Susan Veldheer

Electronic cigarettes (e-cigs): views of aficionados and clinical/public health perspectives

Background:  Electronic cigarettes (e‐cigs) have experienced a rapid growth in popularity but little is known about how they are used.

Development of a questionnaire for assessing dependence on electronic cigarettes among a large sample of ex-smoking E-cigarette users.

INTRODUCTION Electronic cigarettes (e-cigs) are becoming increasingly popular, but little is known about their dependence potential. This study aimed to assess ratings of dependence on electronic cigarettes and retrospectively compare them with rated dependence on tobacco cigarettes among a large sample of ex-smokers who switched to e-cigs. METHODS A total of 3,609 current users of e-cigs who were ex-cigarette smokers completed a 158-item online survey about their e-cig use, including 10 items designed to assess their previous dependence on cigarettes and 10 almost identical items, worded to assess their current dependence on e-cigs (range 0-20). RESULTS Scores on the 10-item Penn State (PS) Cigarette Dependence Index were significantly higher than on the comparable PS Electronic Cigarette Dependence Index (14.5 vs. 8.1, p < .0001). In multivariate analysis, those who had used e-cigs longer had higher e-cig dependence scores, as did those using more advanced e-cigs that were larger than a cigarette and had a manual button. Those using zero nicotine liquid had significantly lower e-cig dependence scores than those using 1-12 mg/ml, who scored significantly lower than those using 13 or greater mg/ml nicotine liquid (p < .003). CONCLUSIONS Current e-cigarette users reported being less dependent on e-cigarettes than they retrospectively reported having been dependent on cigarettes prior to switching. E-cig dependence appears to vary by product characteristics and liquid nicotine concentration, and it may increase over time.

Ten-year weight gain in smokers who quit, smokers who continued smoking and never smokers in the United States, NHANES 2003-2012.

Background/Objectives:Weight gain after quitting smoking is a common concern for smokers and can discourage quit attempts. The purpose of this analysis was to describe the long-term weight gain, smoking cessation attributable (SCA) weight gain and describe their relationship to cigarette consumption and body mass index (BMI) 10 years ago in a contemporary, nationally representative sample of smokers who continued to smoke and those who quit.Subjects/Methods:In all, 12 204 adults ⩾36 years old were selected from the 2003–2012 National Health and Nutrition Examination Survey (NHANES). Ten-year weight gain for never, continuing and former smokers (who quit 1–10 years ago) was calculated by body mass index (BMI) 10 years ago and cigarettes per day (CPD). SCA weight gain was calculated by taking the difference between the adjusted mean 10-year weight gain of former smokers and that of continuing smokers.Results:Mean 10-year weight gain among continuing smokers was 3.5  versus 8.4 kg among former smokers; the SCA weight gain was 4.9 kg. After Bonferroni correction, there was no significant difference in overall weight gain between continuing and former smokers of 1–14 CPD, and SCA weight gain was lowest in this group (2.0 kg, confidence interval (CI): 0.3, 3.7). SCA weight gain was highest for former smokers of ⩾25 CPD (10.3 kg, CI: 7.4, 13.2) and for those who were obese (7.1 kg, CI: 2.9, 11.3) mostly because of lower than average weight gain or weight loss among continuing smokers in these groups.Conclusions:In a current, nationally representative sample, baseline BMI and CPD were important factors that contributed to the magnitude of long-term weight gain following smoking cessation. Light to moderate smokers (<15 CPD) experienced little SCA weight gain, whereas heavy smokers (⩾25 CPD) and those who were obese before quitting experienced the most.

Once bitten, twice shy: concern about gaining weight after smoking cessation and its association with seeking treatment

Concern about weight gain after quitting smoking is often cited as a barrier to smokers making a quit attempt or seeking treatment.

Views of experienced electronic cigarette users

Abstract Background: Awareness and use of electronic cigarettes (e-cigs) has increased significantly in the past five years, but little is known about the experiences, satisfaction, opinions and preferences of e-cigs users. Method: 1177 participants completed an online survey about their electronic cigarette preferences, of which 200 were randomly selected for analysis. The data were analyzed using both qualitative and quantitative methods. Results: Participants found the design, the ability to customize, and the quality of vapour to be the most important characteristics of the device. Participants thought the most positive aspects of e-cig use were help to quit smoking, improved overall health, and reduced cost. The negative aspects associated with its use were mainly related to side effects, such as dry mouth. When asked to explain how e-cigs were used differently than cigarettes, participants reported puffing more regularly, but taking fewer puffs per session. Conclusions: Experienced e-cig users stated that initiating e-cig use helped them to quit or reduce their conventional smoking, which they believe reduced their health risks. In comparison to cigarette smoking, e-cig users reported using their e-cig more times per day, but with fewer puffs at each use time. Users acknowledged that more research is needed to understand the safety and long-term effects of its use. They mentioned dry mouth as a common side effect and common problems with reliability of e-cigs. Understanding these views may help health professionals to assess and assist e-cig users, and in the future, may help regulators to improve quality and reduce risks.

Commentary on Etter & Bullen (2011): Could E-cigs become the ultimate nicotine maintenance device?

