Reply to discrepant results for smoking and cessation among electronic cigarette users.

Association of Attention-Deficit/Hyperactivity Disorder With E-Cigarette Use

Sexy, trashy, cool: Perceptions of electronic cigarette users across sociodemographic groups and E-cigarette use among United States Air Force Airmen

IntroductionTo identify the geospatial association between the presence of tobacco retail outlets (TRO) around schools’ neighborhoods, and current use of cigarettes and e-cigarettes among adolescents in four counties in Texas.MethodsStudents in grades 6, 8 and 10th were surveyed in their schools in 2014–2015. The schools’ addresses was geocoded to determine the presence of at least one TRO within half a mile of the school. Two outcomes were considered: past 30-day use of (a) cigarettes and (b) e-cigarettes. Bayesian structured additive regression models and Kriging methods were used to estimate the geospatial associations between the presence of TRO and use in three counties: Dallas/Tarrant, Harris, and Travis.ResultsWe observed a geospatial association between the presence of TRO around the schools and current use of cigarettes in the eastern area of Dallas County and in the southeastern area of Harris County. Also, a geospatial association between the presence of TRO around the schools and current use of e-cigarettes was observed in the entire Tarrant County and in the northeastern area of Harris County.ConclusionsThere were geospatial associations between the presence of TRO around some schools and cigarette/e-cigarette use among students, but this association was not consistent across all the counties. More research is needed to determine why some areas are at higher risk for this association.

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 cigarette (e-cigarette) use is rising in both the general and clinical populations. Little is known about e-cigarette use in primary care, where physicians report discussing e-cigarette use with patients. Identify how and why smokers in primary care use e-cigarettes. Cross-sectional secondary data analysis from a randomized controlled trial of a tablet intervention to deliver the 5As for smoking cessation in primary care. Current smokers aged 18 and older in three primary care clinics in San Francisco, CA (N=788). Patients reported sociodemographics, cigarette smoking habits, quitting readiness, and ever and current use of e-cigarettes. We also asked reasons they have used or would use e-cigarettes. ICD-9 codes from the medical record determined comorbidities. Fifty-two percent (n=408) of patients reported ever using an e-cigarette, and 20% (n=154) reported past-30-day use. Ever e-cigarette use was associated with younger age and negatively associated with being seen at practices at a public safety-net hospital compared to a practice at University-affiliated hospital. The most common reason for having used e-cigarettes among ever e-cigarette users, and for interest in future use of e-cigarettes among never e-cigarette users, was to cut down cigarette use. The mean number of days of e-cigarette use in the past 30 increased with duration of e-cigarette use. Most current e-cigarette users did not know the nicotine content of their e-cigarettes. Over half of smokers in primary care have ever used e-cigarettes, and one-fifth are currently using them. Most reported using e-cigarettes to cut down or quit cigarettes. Primary care providers should be prepared to discuss e-cigarettes with patients. Screening for e-cigarette use may help identify and treat patients interested in changing their cigarette smoking habits.

Background Cigarette smoking can negatively affect treatment response in inflammatory bowel disease (IBD) patients, especially among those with Crohn’s disease (CD). E-cigarette has been considered a safer alternative to delivering nicotine for IBD patients who smoke. However, given the recent large number of reported e-cigarette-related lung injury cases, CDC released an interim guidance update on those lung injuries. They also coined a term EVALI (e-cigarette, or vaping, product use associated lung injury) emphasizing the possible harms in e-cigarette smoking. To the best our knowledge, we currently do not know the recent smoking habits in American IBD patients, especially when it reveals that e-cigarette use might cause serious lung injuries. Methods We used National Health Interview Survey (NHIS) for 2015–2016, which is a nationally representative survey for noninstitutionalized adults in the US. Weighted counts and percentages were estimated using survey design for the population-level results. We identified those who reportedly were told by a doctor or healthcare professional that they have IBD. We first estimated the prevalence of current e-cigarette or cigarette use among IBD patients. We then estimated the frequency of use (every day or some days) among the current users. We also categorized IBD patients into 4 groups by smoking type: those using e-cigarette only, cigarette only, using both, and neither. To see the characteristics of e-cigarette users, we stratified e-cigarette users by current/former/never cigarette use status. Results We identified 951 participants (population estimate: 3.1 million) with IBD. Among those people, 5.0% (95% CI: 3.1–6.9) was current e-cigarette users while 17.9% (95% CI: 14.8–21.0) was current cigarette smokers. Prevalence of every-day use and some-day use of e-cigarette was similar (2.4% vs 2.6%), while there was much higher prevalence of every-day use than some-day use in cigarette (15.3% vs 2.6%). Those who were using both e-cigarette and cigarette was 3.2% (Table). Majority of e-cigarette users were also currently using cigarette (63.6%, 95% CI: 48.9–78.3), while 32.7% (95% CI: 18.4–47.0) of them were former cigarette smokers. Only 3.7% (0.0–8.9) of them never used cigarettes. Conclusion While numerous studies show e-cigarette use is generally increasing rapidly in the US, we found that 5% of IBD patients are currently using e-cigarette. Almost two-thirds of them were also currently smoking cigarette and one-third of them were former smokers. It is possible that most of the e-cigarette users are still in the process of transitioning from cigarette smoking and thus using both types. We lack information on effects of using e-cigarette or both e-cigarette and cigarette in IBD treatment outcomes, as well as how e-cigarette use will complicate other health risks in IBD patients (e.g. lung injuries). We need further research on these effects to properly guide IBD patients who are in need of smoking cessation.

