Understanding e-Cigarette Addictiveness: Triangulation of Focus Group and Netnographic Data.

BACKGROUND: Numerous studies have shown that e-cigarettes are addictive. For example, we previously showed that users of e-cigarette online forums discuss experiences of addiction in a netnographic analysis. However, it is unclear what makes e-cigarettes addictive apart from nicotine. In a focus group analysis, we recently identified 3 unique features of e-cigarettes that users linked to experiences of addiction: the pleasant taste, unobtrusiveness, and unlimited usability of e-cigarettes. OBJECTIVE: This study aimed to validate the previously identified features of e-cigarette addictive potential by triangulating data from the netnographic analysis and focus group discussions. METHODS: Drawing on a netnographic analysis of 3 popular, German-language e-cigarette forums, we studied whether experiences of addiction were linked to specific e-cigarette features. We included 451 threads in the analysis that had been coded for addictive experiences in a previous study by our team. First, we conducted a deductive analysis with preregistered codes to determine whether the features of pleasant taste, unobtrusiveness, and unlimited usability were mentioned in relation to the addictive potential of e-cigarettes in the online forums. Second, an inductive approach was chosen to identify further possible addictive features of e-cigarettes. RESULTS: Our deductive analysis confirmed that the features highlighted in our previous focus group study (pleasant taste, unobtrusiveness, and unlimited usability) were also frequently discussed in online forums in connection to addictive symptoms. In addition, our inductive analysis identified nicotine dosage as a significant feature linked to addiction. Users reported varying their nicotine doses for different reasons, leading to the identification of four distinct user types based on dosing patterns: (1) high doses for intermittent, (2) high doses for constant use, (3) low doses for constant use, and (4) switching between high and low doses depending on the situation. CONCLUSIONS: Our comprehensive analysis of online forum threads revealed that users' experiences of addiction are linked to 4 specific features unique to e-cigarettes: pleasant taste, unobtrusiveness, unlimited usability, and nicotine dosage. Recognizing these addictive features of e-cigarettes is crucial for designing cessation programs and informing public health policies to reduce the addictiveness of e-cigarettes.

E-Cigarette and Vaping Perspectives: Recommendations for Occupational Health Nurses.

BACKGROUND: Statistics from the Centers for Disease Control indicate that the use of e-cigarettes, vaping, and other electronic nicotine delivery systems (ENDS) are increasing although data on their safety is limited. While most employers ban smoking in the workplace, tobacco-free policies do not always extend specifically to e-cigarette products. METHODS: An IRB approved exploratory, cross-sectional study was conducted to investigate occupational health professionals' (OHPs) knowledge of e-cigarettes, vaping and ENDS and the ability to create change in tobacco-free workplace policies. A 91-item electronic survey was sent via email to 3248 OHPs who were members of the American Association of Occupational Health Nurses. FINDINGS: A total of 299 surveys were returned, but only 230 completed the entire survey. Of those who completed the entire survey, those with advanced education had higher attitude toward change summary scores (p = .043) and those with lower years of practicing had low scores for transformational leadership (p = .039). Approximately 40% of individuals did not have or were unsure that a tobacco-free program was in place that included e-cigarettes, but the majority (90%) perceived their organizational leaders as interested in safety changes. CONCLUSIONS: The majority of respondents understood the health issues inherent in e-cigarettes, were open to implementing policies that included e-cigarettes but needed education and both managerial and employee support to implement policy changes. APPLICATION TO PRACTICE: OHPs are well positioned to be advocates for workplace education, policy development, and worker health promotion for smoking and vaping cessation by leading organizational change.

A comprehensive toxicological analysis of panel of unregulated e-cigarettes to human health.

