People who vape suffer similar changes to their DNA as smokers who develop cancer, researchers have revealed.

Scientists at University College London analysed samples of cheek cells from vape users and compared these with those from cigarette smokers. Both groups had similar changes to the DNA of cells in their mouth.

These changes were, in turn, linked to the future development of lung cancer in smokers.

• Health minister begs husband to stop vaping during live interview

The authors of the study, published in the journal Cancer Research, said the findings did not prove e-cigarettes cause cancer but show that “the devices might not be as harmless as originally thought”.

It is the first major study to draw a link between e-cigarettes and an increased risk of cancer.

Little is known about the long-term effects of e-cigarettes, and debates over their harm have so far mainly focused on concerns about nicotine addiction among the young. On Wednesday MPs will be presented with world-leading legislation restricting the flavours and promotions of vapes, as well as banning smoking for younger generations altogether.

Rishi Sunak said that the bill would “save thousands of lives and billions of pounds for our NHS” and that he was confident of staving off a party rebellion. Some MPs on the Tory right, led by Liz Truss, have criticised the smoking ban for those born after January 1, 2009, as curtailing individual freedom, but all of the UK’s present and former chief medical officers, including Professor Sir Chris Whitty, have taken issue with this argument.

Little is known about long-term side eff­ects of vaping, which is a relatively new phenomenon

TIMES PHOTOGRAPHER RICHARD POHLE

Writing for The Times, they said: “To be pro-individual choice should mean being against the deliberate addiction of children, young people and young adults to something that will harm them, potentially fatally.”

They urged MPs to back the legislation to help end the “flagrant marketing of vapes to children using colours, flavours and packaging”. They added: “Vapes can help smokers quit. But if you don’t smoke, our advice is don’t vape.”

A recent investigation by The Times revealed how the promotion of e-cigarettes by the government and NHS as a tool to stop smoking led to an epidemic of youth vaping, as organisations linked to the tobacco industry played down e-cigarettes’ health risks.

Because vaping is relatively new, ­little is known about long-term side eff­ects. UCL’s study is the first to examine how smoking and vaping can modify the DNA in cells, in a process known as epigenetics. These changes are thought to allow cells to divide more quickly, potentially growing into tumours.

The study involved data from 4,000 people, and looked at cell samples from hundreds of smokers, as well as vapers who don’t regularly use tobacco. This showed that cells in the mouth, which are exposed to tobacco and vape smoke, were “substantially” altered. The changes were also seen in the lung cancer tissue of smokers who developed cancer.

The study’s author, Dr Chiara Herzog, said: “While the scientific consensus is that e-cigarettes are safer than smoking tobacco, we cannot assume they are completely safe to use and it is important to explore their potential long-term risks and links to cancer. We hope this study may help form part of a wider discussion into e-cigarette usage, ­especially in people who have never previously smoked tobacco.”

Her co-author, Professor Martin Widschwendter, said: “Changes that are observed in lung cancer tissue can also be measured in cheek cells from smokers who have not [yet] developed a cancer. Importantly, our research points to the fact that e-cigarette users exhibit the same changes, and these ­devices might not be as harmless as originally thought. Long-term studies of e-cigarettes are needed.”

The study examined the effects on cells by studying a type of epigenetic change in cells called DNA methylation. Epigenetics is the term for factors, such as our environment and lifestyle, that can modify and determine how our DNA is expressed, such as by suppressing genes that stop cells dividing into tumours.

Dr Ian Walker, executive director of policy at Cancer Research UK, said: “This study contributes to our understanding of e-cigarettes, but it does not show that e-cigarettes cause cancer.

“Decades of research has proven the link between smoking and cancer, and studies have so far shown that e-cigarettes are far less harmful than smoking and can help people quit.

“This paper does, however, highlight that e-cigarettes are not risk-free, and so we need additional studies to uncover their potential longer-term impacts on human health.

“Smoking tobacco causes 150 cases of cancer every single day in the UK, which is why we look forward to seeing the government’s age of sale legislation being presented in parliament. Nothing would have a bigger impact on reducing the number of preventable deaths in the UK than ending smoking, and this policy will take us one step closer to a smoke-free future.”

Andrew Beggs, a professor of cancer genetics and surgery at the University of Birmingham, said: “Although it doesn’t show a direct causal effect, this study shows that further research must be done to understand the effects of e-cigarettes on human health and ­whether they could be linked to an increased risk of cancer.”

Behind the story

Few countries have embraced vaping as enthusiastically as Britain, where e-cigarettes have become ubiquitous in high streets, parks and schools across the country (Billy Kenber, Senior Investigations Reporter, writes).

While other nations adopted a precautionary approach in the absence of long-term health data, public health bodies in the UK were early and vocal supporters of the use of e-cigarettes by smokers, declaring them 95 per cent safer than smoking.

The stance, which extended to handing out free vapes to smokers and allowing vape shops to open in hospitals, was spearheaded by academics specialising in addiction who viewed e-cigarettes as a potentially invaluable tool in the battle to persuade smokers to quit the habit.

They saw it as a continuation of the UK’s ‘harm reduction’ approach of offering safer alternatives like nicotine replacement therapy to people unable to give up.

But critics claim this narrow focus on existing smokers meant insufficient consideration was given to the risks to the wider public from non-smokers, including children, taking up vaping.

E-cigarettes were invented by a Chinese pharmacist in 2003 and were initially of niche interest to small numbers of smokers.

But as they grew in popularity, tobacco giants began to buy up existing brands and launch their own e-cigarettes as they sought to take over the market.

The UK’s pro-vaping stance has made it something of a global outlier, with many other countries choosing to restrict vapes to prescription-only, prohibit certain flavours or ban e-cigarette sales altogether.

It retained this approach for years even as public health experts and paediatricians warned that the promotion of vapes was normalising e-cigarettes for non-smokers and risked creating a generation of nicotine-addicted youth vapers, a Times investigation has previously revealed.

An academic article published in 2018 accused Public Health England of “complacency” as “thousands of children become nicotine addicted through vaping” amid the rising popularity of cheap, brightly coloured vapes pioneered in the United States by Juul. It warned of the unknown health consequences of e-cigarettes and the possibility of an “epidemic of devastating lung disease for today’s children”.

Meanwhile, international organisations such as the World Health Organisation continued to question the scientific evidence around e-cigarettes and warned that they were harmful to health.

 

By 2023, more than one in five children under 18 in the UK had tried an e-cigarette, a 30 per cent increase in a year.

The UK’s pro-vaping approach made it a target for those wishing to promote the use of e-cigarettes around the world.

A Times investigation in December exposed ties between tobacco companies and a secretive lobbying campaign to boost e-cigarette sales and block health measures aimed at protecting children.

Cigarette manufacturers fostered links to doctors, scientists and activists who have promoted the use of e-cigarettes and lobbied against efforts to impose tighter regulations on vapes.

This has included funding scientific papers which have played down the risks of children vaping and helping to run a supposedly ‘grassroots’ campaign which presented itself as the voice of ordinary vapers and tried to influence policy decisions.