If people have difficulty overcoming both nicotine dependence and long-term habit change, then surely the solution is to help them avoid most of the health risks with only a minimal alteration in their nicotine-seeking habits. This implies a nicotine replacement device which looks like a cigarette and delivers cigarette-like boli of nicotine, but does not deliver the tar and carbon monoxide which cause the vast majority of smoking-related disease . . . the development and promotion of such a product (and its eventual replacement of tobacco) could have massive beneficial public health implications lasting into the 21st century [4].

Should electronic cigarette use be covered by clean indoor air laws

Background Some jurisdictions have passed legislation that bans electronic cigarette (e-cig) use (vaping) in public places similarly to smoking. Many other jurisdictions have not yet determined how to regulate vaping in public places. This study examined the proportion of current e-cig users who find their vaping restricted in public places and further evaluated factors associated with the differences between restricted and unrestricted vapers. Methods 3960 experienced exclusive e-cig users completed an online survey from December 2012 to May 2014 about their e-cig use. Restricted vapers were defined as those who reported not being able to vape in places where smoking is typically banned. Unrestricted vapers were defined as those who reported being able vape in places where smoking is typically banned. χ2 and two-sided t-tests were used as appropriate to determine differences between variables of interest. Results Participants were a mean age of 40.3 years, 72.0% male, 91.8% white and 85.1% were from the USA. 26.1% (n=1034) of users reported restricted vaping, while 73.9% (n=2926) reported unrestricted vaping. Restricted vapers used less frequently (p<0.001) and were less dependent compared with unrestricted vapers (p=0.001). Of the restricted vapers, only 12% (n=124) reported finding it difficult to refrain from vaping in places where they were not supposed to. These users were more dependent (p<0.001) and more likely to experience strong cravings (p<0.001), compared with users who did not find it difficult to refrain from vaping. Conclusions This study found that most vapers report unrestricted use of their e-cig. Of the restricted vapers, the majority (88%) do not find it difficult to refrain from vaping in places where they are not supposed to vape.

Reasons for non‐adherence to nicotine patch therapy during the first month of a quit attempt

Prior research has shown that the transdermal nicotine patch is a safe and effective aid to smoking cessation, but adherence to the directed use of the nicotine patch is often low. Few studies have examined participant‐reported reasons for non‐adherence to nicotine patch therapy during a quit attempt.

Changes in resting state functional brain connectivity and withdrawal symptoms are associated with acute electronic cigarette use

Resting state functional brain connectivity (rsFC) may be an important neuromarker of smoking behavior. Prior research has shown, among cigarette smokers, that nicotine administration alters rsFC within frontal and parietal cortices involved in executive control, as well as striatal regions that drive reward processing. These changes in rsFC have been associated with reductions in withdrawal symptom severity. We currently have a limited understanding of how rsFC is affected by the use of electronic cigarettes (ecigs), an increasingly popular class of products, the members of which deliver nicotine with varying effectiveness. The current study used fMRI to determine the effects of ecig use on rsFC and withdrawal symptoms. Independent component, dual regression, and permutation analyses were conducted on rsFC collected from ecig users before and after an ecig use episode (n=9) that occurred after 14h of nicotine abstinence. Similar to the known effects of nicotine administration, ecig use decreased rsFC of two clusters in the right frontal pole and frontal medial cortex with an attentional control salience network, and decreased rsFC of five clusters in the left thalamus, insula, and brain stem with a reward network encompassing the striatum. Ecig use increased inverse coupling between the prefrontal reward network and the right frontoparietal executive control network. Reductions in craving and difficulty with concentration were correlated with decreases in coupling strength between reward and executive control networks. These preliminary results suggest that the effects of ecig use on rsFC are similar to those seen with nicotine administration in other forms. In order to gain insight into the addictive potential of ecigs, further research is needed to understand the neural influence of ecigs across the range of nicotine delivery within this class of products.

Associations between unhealthy dieting behaviors and tobacco use among adolescents

BackgroundCigarette smoking is an important risk factor for unhealthy dieting behaviors (UDBs) in youth. The role of alternative tobacco products and UDB engagement has yet to be examined empirically despite concerning trends in use. This study aimed to examine UDB prevalence in a U.S. geographic region-specific adolescent sample and associations with a variety of tobacco use behaviors and perceptions.MethodsWeighted data from the 2013 Virginia Youth Survey were analyzed (n = 6903). UDBs assessed included past 30-day fasting, diet pill use, and vomiting/laxative use. Tobacco-related items were ever and past 30-day cigarette smoking, past 30-day smokeless tobacco and cigar use, and the perception that smokers have more friends. UDB prevalence was recoded by the number of behaviors endorsed (0, 1, and 2+). Bivariate and multinomial regression models were used to examine associations between covariates and number of UDBs endorsed by gender.ResultsOverall, nearly 16% engaged in at least one UDB. Fasting was most prevalent (14.2%) followed by vomiting/laxative (7.0%) and diet pill use (6.1%). Across gender, ever cigarette smoking, past 30-day cigar use, and the perception that smokers have more friends were positively associated with UDB engagement in relative isolation as well as in combination.ConclusionsFindings highlight the importance of tobacco-related factors for weight control behaviors and are the first to identify an association between UDB incidence and an alternative tobacco product, cigars. This work should inform prevention efforts for tobacco use and UDBs and underscores the need to address the use of any tobacco for weight control.