Health Behaviors in Combustible Cigarette, Heated Tobacco Users and Quitters

Latinx individuals who smoke represent a tobacco health disparities group. Yet, limited research has focused on examining dual combustible and electronic cigarette use among Latinx populations. Importantly, Latinx persons who smoke also evince elevated rates of pain problems and symptoms and prior research has consistently linked pain problems and severity to smoking prevalence, maintenance, and behavior. Accordingly, the current study sought to build from the limited work that exists among dual combustible cigarette and electronic cigarette Latinx users comparing levels of pain severity and interference. The current sample consists of 196 adult Latinx daily cigarette smokers (35.48 years old; 39.4% female), of which 72 reported current daily dual use of an e-cigarette. Results indicated that Latinx dual users reported greater levels of pain severity (ηp 2 = .12) and pain interference (ηp 2 = .10) than exclusive combustible cigarette users. The study adds uniquely to the limited literature on the clinical importance of dual cigarette use in relation to pain severity and interference in that pain may serve as an important risk factor for the initiation and maintenance of dual use for increased analgesic nicotine effects.

Combustible cigarette (CC) smokers often use heated tobacco products (HTPs) to quit CC smoking; however, the role of HTPs in quitting CC smoking is uncertain. We evaluated the link between HTP use and quitting CC smoking considering the intensity of HTP use among a large nationally representative sample of Korean adults. We performed a cross-sectional study using data from the 2019 Community Health Survey in Korea. A total of 46 781 adult participants (current CC smokers and former CC smokers <5 years) were included and Poisson regression analysis was performed to evaluate the association between HTP use and quitting CC smoking among ever-CC smokers. In ever CC smokers, compared with never HTP use, current daily HTP use was positively associated with quitting CC smoking (<1-year; prevalence ratio (PR) = 1.63, 95% confidence interval (CI) = 1.36 to 1.96, 1-5 years; PR = 1.47, 95% CI = 1.36 to 1.60), whereas current non-daily HTP use showed an inverse association with quitting CC smoking (<1-year; PR = 0.18, 95% CI = 0.12 to 0.29, 1-5 years; PR = 0.23, 95% CI = 0.17 to 0.31). Former HTP use was positively associated with short-term quitting CC smoking (PR = 1.38, 95% CI = 1.18 to 1.63), but negatively related to quit CC smoking after 1 year (PR = 0.81, 95% CI = 0.74 to 0.88). Daily use of HTPs appeared to be related to the increase in quitting CC smoking, but discontinuation of HTP use was significantly associated with the recurrence of CC smoking among former HTP users of 1-5 years. Among ever CC smokers, daily use of HTPs was positively associated with quitting CC smoking, but non-daily use of HTPs was inversely associated with quitting CC smoking. Former HTP use was linked to an increased likelihood of short-term quitting CC smoking but was significantly associated with CC smoking relapse after 1 year.

Combustible cigarettes have detrimental effects on periodontal disease. However, little evidence is available regarding new heated tobacco product (HTP) use and combined product use (both combustible cigarettes and HTPs). This study aimed to examine the association of combustible cigarettes, HTPs, and combined product use with periodontal disease simultaneously. This cross-sectional study was conducted using data from the 2019 arm of the longitudinal Japan "Society and New Tobacco" Internet Survey. Combustible cigarette users, HTP users, combined product users, never-users, and former users' data were separately obtained. In the present study, the primary outcome was self-reported periodontal disease. We estimated adjusted prevalence ratios (PRs) and confidence intervals (CIs) using multivariable modified Poisson regression analysis after adjusting for 12 confounders. Of the 10,439 JASTIS respondents, the numbers of users of combustible cigarettes only, HTPs only, and both products were 1,304, 437, and 1,049, respectively. Compared with never-users, HTP use was significantly associated with the prevalence of self-reported periodontal diseases (PR 1.43, 95% CI 1.03-1.62). Moreover, former users, combustible cigarette users, and combined product users also showed significant associations (PR 1.56, 95% CI 1.35-1.80; PR 1.29, 95% CI 1.03-1.62; and PR 1.55, 95% CI 1.20-1.99, respectively). Users of HTPs, combustible cigarettes, and combined products as well as former users were all significantly associated with a higher prevalence of periodontal diseases compared to never-users.