Hundreds of British doctors attended smoking cessation training sessions which included advice on the use of e-cigarettes and nicotine replacement therapies by smokers looking to quit. They were run by an NHS doctor who has received millions in funding from a foundation which was solely-funded by a tobacco giant.

Lobbying efforts continued amid a government consultation on how to tackle youth vaping.

In January, Rishi Sunak made his decision, electing to bring in new restrictions on flavours and packaging and pledging to ban disposable vapes.

“We’ve got a generation of nicotine addicted kids,” Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine, has said. “Hopefully, many of them will come off it but it won’t be all.”

 

 

COMMENT

Why MPs must back vape controls

Professor Sir Chris Whitty and all other chief, deputy and former chief medical officers

Millions of smokers want to quit but cannot due to an addiction to nicotine. It is an addiction they know could well kill them but is now trapping them. More than 80 per cent of smokers start before the age of 20, many as children, after persistent marketing.

To be pro-individual choice should mean being against deliberate addiction of children, young people and young adults to something that will harm them, potentially fatally.

Over the life course, addiction to smoking damages individuals, families and society. From stillbirth in pregnant women through asthma in children due to passive smoking, heart disease, stroke, lung disease, diabetes and 15 different types of cancer to dementia, smoking blights lives.

Smoking remains Britain’s biggest preventable killer, resulting in about 80,000 deaths a year, and is a major driver of socioeconomic and geographic inequalities. Passive smoking of second-hand smoke, including by children, damages health for life. The NHS carries the burden of trying to undo some of the damage smoking causes.

Parliament is about to debate a bill which will, if passed, produce enormous public health benefit and, we hope, lead to a smoke-free generation.

At the same time, it will help to ensure the flagrant marketing of vapes to children using colours, flavours and packaging is reduced. The overwhelming majority of doctors, nurses and other healthcare workers, who have seen the misery nicotine addiction causes, will support this bill.

Vapes can help smokers quit. But if you don’t smoke, our advice is don’t vape — and marketing of vapes to children is utterly unacceptable.

We strongly encourage MPs and peers from all four nations and all political parties to support a smoke-free generation and restrictions of marketing of vapes to children.

Signed:
Current Chief Medical Officers
Professor Sir Chris Whitty, Chief Medical Officer for England
Professor Sir Michael McBride, Chief Medical Officer for Northern Ireland
Professor Sir Gregor Smith, Chief Medical Officer for Scotland
Professor Sir Frank Atherton, Chief Medical Officer for Wales

Former Chief Medical Officers
Professor Dame Sally Davies, Former Chief Medical Officer for England
Professor Sir Liam Donaldson, Former Chief Medical Officer for England
Professor Sir Kenneth Calman, Former Chief Medical Officer for England and Scotland.
Dr Henrietta Campbell, Former Chief Medical Officer for Northern Ireland
Dr James McKenna, Former Chief Medical Officer for Northern Ireland
Professor Catherine Calderwood, Former Chief Medical Officer for Scotland
Professor Aileen Keel, Former Chief Medical Officer for Scotland
Professor Sir Harry Burns, Former Chief Medical Officer for Scotland
Dr Ernest Macalpine Armstrong, Former Chief Medical Officer for Scotland
Sir David Carter, Former Chief Medical Officer for Scotland
Dr Ruth Hussey, Former Chief Medical Officer for Wales
Dr Tony Jewell, Former Chief Medical Officer for Wales
Dr Ruth Hall, Former Chief Medical Officer for Wales
Dame Deirdre Hine, Former Chief Medical Officer for Wales
Current Deputy Chief Medical Officers
Professor Thomas Waite, Deputy Chief Medical Officer for England
Dr Jeanelle DeGruchy, Deputy Chief Medical Officer for England
Dr Aidan Fowler, Deputy Chief Medical Officer for England
Professor Lourda Geoghegan, Deputy Chief Medical Officer for Northern Ireland
Dr Naresh Chada, Deputy Chief Medical Officer for Northern Ireland
Professor Marion Bain, Deputy Chief Medical Officer for Scotland
Professor Nicola Steedman, Deputy Chief Medical Officer for Scotland
Professor Graham Ellis, Deputy Chief Medical Officer for Scotland
Professor Chris Jones, Deputy Chief Medical Officer for Wales.

https://www.thetimes.co.uk/article/vaping-cancer-smoking-damage-study-xwtv32fl9

 

Cigarette smoking and e-cigarette use induce shared DNA methylation changes linked to carcinogenesis

Cancer Res. 2024 Mar 19. Online ahead of print.

Chiara Herzog, Allison Jones, Iona Evans, Janhavi R Raut, Michal Zikan, David Cibula, Andrew Wong, Hermann Brenner, Rebecca C Richmond, Martin Widschwendter

 

Abstract

 

Tobacco use is a major modifiable risk factor for adverse health outcomes, including cancer, and elicits profound epigenetic changes thought to be associated with long-term cancer risk. While electronic cigarettes (e-cigarettes) have been advocated as harm reduction alternatives to tobacco products, recent studies have revealed potential detrimental effects, highlighting the urgent need for further research into the molecular and health impacts of e-cigarettes. Here, we applied computational deconvolution methods to dissect the cell- and tissue-specific epigenetic effects of tobacco or e-cigarette use on DNA methylation (DNAme) in over 3,500 buccal/saliva, cervical, or blood samples, spanning epithelial and immune cells at directly and indirectly exposed sites. The 535 identified smoking-related DNAme loci (CpGs) clustered into four functional groups, including detoxification or growth signaling, based on cell type and anatomical site. Loci hypermethylated in buccal epithelial cells of smokers associated with NOTCH1/RUNX3/growth factor receptor signaling also exhibited elevated methylation in cancer tissue and progressing lung carcinoma in situ lesions, and hypermethylation of these sites predicted lung cancer development in buccal samples collected from smokers up to 22 years prior to diagnosis, suggesting a potential role in driving carcinogenesis. Alarmingly, these CpGs were also hypermethylated in e-cigarette users with a limited smoking history. This study sheds light on the cell type-specific changes to the epigenetic landscape induced by smoking-related products.

 

https://aacrjournals.org/cancerres/article/doi/10.1158/0008-5472.CAN-23-2957/741851/Cigarette-smoking-and-e-cigarette-use-induce

 

Note: Open Access. A PDF of the Times article with graphics and current poll results is available upon request.

 

 

 

“Atlantic City casino workers have tried unsuccessfully for years to persuade New Jersey lawmakers to outlaw smoking on gambling floors. [Last] Friday morning, they took their efforts to court. In a lawsuit filed in State Superior Court in Mercer County, groups representing thousands of casino employees accused state legislators of giving special treatment to casino owners by allowing them to let people smoke inside their facilities. The state has allowed casinos to “knowingly force employees to work in toxic conditions,” the workers argued in court documents, and as a result, casino workers have experienced “life-threatening illness and death.”” [Erin Nolan. You Can Still Smoke in Atlantic City Casinos. Workers Want to Ban It, New York Times. Ed. Note: See below for two SHS papers by James Repace.]

