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E-Cigarettes: Epidemiology, Policy and Public Health

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 December 2016) | Viewed by 85583

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Prof. Dr. Mark Wolfson

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Guest Editor

Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
Interests: tobacco; alcohol; opioids; prescription drugs; marijuana; policy; prevention; environmental strategies; research to practice

Special Issue Information

Dear Colleagues,

I am organizing a Special Issue on electronic nicotine delivery systems (ENDS) for the International Journal of Environmental Research and Public Health. The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, I refer you to https://www.mdpi.com/journal/ijerph.

The development of these products, their introduction into markets around the world, and the dramatic upsurge in their use have raised a slew of important research questions. These include questions related to the following:

Measurement (e.g., How can quantity and frequency of use be reliably measured? How can the type of product used best be measured?)
Marketing (e.g., What marketing efforts are different populations being exposed to? What is the impact of marketing on smokers and nonsmokers?)
Politics (e.g., How are traditional cigarette manufacturers and exclusive ENDS manufacturers and retailers attempting to influence policy? How has the advent of ENDS changed the orientation towards tobacco control of governments, non-government organizations, and industry?)
Epidemiology (e.g., How do characteristics of ENDS users vary across nations? What are the patterns of dual- or poly-use of ENDS with other tobacco products?)
Policy (e.g., what effects do age-of-sale laws, prohibitions on use in public places, and other policies have on ENDS and combustible tobacco experimentation, use, and cessation at the population level?)

This Special Issue is open to any subject area related to ENDS epidemiology, policy, and public health. The keywords I’ve listed below are meant to suggest a few of the many possibilities. Inquiries regarding potential topics are welcome.

Prof. Dr. Mark Wolfson
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Electronic Cigarettes
Electronic Nicotine Delivery Systems
Epidemiology
Dual Use
Initiation
Cessation
Substitution
Product Switching
Industry
Marketing
Politics
Policy

Published Papers (10 papers)

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277 KiB

Open AccessArticle

Electronic Cigarette Use and Smoking Abstinence in Japan: A Cross-Sectional Study of Quitting Methods

by Tomoyasu Hirano, Takahiro Tabuchi, Rika Nakahara, Naoki Kunugita and Yumiko Mochizuki-Kobayashi

Int. J. Environ. Res. Public Health 2017, 14(2), 202; https://doi.org/10.3390/ijerph14020202 - 17 Feb 2017

Cited by 22 | Viewed by 10636

Abstract

The benefit of electronic cigarettes (e-cigarettes) in smoking cessation remains controversial. Recently, e-cigarettes have been gaining popularity in Japan, without evidence of efficacy on quitting cigarettes. We conducted an online survey to collect information on tobacco use, difficulties in smoking cessation, socio-demographic factors, and health-related factors in Japan. Among the total participants (n = 9055), 798 eligible persons aged 20–69 years who smoked within the previous five years were analyzed to assess the relationship between the outcome of smoking cessation and quitting methods used, including e-cigarettes, smoking cessation therapy, and unassisted. E-cigarette use was negatively associated with smoking cessation (odds ratio (OR) = 0.632; 95% confidence interval (CI) = 0.414–0.964) after adjusting for gender, age, health-related factors, and other quitting methods. Conversely, smoking cessation therapy (i.e., varenicline) was significantly associated with smoking cessation (OR = 1.885; 95% CI = 1.018–3.492) in the same model. For effective smoking cessation, e-cigarette use appears to have low efficacy among smokers in Japan. Allowing for the fact that this study is limited by its cross-sectional design, follow-up studies are needed to assess the prospective association between e-cigarette use and smoking cessation. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

2211 KiB

Open AccessArticle

The Importance of Conditioned Stimuli in Cigarette and E-Cigarette Craving Reduction by E-Cigarettes

by Martijn Van Heel, Dinska Van Gucht, Koen Vanbrabant and Frank Baeyens

Int. J. Environ. Res. Public Health 2017, 14(2), 193; https://doi.org/10.3390/ijerph14020193 - 15 Feb 2017

