Prevalência e fatores associados ao uso de cigarro eletrônico por estudantes universitários / Prevalence and factors associated with electronic cigarette use by university students / Prevalencia y factores asociados al uso de cigarrillos electrónicos por estudiantes universitarios

Este estudo objetivou estimar a prevalência do uso do cigarro eletrônico e a associação com fatores preditores. Trata-se de um estudo transversal, analítico, com amostra probabilística de universitários matriculados em um Centro Universitário de Montes Claros, Minas Gerais, Brasil no segundo semestre de 2022. A variável dependente referiu-se ao uso do cigarro eletrônico. As variáveis independentes referiram a fatores sociodemográficas, laborais e comportamentais. A associação entre as variáveis investigadas e a prevalência do uso do CE foi verificada pela análise bivariada e a regressão de Poisson. Foram entrevistados 730 universitários, com a média de idade de anos 22,56 (±6,25). Destes, 21,8 % faziam o uso cigarro eletrônico e após a análise multivariada manteve-se associado ao desfecho não ter companheiro (RP= 3,31; IC95% 1,04-10,48), morar com amigos/sozinho (RP=1,53; IC95% 1,07-2,18), ter histórico de usuários de cigarro eletrônico na residência (RP= 1,76; IC95%: 1,17- 1,89), consumir bebida alcoólica (RP= 3,07; IC95%: 1,72-5,49) e não praticar atividade física (RP= 3,37; IC95% 2,35-4,83). Conhecer sobre o cigarro eletrônico foi fator protetor (RP= 0,31 IC95% 0,20-0,46). Registrou-se elevada prevalência do uso do cigarro eletrônico, e manteve associados a fatores sociodemográficos e comportamentais. Esses achados chamam a atenção para a necessidade de novas medidas regulatórias, a fim de reduzir o uso desse dispositivo.

This study aimed to estimate the prevalence of e-cigarette use and the association with predictors. This is a cross-sectional, analytical study with a probabilistic sample of university students enrolled in a University Center of Montes Claros, Minas Gerais, Brazil in the second half of 2022. The dependent variable referred to the use of electronic cigarettes. The independent variables referred to sociodemographic, labor and behavioral factors. The association between the variables investigated and the prevalence of EC use was verified by bivariate analysis and Poisson regression. A total of 730 university students were interviewed, with a mean age of 22.56 (±6.25). Of these, 21.8% used electronic cigarettes and after multivariate analysis, it remained associated with the outcome of not having a partner (PR= 3.31; CI95% 1.04-10.48), living with friends/alone (PR=1.53; CI95% 1.07-2.18), having a history of e-cigarette users in the residence (PR= 1.76; CI95%: 1.17- 1.89), alcohol consumption (PR= 3.07; CI95%: 1.72-5.49) and not practicing physical activity (PR= 3.37; IC95% 2.35-4.83). Knowing about electronic cigarettes was a protective factor (PR= 0.31 CI95% 0.20-0.46). There was a high prevalence of e-cigarette use, and it was associated with sociodemographic and behavioral factors. These findings draw attention to the need for new regulatory measures in order to reduce the use of this device.

Este estudio tuvo como objetivo estimar la prevalencia del uso de cigarrillos electrónicos y la asociación con predictores. Se trata de un estudio analítico transversal con una muestra probabilística de estudiantes universitarios matriculados en un Centro Universitario de Montes Claros, Minas Gerais, Brasil, en el segundo semestre de 2022. La variable dependiente se refería al uso de cigarrillos electrónicos. Las variables independientes se refirieron a factores sociodemográficos, laborales y conductuales. La asociación entre las variables investigadas y la prevalencia de uso de CE fue verificada por análisis bivariado y regresión de Poisson. Fueron entrevistados 730 estudiantes universitarios, con una edad promedio de 22,56 (±6,25). De estos, 21,8% utilizaron cigarrillos electrónicos y después del análisis multivariado, se mantuvo asociado con el resultado de no tener pareja (RP= 3,31; IC95% 1,04-10,48), vivir con amigos/solo (RP=1,53; IC95% 1,07-2,18), con antecedentes de usuarios de cigarrillos electrónicos en la residencia (RP= 1,76; IC95%: 1,17- 1,89), consumo de alcohol (RP= 3,07; IC95%: 1,72-5,49) y no practicar actividad física (RP= 3,37; IC95% 2,35-4,83). El conocimiento de los cigarrillos electrónicos fue un factor protector (RP= 0,31 IC95% 0,20-0,46). Hubo una alta prevalencia de uso de cigarrillos electrónicos, y se asoció con factores sociodemográficos y de comportamiento. Estos hallazgos llaman la atención sobre la necesidad de nuevas medidas regulatorias para reducir el uso de este dispositivo.