 

“The American College of Cardiology has some bad news for e-cigarette users after a new study found that those who vape are 19% more likely to develop heart failure compared to their non-vaping counterparts. Researchers used data from a National Institutes of Health (NIH) study, including surveys and electronic health records, to assess potential correlations between heart failure diagnoses and e-cigarette use in over 175,000 patients… Marketing campaigns for vaping have appealed to younger audiences in recent years, touting flavors like cotton candy, marshmallow and bubble gum to entice potential buyers, similar to decades-long advertisements. Over the years, though, advertisements for traditional cigarettes have dwindled as experts have increasingly sounded the alarm over their potential side effects.” [Taylor Penley. Smoking cigarettes can destroy lungs, but shocking new study reveals why vaping can harm the heart, Fox News. See also: Study Links E-Cigarette Use with Higher Risk of Heart Failure, American College of Cardiology]

 

“A Go Smoke Free spokesman said: …“The new disposable vape ban should help to discourage children from taking up vaping, while encouraging adults to shift to more sustainable alternatives, such as refillable vapes.”… Ministers are seeking to draw up measures which will stop children from taking up the habit, while ensuring that they do not deter the use of e-cigarettes as a route to quit smoking… A Cancer Research UK study found that between January 2021 to August 2023, the prevalence of disposable e-cigarette use grew from 0.1 per cent to 4.9 per cent of the adult population. The proportion of those aged 18 to 24 using disposable vapes was significantly higher at 14.4 per cent, including 7.1 per cent who did not have a history of smoking tobacco.” [Alex Barton. The town named the vape shop capital of the UK, The Telegraph]

 

“A leading medical information company has been urged to cancel a series of new education courses on smoking cessation funded by the tobacco industry giant Philip Morris International (PMI). Physicians and academics have rounded on Medscape for partnering with PMI on five courses launched in the past few months, and they have called for stricter oversight by certification bodies. Anna Gilmore, professor of public health and director of the Tobacco Control Research Group at the University of Bath, UK, said that Medscape had “now lost all credibility and has some serious questions to answer. PMI lost all credibility decades ago, despite its ceaseless and highly misleading attempts to rehabilitate its image. It has now sunk to a new low.” Medscape has temporarily taken down some of the courses while it carries out a review, but it told The BMJ that it had so far “found no evidence of deviation from Medscape’s strict quality and integrity standards.”…

 

““The support for the use of smokeless tobacco products and e-cigarettes in the content aligns with the corporate objectives of Philip Morris International,” [Pamela Ling, director of the Center for Tobacco Control Research and Education at the University of California San Francisco] said. “The tobacco industry has an exceedingly well documented history of denying and distorting scientific evidence, and it has no place in medical education… Robert Jackler, Sewall professor emeritus at the Stanford University School of Medicine in California, said, “I’ve been a physician for over 40 years. I don’t ever remember the tobacco industry sponsoring . . . certified physician education.”… He highlighted a slide of the courses that stated, “The health goal for all smokers should be smoke free, not tobacco/nicotine abstinent.” Jackler commented, “Only purveyors of tobacco products would make such a ridiculous assertion. The health goal is not switching to another PMI product line but rather to break nicotine addiction and thus halt all use of tobacco products.””

 

BMJ Investigation

Exclusive: Outcry as Philip Morris International funds smoking cessation courses on Medscape

BMJ 2024;385:q830 (Published 09 April 2024)

Hristio Boytchev

https://www.bmj.com/content/385/bmj.q830

https://www.bmj.com/content/bmj/385/bmj.q830.full.pdf

 

Note: Open Access.

 

“To date, 66 countries have implemented what are considered best-practice TAPS [tobacco advertising, promotion and sponsorship] bans, protecting almost 2 billion people and, according to Andrew Black, team leader for development assistance at the WHO FCTC Secretariat, they have significantly decreased smoking uptake and prevalence, particularly among young people. Unfortunately, as digital media content and the platforms designed to support their dissemination have continued to evolve, tobacco companies and other nicotine purveyors have found ways to get round the bans, notably by using social media platforms.

 

““Many of the bigger social media platforms and search engines have banned direct promotion, but tobacco companies have just slipped below the surface,” says [University of Sydney Professor Becky] Freeman. “For example, they might use Facebook web pages featuring ‘lifestyle’ content that seeks to normalize tobacco and nicotine consumption by depicting young people smoking or vaping.”… For Freeman, regulatory tightening cannot come too soon. “There has been this narrative that nothing can be done,” she says. “But there is a lot that government can do, as we have shown in Australia.””

 

Editorial

Countering the influence of tobacco

Bull World Health Organ. 2024 Apr 1; 102(4): 230–231.

Published online 2024 Apr 1.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10976864/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10976864/pdf/BLT.24.020424.pdf

 

Note: Open Access.

 

“The study was a cross-sectional descriptive analysis of tobacco expenditure from the Smoking Toolkit Study (STS) matched to income and smoking prevalence data for English local authorities… The total dividend in England is estimated to be £10.9 billion each year, which equates to £1776 per person who smokes or £246 per adult regardless of smoking status… Conclusions This study has estimated that local economies could gain a substantial dividend if everybody stopped smoking, which is larger in lower income areas, meaning that geographical economic inequalities could be reduced… Conclusions: This study has estimated that local economies could gain a substantial dividend if everybody stopped smoking, which is larger in lower income areas, meaning that geographical economic inequalities could be reduced.”

 

Potential smoke-free dividend across local areas in England: a cross-sectional analysis

Tobacco Control Published Online First: 20 March 2024.

Damon Morris, Duncan Gillespie, Martin J Dockrell, Mark Cook, Marie Horton, Jamie Brown, Tessa Elisabeth Langley

https://tobaccocontrol.bmj.com/content/early/2024/02/05/tc-2023-058264

https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2024/02/05/tc-2023-058264.full.pdf

 

Also:

 

Industry Watch: Marlboro Man goes artisanal?

https://tobaccocontrol.bmj.com/content/early/2024/04/02/tc-2024-058645

https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2024/04/02/tc-2024-058645.full.pdf

Across the world availability of flavour accessories for tobacco products

https://tobaccocontrol.bmj.com/content/early/2024/04/05/tc-2023-058255

https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2024/04/05/tc-2023-058255.full.pdf

 

Note: Open Access.

 

Related coverage:

 

Quitting smoking could redirect £11bn a year into local economies, study says

https://www.theguardian.com/society/2024/apr/08/quitting-smoking-could-redirect-11bn-a-year-into-local-economies-study-says

 

“This study investigates the health problems reported by 162 nonsmoking residents residing in 104 multiunit apartments in 71 municipalities in 19 U.S. States and the District of Columbia, plus 2 Canadian Provinces… Nonsmokers complained of eye, nose, throat, and lung irritation, headache, dizziness, nausea, difficulty in breathing, tachycardia, and asthmatic attacks as well as malodors. Many sought medical care and some were hospitalized. Some regarded their apartments as uninhabitable. About 12% resorted to litigation… Conclusions: Secondhand smoke infiltration from smokers’ apartments into nonsmokers’ apartment units in multiunit housing can provoke major morbidity for nonsmoking residents. Nonsmokers’ efforts to eliminate infiltration by sealing of cracks, air cleaning, or increased ventilation proved futile. Building owners and managers need to be educated about protecting nonsmoking residents’ health and welfare from secondhand smoke infiltration. Smoking of tobacco and marijuana products in multiunit housing should be banned.”

