March, 2020:
Are non-smoking young adults who use e-cigarettes more likely to smoke in the future?
https://www.eurekalert.org/pub_releases/2020-03/uob-any030920.php
Young people who have tried e-cigarettes but have never smoked before are nearly five times more likely to go on to try smoking, a new study has found. However, the findings do not provide clear support for the claim that e-cigarettes cause young people to start smoking (the so-called possible “gateway effect”).
Researchers from the University of Bristol’s Tobacco and Alcohol Research Group (TARG), with support from Bristol’s MRC Integrative Epidemiology Unit (IEU) and the NIHR Bristol Biomedical Research Centre (BRC), combined the results of 17 studies to investigate whether e-cigarette use compared to non-use in young non-smokers is associated with subsequent cigarette smoking.
The research, funded by the MRC IEU and NIHR BRC, is published today [11 March 2020] in Tobacco Control.
Existing evidence suggests that e-cigarette use is less harmful than smoking and is an effective aid to stop smoking, but there are concerns that e-cigarettes may be a route into smoking cigarettes, especially among young people. If this is correct, rather than smoking rates falling, smoking rates might remain stable or increase due to a new generation of smokers where e-cigarettes have instigated smoking.
In this study, the researchers combined evidence from 17 studies that had investigated e-cigarette use and subsequent smoking, where an odds ratio could be calculated, to explore whether e-cigarette use, compared to non-use, in young non-smokers is associated with subsequent cigarette use.
Jasmine Khouja, a PhD student in TARG based in the School of Psychological Science, said: “Policymakers have used the findings of studies, including the studies we reviewed in this research, to support the heavy regulation of e-cigarettes, including restrictions on flavours and even total bans, but the evidence that e-cigarette use might cause young people to take up smoking is not as strong as it might appear.”
The study found that young people who had never smoked before but had used e-cigarettes were four-and-a half times more likely to go on to use e-cigarettes. However, the research team also identified a number of issues with the studies included in this analysis, which makes them cautious to conclude that e-cigarette use is causing young people to start smoking.
Whilst the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.
The researchers recommend future studies should address the issues which have been highlighted by using more advanced tests to confirm whether or not young people are smokers or e-cigarette users, using different statistical analyses, and considering whether the e-cigarettes contain nicotine or not.
A previous meta-analysis study carried out in 2016 combined the results of nine studies, which explored whether e-cigarette use among non-smoking adolescents and young adults was linked to later smoking. The study found that young people who had used an e-cigarette were nearly four times more likely to go on to try smoking than those who hadn’t.
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Paper
‘Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis’ by Jasmine N Khouja, Steph F Suddell, Sarah Peters, Amy E Taylor, Marcus R Munafò in Tobacco Control
Young vapers are almost five times more likely to try real cigarettes
The study suggests that e-cigarettes could contribute to a new generation of real smokers
https://inews.co.uk/news/health/young-vapers-e-cigarettes-more-likely-cigarettes-explained-2446147
Younger people who have tried e-cigarettes but had never previously smoked are nearly five times more likely to try tobacco cigarettes, suggesting vaping may play a role in instigating smoking.
Researchers from the University of Bristol’s Tobacco and Alcohol Research Group (TARG) worked with the city’s Medical Research Council’s Integrative Epidemiology Unit and the National Institute for Health Research’s Bristol Biomedical Research Centre to combine 17 studies into whether e-cigarette smoking was associated with subsequent cigarette smoking.
While existing studies suggest that smoking e-cigarettes, also known as vaping, is less harmful than smoking cigarettes and can be an effective quitting tool, concerns have circulated over whether they can present a ‘gateway’ into smoking.
This latest study found that young people who had never previous smoked but had tried vaping were four-and-a-half times more likely to go on to smoke.
Lack of hard evidence
However, the researchers are reluctant to conclude that vaping is causing young people to start smoking, as the results rely on the participants’ self-reported smoking history.
Without biochemical verification, they would be unable to reliably check whether a participant had never previously smoked a cigarette.
“Policymakers have used the findings of studies, including the studies we reviewed in this research, to support the heavy regulation of e-cigarettes, including restrictions on flavours and even total bans, but the evidence that e-cigarette use might cause young people to take up smoking is not as strong as it might appear,” said Jasmine Khouja, a PhD student in TARG based in the School of Psychological Science.
None of the studies were able to provide stronger evidence whether the association of early vaping with later smoking was casual, and much of their evidence also failed to consider the nicotine content of e-liquids.