Cigarros eletrônicos e suas consequências histopatológicas relacionadas à doenças pulmonares / E-cigarettes and histopathological consequences related to lung diseases

O cigarro eletrônico surgiu como uma tentativa para minimizar a dependência ao uso de tabaco, entretanto, engloba controvérsias e dúvidas acerca das reais implicações para o organismo humano. Diante disso, o presente estudo tem como objetivo realizar uma revisão da literatura a fim de relacionar o uso de cigarro eletrônico com suas consequências para os humanos. Os estudos analisados relatam experimentos in vitro e in vivo em camundongos, demonstrando menor concentração de poluentes e nocividades no cigarro eletrônico comparado ao convencional, porém, seu potencial efeito maléfico está relacionado à composição do e-líquido, à maneira do uso e à variedade de aromas presentes nos produtos. Além disso, foram verificadas lesões celulares, hiperreatividade das vias aéreas, liberação de citocinas ­ IL-8, IL-10 e TNF, redução da ação antimicrobiana de queratinócitos e potencial apoptose nas células alveolares. Foi observado também um aumento em até cinco vezes da concentração de carboxihemoglobina em comparação ao cigarro comum e um aumento na auto renovação de células de adenocarcinoma pulmonar de células não pequenas, devido à expressão de SOX2. Observa-se também que em casos de DPOC, o cigarro eletrônico não apresenta agravamentos na fisiologia respiratória, contrapondo outras ocorrências como asma, pneumonia, câncer de pulmão e doenças infecciosas que podem ser ocasionadas ou exacerbadas pelo seu uso. Contudo, pelo curto prazo de observação de seus efeitos, não é possível determinar com precisão a segurança dos cigarros eletrônicos, dessa forma, faz-se necessário que mais pesquisas longitudinais sejam desenvolvidas, auxiliando, assim, na construção de evidências sobre a segurança dos cigarros eletrônicos e na regulamentação futura do produto.

Electronic cigarettes emerged as an attempt to minimize tobacco dependence. However, its use is surrounded by controversies and doubts about the real implications for the human organism. Therefore, this study aims at performing a review of the most recent literature to corelate the use of e-cigarettes with their consequences for the human body. The analyzed studies relate in vitro and in vivo experiments on mice, demonstrating lower concentration of pollutants and harmfulness in the electronic cigarette than in conventional cigarettes. However, its potential harmful effect is related to the composition of the e-liquid, in its use and in the variety of aromas in the products. In addition, cellular lesions, airway hyperreactivity, release of IL-8, IL-10 and TNF cytokines could be observed, as well as reduced keratinocyte antimicrobial action and potential apoptosis in alveolar cells. An increase of up to five-fold the concentration of carboxyhemoglobin in comparison to ordinary cigarettes and an increase in self-renewal of non-small pulmonary adenocarcinoma cells due to the expression of SOX2 have also been related. It could also be observed that in COPD cases, e-cigarettes do not present worsening in respiratory physiology, which contrasts with other occurrences such as asthma, pneumonia, lung cancer, and infectious diseases that can be caused or exacerbated by its use. However, due to the short term of observation of the effects, the safety of e-cigarettes could not be accurately determined, thus, the need for further longitudinal research is necessary, which could be used to help build evidence about the safety of e-cigarettes and also to create future regulation of the product.

When Less is More: Vaping Low-Nicotine vs. High-Nicotine E-Liquid is Compensated by Increased Wattage and Higher Liquid Consumption.