 

Secondhand smoke Infiltration in multiunit housing: Health effects and nicotine levels

Indoor Environments

Volume 1, Issue 2, June 2024, 100013

Available online 26 March 2024, Version of Record 3 April 2024.

James L. Repace

https://www.sciencedirect.com/science/article/pii/S2950362024000109

 

Note: Open Access.

 

“Ms. PJM’s modeled exposure to fine particulate matter from secondhand smoke ranged from the Hazardous to Significant Harm Levels of the EPA Air Quality Index for fine particles (PM2.5). Her modeled dose of serum cotinine ranged from the 90th to beyond the 95th percentile of nonsmokers’ dose, measured in a statistical sample of the U.S. nonsmoking population. Her estimated risk exceeds OSHA’s Significant Risk of Material Impairment of Health Level by a factor of three. She is estimated to have been exposed to the thirdhand smoke of at least 1.4 million cigarettes outgassing from room surfaces during her 20 years of labor… Conclusions: As a result of her occupational exposure to secondhand and thirdhand smoke, Ms. PJM [who had been employed as a motel maid cleaning rooms for 20 years] lost an estimated 33 years of life expectancy. The State of California has been remiss in failing to extend its workplace smoking ban to hotels and motels, leaving their workstaff at grave risk of the manifold diseases of passive smoking.”

 

Case Report

Forensic Analysis of Lung Cancer from Secondhand Smoke Exposure of a Motel Worker

European Society of Medicine

Vol 12 No 3 (2024): March issue, Vol.12, Issue 3

Published Mar 26, 2024

James L. Repace

https://esmed.org/MRA/mra/article/view/5120

https://esmed.org/MRA/mra/article/view/5120/99193547825

 

Note: Open Access.

 

“The study subjects were patients aged ≥20 years undergoing surgery from December 2021 to September 2022 who completed spirometry and reported tobacco (cigarette and HTP [heated tobacco product]) use status during the preoperative assessment… Conclusion: Current HTP use was associated with airway obstruction among patients with cancer who had completely switched from cigarettes even after quitting smoking for a long period. Patients should be routinely screened for HTP use and advised to quit any tobacco.”

 

Association between heated tobacco product use and airway obstruction: a single-centre observational study, Japan

BMJ Open Respir Res. 2024 Mar 9;11(1):e001793.

Satomi Odani, Shihoko Koyama, Isao Miyashiro, Hironobu Tanigami, Yoshifumi Ohashi, Takahiro Tabuchi

https://bmjopenrespres.bmj.com/content/11/1/e001793.long

https://bmjopenrespres.bmj.com/content/bmjresp/11/1/e001793.full.pdf

 

Note: Open Access.

 

 

 

"Tobacco companies still actively target young people via social media, sports and music festivals and new, flavoured products, the World Health Organization (WHO) said [last] Thursday, accusing companies of trying to hook a new generation on nicotine. Amid ever-stricter regulation targeting cigarettes, big tobacco companies and new entrants have begun offering smoking alternatives such as vapes, which they say are aimed at adult smokers. But the WHO said these products' are often marketed to youth… "History is repeating itself, but in a different form. The same nicotine with a different packaging," said Tedros Adhanom Ghebreyesus, the WHO's director-general." [No author. Tobacco and nicotine industry 'hooking the next generation,' WHO report says, CBC News/Thompson Reuters. See also: Tobacco industry ‘aggressively’ targeting youth with ‘manipulative’ tactics: WHO, Global News (Canada); Tobacco and nicotine industry tactics addict youth for life, WHO; Report: Hooking the next generation: how the tobacco industry captures young customers, WHO]

 

"Disposable e-cigarettes have led to a tripling of vaping in young adults and reversed a historic fall in nicotine use, a new study shows. Researchers at University College London found that 29 per cent of people aged 18 to 24 in England used vapes in May 2023, up from 9 per cent in May 2021. This surge coincided with the arrival of single-use e-cigarettes, such as Elf Bars, which are cheap and often come in bright colours and fruity flavours. Although smoking rates have declined, the popularity of disposable vapes mean that overall nicotine use has increased among young adults — many of whom who would “otherwise have avoided nicotine entirely”." [Eleanor Hayward. Disposable e-cigarettes lead to tripling of vaping in young adults, The Times. See below: Lancet study]

 

"Rishi Sunak's flagship bill to eventually ban smoking looks set to be shelved after he called a surprise July general election. The prime minister would not guarantee the law would pass before Parliament [shut] down for the election [last] Friday. Talks between the government and opposition parties over which bills to rush through before then are ongoing. Labour has previously pledged to bring in the ban if it wins power at the election on Thursday 4 July. Mr Sunak also remains committed to creating a "smoke-free generation" and the ban is likely to feature in the Conservative manifesto." [Paul Seddon, Vicki Young. Rishi Sunak's smoking ban bill set to be shelved due to election, BBC News. See also: Video: Sunak 'disappointed' smoking ban bill did not get through, BBC News; Will banning cigarettes create a smoke-free generation?, New Statesman. See below: Science Editorial]

 

"For months now, Cancer Research UK has been campaigning in favour of the Tobacco and Vapes Bill, and I had been quietly optimistic that my son and his friends would be forever protected from a lifetime of addiction to tobacco. But this week, that all changed. When the general election was called by the prime minister, hard-won progress on the bill was brought to a grinding halt. And now, as the bill slips through the cracks during wash-up, we are heading back to square one… I want my son to live in a world where cancers caused by smoking are a thing of the past. Our political leaders want the same for their children, too. I implore them to think not just about the next five years they might potentially spend in office, but to look beyond to the future. Failure to do so would be a betrayal of an entire generation. " [Michelle Mitchell, Chief Executive, Cancer Research UK. Abandoning the Tobacco and Vapes Bill would betray a generation, Politics.co.uk]

 

"Last fall, [former tobacco control activist Cliff] Douglas announced he was taking the helm of the Foundation for a Smoke-Free World, an organization with the stated goal to “end smoking in this generation.” Philip Morris International, which sells cigarettes globally but not in the United States, has been the foundation’s sole funder since its inception in 2017…. Douglas said that PMI had no role in his hiring, and that he was selected by the foundation’s wholly independent board of directors. He negotiated a split with PMI before taking the job, though the foundation will likely be dependent on its funding for some time thanks to a $140 million final payment. He also is renaming the organization, which… will be called Global Action to End Smoking… “We are public health, pure and simple,” Douglas said." [Nicholas Florko. After decades fighting Big Tobacco, Cliff Douglas now leads a foundation funded by his former adversaries, STAT News]

 

" Pre-disposables, vaping and smoking prevalence had been stable or declining across all age groups. However, post-disposables, the odds of current vaping increased by 99% per year among 18 to 24-year-olds (odds ratio [OR] = 1.99; 95% confidence interval [CI] = 1.71 to 2.31), compared with 39% (OR = 1.39; 95% CI = 1.26 to 1.52) in 25 to 44-year-olds and 23% (OR = 1.23; 95% CI = 1.12 to 1.35) in those aged 45 or older… Interpretation: Since disposable vapes started becoming popular in England, historic declines in nicotine use have reversed. Now, nicotine use appears to be rising, driven primarily by sharp increases in vaping among young people. Smoking declines have been most pronounced in age groups with the largest increases in vaping."

