Electronic Cigarette

The past few weeks witnessed the death of a few people who were smoking electronic cigarettes (ECs) in the United States. Deaths included different age groups, including middle-aged individuals. One of them was a 50‑year‑old woman who had a history of health problems. She became seriously ill shortly after she started using EC and her symptoms progressed rapidly. The US Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and state health departments are investigating this outbreak; however, no definitive cause could be found.

Background and aims
The rapid increase in use of electronic cigarettes (e-cigarettes) has created an international policy dilemma concerning how to use these products. This study assesses the types of beliefs that e-cigarette users in the UK may hold concerning regulation.
Design
Qualitative thematic analysis of written answers to open-ended questions.
Setting
UK, questionnaire conducted by post, 44% recruited from online forums/56% non-online.
Participants
Fifty-five UK vapers, 55% male, mean age 46, 84% sole users of e-cigarettes, 95% vaping daily.
Measurements
Open-ended questions on regulatory and policy options.
Findings
‘Protecting youth’ was seen as a fundamental regulatory requirement which should be achieved through childproofing, age limits, no advertising aimed at children and health warnings about addictiveness of nicotine, but not the restriction of flavours. There was little support for regulating e-cigarettes as medicines or limiting the strength of nicotine liquids. In terms of public use, participants argued against a blanket ban on public vaping given perceptions of a lack of scientific evidence of harm. However, they supported the principle of autonomy, that individuals and organizations have the right to restrict vaping. Some participants suggested banning vaping in places such as schools, hospitals or around food, in line with current smoking norms. Vapers’ regulatory positions were accompanied by political concerns about the use (and misuse) of scientific evidence.
Conclusions
With regard to regulation of e-cigarettes, issues that are salient to UK vapers may include the need for youth protection, regulation as medicines, strength of e-liquids, bans on public vaping and concerns about the misuse of scientific evidence.

Celebrities endorsing e-cigarette brands on social media may exert a strong influence on e-cigarette uptake. Using a between-subject experiment, this study examines the effects of endorser type (celebrities, non- celebrities and products only) in e-cigarette brand Instagram advertisements on e-cigarette attitudes and smoking intentions. Results showed that celebrity endorsers significantly increased positive attitudes towards e-cigarettes and smoking intentions, compared to non-celebrities or products only. Celebrity endorsers also rated significantly higher on trustworthiness, expertise, goodwill and attractiveness, compared to non- celebrities. Additionally, identification, social comparison, health consciousness and social networking site use moderated between endorser type and key dependent measures. Implications for e-cigarette marketing regulation are discussed.

Electronic cigarettes (e-cigarettes) are growing in popularity among young smokers in France seeking to reduce tobacco-induced harms without abandoning the small everyday pleasures and social relationships that unfold around smoking. But e-cigarettes raise ideological challenges: The World Health Organization and the French Agency for Safety of Medicine and Health Products (Agence Nationale de Sécurité du Médicament) have denied e-cigarettes the status of pharmaceutical substitution products in the cessation of smoking, while their possibilities for pleasure are seen as a threat by France’s public health council, the Haut Conseil de Santé Public. This paper discusses how different actors (policy makers, tobacco companies, and users themselves) have embraced this new technology. I argue that e-cigarettes have become a valued form of substitution precisely because they provide occasions for social bonding, gustatory pleasure, and the non-medicalized management of health with endless possibilities for individualized tailoring.

Exposure to environmental tobacco smoke (ETS) from combustible tobacco products causes various diseases and makes quitting smoking more difficult. However, little is known about exposure of e-cigarette users to ETS from combustible tobacco products. This study aimed to investigate e-cigarette users' exposure to ETS from tobacco smokers. The association between ETS exposure frequency and different types of smokers including e-cigarette users was examined using ordered logistic regression analysis and nationally representative survey data on 28,765 individuals who were interviewed in the Canadian Tobacco, Alcohol and Drugs Surveys conducted during 2013 and 2015. Survey respondents were classified into one of five smoker types: smokers of tobacco only, dual users of tobacco and e-cigarettes, users of e-cigarette only, former smokers and never smokers. The analyses were conducted using the entire sample and by age group. Young to mid-age (15-54) dual users of both regular cigarettes...

