-probability quota sampling method. RESULTS: Data were collected from 1080 adults, age M±SD 48.4±15.5 years, 53% females. Past 30-day smoking was declared by 30.4% of adults in Poland, including 24.5% of daily smokers. Ever e-cigarette use was declared by 33% of respondents, and 20.6% had ever tried heated tobacco. Past 30-day e-cigarette use was declared by 15.2% of adults, wherein 5.9% were daily e-cigarette users. Past 30-day heated tobacco use was declared by 10.9% of respondents, wherein 4.9% were daily heated tobacco users. One-tenth of adults were dual users (cigarette and e-cigarette or heated tobacco), and 6.5% were past 30-day triple users. Age 40-59 years, having less than higher education, and bad economic status were significantly associated with daily smoking (p < 0.05). Age 18-39 years, having less than higher education, and active occupational status (employment/ self-employment) were associated with daily e-cigarette use (p < 0.05). Age 18-39 years and active occupational status were associated with daily heated tobacco use (p < 0.05). CONCLUSIONS: This study provides comprehensive epidemiological data on the current prevalence of smoking, e-cigarette use, and heated tobacco use. The introduction of e-cigarettes and heated tobacco products evoked changes in social behaviors related to nicotine use. Int J Occup Med Environ Health. 2024;37(3).

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.

Harm perceptions across vaping product features: An on-line cross-sectional survey of adults who smoke and/or vape in the United Kingdom.

BACKGROUND AND AIMS: Vaping products are diverse with a wide variety of features, and popular products change rapidly. This study examined the features and types of vaping products that people who smoke and/or vape perceive contribute to the health harms of vaping. DESIGN, SETTING AND PARTICIPANTS: This was a cross-sectional survey co-designed with adults who smoked/vaped and pre-registered. An on-line survey (November 2022) was used of a convenience sample of adults in the United Kingdom who smoked and/or vaped (n = 494). MEASUREMENTS: As primary outcomes, respondents were asked to select any of 15 vaping product features they perceived might have any effect on the health harms of vaping (for each: selected, not selected). Independent variables were smoking/vaping status (smoke and vape; vape, formerly smoked; vape, never regularly smoked; smoke, do not currently vape); relative vaping harm perceptions [less harmful than smoking (accurate), equally/more harmful than smoking or do not know/refused (other)]. Binary logistic regressions were used to compare outcomes by current vaping/smoking status and relative harm perceptions, adjusting for age and sex. FINDINGS: Most people (54.7%) selected between one and three features. The most frequently selected were nicotine concentration (62.2%) and amount of e-liquid consumed (59.1%), followed by nicotine type (e.g. salt or freebase; 33.0%), source/purchase location (25.3%), flavours (24.7%), temperature to heat e-liquid (21.1%), heat produced by device (20.9%), e-liquid brand (20.9%), amount of emissions (18.6%), device type (e.g. disposable, pod, tank; 17.2%), material of tank (17.0%), power/wattage (13.0%), device brand (8.1%), device size (4.1%) and device weight (2.4%). Higher nicotine concentrations, more e-liquid and salt (versus freebase) nicotine were perceived to confer greater harms. Disposables were perceived as slightly more harmful than reusable devices. There were few differences by current vaping/smoking status and between those with accurate (versus other) harm perceptions of vaping relative to smoking (P > 0.05 for most contrasts, adjusting for age and sex). CONCLUSIONS: Certain features and types of vaping products [higher nicotine concentrations, more e-liquid consumed and salt (versus freebase) nicotine] were perceived to confer greater health harms among a sample of UK adults who smoked and/or vaped. Findings are consistent with pervasive misperceptions that nicotine is a major cause of harm, although e-liquid volume is likely to contribute to harms.

An Internet Snapshot Survey Assessing the sale of Synthetic Cannabinoid Receptor Agonists for use with Electronic Vaping Devices.