(1) Background: Previous research (Van Gucht, Adriaens, and Baeyens, 2017) showed that almost all (99%) of the 203 surveyed customers of a Dutch online vape shop had a history of smoking before they had started using an e-cigarette. Almost all were daily vapers who used on average 20 mL e-liquid per week, with an average nicotine concentration of 10 mg/mL. In the current study, we wanted to investigate certain evolutions with regard to technical aspects of vaping behaviour, such as wattage, the volume of e-liquid used and nicotine concentration. In recent years, much more powerful devices have become widely available, e-liquids with very low nicotine concentrations have become the rule rather than the exception in the market supply, and the legislation has been adjusted, including a restriction on maximum nicotine concentrations to 20 mg/mL. (2) Methods: Customers (n = 150) from the same Dutch online vape shop were contacted (to allow a historical comparison), as well as 274 visitors from the Facebook group "Belgian Vape Bond" to compare between groups from two different geographies and/or vaping cultures. (3) Results: Most results were in line with earlier findings: Almost all surveyed vapers were (ex-)smokers, had started (80%) vaping to quit smoking and reported similar positive effects of having switched from smoking to vaping (e.g., improved health). A striking observation, however, was that whereas customers of the Dutch online vape shop used e-liquids with a similar nicotine concentration as that observed previously, the Belgian vapers used e-liquids with a significantly lower nicotine concentration but consumed much more of it. The resulting intake of the total quantity of nicotine did not differ between groups. (4) Conclusions: Among vapers, different vaping typologies may exist, depending on subcultural and/or geographic parameters. As a consequence of choosing low nicotine concentrations and consuming more e-liquid, the Belgian vapers may have a greater potential to expose themselves to larger quantities of harmful or potentially harmful constituents (HPHCs) released during vaping.

Risk versus regulation: an update on the state of e-cigarette control in Australia.

E-cigarettes are increasingly common around the world, particularly among youth. Ingestion of nicotine-containing e-liquid, while relatively rare, is the major toxicological risk associated with their use. Current Australian regulation has nicotine for use in e-cigarettes listed as a dangerous poison in Schedule 7, with its supply or sale illegal in all states and territories, while regulation on the sale of e-cigarettes and accessories varies by state. However, with increasing evidence that e-cigarettes produce far fewer toxic by-products than their combustible counterparts perhaps it is time to review this regulation.

Are electronic cigarettes a healthier alternative to conventional tobacco smoking?

Electronic cigarettes (EC) with and without nicotine are used by more and more consumers within the last decade. The long-term risks of vapor inhalation are unknown. This study should describe the state of the art of knowledge with respect to the following four items: (1) ingredients of the vapor and their potential risks, the influence of EC on smoking of combustible tobacco to (2) adults and (3) the youth, and (4) the side effects of passive vaping. The vapor of EC contains, in comparison to tobacco smoke, less harmful substances, qualitatively and quantitatively. But, due to failing standardization of EC, this comparison is difficult. Adults are often using both, EC and combustible cigarettes dually. In addition, EC were used for supporting smoke-quitting. Unfortunately, consuming EC with and without nicotine due later to a higher risk of conventional tobacco smoking for the user. In general, the effects of passive vaporing are unknown. Although the vapor of EC is less harmful than tobacco smoke, EC are not hazard-free lifestyle products. Technical standardization should be desirable. Adult smoker's benefit using EC is given by completely change to EC only. The rates of success using EC for smoke quitting are not well evaluated. Children and their parents should be informed on the risks of EC use as a precursor of combustible smoking mandatorily. Internet selling EC to any non-adult should be forbidden by law. EC ought not to be allowed to weaken non-smoker's rights, and third persons should be protected by the potential hazards of EC vaporing.

A framework to investigate the impact of topography and product characteristics on electronic cigarette emissions.