Electronic cigarettes, commonly referred to as e-cigarettes have gained popularity over recent years especially among young individuals. In the light of the escalating prevalence of the use of these products and their potential for long-term health effects, in this study as the first of its kind a comprehensive toxicological profiling of the liquid from a panel of unregulated e-cigarettes seized in the UK was undertaken using an in vitro co-culture model of the upper airways. The data showed that e-cigarettes caused a dose dependent increase in cell death and inflammation manifested by enhanced release of IL1ß and IL6. Furthermore, the e-cigarettes induced oxidative stress as demonstrated by a reduction of intracellular glutathione and an increase in generation of reactive oxygen species. Moreover, the assessment of genotoxicity showed significant DNA strand breaks (following exposure to Tigerblood flavoured e-cigarette). Moreover, relevant to the toxicological observations, was the detection of varying and frequently high levels of hazardous metals including cadmium, copper, nickel and lead. This study highlights the importance of active and ongoing collaborations between academia, governmental organisations and policy makers (Trading standards, Public Health) and national health service in tackling vape addiction and better informing the general public regarding the risks associated with e-cigarette usage.

Food insecurity and substance use among young adults in the United States.

PURPOSE: The purpose of this study was to examine the association between food insecurity and substance use among young adults aged 18-25 in the U.S. METHODS: A cross-sectional online survey was completed by a diverse sample of 1024 young adults (50.2 % female; 62 % non-white; m age = 21.7[SD = 2.26]) between January-April 2022. Logistic regression analyses were used to examine the association between food insecurity and current cigarette use, Electronic Nicotine Delivery System (ENDS) use, cannabis use, alcohol use, and binge drinking controlling for socio-demographic and economic factors, mental health, and experiences of discrimination. RESULTS: Nearly 70 % of participants reported being food insecure over the past year. Substance use was also common: 45.9 % of participants reported current cigarette use, 50.9 % ENDS use, 57 % cannabis use, 65.9 % alcohol use, and 50.4 % engaged in binge drinking in the past two weeks. Being food insecure was associated with greater odds of cigarette use (OR = 2.49, 95 % CI = [1.77, 3.50]), ENDS use (OR = 2.18, 95 % CI = [1.58, 3.01]), cannabis use (OR = 1.73, 95 % CI = [1.26, 2.37]), alcohol use (OR = 1.60, 95 % CI = [1.16, 2.19]) and binge drinking (OR = 1.98, 95 % CI = [1.44, 2.72]), controlling for all other factors. CONCLUSION: Food insecurity may serve as an important indicator of substance use among young adults. Practitioners should consider screening for food insecurity, providing information about food access, and developing interventions to address food insecurity among the young adults with whom they work. Future research should examine these associations prospectively to better understand how food insecurity may contribute to the initiation and/or escalation of substance use.

Identification of cigarettes with different grades by using FTIR microspectroscopy.

In this paper, FTIR microspectroscopy was used to identify the cigarettes of three different grades such as Jinwan cigarettes (J group), Yinxiangyipin cigarettes (Y group) and Hongsanhuan cigarettes (H group). IR spectra and peak-area ratios (A2923 /A816, A1601 /A2923, A1601/A920 and A1072/A816) revealed significant differences among H, Y and J groups, reflecting the changes in chemical compositions with increased grade. Discriminant analysis was carried out on basis of the above peak-area ratios, achieving 100% accuracy for identification of H, Y and J groups. Principal component analysis (PCA) showed that carbohydrates and proteins were closely related to the quality of the cigarettes. In addition, curve fitting further confirmed that the structure of carbohydrates underwent changes due to the quality of the cigarettes. The above results suggest that FTIR microspectroscopy can identify different grades of the cigarettes, which may be helpful for tobacco research.

Electronic cigarettes and peri-implantitis: an umbrella review.

OBJECTIVES: Electronic cigarettes (e-cigarettes) are offered to consumers as a healthier option than traditional tobacco. However, the long-term effect of non-heat-burning tobacco and e-cigarettes on periodontal and peri-implantitis is unknown. The present review evaluates the impact of electronic cigarettes on peri-implantitis and compares the results with traditional cigarettes and non-smokers. MATERIALS AND METHODS: Systematic/meta-analysis studies were searched in PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar until December 30, 2022. RESULTS: Five systematic/meta-analysis studies were identified based on the search strategy in the selected databases. The overall quality assessment of the studies showed acceptable evidence with high quality. All systematic review studies showed that compared to traditional tobacco smoke, electronic cigarettes might reduce or not change the clinical inflammatory symptoms of periodontitis and peri-implantitis, such as bleeding on probing, probing depth, peri-implant bone loss, and response to treatments. CONCLUSION: Electronic cigarettes contain nicotine, which can harm periodontal and implant health. On the other hand, a wide range of oral health consequences may be associated with using e-cigarettes. E-cigarette is a potential risk factor for the healing process and the results of implant treatment.