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.

Objective: To describe the prevalence of e-cigarette use among adolescent in Zhejiang province, and to analyze its distribution of different genders and school types to provide evidence for controlling the use of e-cigarette among adolescent. Methods: A total of 7 663 students from 60 middle schools through stratified multi-stage cluster sampling methods from Zhejiang province were surveyed by using questionnaire. Indicators as tried to use e-cigarette rate, current e-cigarette using rate, and other indicators were collected. All data were weighted by age proportions of adolescent in Zhejiang. Results: The prevalence of tried to use and current using e-cigarettes among middle school students were 6.99% and 1.45%, respectively; and there were 4.19% juniors who were susceptibility to future e-cigarette use. The rate of tied to use e-cigarette, current using e-cigarette and susceptibility to future e-cigarette use were higher in boys than in girls. The rate of current using e-cigarette was 2.07% for rural and 0.48% for urban. Technical secondary school students had the highest rate of tried to use e-cigarette and susceptibility to future e-cigarette use (13.53%, 6.91%). Junior school students (2.96%) had the lowest level of susceptibility to future tobacco use. The rate of tried e-cigarette use and current e-cigarette use and susceptibility to future e-cigarette use were higher in the group of "One of students' parents was smoker" (8.63%, 2.19%, 5.23%). The highest rate of current smoking was found in the group of "Weekly allowance more than 50 Yuan" (10.02%, 2.54%, 6.29%). Compared to technical secondary school students, senior school student (OR=0.57) and junior school students (OR=0.45) were less likely to try to use e-cigarette. Students whose weekly allowance were less than 20 Yuan were less likely to try to use e-cigarette (OR=0.49). Students who were boys (OR=5.44) and one of their parents was smoker (OR=1.59) were more likely to try to use e-cigarette. Conclusions: There were middle school students with tried e-cigarette use and current e-cigarette use, especially in technical secondary schools. The prevalence of e-cigarette using among middle school students increased with age. It is important to further spread of e-cigarette knowledge widely and deeply, and reduce the susceptible population of adolescents using e-cigarettes.

The prevalence of electronic cigarette (e-cigarette) use and its impact on smoking cessation among cancer survivors in the United States is largely unknown. We sought to estimate the prevalence of e-cigarette use and examine its associations with cigarette smoking and smoking quit attempts among smoking-related cancer survivors in the United States. We obtained data from the 2014-2017 annual cycles of the National Health Interview Survey for participants with self-reported history of smoking-related cancer(s). We calculated the prevalence of current e-cigarette use and utilized multinomial logistic regression in examining the independent association between e-cigarette use and cigarette smoking. Appropriate survey weights were applied in estimating the prevalence rates, relative risk ratios (RRR), ORs, and confidence intervals (CI). Our sample comprised 3,162 smoking-related cancer survivors. The prevalence of current e-cigarette use was 3.18% (95% CI, 2.40-3.96). Current e-cigarette users were 83 times as likely as never users to be current cigarette smokers (RRR, 82.89; 95% CI, 16.54-415.37). Among those with a history of cigarette smoking, current e-cigarette users were 90% less likely to be former smokers (OR, 0.10; 95% CI, 0.05-0.18). No association was seen between current e-cigarette use and a smoking quit attempt in the prior year. E-cigarette use among cigarette ever smokers was associated with a lower likelihood of being a former smoker/having quit smoking, and e-cigarette use was not associated with smoking quit attempts. Our findings do not provide evidence that e-cigarette use facilitates smoking cessation among smoking-related cancer survivors.

E-cigarette and Smokeless Tobacco Use and Switching Among Smokers: Findings From the National Adult Tobacco Survey

Research indicates youth e-cigarette use may lead to the use of conventional cigarettes, but the specific effects of flavored e-cigarettes-which greatly appeal to youth-are unknown. Therefore, this study examines how flavored e-cigarette use predicts cigarette smoking susceptibility among youth non-smokers. We used 2014 National Youth Tobacco Survey to explore the relationship between current e-cigarette use (non-use, flavored and plain e-cigarette use) and smoking susceptibility among 18,392 youth non-smokers (ages 11-18 years). Overall, 2.2% and 2.1% of non-smoking youth currently used plain and flavored e-cigarettes. Compared to 30.0% of non-users, 61.1% and 74.1% of plain and flavored e-cigarette users reported smoking susceptibility. Flavored e-cigarette users were more likely to be susceptible than plain e-cigarette users (AOR=1.7, p< .001) and non-users (AOR=3.8, p< .0001). The magnitude of the relationship between flavored e-cigarette use and smoking susceptibility was significantly higher for females (AOR=6.5, p< .01) than males (AOR=2.5, p< .01). Flavored more so than plain e-cigarette use is strongly associated with smoking susceptibility among non-smoking youth. Flavored e-cigarettes are recruiting females and those with low smoking-risk profile to experiment conventional cigarettes. Legislative efforts to ban e-cigarettes with child-friendly flavors should be enhanced.