BackgroundTobacco use remains highly prevalent in China, with the emergence of a growing range of tobacco and nicotine products that vary in design and social presentation, raising questions about how these product characteristics are perceived by consumers. This study assessed the attractiveness of five tobacco products among the general Chinese public, including both non-smokers and smokers, and explored the factors influencing their perceived appeal.MethodsUsing a self-designed attractiveness scale, an online survey was administered via smartphone to adults aged 18 years or older across six geographically representative cities in China (Beijing, Shanghai, Guangzhou, Shenzhen, Chengdu, and Zhengzhou). The survey assessed the attractiveness of five tobacco products, including combustible cigarette (CC), e-cigarette (EC), heated tobacco product (HTP), oral nicotine product (ONP) and tobacco-free oral nicotine pouch (TFONP). Attractiveness ratings for different tobacco products were calculated, and mixed linear models were employed to explore associated influencing factors.ResultsA total of 15,601 valid questionnaires were collected, including 9,700 non-smokers and 5,901 smokers. CC had the highest familiarity score (3.97 ± 1.04) and were perceived as having the highest health risks (4.38 ± 0.76) and the highest addictiveness (4.22 ± 0.87). All alternative tobacco products received significantly lower ratings on these measures compared with CC (all p < 0.05). Total attractiveness scores were similar for CC and e-cigarettes (both 3.04) but lower for HTP/ONP/TFONP (range: 2.59–2.63; all p < 0.05). In the multivariable Model 1, which did not include “perceived health risks,” smoking status showed no significant association with attractiveness (β = 0.001, p = 0.896). After incorporating this variable in Model 2, the association became modestly negative and statistically significant (β = −0.06, p < 0.001). Relative to CC, e-cigarettes were associated with higher attractiveness ratings (β = 0.14), while HTP, NOP, and TFONP were associated with lower attractiveness ratings (β = −0.09 to −0.14; all p < 0.001). Use history exhibited the strongest association with attractiveness (β = 0.56). In addition, higher “familiarity with tobacco products,” “perceived social support” and “perceived addictiveness” were positively associated with product appeal, whereas greater “perceived severity of withdrawal” and “perceived health risks” were negatively associated with appeal. Attractiveness ratings also varied somewhat across cities, and gender, age, and occupation had certain influences on the ratings.ConclusionThis study identified distinct patterns of perceived appeal across five tobacco/nicotine product types among Chinese adults. E-cigarettes received the highest appeal ratings among non-smokers, whereas combustible cigarettes remained the most appealing among CC users. Prior product use history showed the strongest association with appeal. Perceived health risks were inversely associated with appeal and appeared to partly account for the smoking–appeal association, as the association between smoking status and attractiveness ratings changed after adjustment for perceived health risks. In contrast, greater familiarity and higher perceived social support were positively associated with appeal.

Poor sleep health is associated with numerous health concerns, and sleep problems are exacerbated by cigarette smoking. Although rates of traditional tobacco use are declining, rates of electronic cigarette (e-cigarette) use are comparatively high and growing. Given that nicotine is a primary mechanism by which smoking negatively impacts sleep health, e-cigarette use may also be linked to poor sleep health; however, no research has investigated this association. Participants were 1,664 college students, 40.9% of whom reported ever trying or currently using an e-cigarette. Questionnaires assessed demographic information, sleep health and e-cigarette use status and patterns. All measures were completed remotely via a secure online survey. Analysis of covariance was used to compare the sleep health of daily/non-daily e-cigarette users to (a) non-users and (b) users of combustible cigarettes. Gender and drinks per week were included as covariates in analyses. Current combustible and e-cigarette users reported significantly more sleep difficulties than never users. Users of e-cigarettes reported greater use of sleep medication than combustible cigarette users. Similar to combustible cigarette smoking, e-cigarette use (vs. non-use) was associated with worse sleep health, even among non-daily e-cigarette users. These findings may indicate a need for assessment of and education on the role of e-cigarette use in sleep health among individuals who report experimentation with or current use of e-cigarettes. Future research should examine these relationships prospectively.

ObjectiveWe assessed the prevalence of, and factors associated with, heated tobacco product (HTP) use and analysed the association between HTP use and quitting combustible cigarettes (CCs) in Korean adults.MethodsWe conducted an online survey with 7,000 adults (males, 2,300; females, 4,700; ages 20–69) out of 70,000 age-, sex- and provincial-distribution-matched individuals based on 2018 national population statistics. Females were oversampled because the prevalence of tobacco product use is very low among women in Korea. Chi-square tests were used for bivariate analyses, and odds ratios were assessed after adjusting for sociodemographic variables.ResultsThe prevalence of current CC, electronic cigarette (EC), and HTP use was 24.8% (males, 40.4%; females, 9.3%), 6.8% (males, 10.1%; females, 3.4%), and 10.2% (males, 16.2%; females, 4.3%), respectively. Among the 574 current HTP users, 77 (13.4%) were HTP-only users and >80% were either dual users of HTP and CC/EC, or triple users of HTP, EC, and CC. Among the current CC users, the odds of having attempted to quit CCs in the past year were greater among EC-only users (aOR 2.92; 95% CI 1.81–4.69) and dual users of HTPs and ECs (aOR 8.42; 95% CI 4.85–14.62) than among non-HTP and non-EC users. Among 2,121 ever CC smokers, the likelihood of being a former CC smoker was 0.19 (95% CI 0.15–0.24) for HTP users, 0.29 (95% CI 0.20–0.42) for EC users, and 0.03 (95% CI 0.01–0.06) for users of both HTPs and ECs compared with non-HTP and non-EC users.ConclusionEC-only use and dual use of HTPs and ECs were associated with increased attempts to quit CCs; however, HTP and EC use was associated with lower odds of CC smoking abstinence.

