Chronic health effects associated with electronic cigarette use: A systematic review.

Introduction: Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report. Methods: Three bibliographic databases were searched to identify studies comparing the chronic health effects of e-cigarette users (ECU) to non-smokers (NS), smokers, and/or dual users indexed between 31 August 2017 and 29 January 2021. Two independent reviewers screened abstracts and full texts. Data were extracted by one reviewer and verified by a second one. Outcomes were synthesized in a narrative manner using counts and based on statistical significance and direction of the association stratified by study design and exposure type. Risk of bias and certainty of evidence was assessed. The protocol was prospectively registered on Open Science Framework https://osf.io/u9btp. Results: A total of 180 articles were eligible. This review focused on 93 studies for the 11 most frequently reported outcomes and from which 59 reported on daily e-cigarette use. The certainty of evidence for all outcomes was very low because of study design (84% cross-sectional) and exposure type (27% reported on exclusive ECU, i.e., never smoked traditional cigarettes). Overall, the summary of results for nearly all outcomes, including inflammation, immune response, periodontal and peri-implant clinical parameters, lung function, respiratory symptoms, and cardiovascular disease, suggested either non-significant or mixed results when daily ECU was compared to NS. This was also observed when comparing exclusive ECU to NS. The only notable exception was related to oral health where most (11/14) studies reported significantly higher inflammation among daily ECU vs. NS. Compared to the smokers, the exclusive-ECUs had no statistically significant differences in inflammation orperiodontal clinical parameters but had mixed findings for peri-implant clinical parameters. Conclusions: This review provides an update to the 2018 NASEM report on chronic health effects of e-cigarette use. While the number of studies has grown, the certainty of evidence remains very low largely because of cross-sectional designs and lack of reporting on exclusive e-cigarette exposure. There remains a need for higher quality intervention and prospective studies to assess causality, with a focus on exclusive e-cigarette use.

A pan-Canadian measure of active living environments using open data.

BACKGROUND: Neighbourhood environments that support active living, such as walking or cycling for transportation, may decrease the burden of chronic conditions related to sedentary behaviour. Many measures exist to summarize features of communities that support active living, but few are pan-Canadian and none use open data sources that can be widely shared. This study reports the development and validation of a novel set of indicators of active living environments using open data that can be linked to national health surveys and can be used by local, regional or national governments for public health surveillance. DATA AND METHODS: A Geographic Information System (GIS) was used to calculate a variety of measures of the connectivity, density and proximity to destinations for 56,589 dissemination areas (DAs) across Canada (2016 data). Pearson correlation coefficients were calculated to assess the association between each measure and the rates of walking to work and taking active transportation to work (a combination of walking, cycling and using public transportation) from census data. The active living environment measures selected for the final database were used to classify the DAs by the favourability of their active living environment into groups by k-medians clustering. RESULTS: All measures were correlated with walking-to-work and active-transportation-to-work rates at the DA level, whether they were derived using proprietary or open data sources. Coverage of open data was consistent across Canadian regions. Three measures were selected for the Canadian Active Living Environments (Can-ALE) dataset based on the correlation analysis, but also on the principles of suitability for a variety of community sizes and openly available data: (1) three-way intersection density of roads and footpaths derived from OpenStreetMap (OSM), (2) weighted dwelling density derived from Statistics Canada dwelling counts and (3) points of interest derived from OSM. A measure of access to public transportation was added for the subset of DAs in larger urban areas and was strongly related to active-transportation-to-work rates. Active-transportation-to-work rates were graded, in steps, by the five Can-ALE groups derived from the cluster analysis, although walking-to-work rates exceeded the national average only in the most favourable active living environments. DISCUSSION: Open data may be used to derive measures that characterize the active living environments of Canadian communities.

Neighborhood Walkability and Body Mass Index Trajectories: Longitudinal Study of Canadians.

OBJECTIVES: To assess the impact of neighborhood walkability on body mass index (BMI) trajectories of urban Canadians. METHODS: Data are from Canada's National Population Health Survey (n = 2935; biannual assessments 1994-2006). We measured walkability with the Walk Score. We modeled body mass index (BMI, defined as weight in kilograms divided by the square of height in meters [kg/m(2)]) trajectories as a function of Walk Score and sociodemographic and behavioral covariates with growth curve models and fixed-effects regression models. RESULTS: In men, BMI increased annually by an average of 0.13 kg/m(2) (95% confidence interval [CI] = 0.11, 0.14) over the 12 years of follow-up. Moving to a high-walkable neighborhood (2 or more Walk Score quartiles higher) decreased BMI trajectories for men by approximately 1 kg/m(2) (95% CI = -1.16, -0.17). Moving to a low-walkable neighborhood increased BMI for men by approximately 0.45 kg/m(2) (95% CI = 0.01, 0.89). There was no detectable influence of neighborhood walkability on body weight for women. CONCLUSIONS: Our study of a large sample of urban Canadians followed for 12 years confirms that neighborhood walkability influences BMI trajectories for men, and may be influential in curtailing male age-related weight gain.

Achieving recommended daily physical activity levels through commuting by public transportation: unpacking individual and contextual influences.

This paper estimates the amount of daily walking associated with using public transportation in a large metropolitan area and examines individual and contextual characteristics associated with walking distances. Total walking distance to and from transit was calculated from a travel diary survey for 6913 individuals. Multilevel regression modelling was used to examine the underlying factors associated with walking to public transportation. The physical activity benefits of public transportation varied along gender and socio-economic lines. Recommended minutes of daily physical activity can be achieved for public transportation users, especially train users living in affluent suburbs.