Many e-cigarette users find the variety of e-cigarette flavors appealing. We examined whether preferences for e-liquid flavors and the total number of flavors preferred differed between samples of adolescent and adult e-cigarette users. We also examined whether these preferences were associated with e-cigarette use frequency for adolescents or adults, respectively. The analytic samples comprised 1) 396 adolescent, past-month e-cigarette users from 5 Connecticut high schools who completed an anonymous, school-based survey in Fall 2014 (56.1% male; 16.18 [1.18] years; 42.2% past-month smokers), and 2) 590 adult, past-month e-cigarette users who completed an anonymous, MTurk survey in Fall 2014 (53.7% male; 34.25 [9.89] years; 51.2% past-month smokers). Compared to adults, a larger proportion of adolescents preferred fruit, alcohol, and "other"-flavored e-liquids, whereas adults disproportionately preferred tobacco, menthol, mint, coffee, and spice-flavored e-liquids (p-value...

BackgroundIn cross-sectional surveys, increasing numbers of adolescents report using both electronic cigarettes (e-cigarettes) and cigarettes. This study assessed whether adolescent e-cigarette use was associated prospectively with initiation or escalation of cigarette use.MethodsData were from 2836 adolescents (aged 13–14 years at baseline) in 20 schools in England. At baseline, breath carbon monoxide levels, self-reported e-cigarette and cigarette use, sex, age, friends and family smoking, beliefs about cigarette use and percentage receiving free school meals (measure of socioeconomic status) were assessed. At 12-month follow-up, self-reported cigarette use was assessed and validated by breath carbon monoxide levels.ResultsAt baseline, 34.2% of adolescents reported ever using e-cigarettes (16.0% used only e-cigarettes). Baseline ever use of e-cigarettes was strongly associated with subsequent initiation (n=1726; OR 5.38, 95% CI 4.02 to 7.22; controlling for covariates, OR 4.06, 95...

The study analyzes the diffusion of electronic cigarettes as an innovation, as well as how industry, society, and the individual affect its market dynamics. The study is based on five surveys conducted during the years 2017−2019, and including participants of all ages (age 12 to 80 and beyond). The article describes indicators for evaluating the sustainability of a really-new product like electronic cigarettes, following the market trajectory of this product as it sets its dominant design and shapes the use-system for the product type from now onward. This process has two phases: trial and adoption. The probability of each nicotine product type's adoption is different, depending on the prevalence of trials of that product among the population. The results of e-cigarette trials and additional indicators reveal the point (critical mass-point) where social influence outweighs rational evaluation by the individual regarding nicotine products. By using triers' prevalence as the indicator for measuring an entry of really-new product into the market, the authors could identify the sustainability of that really-new product at a much early phase. Therefore, the prevalence of triers can be used as a predictor for the diffusion rate of an innovative product in a certain population and should be measured. The authors also propose a regression model that estimates the prevalence of triers based on the extent of users in the population.

Electronic cigarettes (e-cigarettes) are advertised as being safer than tobacco cigarettes products as the chemical compounds inhaled from e-cigarettes are believed to be fewer and less toxic than those from tobacco cigarettes. Therefore, continuous careful monitoring and risk management of e-cigarettes should be implemented, with the aim of protecting and promoting public health worldwide. Moreover, basic scientific data are required for the regulation of e-cigarette. To date, there have been reports of many hazardous chemical compounds generated from e-cigarettes, particularly carbonyl compounds such as formaldehyde, acetaldehyde, acrolein, and glyoxal, which are often found in e-cigarette aerosols. These carbonyl compounds are incidentally generated by the oxidation of e-liquid (liquid in e-cigarette; glycerol and glycols) when the liquid comes in contact with the heated nichrome wire. The compositions and concentrations of these compounds vary depending on the type of e-liquid and the battery voltage. In some cases, extremely high concentrations of these carbonyl compounds are generated, and may contribute to various health effects. Suppliers, risk management organizations, and users of e-cigarettes should be aware of this phenomenon.

Electronic cigarettes (e-cigarettes) have recently come to the fore as an alternative to traditional cigarettes. Commonly they are advertised both as smoking cessation treatment and as a means to circumvent public smoking bans. While some jurisdictions have enacted ordinances restricting the practice, in most places the regulatory situation remains unclear; though it is likely existing legislation can be applied to e-cigarettes as well. While the legal situation requires clarification, this article briefly discusses the available public health evidence regarding these products.