Electronic cigarette (e-cigarette) use is rapidly increasing, with many users reporting trying e-cigarettes as a method to quit combustible cigarettes. This review highlights recently published studies assessing the use of e-cigarettes as a tool for cessation of combustible cigarettes. When evaluating data from four randomized controlled trials and multiple cohort studies, differential association between e-cigarette use and cessation rates was seen. Cessation rates are highest in UK cohort studies and in studies using a multifaceted approach, such as with the addition of varenicline. The largest evidence base is derived from observational cohort studies. Overall, the current evidence remains too small for conclusive results regarding efficacy of e-cigarettes for combustible cessation. There does appear to be a consistent reduction in daily combustible cigarette use in regular e-cigarette users. Currently, there are conflicting data which can be used to support or dismiss e-cigarettes as a tool for smoking cessation. As larger population-based studies become available, the potential harms and benefits of e-cigarettes will become clearer. In the short term, shared decision-making with combustible cigarette users will be imperative when considering e-cigarettes as a smoking cessation tool.

Any potential harm-reduction benefit of electronic cigarettes (e-cigarettes) could be offset by nonsmokers who initiate e-cigarette use and then smoke combustible cigarettes. We examined correlates of e-cigarette use at baseline with combustible cigarette smoking at 1-year follow-up among adult distant former combustible cigarette smokers (ie, quit smoking ≥5 years ago) and never smokers. The Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal study, surveyed 26 446 US adults during 2 waves: 2013-2014 (baseline) and 2014-2015 (1-year follow-up). Participants completed an audio computer-assisted interview in English or Spanish. We compared combustible cigarette smoking at 1-year follow-up by e-cigarette use at baseline among distant former combustible cigarette smokers and never smokers. Distant former combustible cigarette smokers who reported e-cigarette past 30-day use (9.3%) and ever use (6.7%) were significantly more likely than those who had never used e-cigarettes (1.3%) to have relapsed to current combustible cigarette smoking at follow-up (P < .001). Never smokers who reported e-cigarette past 30-day use (25.6%) and ever use (13.9%) were significantly more likely than those who had never used e-cigarettes (2.1%) to have initiated combustible cigarette smoking (P < .001). Adults who reported past 30-day e-cigarette use (7.0%) and ever e-cigarette use (1.7%) were more likely than those who had never used e-cigarettes (0.3%) to have transitioned from never smokers to current combustible cigarette smokers (P < .001). E-cigarette use predicted combustible cigarette smoking in multivariable analyses controlling for covariates. Policies and counseling should consider the increased risk for nonsmokers of future combustible cigarette smoking use as a result of using e-cigarettes and any potential harm-reduction benefits e-cigarettes might bring to current combustible cigarette smokers.

Subjective sleep quality and electronic cigarette dependence, perceived risks of use, and perceptions about quitting electronic cigarettes

The association of Heated Tobacco Products (HTPs) use on cancer-related biomarkers remains unclear. This study aimed to compare the levels of tumor markers, specifically alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), and prostate-specific antigen (PSA), between combustible cigarette (CC) smokers, any HTP users, and quitters. This cross-sectional study compared tumor marker levels (AFP, CA 19-9, CEA, PSA) among 750 adult males: 250 CC smokers, 250 any HTP users, and 250 quitters. Data were collected from health screenings (2021-2022). Participants were aged >18 years with at least one year of smoking history. CEA was significantly higher in CC smokers (median: 2.4) than any HTP users (median: 2.0) and quitters (median: 1.6), with any HTP users exceeding quitters. PSA was higher in any HTP users (median: 0.86) than quitters (median: 0.74). No significant differences were observed in AFP and CA 19-9. HTP users exhibit lower CEA levels compared to conventional cigarette smokers, yet their levels remain higher than those of quitters. Additionally, quitters were found to have lower PSA levels than HTP users. Further research is needed to determine the reasons for these differences.

Carcinogenic biomarkers of exposure in the urine of heated tobacco product users associated with bladder cancer: A systematic review.