 

Trends in vaping and smoking following the rise of disposable e-cigarettes: a repeat cross-sectional study in England between 2016 and 2023

Lancet Global Health

Published: May 23, 2024

Harry Tattan-Birch, Jamie Brown, Lion Shahab, Emma Beard, Sarah E. Jackson

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(24)00091-7/fulltext

 

Note: Open Access.

 

Related coverage:

 

Disposable e-cigarettes lead to tripling of vaping in young adults

https://www.thetimes.co.uk/article/disposable-e-cigarettes-lead-to-tripling-of-vaping-in-young-adults-0m8p38dp2

 

"Politicians fueled by tobacco industry lobbying argue that sunset laws are paternalist, undermining freedom of choice. Yet smoking is far from a free choice. Most smokers want to stop, but seductive marketing and packaging disguise severe harms, and deliberately elevated nicotine levels drive compulsive use. Governments have no moral or legal justification to allow the wide availability of a deadly product that their own health agencies warn against using. The truth is that there is no safe age to start smoking. Preventing tobacco dependency, beginning with young people, would garner huge public support."

 

Editorial

Pursuing a smoke-free generation

SCIENCE

23 May 2024 Vol 384, Issue 6698 p. 829

LAWRENCE O. GOSTIN

https://www.science.org/doi/10.1126/science.adq5006

 

Note: Open Access.

 

 

"Introduced as battery-powered sticks that emit nicotine-infused vapor, vape pens have transformed into increasingly sophisticated entertainment devices. And that, researchers say, is a potentially huge problem. Disposable vapes gained small illuminated displays last year, typically to show how much battery life remained. In about six months, though, the displays grew to the size of a flip phone screen and came equipped with retro games similar to Pac-Man and Tetris — on a product that costs less than $20. The speed at which vapes advanced to include an interactive display, as well as the devices’ potential appeal to young people, is raising concerns about nicotine addiction among teenagers, say UC Riverside researchers Man Wong and Prue Talbot…

 

"The catalyst for this new generation of vapes, Wong said, was Geek Bar Pulse, a vape that had the first full-length screen... Researchers still aren’t sure what the health effects of vapes are. In the absence of clear guidance, users will generally assume the devices are not as bad as cigarettes “because they don’t have as many chemicals,” Talbot said. In truth, she said, vapes and e-cigarettes “have different chemicals, and some of those chemicals are toxic, and we don’t know exactly what the long-term effects are.”" [Karen Garcia. ‘Smart vapes’ featuring video games could lure youths to nicotine addiction, UC Riverside experts say, LA Times]

 

"Thousands of teachers from across England are warning that vaping in schools is causing widespread issues with children's behaviour and health. Teaching union NASUWT [National Association of Schoolmasters Union of Women Teachers] commissioned a survey of 4,000 teachers - and more than 85% of them warned vaping on school premises is causing problems. It comes as a Bath Professor who tested vapes in 30 schools in England found Spice and THC present in vapes in 25 of those schools. He is now fearful a child will die this summer holiday because their vape is unknowingly laced with Spice." [No author. Vapes in schools: The scale of the issue revealed with kids as young as five vaping, ITV; See also: ‘We’re going to see a death’ - stark warning as vapes spiked with Spice in England's schools, ITV]

 

"British American Tobacco (BAT) shares rose almost 3% in early Thursday [July 25] trade as it beat first-half profit forecasts and investors latched on to some positives at its key U.S. business. The maker of Lucky Strike and Dunhill cigarettes made over 40% of its revenues in the United States in 2023, mostly from tobacco, though it is also trying to grow income from smoking alternatives. But the company has struggled in this key market as under-pressure consumers have been swapping from its more expensive cigarette brands to cheaper alternatives or e-cigarettes. BAT's e-cigarettes have lost share to a flood of illegal disposable vapes." [Emma Rumney. BAT shares climb as first-half results fuel US optimism, Reuters ; See also: BAT Warns New Products Are Unlikely to Make £5 Billion in 2025, Bloomberg News]

 

"When I set out to write a medical memoir chronicling my seven-year battle with lung cancer, I wanted to provide a road map and reassurance for fellow sufferers, whether at the moment of diagnosis or while undergoing treatment… I soon realized that I would have to include the whole truth if I hoped to save anyone other than myself. My three primary cancers were very likely the result of a thirty-year history of cigarette smoking… What is the source of my reluctance to include the information? Stigma… For many people, it seems easier to empathize with someone who is ill through no apparent fault of their own. However, all afflicted individuals need our compassion and support to make the lifestyle changes or treatment choices necessary to alter their health outcomes." [Jan Pezarro. My Ten-Year-Old Daughter Tried to Warn Me, but Nothing Prepared Me for My Diagnosis, Newsweek]

 

"In 2017, tobacco companies spent around $1 million every hour to promote cigarettes and smokeless tobacco in the US. That same year, they were also mandated to sponsor and disseminate Federal court ordered Corrective Statements (CSs) advertisements in outlets such as newspapers and major television networks. Thus, it is crucial to monitor the marketing activities of the tobacco industry to bolster effective tobacco control efforts… Between 2009 and 2018, the total adjusted cigarette marketing expenditures exhibited no significant changes… In response to marketing regulations, tobacco companies shifted their funds to less regulated channels. In 2018, a significant portion of promotional expenditures were directed toward various price discounts, which could potentially expose vulnerable children and youths to cigarette marketing."

 

Comparative analysis of tobacco industry cigarette marketing expenditures in the United States, 2009–2018

Humanities and Social Sciences Communications volume 11, Article number: 957 (2024)

Published: 26 July 2024

Shaikha AlDukhail & Israel T. Agaku

https://www.nature.com/articles/s41599-024-03445-z

 

Note: Open Access.

 

"In 2022, the majority of the 28.8 million U.S. adults who smoked cigarettes wanted to quit, approximately one half tried to quit, but fewer than 10% were successful. Fewer than 40% of adults who smoked used treatment (counseling or medication) when trying to quit; one half received clinician advice or assistance to quit. Compared with adults who smoked nonmenthol cigarettes, those who smoked menthol cigarettes had similarly low quit success despite a higher quit attempt prevalence, potentially related to their lower treatment use."

 

Adult Smoking Cessation — United States, 2022

MMWR Weekly / July 25, 2024 / 73(29);633–641

Brenna VanFrank, Ann Malarcher, Monica E. Cornelius, Anna Schecter. Ahmed Jamal, Michael Tynan

https://www.cdc.gov/mmwr/volumes/73/wr/mm7329a1.htm

https://www.cdc.gov/mmwr/volumes/73/wr/pdfs/mm7329-H.pdf

 

Note: Open Access.

