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Smoking Helps Open Gateway to Coronavirus Infection, Study Shows

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Severe E-Cigarette, or Vaping, Product Use Associated Lung Injury Requiring Venovenous Extracorporeal Membrane Oxygenation,_or_Vaping,_Product_Use.11.aspx



To report a severe case of e-cigarette or vaping product use-associated lung injury with complex course requiring venovenous extracorporeal membrane oxygenation.


Case report.


PICU in an academic medical center.


A 16-year-old girl presenting with gastrointestinal and respiratory symptoms was admitted to our PICU after having progressive respiratory failure and bilateral pulmonary ground-glass opacities on chest CT.


Venovenous extracorporeal membrane oxygenation

Measurements and Main Results:

After extensive infectious workup was unrevealing, she reported a history of vaping e-cigarette containing either nicotine or delta-9-tetrahydrocannabinol oil prior to symptom onset. She was given a presumptive diagnosis of e-cigarette or vaping product use-associated lung injury. The PICU team in consultation with pulmonology and medical toxicology started high-dose IV methylprednisolone 1 mg/kg bid. Despite initial improvements, she continued to require positive pressure ventilation and developed pneumomediastinum with progression to tension pneumothoraces and a persistent air leak. Unable to maintain her oxygenation, she was placed on venovenous extracorporeal membrane oxygenation for a prolonged course and had a tracheostomy placement. The clinical course, severity, and range of interventions in affected patients around the country have varied widely. Respiratory symptoms have been the most severe, but the constellation of symptoms in e-cigarette or vaping product use-associated lung injury include constitutional symptoms (fevers, weight-loss) and gastrointestinal symptoms (nausea, vomiting, diarrhea). In many cases, steroid use led to rapid clinical improvements. However, other cases with severe illness, like our patient, necessitated high-dose IV steroids, intubation, and venovenous extracorporeal membrane oxygenation. The underlying etiology and pathophysiology of e-cigarette or vaping product use-associated lung injury remains unknown. The Centers for Disease Control and Prevention in conjunction with state/local health departments and the Food and Drug Administration is actively investigating the outbreak.


Clinicians need to be aware of the current outbreak of e-cigarette or vaping product use-associated lung injury and ask about vaping in patients presenting with gastrointestinal and respiratory symptoms. Treatment options are anecdotal and necessitate a multidisciplinary approach.

Dependence on e‐cigarettes and cigarettes in a cross‐sectional study of US adults


Background and Aims

Cigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e‐cigarette use. This study assesses dependence among current and former adult e‐cigarette users on cigarettes and e‐cigarettes, compared with dependence on cigarettes.


Cross‐sectional data from the Population Assessment of Tobacco and Health (PATH) study from 2013‐2016. Psychometrically‐assessed dependence was compared for cigarettes and e‐cigarettes among current and former exclusive and dual users of the products, and among e‐cigarette users who had and had not recently stopped smoking.


A population‐based representative sample of US adults.


Participants were 13,311 US adults (18+) in Waves 1‐3 of PATH reporting current established smoking, current use of e‐cigarettes, or stopping use of either product in the past year who were administered dependence assessments for cigarettes and/or e‐cigarettes.


A 16‐item scale assessing tobacco dependence (on a 1‐5 scale), previously validated for assessment and comparison of dependence on varied tobacco products, including cigarettes and e‐cigarettes, with a variation assessing residual dependence among users who stopped in the past year.


Among current users, dependence on e‐cigarettes was significantly lower than dependence on cigarettes, in within‐subjects comparisons among dual users of both e‐cigarettes and cigarettes (1.58 [SE=0.05] vs. 2.76 [0.04]), p<0.0001), and in separate groups of e‐cigarette users and cigarette smokers (1.95 [0.05] vs. 2.52 [0.02], p<0.0001), and among both daily and non‐daily users of each product. Among former users, residual symptoms were significantly lower for e‐cigarettes than cigarettes, both among former dual users (1.23 [0.07] vs. 1.41 [0.06], p<0.001) and among users of one product (1.28 [0.03] vs. 1.53 [0.03], p<0.0001). The highest level of e‐cigarette dependence was among e‐cigarette users who had stopped smoking (2.17 [0.08]).