SIGNIFICANCE: Protocols for testing and reporting emissions of Harmful and Potentially Harmful Constituents (HPHCs) from electronic cigarettes (e-cigs) are lacking. The premise of this study is that multi-path relationships may be developed to describe interactions between product characteristics, use behavior and emissions to develop appropriate protocols for tobacco product regulatory compliance testing. METHODS: This study proposes a framework consisting of three component terms: HPHC mass concentration, HPHC mass ratio and total particulate mass (TPM) concentration. The framework informs experiments to investigate dependence of aerosol emissions from five electronic cigarettes spanning several design generations and three e-liquids for six repeated trials at each of ten flow conditions. RESULTS: Results are reported for TPM concentration as a function of flow conditions spanning the range of natural environment topography observed in prior studies. An empirical correlation describing TPM concentration as a function of flow conditions and coil power setting (6, 7.5 and 10 watts) for the Innokin iTaste MVP 2.0 vaporizer with Innokin iClear 30 dual coil tank is presented. Additional results document the impact of flow conditions and wick and coil design on TPM concentration through comparison of the Innokin iClear 30 (upper coil, capillary action wick) and the Innokin iClear X.I (lower coil, gravity fed wick) operated at 7.5 watts. The impact of e-liquid on TPM concentration is illustrated by comparing emissions from an NJOY Vape Pen filled with AVAIL Arctic Blast, Tobacco Row, and Mardi Gras e-liquids. TPM concentration is shown to depend upon flow conditions across a range of e-cigarette product designs including cig-a-like, pen-style, box-mod and emergent disposable-cartridge style devices. CONCLUSIONS: A framework provides a foundation for reporting emissions across a variety of e-cigs, e-liquids and research laboratories. The study demonstrates TPM concentration is a function of topography behavior (i.e. puff flow rate and puff duration) for varying device operating power and product characteristics.

New approach for e-cigarette aerosol collection by an original automatic aerosol generator utilizing melt-blown non-woven fabric.

Currently, there is lack of standardized conditions for the collection and analysis of e-cigarette (EC) aerosol. Considering the urgent need for the development of these guidelines, a procedure for EC aerosol analysis was developed. A novel automatic e-cigarette aerosol generator was designed. For the first time, melt-blown non-woven fabric was applied for the effective uptake of compounds released from vaporized e-liquid. The extraction procedure was optimized in terms of type of extraction solvent, amount of sorbent and solvent volume. For optimization, a model e-liquid containing flavour additives belonging to various chemicals group with various chemical properties was investigated. The aerosol trapping efficiency was satisfactory and was equal to 92 ±â€¯7%. Final determination was performed by GC-MS/MS. Quantitation was based on the mass change tracking approach (MCT), which assumes the monitoring of e-liquid mass changes before and after vaping. The combination of non-woven fabric and sampling approach (MCT) was proven to be effective in acquisition of reliable data. Thus, the concentrations in aerosol and emission factors were calculated for aerosols collected during the vaping of both model e-liquids and real samples. Validation was performed by evaluating key analytical parameters, such as linearity, accuracy, precision, limit of detection (LOD) and quantitation (LOQ). For all investigated compounds, recoveries from 70% to 118% together with precision and reproducibility below 12% were achieved. The applicability of the described approach was examined by analysing EC refill solutions commercially available on the Polish market.

Accounting for effects of system dynamics to improve accuracy of emissions reported in e-cig vaping machines.

Laboratory emissions testing of electronic cigarettes continues to be a focus in the tobacco research community. In particular, to inform policy regarding appropriate test protocols to regulate the manufacture, marketing and sale of tobacco products. This study aims to enhance current understanding of the way laboratory systems used to generate topography profiles and capture resultant emissions from inhaled tobacco products may interact with the device under test. A programmable emission system (vaping machine) is introduced and characterized. The operating envelope of this system is presented. This study demonstrates that the performance of an emissions system may be influenced by various factors, resulting in discrepancies between command puff parameter inputs and the observed puffs generated. The study findings conclude that any emissions system should be characterized with the desired test device to determine the effective operating range of the system under "Load" conditions. Furthermore, reporting emissions from electronic cigarettes as a function of "command" puff flow rate and cumulative volume result in under-estimation bias and may give rise to incorrect conclusions regarding the impact of product characteristics on emissions. Conversely, reporting emissions in terms of "observed" puff flow rate and cumulative volume reduces bias errors and limits opportunity for intentional misrepresentation of results.