INTRODUCTION: Synthetic cannabinoid receptor agonists (SCRAs) are associated with significant toxicity and are increasingly used in electronic vaping devices. We assessed the availability of SCRA vaping products to UK purchasers on the surface web. METHODS: An internet snapshot survey was performed between October 2022 and January 2023 on 'google.com' using the search terms "buy c-liquid vape", "buy herbal incense vape liquid", "buy cannabis vape liquid", "buy hashish vape liquid", "buy K2 vape liquid". RESULTS: 62 websites selling 128 SCRA vaping brands were identified. Most were purportedly based in the USA (41 websites, 66%) and most sold other controlled substances. Purchase incentives offered included discreet packaging (38, 61%), discounts for bulk purchase (34, 55%) and tracked delivery (30, 48%). Many websites stated SCRA products were: not for human consumption (41, 66%), for research purposes only (15, 24%), or legal (28, 45%). Websites sold a median (IQR) of 16 (7-25) SCRA vaping brands. Almost all were bottles of vaping liquid (1220/1225, 99.6%). The most common bottle size was 5mL (60%), the median (IQR) total volume of SCRA liquid per sale was 50mL (10-200mL). Median (IQR) price was £3.39/mL (£2.01/mL- £5.29/mL). Price decreased with increasing volume purchased (£6.58/mL for ≤ 5mL, £1.60/mL for > 200mL). CONCLUSION: SCRA vaping products are easily obtainable online, in both small and bulk quantities. Information provided to purchasers on safety and legality is lacking or misleading. Further studies are needed to confirm the chemistry of these products. Policymakers should consider steps to limit the potential harm caused by the purchase and use of these products.

Tobacco industry strategies to influence the regulation of new and emerging tobacco and nicotine products in Latin America and the Caribbean.

Objective: To document tobacco industry strategies to influence regulation of new and emerging tobacco and nicotine products (NETNPs) in Latin America and the Caribbean. Methods: We analyzed industry websites, advocacy reports, news media and government documents related to NETNPs, focusing on electronic cigarettes and heated tobacco products. We also conducted a survey of leading health advocates. We applied the policy dystopia model to analyze industry action and argument-based strategies on NETNP regulations. Results: Industry actors engaged in four instrumental strategies to influence NETNP regulation - coalition management, information management, direct involvement in and access to the policy process, and litigation. Their actions included: lobbying key policy-makers, academics and vaping associations; providing grants to media groups to disseminate favorable NETNP information; participating in public consultations; presenting at public hearings; inserting industry-inspired language into draft NETNP legislation; and filing lawsuits to challenge NETNP bans. The industry disseminated its so-called harm reduction argument through large/influential countries (e.g., Argentina, Brazil, and Mexico). Industry discursive strategies claimed NETNPs were less harmful, provided safer alternatives, and should be regulated as so-called harm reduction products or have fewer restrictions on their sale and use than those currently in place. Conclusion: Our analysis provides a better understanding of industry strategies to undermine tobacco and nicotine control. To help counter industry efforts, health advocates should proactively strengthen government capacities and alert policy-makers to industry attempts to create new regulatory categories (so-called reduced-risk products), provide misleading information of government authorizations of NETNPs, and co-opt so-called harm-reduction messages that serve the industry's agenda.

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.

Hamman Syndrome with a Rare Feature of Pneumorrhachis - An Unusual Complication of Polysubstance abuse and e-vaping.

Hamman syndrome is defined as dissection of air in mediastinum and skin fascia usually due to increased intrathoracic pressure. The air leak tends to make its way into pleural and pericardial layers; however, in rare instances air can also dissect into epidural spaces, regarded as pneumorrhachis. We present a case of a young male with a history of polysubstance abuse and e-vaping, who presented with symptoms of altered mental status. Given the concerning physical examination, a computed tomography of the chest was undertaken, which showed pneumothorax, pneumomediastinum and pneumorrhachis. The patient was closely monitored in the intensive care unit and improved after symptomatic management. The symptoms of pneumorrhachis depend on the volume and location of air in intracranial and intraspinal space. Although asymptomatic in our case, it is crucial for clinicians to be aware that pneumorrhachis with Hamman syndrome can potentially cause neurological deficits and cardiopulmonary arrest in severe cases due to increased intraspinal and intracranial hypertension, emphasising the need for close monitoring. LEARNING POINTS: Elevated intrathoracic pressure generated by deep inhalation of an aerosolised product is one of the triggers of air dissection in pleural, pericardial, and mediastinal regions. In rare instances, air can also translocate into intracranial and intraspinal spaces, which is referred to as pneumorrhachis.Mostly asymptomatic, pneumorrhachis has the potential to develop acute neurological deficits due to increased intracranial and intraspinal pressure, validating the need for acute monitoring.Most cases of pneumorrhachis are managed conservatively. However, severe cases warrant decompression or high concentrations of oxygen administration to facilitate air absorption.