 

Related coverage:

 

Study finds that despite wanting to quit, only 8.8 percent quit smoking in 2022

https://medicalxpress.com/news/2024-07-percent.html#google_vignette

 

"We compared cigarette smoking and use of electronic cigarettes (vaping) among 4,975 cases with lung cancer to 27,294 control subjects without cancer… We found that vaping combined with cigarette smoking was eight times more common in the cases with lung cancer than the control subjects, and the risk of developing lung cancer was four times higher among those who combined vaping and cigarette smoking than those who only smoked.  These findings were consistent for men and women and for all major cell types of lung cancer.  Our results suggest that vaping in combination with cigarette smoking accelerates the rate of developing lung cancer compared to smoking alone."

 

Vaping, Smoking and Lung Cancer Risk

J Oncol Res Ther 9: 10229.

Bittoni MA, Carbone DP, Harris RE

https://www.gavinpublishers.com/article/view/vaping-smoking-and-lung-cancer-risk

https://www.gavinpublishers.com/assets/articles_pdf/Vaping-Smoking-and-Lung-Cancer-Risk.pdf

 

Note: Open Access.

 

Related coverage:

 

Smoking & Vaping Together Raise Lung Cancer Risks Even Higher

https://www.usnews.com/news/health-news/articles/2024-08-02/smoking-vaping-together-raise-lung-cancer-risks-even-higher

 

"This randomized crossover clinical trial that included 50 adult e-cigarette users who preferred using a salt-based, high-nicotine concentration of 5% found that partial nicotine reduction significantly increased users’ topography parameters, including puffing time, puff duration, and inhalation volume. Meaning  Results of this study provide evidence of compensatory puffing behavior among current e-cigarette users in this population when partial nicotine reduction is applied, suggesting that at least for current e-cigarette users, partial nicotine reduction can lead to enhanced exposure to some toxicants in the short [term]."

 

Partial Nicotine Reduction and E-Cigarette Users’ Puffing Behaviors Among Adults Aged 21 to 35 Years

A Randomized Crossover Clinical Trial

JAMA Netw Open. 2024;7(7):e2422954.

July 26, 2024

Tarana Ferdous, Simanta Roy, Sreshtha Chowdhury, Rime Jebai, Leonardo Maya, Anthony P. DeCaprio, Zoran Bursac, Wasim Maziak

https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2821557

 

Related Invited Commentary:

 

Lowering Nicotine Levels to Reduce Dependence on E-Cigarettes—Promising yet Complicated

https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2821564

 

Note: Open Access.

 

Relevant NEJM Correspondence:

 

An Exchange about “Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes”

https://evidence.nejm.org/doi/full/10.1056/EVIDe2400220

 

"In this cohort study of 1985 adults who smoked cigarettes and used e-cigarettes, use of e-cigarettes in 2019 to 2021 vs 2014-2015 to 2015-2016 and daily use of e-cigarettes vs nondaily use were associated with greater overall cigarette discontinuation rates. Meaning: These results suggest that public health policy decisions regarding e-cigarettes should be based on data from e-cigarettes marketed in recent years that have evolved outside the regulated market."

 

E-Cigarette Characteristics and Cigarette Cessation Among Adults Who Use E-Cigarettes

JAMA Netw Open. 2024;7(8):e2423960.

August 1, 2024

Karin A. Kasza, Cheryl Rivard, Maciej L. Goniewicz, Geoffrey T. Fong, David Hammond, K. Michael Cummings, Andrew Hyland

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821816

 

Note: Open Access.

 

Related PR:

 

Daily Use of E-Cigarettes Linked to Higher Cigarette Quit Rates, Roswell Park Research Shows

https://www.roswellpark.org/newsroom/202408-daily-use-e-cigarettes-linked-higher-cigarette-quit-rates-roswell-park-research

More E-Cig Use Linked to Greater Chances of Quitting Smoking

https://www.medpagetoday.com/pulmonology/smoking/111339

 

"Using data from the State and National Youth Risk Behavior Surveys, we find that the adoption of an ENDS [electronic nicotine delivery systems] flavor restriction reduces frequent and everyday youth ENDS use by 1.2 to 2.5 percentage points. Auxiliary analyses of the Behavioral Risk Factor Surveillance System show similar effects on ENDS use for young adults ages 18-20. However, we also detect evidence of an unintended effect of ENDS flavor restrictions that is especially clear among 18-20-year-olds: inducing substitution to combustible cigarette smoking. Finally, there is no evidence that ENDS flavor restrictions affect ENDS use among adults aged 21 and older or non-tobacco-related health behaviors such as binge drinking and illicit drug use."

 

The Effect of E-Cigarette Flavor Bans on Tobacco Use

NBER WORKING PAPER 32535

ISSUE DATE June 2024

Chad D. Cotti, Charles J. Courtemanche, Yang Liang, Johanna Catherine Maclean, Erik T. Nesson & Joseph J. Sabia

https://www.nber.org/papers/w32535

https://www.nber.org/system/files/working_papers/w32535/w32535.pdf

 

Note: Open Access.

 

Related coverage:

 

Flavored Vape Bans Led to Increase in Teen Smoking: Study

https://www.newsweek.com/flavored-vape-bans-teen-smoking-1910815

 

Ed. Note: The Newsweek story claims the study "was funded with a grant from Global Action to End Smoking, an independent, U.S. nonprofit organization" but, of course, the independence of GAES is questionable at best given it's the rebranded Foundation for a Smoke-Free World (FSFW), founded and funded by Philip Morris International (PMI).

 

"TNE [Total nicotine equivalents], NNAL [4-(methylnitrosamino)-1–3-(pyridyl)-1-butanol], and Cd [cadmium] were higher in cases than controls (adjusted for age, race, sex, body mass index, and cigarettes per day). Among cases, these levels were higher in African Americans compared with Whites. After accounting for age, sex, body mass index, and pack-years, a one-SD increase in log-TNE (OR = 1.30; 95% CI, 1.10–1.54) and log-NNAL (OR = 1.27; 95% CI, 1.03–1.58 with TNE adjustment) was associated with lung cancer risk. In this study, in which NNAL concentration is relatively high, the association for log-TNE was attenuated after adjustment for log-NNAL… Impact: Urinary NNAL, TNE, and Cd concentrations in current smokers, particularly African American smokers, may be useful for predicting lung cancer risk."

 

Association of Urinary Biomarkers of Tobacco Exposure with Lung Cancer Risk in African American and White Cigarette Smokers in the Southern Community Cohort Study

Cancer Epidemiol Biomarkers Prev (2024) 33 (8): 1073–1082.