E-cigarette curiosity among U.S. middle and high school students: Findings from the 2014 national youth tobacco survey

We report the country-level prevalence of awareness about electronic cigarette use, and ‘dual use’ and its association with age, sex, country income, and e-cigarette regulatory status. We analyzed the most recent Global Youth Tobacco Surveys done on nationally representative samples of school-going youth aged 13–15 years in 75 countries/territories. The weighted prevalence of ‘awareness’ (heard about e-cigarettes), ‘ever use’ (even tried a few puffs), ‘current use’ (during the last 30 days), and ‘dual use’ (e-cigarette use and cigarette smoking during the last 30 days) were estimated. Awareness was > 80% in 13 countries mostly from Europe Poland being the highest at 95.8% (95% CI 94.8- 96.6). In seven countries, 30–50% of the youth had ever used an e-cigarette, Italy was the highest at 55.1% (95%CI 51–3,58.9). In 30 countries, current e-cigarette use was > 10%, the highest of 35.1% (95%CI 32.4–38.0) in Guam. Awareness and use were highest in the European region (74.6% and 34.5%) and HIC (83.6% and 39.4%). Youth from HIC (compared to lMIC) and countries having restrictive e-cigarette regulations (compared to NRP) had 2.4 times (aOR 2.2.4, 95% CI 2.2, 2.7) and 1.8 times (aOR 1.8, 95% CI 1.6, 2.0) higher odds of being current e-cigarette users respectively. Youth in countries with the most restrictive e-cigarette regulations (compared to NRP) had 0.6 times lower odds of being current e-cigarette users (aOR 0.6, 95% CI 0.6, 0.7). Awareness and e-cigarette use varied by sex, country income level, and region. Continued global surveillance of youth e-cigarette use is needed for the formulation of e-cigarette regulatory policy. Awareness and use of e-cigarettes were higher among boys, in countries in Europe and America regions, and among those with higher income and restrictive policies, whereas it was lower in countries having the most restrictive policies. Higher awareness is strongly correlated with a trial and current use of e-cigarettes. E-cigarette marketing should be restricted, and continued surveillance of e-cigarette use is needed. Most restrictive policies such as the ban on e-cigarettes appear to reduce e-cigarette use among the youth.

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine in the form of aerosol. We identify differences and associations in e-cigarette use by sociodemographic characteristics and describe the reported reasons for initiating use among Mississippi adults. We used the 2015 Mississippi Behavioral Risk Factor Surveillance System, which collected information on e-cigarette use from 6,035 respondents. The prevalence of current e-cigarette use and having ever tried an e-cigarette was determined overall and by sociodemographic characteristics. Weighted prevalences and 95% confidence intervals were calculated, and prevalences for subgroups were compared using the X2 tests and associations were assessed using logistic regression. In 2015, 4.7% of Mississippi adults currently used e-cigarettes, while 20.5% had ever tried an e-cigarette. The prevalence of current e-cigarette use was significantly higher for young adults, whites, men, individuals unable to work, those with income $35,000–$49,999, and current smokers compared to their counterparts. Similar results were observed for having ever tried an e-cigarette. E-cigarette use was associated with age, race, income, and smoking status. Most (71.2%) of current e-cigarette users and over half (52.1%) of those who have ever tried e-cigarettes reported that a main reason for trying or using e-cigarettes was “to cut down or quit smoking.”

We examined the impact of e-cigarette advertising on e-cigarette use behaviors among youth over time. At baseline, 3907 students participated in a youth tobacco surveillance study from 2014-2015 and 2488 students completed a 6-month follow-up. Weighted logistic regression models investigated the recall of e-cigarette advertisements (TV/radio/billboards/retail/Internet) as a risk factor for e-cigarette perceived harm, use, and susceptibility. The odds of ever e-cigarette use was 3 times higher (AOR=2.99; 95% CI, 1.50-5.97) at 6-month follow-up among e-cigarette never-users who recalled e-cigarette advertisements in retail stores at baseline, compared to those who did not. Likewise, the odds of current e-cigarette use and susceptibility to e-cigarette use at 6-month follow-up were 2.03 (95% CI, 1.11-3.72) and 1.77 (95% CI, 1.20-2.61), respectively. Additionally, recall of e-cigarette advertisements on the Internet at baseline was significantly related to current use (AOR=2.17; 95% CI, 1.05-4.48) and susceptibility to use e-cigarettes (AOR=1.72;95% CI, 1.15-2.58) at 6-month follow-up. Recall of e-cigarette advertisements at point-of-sale and on the Internet was significantly associated with adolescent e-cigarette susceptibility and use, which supports the need to minimize adolescent exposure to these advertisements.