We tested the hypotheses that prior aerobic (Study 1) or anaerobic (Study 2) exercise attenuates the increase in renal vascular resistance (RVR) during sympathetic stimulation. Ten healthy young adults (5 females) participated in both Study 1 (aerobic exercise) and Study 2 (anaerobic exercise). In Study 1, subjects completed three minutes of face cooling pre- and post- 30 min of moderate intensity aerobic exercise (68 ± 1% estimate maximal heart rate). In Study 2, subjects completed two minutes of the cold pressor test pre- and post- the completion of a 30 s maximal effort cycling test (Wingate Anaerobic Test). Both face cooling and the cold pressor test stimulate the sympathetic nervous system and elevate RVR. The primary dependent variable in both Studies was renal blood velocity, which was measured at baseline and every minute during sympathetic stimulation. Renal blood velocity was measured via the coronal approach at the distal segment of the right renal artery with pulsed wave Doppler ultrasound. RVR was calculated from the quotient of mean arterial pressure and renal blood velocity. In Study 1, renal blood velocity and RVR did not differ between pre- and post- aerobic exercise (P ≥ 0.24). Face cooling decreased renal blood velocity (P < 0.01) and the magnitude of this decrease did not differ between pre- and post- aerobic exercise (P = 0.52). RVR increased with face cooling (P < 0.01) and the extent of these increases did not differ between pre- and post- aerobic exercise (P = 0.74). In Study 2, renal blood velocity was 2 ± 2 cm/s lower post- anaerobic exercise (P = 0.02), but RVR did not differ (P = 0.08). The cold pressor test decreased renal blood velocity (P < 0.01) and the magnitude of this decrease did not differ between pre- and post- anaerobic exercise (P = 0.26). RVR increased with the cold pressor test (P < 0.01) and the extent of these increases did not differ between pre- and post- anaerobic exercise (P = 0.12). These data indicate that 30 min of moderate intensity aerobic exercise or 30 s of maximal effort anaerobic exercise does not affect the capacity to increase RVR during sympathetic stimulation following exercise.

Prior studies established significant associations between e-cigarette use and combustible cigarette smoking in the general population; however, little is known about such associations among cancer survivors. Thus, the current study examined possible associations between e-cigarette use and combustible cigarette smoking among U.S. cancer survivors. Cross-sectional data were drawn from the 2016 Behavioral Risk Factor Surveillance System Survey. Binary logistic regression was used to analyze the associations between e-cigarette user status and combustible cigarette-smoking status in a sample of 4680 cancer survivors, controlling for alcohol use and sociodemographic factors. Analyses were weighted for unequal probability of sample selection to reflect national cancer survivor population estimates. Prevalence for current e-cigarette use and combustible cigarette smoking for cancer survivors was 2.57% and 16.16%, respectively. In the adjusted analyses, cancer survivors who reported current e-cigarette use, compared to never-users, had greater odds of being current combustible cigarette smokers (odds ratio [OR] = 11.81, 95% confidence interval [CI] = 5.38-25.93). Likewise, former e-cigarette users, compared to never-users, had greater odds of being current combustible cigarette smokers (OR = 15.90, 95% CI = 10.68-23.36). Among cancer survivors in the USA, e-cigarette use had a positive and highly significant association with combustible cigarette smoking. In order to prevent multiple and substitute use of nicotine-delivery products, prevention interventions and cessation programs designed for cancer survivors should specifically target both current combustible cigarette smokers and non-smokers who report former and current e-cigarette use.

Electronic nicotine delivery systems (ENDSs) are designed as a non-combustible alternative to cigarettes, aiming to deliver nicotine without the harmful byproducts of tobacco combustion. As the category evolves and new ENDS products emerge, it is important to continually assess the levels of toxicologically relevant chemicals in the aerosols and characterize any related toxicology. Herein, we present a proposed framework for characterizing novel ENDS products (i.e., devices and formulations) and determining the reduced risk potential utilizing analytical chemistry and in vitro toxicological studies with a qualitative risk assessment. To demonstrate this proposed framework, long-term stability studies (12 months) analyzing relevant toxicant emissions from six formulations of a next-generation product, JUUL2, were conducted and compared to reference combustible cigarette (CC) smoke under both non-intense and intense puffing regimes. In addition, in vitro cytotoxicity, mutagenicity, and genotoxicity assays were conducted on aerosol and smoke condensates. In all samples, relevant toxicants under both non-intense and intense puffing regimes were substantially lower than those observed in reference CC smoke. Furthermore, neither cytotoxicity, mutagenicity, nor genotoxicity was observed in aerosol condensates generated under both intense and non-intense puffing regimes, in contrast to results observed for reference cigarettes. Following the proposed framework, the results demonstrate that the ENDS products studied in this work generate significantly lower levels of toxicants relative to reference cigarettes and were not cytotoxic, mutagenic, or genotoxic under these in vitro assay conditions.

Plasma protein binding and tissue retention kinetics influence the rate and extent of nicotine delivery to the brain