Understanding the motivational mechanisms for smoking and vaping among dual users and exclusive smokers.

BACKGROUND: Understanding the motivational processes that influence e-cigarette use in a laboratory setting may help elucidate mechanisms that support long-term ecigarette use, which could have significant clinical and public health consequences. METHODS: Secondary analyses were conducted on data from exclusive smokers (N=47) and dual users (N=88) who underwent a laboratory ad lib use session. Participants were given 10minutes to smoke (exclusive smokers) or vape (dual users) as much as they wanted. Withdrawal was assessed pre- and post-use. Smoking and vaping behavior was coded from session videos. Person-level predictors included cigarette/ecigarette craving-relief expectancies, demographics, and cigarette/e-cigarette use and dependence. Smoking and vaping status was assessed at Year 1 using self-reported 30-day point prevalence. Data were analyzed using general linear models and logistic regressions. RESULTS: Both groups reported reductions in withdrawal after product use, including cigarette craving. Baseline e-cigarette craving-relief expectancies, pre-session ecigarette craving, heaviness of e-cigarette use, and relative e-cigarette dependence were significant univariate predictors of continued vaping in dual users at Year 1 (ORs>1.04, ps<.05). Dual users and exclusive smokers did not differ on use behavior (i.e., average number of puffs, ps>.16). CONCLUSIONS: E-cigarette use alleviated withdrawal, including cigarette and e-cigarette craving, in dual users. Laboratory use behavior did not differ between dual users using e-cigarettes and exclusive smokers using cigarettes. Greater e-cigarette craving-relief expectancies, e-cigarette craving, heaviness of e-cigarette use, and morning product use pattern ('relative dependence') may reflect mechanisms that sustain e-cigarette use.

Adverse effects of electronic cigarettes on human health.

Many people have associated e-cigarettes with adjectives such as trendy and cool, and regarded vaping as "a safer alternative to cigarette smoking". Compared with the conventional cigarettes, the public is less familiar with the dangers of e-cigarettes. E-cigarettes produce an aerosol by heating the e-liquid (usually comprising nicotine, flavorings, propylene glycol, vegetable glycerin, and other additives). Harmful substances are generated during the vaporization, such as formaldehyde. Cellular damages and DNA hypermethylation are also found to be associated with vaping. We reviewed the clinical neoplastic cases of patients with vaping history (three oral squamous cell carcinomas, one conjunctival squamous intraepithelial neoplasia, and one thoracic NUT-midline carcinoma). These patients tend to be younger than the average cancer patients. Although the exact relations between the cellular damages or DNA hypermethylation and vaping still need further investigations, we should be very careful about the dangers of using e-cigarettes as aids for cigarette smoking cessation.

Problematic social media use and vaping among Mexican-American college students.

Introduction: Social media use and vaping nicotine are highly prevalent in the daily lives of young adults, especially among Mexican-American college students. The excessive and compulsive use of social media platforms, coupled with the urge to stay continuously connected, can lead to problematic social media use. To date, no studies have explored the impact of problematic social media use on the daily patterns of vaping among this vulnerable population. Methods: In Spring 2023, we employed Ecological Momentary Assessment over a period of 14 days to collect real-time daily data on participants' social media use and vaping behaviors via a mobile phone-based application. Participants were 51 Mexican-American college students aged 18-25 years, 72.5% female, who were current vapers. We used generalized linear regression models to examine differences in vaping behaviors among participants with and without problematic social media use. All regression models adjusted for age, sex, and SES. Results: Participants with problematic social media use vaped on an average of 5.9 days compared to 5.7 days reported by those without problematic social media use (p < .05). Problematic social media use is associated with more frequent daily vaping [b = 0.03; 95% CI: 0.02-0.05], increased number of days vaping [b = 0.14; 95% CI: 0.07-0.20], and vaping higher nicotine concentrations [b = 0.08; 95% CI: 0.03-0.14]. Conclusion: Results suggest that problematic social media use significantly increases the risk of daily vaping among Mexican-American college students. Findings highlight the need to strengthen digital resilience and social media literacy to help college students navigate and mitigate the risks of social media.