Sharon E. Murphy, Cherie Guillermo, Nicole M. Thomson, Steven G. Carmella, Milo Wittmann, Melinda C. Aldrich, Qiuyin Cai, Shannon M. Sullivan, Daniel O. Stram, Loïc Le Marchand, Stephen S. Hecht, William J. Blot, S. Lani Park

https://aacrjournals.org/cebp/article-abstract/33/8/1073/746518/Association-of-Urinary-Biomarkers-of-Tobacco

 

"Tobacco companies have capitalized on the Olympics’ widespread cultural impact since the birth of the modern Olympic Games in 1896—until the practice was stopped in 1987. A new online exhibition by The University of Alabama Center for the Study of Tobacco and Society explores this history with archival print and film advertisements from 1910 to 1988… In a 1935 ad in the Saturday Evening Post, Olympic high-diving champion Harold “Dutch” Smith states, “Camels don’t get your wind.” And in a 1960 ad featured in Ebony magazine, Olympic 400 meter champion George Rhoden holds a cigarette against the backdrop of an Olympic track with the quote, “Kent is my favorite, too.” While this year’s Olympic Games in Paris will be completely tobacco-free—all Olympics Games have been smoke-free since 1988 and tobacco-free since 2010—these archival images provide a surreal window into a century of shared history between tobacco companies and the world’s greatest athletes."

 

Before the Olympics were smoke-free, tobacco brand deals ran rampant

Cancer Letter

July 26, 2024 Vol.50 No.30

https://cancerletter.com/in-the-archives/20240726_5/

 

See also:

 

Smoke rings: Tobacco and the Olympics

https://cancerhistoryproject.com/

 

 

"In response to growing concerns about the rising use of nicotine replacement therapies (NRTs) among youth, particularly nicotine pouches, Health Minister Mark Holland is putting through restrictions aimed at curbing their appeal and accessibility. These measures, which will take effect [tomorrow] Aug. 28, include strict advertising restrictions, prohibiting certain flavours and limiting sales to behind the counter at pharmacies… “As of next Wednesday, there’s a couple of things that are going to happen. The first is these products are going to be moved behind the counter, [Holland said]… “The second thing is these nonsense flavours targeting our kids are gone … so Tropical Breeze and Cool Berry Splash … whatever they have, it’s over. Those products will be recalled and unavailable.”" [Katie Dangerfield. Canada restricts sale of nicotine pouches. Here’s what’s changing, Global News]

 

"Cigarette smoking in the United States hit an historic low this year, according to Gallup, which has been monitoring smoking trends for eight decades. The latest survey, based on Gallup's annual Consumption Habits poll conducted in July, shows 11% of U.S. adults said they smoked cigarettes in the past week. That matches Gallup's other lowest outcome in 2022, and comes close to the 12% smoking trend in 2023. In 1944, when Gallup first questioned Americans about cigarettes, 41% of adults said they had smoked. Smoking peaked in 1954 with 45% of respondents admitting they had recently lit-up a cigarette. By the late 1980s, the smoking rate had declined but was still more than three times what it is today." [Sheri Walsh. Cigarette smoking hits 80-year low in U.S., UPI]

 

"Last month, Philip Morris International beat estimates, and CEO Jacek Olczak credited it to “the excellent momentum of our smoke-free business,” including its most popular U.S. smokeless product, Zyn. The company also announced that annual sales of Zyn would reach around 580 million cans, reflecting roughly 50 percent growth over last year. Meanwhile, on TikTok, creators have been showing off their “lip pillows” (i.e., pouches tucked into their gums), tossing tins to their favorite musicians onstage and leaning hard into words and phrases such as Zynfluencer, Zynful moments and Zynbabwe. The hype has led to a nationwide Zyn shortage, with some convenience stores hanging signs outside telling their customers whether they have any in stock. In response, Philip Morris announced plans to build a new $600 million factory in Colorado to help meet demand." [Shane O’Neill. How Zyn became ‘in’ amid right-wing fervor for nicotine, Washington Post]

 

"The percentage of smokers who are using vapes as well as smoking cigarettes has also nearly doubled in the past three years, while ex-smokers who turn to e-cigarettes to quit are using them for longer… The Smokefree GB analysis, conducted by Action on Smoking and Health (Ash) and based on data collected by YouGov for the public health charity, estimates 11% of the adult population in Britain vape, the equivalent of 5.6 million people and the highest rate ever." [Storm Newton. Proportion of British adults vaping at its highest level, analysis finds, The Independent]

 

"Carlsbad, a surfing hot spot near San Diego, has decided to prohibit people from lighting up inside apartments, condos and other shared buildings where multiple families live. From January residents will not be able to smoke or vape cannabis and nicotine products indoors or on balconies, porches and decks. The law does not apply to single-family homes or hotels and motels…At least 84 of California’s 483 municipalities — including Beverly Hills, Cupertino and Pasadena — have enacted similar bans in multi-family private residences, according to the American Nonsmokers’ Rights Foundation." [Keiran Southern. No smoking in your own home, California city orders residents, The Times]

 

"Tobacco’s stubborn resistance to public-health common sense is an all-too-predictable story. Companies that profit from harmful or unhealthy products—from ultra-processed foods to prescription opioids to social media—often follow a familiar playbook of misdirection and denial to extend their sales for as long as they can. Their strategies can be so effective that public perception takes decades to catch up, fueling public-health crises that seem almost impossible to control. Companies often manufacture doubt just as effectively as they manufacture unhealthy products." [Jonathan Quick, Gavin Yamey and Eszter Rimányi. Products Can Harm People for Decades Before Companies Change. Here’s How to Stop Them, Time. See also: PLoS Global Public Health study immediately below.]

 

"From the peak of consumption to the most recent data, U.S. cigarette sales fell by 82%, sugar consumption by 15%, and prescription opioid prescriptions by 62%. For each, the consumption tipping point occurred when compelling evidence of harm, professional alarm, and an authoritative public health voice and/or public mobilization overcame corporate marketing and resistance efforts. The gap between suspicion of harm and the consumption tipping point ranged from one to five decades–much of which was attributable to the time required to generate sufficient evidence of harm... To our knowledge, this is the first comparative analysis of three successful efforts to change the product consumption patterns and the associated adverse health impacts of these products. The MDE [market-driven epidemics] epidemiological approach of shortening the latent time to effective mitigation provides a new method to reduce the impacts of harmful products."

 

Dynamics of combatting market-driven epidemics: Insights from U.S. reduction of cigarette, sugar, and prescription opioid consumption

PLoS Global Public Health

Published: July 24, 2024

Eszter Rimányi, Jonathan D. Quick, Gavin Yamey, Mustapha Immurana, Vasanti S. Malik, Tanya Doherty, Zain Jafar

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0003479

 

Note: Open Access.

 

Related report & PR:

 

Products Can Harm People for Decades Before Companies Change. Here’s How to Stop Them

https://time.com/7009472/market-driven-epidemics/

How to Spot — and Stop — a Market-Driven Epidemic

https://globalhealth.duke.edu/news/how-spot-and-stop-market-driven-epidemic

 

"A deceptive and deadly marketing approach that Western tobacco companies were forced to disavow is propelling cigarette sales in China to new heights... Although cigarette packages do not actually display the words ”low tar”, they prominently display their tar content, and some incorporate the tar levels in their name. Zhongnanhai, a popular China Tobacco brand developed for the chain-smoking Chairman Mao Zedong, sells lines named “Black Eight” and “Five”—a reference to their machine-measured levels of tar in milligrams. “The Chinese state tobacco monopoly started late but is following Big Tobacco's low tar marketing strategy from the 20th century”, said Mary Assunta, a senior policy adviser at the Southeast Asia Tobacco Control Alliance. “It's not surprising smokers would choose Chinese-branded low tar cigarettes. Many smokers mistakenly think they are safer.”"