This makes it difficult to conclude whether nicotine was the mechanism driving the association, the report, published in journal Tobacco Control, claimed.
Derailing efforts to quit
A separate study from the Ohio State University College of Public Health in December warned that knee-jerk reaction bans on e-cigarettes could derail the efforts of millions of people trying to stop smoking traditional nicotine cigarettes.
The US Centres for Disease Control and Prevention (CDC) had reported 48 deaths and 2,291 cases of serious lung injury linked to smoking e-cigarettes, also known as vaping, as of 3 December, prompting the American Medical Association to call for a blanket ban.
Amy Fairchild, dean of The Ohio State University College of Public Health, said that while the alarm was justifiable, the response needed to acknowledge the “powerful evidence” supporting the availability of legal nicotine products.
Smoking or vaping increases risks for those with coronavirus
https://www.reuters.com/article/us-health-coronavirus-usa-vaping/smoking-or-vaping-increases-vulnerability-to-coronavirus-says-nyc-mayor-idUSKBN20V0Z0
(Reuters) – Smoking or vaping makes people more vulnerable to suffering severe illness once infected by coronavirus, a spokeswoman for New York City Mayor Bill de Blasio said on Sunday.
De Blasio told a press conference earlier on Sunday that people who smoke or vape are at higher risk.
“If you are a smoker or a vaper that does make you more vulnerable,” de Blasio said, urging New Yorkers to seek help in quitting. “If you are a smoker or a vaper this is a very good time to stop that habit and we will help you.”
De Blasio also said people over the age of 50 and with heart disease, lung disease, cancer, immune system vulnerability or diabetes face increased risks.
Simulating the impact of a cigarette minimum floor price law on adult smoking prevalence in California
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntaa046/5799227
Abstract
Introduction
Minimum floor price laws (MFPLs) are an emerging tobacco control policy that sets a minimum price below which a specific tobacco product cannot be sold. MFPLs target cheaper products and may disproportionately impact consumers choosing low price brands or using discounts to reduce prices. We developed a static microsimulation model for California, USA to project short-term effects of different MFPL options for a 20-stick pack of cigarettes on adult smoking behaviors.
Methods
We simulated 300,000 individuals defined by race/ethnicity, sex, age, and poverty status. Smoking behaviors and cigarette prices were assigned based on demographic distributions in the 2014-2016 California Behavioral Risk Factor Surveillance System. We drew 100 random samples (n=30,000), weighted to state-level California demographic characteristics. We simulated six MFPL options and modeled impacts on smoking prevalence and cigarette consumption, in general, and separately for those in households below or above 250% of the federal poverty level (FPL), assuming a price elasticity of -0.4.
Results
Predicted changes in prices, prevalence, and consumption increased exponentially as the floor price increased from $7.00 to $9.50. Assuming 15% policy avoidance, projected increases in average cigarette prices ranged from $0.19 to $1.61. Decreases in smoking prevalence ranged from 0.05 to 0.43 percentage points, and decreases in average monthly cigarette consumption ranged from 1.4 to 12.3 cigarettes. Projected prices increased, and prevalence and consumption decreased, more among individuals in households below 250% FPL.
Conclusions
MFPLs are a promising tobacco control strategy with the potential to reduce socioeconomic disparities in cigarette smoking prevalence and consumption.
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
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntaa022/5802027
Abstract
Introduction
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.
Methods
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.
Results
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).
Conclusions
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.
Implications
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.
Juul and the upsurge of e-cigarette use among college undergraduates
Abstract
Objective: Examine trends in e-cigarette use, and Juul use specifically, among U.S. college students.
https://www.tandfonline.com/doi/full/10.1080/07448481.2020.1726355
Participants: In 2016, we established a cohort of 529 incoming first-year students to a large Midwestern University. In 2018, these students (now third-years) were re-contacted, and a new sample of 611 incoming first-year students was enrolled.
Methods: First-year students in 2016 completed a survey assessing their e-cigarette use; in 2018, first- and second-year students reported on e-cigarette use, and use of Juul specifically.
Results: From 2016 to 2018, past 30-day e-cigarette use rose from 5.9% to 27.7%. In 2018, for Juul alone, ever use was above 35% and past 30-day use was above 20% for both cohorts. Juul use did not differ by gender, but was associated with higher socioeconomic status (SES) and being White.
Conclusions: Findings present disturbing possibilities for long-term nicotine addiction among the next generation, and underscore the need for a rapid public health response.