Change in vaping, smoking and dual-use identities predicts quit success and cigarette usage: A prospective study of people quitting smoking with electronic cigarette support.

OBJECTIVE: Electronic cigarettes (ECs) are an efficacious support for some but not all people wishing to stop using tobacco. While advice and practical support have been identified as increasing quit success, little research has explored the role of changes in smoking and EC-related social identities. METHODS: A prospective study following 573 people attempting to quit smoking with EC support. Self-report measures of identification with being a smoker, non-smoker, vaper and dual user (people using ECs and tobacco products) were taken prior to the quit attempt and at a 12-week follow-up. RESULTS: Baseline identifications with being a smoker, non-smoker or dual user were not associated with smoking outcomes. Baseline vaper identity baseline was linked to more frequent tobacco abstinence at follow-up and lower levels of cigarette smoking. Levels of social identification at follow-up were consistently linked with outcomes, with vaper identity and non-smoking identities being protective and dual user identity being related to lower abstinence rates but decreased tobacco usage. Changes in identity over time were the most consistent predictor of outcomes. CONCLUSIONS: Findings have implications for smoking cessation practice, informing how and when identity-based interventions may be effective and our understanding of how identity transitions occur.

Medicalisation of vaping in the UK? E-cigarette users' perspectives on the merging of commercial and medical routes to vaping.

BACKGROUND: In the UK, most smokers choosing e-cigarettes to quit smoking will access vaping via commercial routes. In recent years, however, a shift towards medicalisation of vaping has become apparent, with public health guidance supporting e-cigarettes for smoking cessation and increased partnership working between healthcare professionals and the vaping industry. To achieve the UK's Smokefree 2030 target, the UK Government has set out measures to use e-cigarettes in National Health Service (NHS) settings and to move towards streamlining processes to make e-cigarettes available to a million smokers. This article aims to understand acceptability of different approaches by seeking perspectives of people with lived experience of e-cigarette use for smoking cessation. METHODS: Mixed methods data collected between March 2018 and March 2019 as part of a broader study of e-cigarette use trajectories (ECtra study). Data here relate to the views of partnership working and medicalisation of vaping extracted from 136 interviews/extended surveys of people who had used e-cigarettes to try to stop smoking. Qualitative data were thematically analysed. Participant ratings of interventions were presented descriptively, and differences in participant characteristics and ratings were reported. RESULTS: Three qualitative themes were identified: pro-partnership, anti-partnership and medicalisation dissonance. Medicalisation was discussed for its potential to reassure smokers about e-cigarette harms and its potential to reach smokers from disadvantaged backgrounds. Concerns were raised about cost-effectiveness, quality of support, conflicts of interest and limiting product choice. Most participants rated interventions involving partnership working as potentially helpful in switching from smoking to vaping. There were no statistically significant associations between age, gender and socioeconomic status, and helpfulness ratings. CONCLUSION: Both commercial and medical routes to vaping offer perceived benefits to vapers and may complement and reinforce each other to support smoking cessation.

Changes in puffing topography and subjective effects over a 2-week period in e-cigarette naïve smokers: Effects of device type and nicotine concentrations.

INTRODUCTION: This study aimed to document changes in puffing topography and, the effects of device type and nicotine concentration on puffing topography, subjective effects and smoking behaviour over two weeks of e-cigarette (EC) use. METHODS: EC naïve smokers (N = 50; 64% female) were randomly allocated to a cigalike (18 mg/mL) or tank containing either 18 (Tank18) or 6 mg/mL nicotine concentrations (Tank6). In 3 separate sessions (Baseline, 1 and 2 weeks post-baseline), participants vaped 20 min ad-libitum. Puff duration, puff number, inter-puff intervals (IPI), exhaled carbon monoxide (CO), cigarettes per day (CPD), cigarette dependence, craving, withdrawal, and subjective effects were recorded. RESULTS: Two weeks post-baseline, puff duration and IPI significantly increased whilst puff number decreased. Cigalikes were associated with greater puff number and shorter IPI compared to Tanks; there was no difference between Tank18 and Tank6. CPD, CO and cigarette dependence reduced significantly from baseline to week1 but did not differ between conditions. During each session, there was a significant reduction in craving, whilst withdrawal symptoms were only alleviated in week1 and 2; there was no difference between conditions. Tank18 consistently rated highest on positive effects including satisfaction; satisfaction scores for Cigalikes and Tank6 declined overtime. CONCLUSIONS: Cigalikes and tanks were both effective for reducing craving, withdrawal symptoms and CPD although for the former, this may only be achieved through more frequent puffing. That the Tank18 yielded greater satisfaction suggests tank devices and higher nicotine concentrations may be more suitable in the early stage of a smoking cessation attempt.