Effect of nicotine mouth spray on urges to vape: A randomized, placebo-controlled, pharmacodynamic clinical trial in exclusive e-cigarette users.

AIMS: To determine whether nicotine mouth spray provides rapid and prolonged relief of urges to vape and measure the steady-state plasma nicotine levels during vaping and ad libitum mouth spray usage in e-cigarette users. DESIGN: Randomized, parallel group, double-blind trial. SETTING: Single site at Hammersmith Medicines Research Ltd (HMR), London, UK. PARTICIPANTS: 216 (25.9% females, average age 27.6 ± 7.63 [standard deviation, SD]) exclusive vapers who used their e-cigarette within 30 minutes of waking up and had vaped about 2 years on average. INTERVENTIONS: Two sprays of 1 mg nicotine mouth spray (Nicorette QuickMist Freshmint, n = 109), or placebo (identical in appearance and presentation, n = 107). MEASUREMENTS: Urge to vape was rated on a 100 mm visual analogue scale before and repeatedly for 2 hours after administration. The primary outcome measured average change from baseline in urges to vape ratings during the first hour. FINDINGS: Nicotine mouth spray achieved statistically significantly greater reductions in urges to vape than placebo from the first assessment point at 30 seconds to 1 hour, when the estimated mean treatment difference was 11.90 mm (95% confidence interval [CI] = 6.86-16.95, P < 0.001). The integrated urge to vape over 11 hours ad libitum usage showed a statistically significant benefit compared with placebo (2.00 [0.88 SD] vs 2.51 [0.84 SD], P < 0.001). Mean steady-state plasma nicotine concentrations were lower after nicotine mouth spray usage compared with vaping (6.22 [4.70 SD] ng/ml vs 9.91 [7.59 SD] ng/ml, respectively). Adverse events were more commonly reported in the nicotine mouth spray group and were mostly mild. CONCLUSIONS: Among regular e-cigarette users, nicotine mouth spray provided statistically significant and fast relief of urges to vape one hour after dosing. Nicotine mouth spray showed statistically significant reductions in urges to vape as soon as 30 seconds and up to 2 hours after dosing compared with placebo, and nicotine mouth spray was well-tolerated and safe.

Prevalence and Sociodemographic Correlates of Smoking among Schoolchildren in Albania.

Smoking among children remains a critical public health issue, with millions of minors engaging in tobacco use, leading to addiction and long-term health consequences. Our objective was to assess the prevalence and sociodemographic distribution of smoking habits among Albanian children. A cross-sectional study was conducted in Albania in 2022, including a nationwide representative sample of 5454 schoolchildren aged 11, 13, and 15 years (N = 5454; ≈52% girls; response rate: 96%). Data on smoking habits were gathered, along with sociodemographic factors of schoolchildren. Binary logistic regression was used to assess the associations of smoking variables with sociodemographic factors. The prevalence of smoking variables was 12% for lifetime cigarette smoking, 7% for current cigarette smoking, 20% for lifetime smoking of e-cigarettes, and 13% for current smoking of e-cigarettes. Independent positive correlates of both cigarette and e-cigarette smoking included male gender, age 15, and pertinence to more affluent families (all p < 0.01). The prevalence of smoking among Albanian children is seemingly high, which should be a cause of serious concern to decisionmakers and policymakers in this transitional country. Albania should immediately consider the implementation of expanded comprehensive tobacco control measures, which will save lives, reduce illness, and help reduce the economic burden associated with tobacco-related illness.