Sudden sensorineural hearing loss associated with electronic cigarette liquid: The first case in the literature.

Pediatric sudden sensorineural hearing loss (SSNHL) is a quite rare otologic emergency. Etiology of SSNHL isn't enough clear. Electronic cigarette (EC) is a device that uses increasingly and it contain liquid which keep nicotin and various chemicals. This liquid can be ingested mistakenly by children and various side effects may develop. But hearing loss wasn't reported before as a side effect. We presented an interesting case, she was 6-year-old who developed bilaterally SSNHL associated with drinking electronic cigarette liquid.

Evaluation of E-Vapor Nicotine and Nicotyrine Concentrations under Various E-Liquid Compositions, Device Settings, and Vaping Topographies.

Nicotine is one of the major components of electronic cigarette (e-cigarette) emissions. Nicotyrine is a product of nicotine dehydrogenation in e-vapor and is a known inhibitor of human cytochrome P450 enzyme, which mediates nicotine metabolism. However, the emission of nicotine and especially nicotyrine from e-cigarettes has not been studied under real-world vaping patterns. This study examined the impact of e-liquid composition, e-cigarette device power output, and vaping topography on nicotine and nicotyrine concentrations under real-world vaping patterns. The amount of nicotine emitted from e-cigarettes vaped at high e-liquid nicotine levels, high device power, and large puff volumes ranged from 0.365 µg/puff to 236 µg/puff and was comparable to the amount of nicotine emitted from regular cigarettes. E-cigarette coil temperatures (200-300 °C) favored the formation of nicotyrine: E-cigarette vaping generated 2- to 63-fold more nicotyrine per unit nicotine emission than conventional cigarette smoking. High nicotyrine emission from e-cigarettes indicates that nicotine metabolism could be potentially interrupted, which could lead to reduced e-cigarette usage, and result in lower exposures to toxic chemicals (e.g., formaldehyde and acetaldehyde). However, higher serum nicotine levels might increase cancer risks by stimulating nicotinic acetylcholine receptors (nAchRs).

Influence of Coil Power Ranges on the E-Liquid Consumption in Vaping Devices.

As electronic cigarettes (e-cigarettes) represent a new constantly evolving product category, the systematic analysis of the developed devices and the e-liquid vaporization is challenging. Indeed, understanding how e-cigarettes work and the role of key parameters in the process are major issues. This work focuses on an experimental study of how the power supplied by the battery to the atomizer coil influences e-liquid consumption. The reproducibility and the repeatability of e-liquid consumption were investigated over 20 series of 20 puffs for one of the tested atomizers. Then, the reproducibility and the repeatability of the e-liquid consumption was investigated over five series of 20 puffs for each tested atomizer. The wire behavior according to the supplied power could be separated into three regimes: under-heating (insufficient power to generate an aerosol), optimal vaporization characterized by a linear trend (vaporization of the e-liquid proportional to the supplied energy) and over-heating (dry-burn occurs). Using a controllable and repeatable energy supply, the reproducibility of the quantity of vaporized e-liquid was verified for each of the five series of 20 puffs programed for all the atomizers except one. Finally, the influence of the supplied power on the vaporization and the consumption of the e-liquid as well as the optimal power ranges were investigated and discussed. The results showed that atomizers with resistance ranging from 1 Ω to 1.8 Ω are efficient using all the energy supplied by the battery to vaporize the e-liquid and reducing the energy lost in the cotton or in the metal part of atomizer coil.

Electronic Cigarette Harm and Benefit Perceptions and Use Among Youth.