 

World Report

Low tar cigarette marketing driving a boom in sales in China

The Lancet

Volume 404, ISSUE 10453, P642-645, August 17, 2024

Jason McLure, Jude Chan

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01686-6/fulltext

 

Note: Open Access.

 

"In this crossover randomized clinical trial of 72 participants aged 21 to 25 years [in Columbus, Ohio] who used e-cigarettes, salt-based (vs freebase) nicotine resulted in higher nicotine intake after both 5-minute standardized and 30-minute ad libitum vaping, particularly at 5% (vs 1%) nicotine. Compared with freebase nicotine, nicotine salts yielded more positive subjective effects ratings and intense puffing behaviors, and menthol (vs tobacco) flavor yielded more positive subjective effects ratings. Meaning: The findings imply that salt-based nicotine formulations prevalent in the market may increase nicotine dependence among young adults already using e-cigarettes and warrant regulation."

 

E-Cigarette Nicotine Delivery Among Young Adults by Nicotine Form, Concentration, and Flavor

A Crossover Randomized Clinical Trial

JAMA Netw Open. 2024;7(8):e2426702.

August 9, 2024

Yoo Jin Cho, Toral Mehta, Alice Hinton, Ruth Sloan, Jean Nshimiyimana, Alayna P. Tackett, Megan E. Roberts, Marielle C. Brinkman, Theodore L. Wagener

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822152

 

Note: Open Access.

 

Related coverage:

 

Study reveals how salt-based nicotine and menthol flavors influence e-cigarette use in young adults

https://www.news-medical.net/news/20240814/Study-reveals-how-salt-based-nicotine-and-menthol-flavors-influence-e-cigarette-use-in-young-adults.aspx

 

"We analyzed the effects of the two major components, PG/VG [propylene glycol/ vegetable glycerin] and nicotine, on tumor development in preclinical models. We found that PG/VG promoted tumor cell migration in migration assays and contributed to more aggressive, metastatic, and immunosuppressive tumors in vivo, aggravated by the presence of nicotine… These findings suggest that the major components used in e-cigarette fluid can impact tumor development through induced immunosuppression."

 

E-cigarette exposure disrupts antitumor immunity and promotes metastasis

Front. Immunol., 15 August 2024

Marcel Arias-Badia, Chien-Chun Steven Pai, PeiXi Chen, Anthony Chang, Yee May Lwin, Aahir Srinath, Jeffrey E. Gotts, Stanton A. Glantz, Lawrence Fong

https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1444020/full

 

Note: Open Access.

 

Related J Physiol research:

 

Influence of gestational window on offspring vascular health in rodents with in utero exposure to electronic cigarettes

https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP286493

 

"We report the effects of vaping versus smoking on the oral cell methylome of healthy young vapers and smokers relative to non-users. Whereas vapers and smokers differ in number of differentially methylated regions (DMRs) (831 vs 2,863), they share striking similarities in the distribution and patterns of DNA methylation, chromatin states, transcription factor binding motifs, and pathways. There is substantial overlap in DMR-associated genes between vapers and smokers, with the shared subset of genes enriched for transcriptional regulation, signaling, tobacco use disorders, and cancer-related pathways… Our data support a potential link between epigenomic dysregulation in youth vapers and disease risk. These novel findings have significant implications for public health and tobacco product regulation."

 

Epigenomic Dysregulation in Youth Vapers: Implications for Disease Risk Assessment

Am J Respir Cell Mol Biol. 2024 Aug 12. Online ahead of print.

Stella Tommasi, Luciano Brocchieri, Silvia Tornaletti, Ahmad Besaratinia

https://www.atsjournals.org/doi/10.1165/rcmb.2024-0207OC

 

Related PR:

 

First genome-wide comparison of vapers and smokers finds similar DNA changes linked to disease risk

https://keck.usc.edu/news/first-genome-wide-comparison-of-vapers-and-smokers-finds-similar-dna-changes-linked-to-disease-risk/

 

"A 2-group randomized clinical trial was conducted with 1503 adolescent e-cigarette users, with 70.8% retention at 7 months. In intention-to-treat analysis, with missingness coded as vaping, abstinence rates were 37.8% among participants assigned to the text message intervention and 28.0% among participants assigned to assessment-only control, a statistically significant difference. No baseline characteristics moderated the treatment-outcome relationship, including nicotine dependence. Meaning: A tailored, interactive text message program increased self-reported vaping cessation rates among adolescents recruited via social media channels."

 

A Vaping Cessation Text Message Program for Adolescent E-Cigarette Users

A Randomized Clinical Trial

JAMA. Published online August 7, 2024

Amanda L. Graham, Sarah Cha, Megan A. Jacobs, Michael S. Amato, Anna L. Funsten, Giselle Edwards, George D. Papandonatos

https://jamanetwork.com/journals/jama/fullarticle/2822082

 

Note: Open Access. Related JAMA resources available upon request.

 

Related JAMA Resources & PR:

 

E-Cigarette Use in Adults

https://jamanetwork.com/journals/jama/article-abstract/2822085  

E-Cigarette Use in Adolescents and Adults—A JAMA Collection

https://jamanetwork.com/journals/jama/article-abstract/2822167

JAMA Publishes New Study on Proven Effectiveness of Truth Initiative’s Text Message Quit Vaping Program Among Teens

https://truthinitiative.org/press/press-release/jama-publishes-new-study-proven-effectiveness-truth-initiatives-text-message

 

"Maternal cigarette smoking either before pregnancy or during any trimester of pregnancy significantly increased the risk of infant SNM [severe neonatal morbidity], even at a very low intensity (ie, 1–2 cigarettes per day). For example, compared with women who did not smoke before pregnancy, the adjusted odds ratios and 95% confidence intervals (OR, 95% CI) of composite SNM in the newborn from women who smoked 1–2, 3–5, 6–9, 10–19, and ≥20 cigarettes per day before pregnancy were 1.16 (1.13 to 1.19), 1.22 (1.20 to 1.24), 1.26 (1.23 to 1.29), 1.27 (1.25 to 1.28), and 1.31 (1.30 to 1.33), respectively. Furthermore, smokers who stopped smoking during pregnancy still had a higher risk of composite SNM than never smokers before and throughout pregnancy."

 

Maternal cigarette smoking before or during pregnancy increases the risk of severe neonatal morbidity after delivery: a nationwide population-based retrospective cohort study

J Epidemiol Community Health Published Online First: 20 August 2024.

Lili Yang, Liu Yang, Huan Wang, Yajun Guo, Min Zhao, Pascal Bovet, Bo Xi

https://jech.bmj.com/content/early/2024/07/09/jech-2024-222259

 

Note: Open Access.

 

Related coverage:

 

No amount of smoking is safe during any stage of pregnancy, study finds

https://www.euronews.com/health/2024/08/21/no-amount-of-smoking-is-safe-during-any-stage-of-pregnancy-study-finds