Fetal Growth Following Electronic Cigarette Use in Pregnancy.

Electronic cigarette (e-cig) use in pregnancy is common, but potential effects on fetal development are largely unknown. This study's goal was to examine the association between e-cig exposure and fetal growth. Data were extracted from medical charts in this single-site retrospective study. The sample, excluding those with known tobacco, alcohol, illicit drug, opioid, and benzodiazepine use, contained women who used e-cigs throughout pregnancy and non-e-cig user controls. Fetal size measurements from second- and third-trimester ultrasounds and at birth were expressed as percentiles for gestational age. Following adjustment for confounding factors, in the second trimester, only femur length was significant, with an adjusted deficit of 11.5 percentile points for e-cig exposure compared to controls. By the third trimester, the femur length difference was 28.5 points, with the fetal weight difference also significant (17.2 points). At birth, all three size parameter differences between groups were significant. Significant size deficits were predicted by prenatal e-cig exposure, becoming larger and impacting more parameters with increasing gestation. While additional studies are warranted to confirm and expand upon these findings, this study adds to emerging data pointing to specific harms following e-cig exposure in pregnancy and suggests that e-cigs may not be a "safer" alternative to combustible cigarette smoking in pregnancy.

Adolescent vaping behaviours: Exploring the dynamics of a social contagion model.

Vaping, or the use of electronic cigarettes (e-cigarettes), is an ongoing issue for public health. The rapid increase in e-cigarette usage, particularly among adolescents, has often been referred to as an epidemic. Drawing upon this epidemiological analogy between vaping and infectious diseases as a theoretical framework, we present a deterministic compartmental model of adolescent e-cigarette smoking which accounts for social influences on initiation, relapse, and cessation behaviours. We use results from a sensitivity analysis of the model's parameters on various response variables to identify key influences on system dynamics and simplify the model into one that can be analysed more thoroughly. We identify a single feasible endemic equilibrium for the proportion of smokers that decreases as social influence on cessation increases. Through steady state and stability analyses, as well as simulations of the model, we conclude that social influences from and on temporary quitters are not important in overall model dynamics, and that social influences from permanent quitters can have a significant impact on long-term system dynamics. In particular, we show that social influence on cessation can induce persistent recurrent smoking outbreaks.

Inequalities in Smoking and E-Cigarette Use in Young Adults With Mental Ill-Health, 20 years After Ireland's Smoking Ban.

Background: Ireland's Smoking Ban reduced health inequalities known to be associated with smoking but some groups may not have benefitted. Mental ill-health and smoking are known to be associated with health inequalities. Whether similar patterns exist for e-cigarette use is less clear, as few data exist. Objectives: To examine: (1) self-reported doctor-diagnosed mental ill-health in Irish 20-year-olds; (2) smoking, e-cigarette, and dual use in those with and without mental ill-health; and (3) protective and risk factors for smoking and e-cigarette use in these groups. Methods: We use cross-sectional data from 20 year-olds in Wave 4 of Growing Up in Ireland Child Cohort. They were asked to self-report mental ill-health which had been diagnosed by a clinician, and their smoking and e-cigarette use. All analyses were performed using SPSS v27. Results: 19.4% (n = 1008) of the total sample (n = 4729) reported a mental ill-health diagnosis. Comparing those with and without, those with mental ill-health had significantly higher prevalence of current smoking (47%, n = 419 vs 36%, n = 1361; OR 1.57, CI: 1.36, 1.82), e-cigarette use (17%, n = 152 vs 13%, n = 485; OR 1.40, CI:1.15, 1.70), and dual use (12%, n = 109 vs 9%, n = 328; OR 1.46, CI:1.16, 1.84). Risk factors for smoking and e-cigarette use were, earlier smoking initiation, peers or primary caregivers who smoked, being in paid employment, one-parent family background, and social media use. Being female was protective. Most risk factors were significantly higher in young adults with mental ill-health but, after adjusting for these variables, respondents with mental ill-health still have significantly higher adjusted higher odds of smoking (aOR 1.28, CI:1.05, 1.56). Conclusions: Inequalities in smoking and e-cigarette use in young adults with mental ill-health are evident 20 years after Ireland's National Smoking Ban. Despite extensive Tobacco Control interventions in the past 20 years, there is still need in Ireland for new targeted interventions to reduce health inequalities for left-behind young smokers with mental ill-health.

Effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang Province, Thailand.

INTRODUCTION: The use of e-cigarettes is increasing worldwide, especially among young adults. Due to the health risks, this study aimed to assess undergraduate students' e-cigarette use and attitudes toward them, and evaluate the effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang province, Thailand. METHODS: Participatory action research (PAR) was conducted among 46 undergraduate students. To assess the situations of undergraduate students' e-cigarette use and attitudes toward them, in-depth interviews were conducted with 18 of those students - nine users and nine non-users. The remaining 28 were student leaders who were given questionnaires and took part in focus groups to evaluate the effectiveness of the intervention program in developing e-cigarette control leaders. Descriptive statistics and the Wilcoxon signed rank test were used to analyze quantitative data. The qualitative data were analyzed using a thematic analysis of the content. This study took place at the University in Lampang province, Thailand, in 2023. RESULTS: Regarding the use of e-cigarettes on the part of undergraduate students and their attitudes about their use, the majority of users stated that e-cigarettes were accessible, appealing, and more socially acceptable than conventional cigarettes. However, most non-users cited vapor smell and health impacts as their main reason for not using e-cigarettes. The intervention program to develop leaders in e-cigarette control could significantly enhance the leaders' knowledge (p<0.001) and attitude regarding e-cigarettes (p=0.001). After their anti-e-cigarette campaign, the soft skills and managerial abilities of the leaders in e-cigarette control improved, and the knowledge and attitude regarding e-cigarettes of undergraduate students who attended the campaign also increased. CONCLUSIONS: The intervention program to develop leaders in e-cigarette control resulted in positive outcomes. This program could enhance the leaders' knowledge and attitude regarding e-cigarettes. Their soft skills and managerial abilities in e-cigarette control also improved.

E-Cigarette-Associated Acute Severe Asthma in a Smoking-Naïve Adolescent: A Case Report.

Electronic cigarettes (e-cigarettes) have become a prevalent phenomenon among adolescents and young adults, particularly as a perceived less harmful alternative to traditional tobacco cigarettes. A number of potential health risks associated with e-cigarettes have been identified, including links to cardiovascular diseases, asthma, and cancer. Given that adolescents have not yet completed their physical development, they are particularly susceptible to adverse health effects associated with e-cigarettes. This case report details the presentation of a healthy 16-year-old female patient who developed her first episode of acute severe asthma and a concomitant lower respiratory tract infection in a primary care practice setting. Prior to the onset of her symptoms, the smoking-naïve patient intermittently shared a nicotine-containing e-cigarette with a friend over a three-day period. Following outpatient treatment with inhaled corticosteroids, beta-2 agonists, and antibiotics, the asthma and lower respiratory tract infection were found to be reversible within the first week of treatment initiation. It is imperative that preventive measures at the political level be implemented to counteract the appeal and use of e-cigarettes among adolescents.

Associations of close social connections with smoking and vaping: a population study in England.