Vapers exhibit similar subjective nicotine dependence but lower nicotine reinforcing value compared to smokers.

INTRODUCTION: E-cigarette use has increased rapidly over the last 10 years, mostly among smokers and ex-smokers. Although there may be some degree of dependency on nicotine via e-cigarette use, the nature of this dependency is poorly understood. The aim of this paper is to use tasks from behavioural economics to compare the value that smokers place on tobacco cigarettes to the value that vapers place on e-cigarettes. METHOD: Exclusive current smokers (n = 25) and vapers (n = 20) attended one session where they completed the Cigarette/e-cigarette Dependence Scale, the Cigarette/e-cigarette Purchasing Task (CPT) and the Concurrent Choice Task (CCT). The CPT requires participants to indicate how many puffs of their chosen product they would purchase at increasing price points. The CCT requires participants to choose between earning a money point or a point towards a cigarette/e-cigarette after being presented with a neutral, money or cigarette/e-cigarette cue. RESULTS: Overall scores on the self-report scales suggest a comparable level of dependency between smokers and vapers. The CPT revealed that vapers are more sensitive than smokers to escalating costs as consumption declined as costs increased. On the CCT, when primed with money, vapers showed a decrease in choosing e-cigarettes. CONCLUSION: These findings suggest that, on behavioural economic tasks, tobacco cigarettes have a higher relative value than e-cigarettes. Vapers appear to place a lower limit on what they will spend to access e-cigarettes and more readily choose money over e-cigarette puffs when primed by money cues.

How to choose healthier urban biking routes: CO as a proxy of traffic pollution.

According to the World Health Organization (WHO) air pollution in urban areas, mainly associated with inhalation of gaseous pollutants and particulate matter emitted from motor vehicles, is responsible for one million deaths per year. Carbon monoxide (CO) from the incomplete combustion of fuel is known to bind with hemoglobin, decreasing the blood oxygen-delivery and inducing tissues hypoxia; being more pronounced under conditions of stress like physical activity. The present study demonstrates the usefulness of a compact CO sensor (Alphasense CO-B4) mounted on a bicycle to evaluate atmospheric levels of CO associated with urban microenvironments within a growing Australian city (Brisbane). Urban bike pathways show pronounced and significant variations in air quality according to the surrounding microenvironment and the time of day. The inhaled dose in real time and the CO total dose over each trip were valuable for estimating the air quality of the route, and identifed how the health benefits of riding a bicycle could be partially offset by poor air quality depending on where and when a cycle route is taken in the inner-city. Finally, environmental conditions, such as wind speed, were found to significantly affected atmospheric CO concentrations, at least during the study period. The present work provides information regarding commuters' exposure to atmospheric pollutants, necessary for modifying the population's (including cyclists) perception of pollution in the urban environment, providing people with the opportunity to choose a healthier route.

Nicotine absorption from e-cigarettes over 12 months.

BACKGROUND: Research indicates that, over time, exclusive e-cigarette users (vapers) gradually reduce the nicotine concentration in their e-liquid and transition to more sophisticated devices. Alongside this, consumption of e-liquid increases and constant cotinine levels are maintained. AIMS: We aimed to confirm these observations in 27 experienced vapers tested at baseline and 12 months later, by measuring nicotine absorption (via salivary levels of the nicotine metabolite cotinine; ng/mL), nicotine concentrations in e-liquid (mg/mL), volume of e-liquid consumed (mL per day), device types and flavours used, both at baseline and 12 months. RESULTS: Vapers reduced both their nicotine concentrations in e-liquid over 12 months (from 13.83 mg/mL at baseline to 9.91 at follow up) but significantly increased their e-liquid consumption (from 4.44 to 6.84 mL). No significant changes in salivary cotinine concentrations (370.88 ng/mL at baseline and 415.78 ng/mL at follow up) were observed. There was an increase in sub-ohming (using an atomiser coil with resistance of <1â€¯Ω with increased power) at 12 months, and in the use of fruit flavoured e-liquids. CONCLUSIONS: Our sample of experienced vapers reduced the concentration of nicotine in their e-liquid over time, but maintained their nicotine intake possibly through self-titration via more intensive puffing. Findings suggest there may be little benefit in reducing nicotine e-liquid concentration since this appears to result in higher e-liquid consumption which may incur both a financial and health cost. Gaining an understanding of underlying reasons for lowering e-liquid concentration would be a useful line of empirical enquiry.

Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack.

AIMS: To analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors in a clinical non-experimental setting. DESIGN: Retrospective study. SETTING: A community drug service in London, UK. PARTICIPANTS: 325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine). MEASUREMENTS: Logistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start (or at the date of transfer to another service). FINDINGS: For the general model participants choosing methadone were more likely to use heroin at follow up (OR=2.36, 95% CI: 1.40-3.17) as were daily crack users on methadone (OR=2.62, 95% CI: 0.96-7.16). For the methadone model only daily crack use predicted heroin use at follow up (OR=2.62, 95% CI: 0.96-7.16). For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR=0.85, 95% CI: 0.75-0.95; OR=1.31, 95% CI: 1.06-1.60 and OR=6.04, 95% CI: 1.26-28.92). Both use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR=6.68, 95% CI: 0.37-119.59; OR=106.31, 95% CI: 3.41-3313.30) and daily (OR=57.49 (95% CI: 2.37-1396.46; OR=170.99 (95% CI: 4.61-6339.47) users. CONCLUSIONS: Most of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. Crack use was a significant predictor of heroin abstinence at follow up in all models, however for buprenorphine only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.

Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation.

The neural circuitry implicated in addictive drug use, which appears to be down-regulated in early abstinence, corresponds closely with brain reward pathways. A literature review suggests that responses to incentive stimuli and the ability to inhibit reflexive responses, both of which have been associated with normal functioning in these pathways, might be weakened during acute abstinence from chronic drug use. In an ongoing study, 82 smokers, abstinent overnight before two separate testing occasions, have been assessed after administration of nicotine and placebo lozenges (order of sessions counterbalanced). Nicotine administration is associated with a significant reduction in anhedonia, a near-significant increase in response to financial incentive, enhanced ability to inhibit reflexive eye movements, and increased attentional bias to words with appetitive significance. Fifty-nine participants then initiated a quit attempt and 19 reported relapsing within 7 days. Comparing their performance in the two prequit lozenge assessment sessions, relapsers showed a stronger effect of nicotine on enhancing their ability to inhibit reflexive eye movements and a near-significant trend towards greater nicotine-induced increases in attentional bias toward appetitive words.

A randomized trial of winged Vialon cannulae and metal butterfly needles.

The purpose of this parallel randomized study was to evaluate whether subcutaneous infusion sites initiated with winged vialon cannulae would have fewer skin reactions and longer site duration than metal butterfly needles and reduce needlestick injuries to staff. Data were collected on 42 hospice inpatients from the time of insertion of the first needle or cannula to the time of the first replacement of that device. A non-parametric survival plot for time (Kaplan-Meier method) was conducted and the survival time to replacement of the Vialon cannula was found to be longer than the metal butterfly needle. During the study period there were a total of four needlestick injuries to staff from metal butterfly needles. The authors conclude that Vialon cannulae reduce the frequency of site changes and are safer for staff to use because of the reduced risk of needlestick injuries.

The effectiveness of low-strength anthralin in psoriasis. A paired comparison study.

Recent trends in psoriasis therapy favor using lower-strength anthralins. To assess the effectiveness of a low concentration (0.01%) v a mid concentration (0.1%) of anthralin, combined with UV-B therapy, a prospective double-blind study was undertaken. Nine patients with chronic plaque-type psoriasis involving more than 25% of the total body surface (excluding the scalp) were treated in a paired comparison manner. Patients were examined each day and the degree of erythema, induration, and scale of lesions was recorded for each side of the body. In all nine patients, the side receiving 0.1% anthralin required an average of 10.8 treatment days to achieve the predefined end point: complete flattening of all plaques to palpation. An identical rate of improvement for the 0.01% anthralin-treated side was noted in five of nine patients. The remaining four patients failed to reach the end point on the 0.01% anthralin-treated side even after an average of 15 treatment days.