Use of e‐cigarettes appears to be consistently associated with lower nicotine dependence than cigarette smoking.

Popularity of vaping grows as more studies reveal health risks

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Secondhand smoke kills one person for every 52 smokers

Secondhand smoke kills one person for every 52 smokers, study says. That’s a million people worldwide each year

(CNN)It took a mere 52 smokers to kill one person via secondhand smoke in 2016, according to a new analysis of worldwide statistics on the impact of smoking.

Considering there are an estimated billion smokers in the world, that means a million people die each year simply by inhaling the smoke around them, according to the study published Tuesday in the journal JAMA Network Open.

“There’s a sense of secondhand smoke being benign, or not as damaging as the actual smoking is,” said study co-author Dr. Jagat Narula, associate dean of global affairs at the Icahn School of Medicine at Mount Sinai in New York City.

“But it’s truly deadly,” Narula added.

“This study confirms what other research has shown: That nonsmokers are at risk from secondhand smoke and that no one should be exposed to it,” said Dr. Albert Rizzo, chief medical officer for the American Lung Association, who was not involved in the study.

“While it may be called ‘secondhand,’ the health effects of those exposed are truly firsthand,” Rizzo said.

Role of smokers

Secondhand smoke is defined as the mixture of the smoke breathed out by the smoker combined with the smoldering end of a cigarette, cigar or pipe. According to the United States National Library of Medicine, secondhand smoke contains more than 7,000 chemicals, 70 of which are known to cause cancer and hundreds more are toxic.

Even a low dose of secondhand smoke can contribute to sudden infant death and cause ear infections and asthma attacks in children while causing cancer and heart disease in adults.

“In 2006 the US Surgeon General declared there was no safe level of exposure to secondhand smoke,” Rizzo said.

While the harmful effects of secondhand smoke have been known for years, no one knew the full impact on deaths on a global basis, Narula said.

“We wanted to calculate how many smokers are needed to kill one innocent nonsmoker,” he said.

The Mount Sinai researchers worked in tandem with colleagues at the Amsterdam Medical Center, Amsterdam UMC, to analyze a number of datasets from the World Health Organization, the Global Burden of Disease Reports, International Mortality and Smoking Statistics and others.

They looked at the number of active smokers and secondhand smoke victims over a 26-year period from 1990 to 2016.

They developed a “secondhand smoke index” and applied it to North America; South Asia; Middle East and North Africa; East Asia and Pacific; Europe and Central Asia; Sub-Saharan Africa; Latin America and the Caribbean.

Globally, in 1990 it took only 31 smokers to kill one person; in 2016 that number rose to 52 smokers, the study found — an improvement due to smoking bans in restaurants, business and the like in some countries.

North America had the most favorable secondhand smoke index: around 86 smokers for each death. The Middle East and Southeast Asia had least favorable numbers due to few protective measures — around 43 smokers to one death.

More protections needed, study says

Despite the advances in some countries, the absolute number of people who smoked between 1990 and 2016 has been on the rise, the study says. That’s mostly due to the increase in smoking in China and India and other low-to-middle income countries, a trend which is expected to continue.

“This study demonstrates the devastating effect of secondhand smoke,” Narula said. By putting the blame for deaths directly at the feet of smokers, he added, this study will hopefully “influence public opinion against secondhand smoke exposure” and encourage governments to pass and enforce “stringent” anti-tobacco controls.

While developing countries need to step up their game, there is still much to be done in the US and other developed countries, said lead author Dr. Leonard Hofstra, a professor of cardiology at Amsterdam UMC.

“There is a lot to gain when it comes to strengthening policies to protect nonsmokers, especially children,” he said. “For example, it should not be allowed for parents to smoke inside their cars with them.”

Twenty-two states in the US have “not yet passed comprehensive laws protecting their citizens — and the Lung Association calls on them to do so,” Rizzo said, adding that the public can also make use of online tools provided by the American Lung Association “to end their addiction.”

CNN reached out to various tobacco companies for their response but did not hear back before our publication deadline.