INTRODUCTION: Studies consistently demonstrate smoking is a socially contagious behaviour, but less is known about the influence of social connections on vaping. This study examined associations between having close social connections who smoke or vape and relevant smoking and vaping outcomes. METHODS: This was a representative cross-sectional survey of adults (≥16y) in England. Participants (n=1,618) were asked how many people they discuss important matters with (i.e., close social connections) and how many of them smoke/vape. We tested associations between (i) smoking and (ii) vaping among close social connections and participants' own smoking and vaping status; harm perceptions of e-cigarettes (among current smokers); attempts and success in quitting smoking (among past-year smokers); and use of e-cigarettes as a smoking cessation aid (among past-year smokers who tried to quit). RESULTS: Adults with ≥1 close social connection who smoke were more likely than those with none to smoke themselves (32.8% vs. 9.4%; ORadj=7.23[95%CI 4.74-11.0]) and had an uncertain lower likelihood to quit (12.2% vs. 19.8%; ORadj=0.46[0.17-1.23]). Those with ≥1 close social connection who vape were more likely than those with none to vape themselves (29.6% vs. 6.3%; ORadj=5.16[3.15-8.43]) and to use e-cigarettes in their most recent attempt to quit (57.0% vs. 27.9%; ORadj=18.0[1.80-181]), and had an uncertain higher likelihood to perceive e-cigarettes as less harmful than cigarettes (30.8% vs. 12.2%; ORadj=2.37[0.82-6.90]). CONCLUSIONS: In England, we replicated well-established associations with smoking and found similar evidence for vaping. People were much more likely to vape and to use e-cigarettes to quit smoking if they had close social connections who vaped. IMPLICATIONS: The cross-sectional design means it is not clear whether smoking/vaping among close social connections influences people to smoke/vape themselves, or whether people who smoke/vape select to form close social connections with others who similarly smoke/vape. Further research is required to establish causality. If the associations we observed are causal, interventions that encourage smokers to switch to vaping may have positive spillover effects on social connections' perceptions of e-cigarettes and use of these products to support smoking cessation.

Vaping Devices with Video Games.

The United States Food and Drug Administration (FDA) and other agencies have warned e-cigarette to companies to stop selling vaping products that look like toys because these products could attract youth to nicotine use. The vaping industry has gone a step further, producing vaping devices that are fully functional video games. We have observed several new vaping devices that contain youth-oriented video games such as Pac-Man, Tetris, Mario, Q*bert, and virtual pets. Some of these games reward users for each puff of nicotine. The incorporation of video games into vaping devices raises public health concerns regarding the potential appeal to younger users and the potential to escalate nicotine use and dependence. It is crucial to address these devices through robust policy, educational initiatives, and enforcement of existing policies.

Patterns and perceptions of vaping among adults living in social housing: a representative survey in Great Britain, 2023.

BACKGROUND: Vaping products are effective for helping people to stop smoking and may therefore offer a potential means to reduce high rates of smoking in socioeconomically disadvantaged groups. This study aimed to examine current patterns and perceptions of vaping among people living in social housing in Great Britain compared with those living in other housing types. METHODS: Data were from the Smoking Toolkit Study; a nationally-representative survey conducted in 2023 (n = 23,245). Logistic regression tested cross-sectional associations between living in social (vs. other) housing and current vaping among adults; vaping frequency, device type, nicotine concentration, and source of purchase among current vapers; use of vaping products as a smoking cessation aid among past-year smokers who tried to quit; and harm perceptions of vaping products relative to cigarettes among current smokers. RESULTS: Current vaping prevalence was twice as high among adults living in social housing (19.4%) compared with those in other housing types (10.4%; OR = 2.07, 95%CI = 1.84-2.33). This was partly explained by differences in sociodemographic characteristics and smoking status; after adjustment, the odds of being a current vaper were 33% higher (ORadj=1.33, 95%CI = 1.14-1.54). Among vapers, there were no notable differences by housing tenure in vaping frequency, main device type used, usual nicotine concentration, usual source of purchase, or use as a smoking cessation aid. However, current smokers living in social housing were more likely to think vaping is more harmful than cigarettes (31.6% vs. 21.8%; ORadj=1.61, 95%CI = 1.30-1.99). CONCLUSIONS: In Great Britain, adults who live in social housing are more likely to vape than those who live in other housing types, even after accounting for their younger age and higher smoking rates. However, misperceptions about the relative harms of vaping products and tobacco are common among smokers living in social housing. Interventions addressing these misperceptions could help encourage more people living in social housing to switch from smoking to vaping and reduce smoking-related health inequalities. PRE-REGISTRATION: The study protocol and analysis plan were pre-registered on Open Science Framework (https://osf.io/n3mvs/).