INTRODUCTION: The purpose of this study is to examine adolescent perceptions of harms and benefits associated with electronic cigarettes (e-cigarettes) and their associations with use. METHODS: Data from the 2016 Florida Youth Tobacco Survey were analyzed in 2017. Participants who were in high school aged 14-17 years were included (n=22,884). Logistic regression analyses were used to compare e-cigarette use groups on perceived harms and benefits of e-cigarettes. RESULTS: Less than one half of the sample reported that e-cigarettes are harmful to their health and less than two thirds reported that individuals can get addicted to e-cigarettes. Compared with committed never users, susceptible never users and all e-cigarette use groups were less likely to report that e-cigarettes were harmful to their health, people can get addicted to e-cigarettes, and that smoke from others' e-cigarettes were harmful. Furthermore, susceptible never users and all use groups were more likely to report that it would be easy to quit using e-cigarettes than committed never users. Susceptible never users and all use groups were also more likely to perceive benefits of e-cigarette use including having more friends, looking cool or fitting in, feeling more comfortable in social situations, and stress relief compared with committed never users. CONCLUSIONS: Youth who are susceptible to use, currently use, or have used e-cigarettes are less likely to report harms and more likely to perceive benefits associated with e-cigarette use compared with committed never users. Addressing harm and benefit perceptions may be important for interventions designed to reduce e-cigarette use among adolescents.

E-cigarettes, vaping and performativity in the context of tobacco denormalisation.

E-cigarettes are devices through which a nicotine solution is 'vapourised' and inhaled by the user. Unlike cigarettes, the process involves no tobacco combustion. However, the inhalation and exhalation of vapour is reminiscent of smoking and there is debate about the possible harms and benefits of e-cigarette use, including the 'renormalisation' of smoking. Despite these debates, there has been little exploration into the embodied and semiotic similarities between smoking and vaping. This paper views the practices of vaping and smoking through the lens of performativity that is, the accumulation of meaning associated with the habits over time and space. Through in-depth interviews, we explore how young adults from primarily disadvantaged areas in Scotland, understand the similarity in practices between smoking and vaping. Participants talked about financial barriers to using different types of e-cigarettes, and how their use reflected their views on smoking cessation. They also discussed the embodied similarities between smoking and vaping, with divergent opinions on whether this continuance of habit was beneficial or not, revealing still developing and ambiguous norms around performativity. The norms of vaping were also frequently discussed, with participants' experiences and views reflecting the contested position of vaping in an environment where cigarette smoking is denormalised.

Measurement of heating coil temperature for e-cigarettes with a "top-coil" clearomizer.

OBJECTIVES: To determine the effect of applied power settings, coil wetness conditions, and e-liquid compositions on the coil heating temperature for e-cigarettes with a "top-coil" clearomizer, and to make associations of coil conditions with emission of toxic carbonyl compounds by combining results herein with the literature. METHODS: The coil temperature of a second generation e-cigarette was measured at various applied power levels, coil conditions, and e-liquid compositions, including (1) measurements by thermocouple at three e-liquid fill levels (dry, wet-through-wick, and full-wet), three coil resistances (low, standard, and high), and four voltage settings (3-6 V) for multiple coils using propylene glycol (PG) as a test liquid; (2) measurements by thermocouple at additional degrees of coil wetness for a high resistance coil using PG; and (3) measurements by both thermocouple and infrared (IR) camera for high resistance coils using PG alone and a 1:1 (wt/wt) mixture of PG and glycerol (PG/GL). RESULTS: For single point thermocouple measurements with PG, coil temperatures ranged from 322 ‒ 1008°C, 145 ‒ 334°C, and 110 ‒ 185°C under dry, wet-through-wick, and full-wet conditions, respectively, for the total of 13 replaceable coil heads. For conditions measured with both a thermocouple and an IR camera, all thermocouple measurements were between the minimum and maximum across-coil IR camera measurements and equal to 74% ‒ 115% of the across-coil mean, depending on test conditions. The IR camera showed details of the non-uniform temperature distribution across heating coils. The large temperature variations under wet-through-wick conditions may explain the large variations in formaldehyde formation rate reported in the literature for such "top-coil" clearomizers. CONCLUSIONS: This study established a simple and straight-forward protocol to systematically measure e-cigarette coil heating temperature under dry, wet-through-wick, and full-wet conditions. In addition to applied power, the composition of e-liquid, and the devices' ability to efficiently deliver e-liquid to the heating coil are important product design factors effecting coil operating temperature. Precautionary temperature checks on e-cigarettes under manufacturer-recommended normal use conditions may help to reduce the health risks from exposure to toxic carbonyl emissions associated with coil overheating.