Young People Have No Idea How Much Nicotine They Vape: Study

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Associations Between Nicotine Metabolite Ratio and Gender With Transitions in Cigarette Smoking Status and E-Cigarette Use

Findings Across Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study



Nicotine metabolite ratio (NMR), the ratio of trans 3′-hydroxycotinine to cotinine, is a biomarker of nicotine metabolism. Discrepant findings among clinical trials and population-based studies warrant replication on whether higher NMR, or faster nicotine metabolism, is associated with quitting cigarette smoking. Associations of NMR and e-cigarette use are largely unknown, as well as the relationship between NMR and gender on quitting cigarette smoking or e-cigarette use.


The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative, longitudinal cohort study assessing tobacco use in the US population. In the current study, the PATH (waves 1 and 2; adult interviews) was used to evaluate longitudinal predictions in relationships among NMR and gender and their association with transitions (quit vs. current stable) in cigarette smoking status and e-cigarette use status across waves 1 and 2 of the PATH study.


NMR and gender were not significantly associated with quit behavior for combustible cigarettes. Regarding e-cigarettes, a significant two-way interaction demonstrated that women with higher NMR were less likely to quit e-cigarette use compared to women with lower NMR (odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.02–0.57; p = .01).


Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism across waves 1 and 2 of the PATH study. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women.


Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. Establishing parameters for NMR collection and for the use of NMR as a biomarker for cigarette smoking behavior and e-cigarette use is an important next step, and may have implications for early intervention and treatment for cessation.

Vaping, lung damage, and cytopathology: A new twist in the medical mystery

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It’s not safe to sit near smokers

Sitting near smokers in the cinema exposes you to up to ten cigarettes’ worth of smoke, a study suggests.

Researchers found that smokers can carry hazardous compounds from cigarette smoke on their clothes and skin — third-hand smoke — that is then released.

The study, carried out at Yale University, raises questions about whether regulations creating non-smoking areas do enough to minimise the risks of second and third-hand smoke.

Researchers tracked thousands of compounds in a cinema screening room over a week. They found that the volatile organic compounds found in tobacco smoke rose dramatically when audiences arrived for a film. Despite the screening room being a well-ventilated non-smoking area, the amounts were the equivalent of smoking between one and ten cigarettes in an hour.

This is the first study to demonstrate real-world third-hand smoke emissions in an indoor non-smoking environment. Years of research have shown that no level of exposure to cigarettes is safe. Public health initiatives focused on reducing second-hand exposure by banning smoking in public places, but the latest research, published in Science Advances, shows that even with no cigarette present, people are at risk of inhaling evaporated gases or dust that settles on surfaces after smoking.

Drew Gentner, associate professor of chemical and environmental engineering at Yale, said: “People are substantial carriers of third-hand smoke contaminants to other environments. The idea that someone is protected because they’re not directly exposed to second-hand smoke is not the case.”

Exploring the Point-of-Sale Among Vape Shops Across the United States

Audits Integrating a Mystery Shopper Approach



Vape shops represent prominent, unique retailers, subject to Food and Drug Administration (FDA) regulation in the United States.

Aims and Methods

This study assessed compliance of US vape shop retail marketing strategies with new regulations (eg, required age verification, prohibited free samples) and pre-implementation conditions for other regulations (eg, health warning labels on all nicotine products, required disclosures of e-liquid contents).


95.0% of shops displayed minimum-age signage; however, mystery shoppers were asked for age verification at 35.6% upon entry and at 23.4% upon purchase. Although 85.5% of shops had some evidence of implementing FDA health warnings, 29.1% had signage indicating prohibited health claims, 16.3% offered free e-liquid samples, 27.4% had signage with cartoon imagery, and 33.3% were within two blocks of schools. All shops sold open-system devices, 64.8% sold closed-system devices, 68.2% sold their own brand of e-liquids, 42.5% sold e-liquids containing cannabidiol, 83.2% offered price promotions of some kind, and 89.9% had signage for product and price promotions.


Results indicated that most shops complied with some implementation of FDA health warnings and with free sampling bans and minimum-age signage. Other findings indicated concerns related to underage access, health claims, promotional strategies, and cannabidiol product offerings, which call for further FDA and state regulatory/enforcement efforts.