Cited by 18 | Viewed by 8142

Abstract

This study examined the impact of four variables pertaining to the use of e-cigarettes (e-cigs) on cravings for tobacco cigarettes and for e-cigs after an overnight abstinence period. The four variables were the nicotine level, the sensorimotor component, the visual aspect, and the aroma of the e-cig. In an experimental study, 81 participants without prior vaping experience first got acquainted with using e-cigs in a one-week tryout period, after which they participated in a lab session assessing the effect of five minutes of vaping following an abstinence period of 12 h. A mixed-effects model clearly showed the importance of nicotine in craving reduction. However, also non-nicotine factors, in particular the sensorimotor component, were shown to contribute to craving reduction. Handling cues interacted with the level (presence/absence) of nicotine: it was only when the standard hand-to-mouth action cues were omitted that the craving reducing effects of nicotine were observed. Effects of aroma or visual cues were not observed, or weak and difficult to interpret, respectively. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

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263 KiB

Open AccessArticle

Perceptions of E-Cigarettes among Black Youth in California

by Catherine A. Hess, Tamar M. J. Antin, Rachelle Annechino and Geoffrey Hunt

Int. J. Environ. Res. Public Health 2017, 14(1), 60; https://doi.org/10.3390/ijerph14010060 - 11 Jan 2017

Cited by 13 | Viewed by 6330

Abstract

Research suggests that Black youth are less likely to use e-cigarettes than their white counterparts, yet little is known as to why. We examined perceptions of e-cigarettes among Black young adults (ages 18–25) to explore the meanings these youth ascribe to e-cigarettes and the role that identity plays in how these devices are viewed. Analysis of in-depth interviews with 36 Black smokers and non-smokers in the San Francisco Bay Area suggests that Black youth perceive e-cigarettes as serving distinct, yet overlapping roles: a utilitarian function, in that they are recognized as legitimate smoking cessation tools, and a social function, insofar as they serve to mark social identity, specifically a social identity from which our participants disassociated. Participants described e-cigarette users in highly racialized and classed terms and generally expressed disinterest in using e-cigarettes, due in part perhaps to the fact that use of these devices would signal alignment with a middle class, hipster identity. This analysis is discussed within a highly charged political and public health debate about the benefits and harms associated with e-cigarette use. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

1085 KiB

Open AccessArticle

The Trend of Voluntary Warnings in Electronic Nicotine Delivery System Magazine Advertisements

by Ce Shang and Frank J. Chaloupka

Int. J. Environ. Res. Public Health 2017, 14(1), 62; https://doi.org/10.3390/ijerph14010062 - 10 Jan 2017

Cited by 19 | Viewed by 7022

Abstract

Some manufacturers of electronic nicotine delivery systems (ENDS) voluntarily carried health warnings in their advertisements. This study examined these voluntary warnings in magazine ads and plotted their trends between 2012 and early 2015. ENDS magazine ads were obtained through Kantar media and warnings were collected from the Chicago Public Library or the Trinkets and Trash surveillance system. The prevalence of voluntary warnings, warnings with the specific capitalized word “WARNING”, and MarkTen warnings were examined after being weighted using factors related to exposure between January 2012 and March 2015. Five brands (MarkTen, NJOY, MISTIC, and some Blu) carried warnings during the study period. The prevalence of warnings post 2012 that contained a description of nicotine did not significantly increase until the launch of MarkTen, which also happened several months before April 2014 when the U.S. food and drug administration (FDA) published its proposed deeming rule. In addition, none of these warnings met the criteria required by the FDA in the final rules. Voluntary warnings, particularly MarkTen warnings, significantly increased in ENDS magazine ads between 2014 and 2015. It is important to monitor how ENDS manufacturers will comply with the FDA regulation related to warnings and how this regulation will ultimately impact ENDS risk perceptions and use. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

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308 KiB

Open AccessArticle

Use of Electronic Nicotine Delivery Systems among Adults with Mental Health Conditions, 2015

by Claire Adams Spears, Dina M. Jones, Scott R. Weaver, Terry F. Pechacek and Michael P. Eriksen

Int. J. Environ. Res. Public Health 2017, 14(1), 10; https://doi.org/10.3390/ijerph14010010 - 23 Dec 2016

Cited by 41 | Viewed by 7598

Abstract

Adults with mental health conditions (MHC) are especially likely to smoke and experience tobacco-related health disparities. Individuals with MHC may also use electronic nicotine delivery devices (ENDS) at disproportionately high rates. However, there is a relative dearth of knowledge regarding ENDS use among individuals with MHC. In a large representative sample of U.S. adults (n = 6051), associations between self-reported MHC diagnoses and ENDS use and susceptibility were examined, stratified by smoking status. Participants with MHC were approximately 1.5 times more likely to have used ENDS in their lifetime and almost twice as likely to currently use ENDS as those without MHC. MHC status was most strongly linked to higher ENDS use among former smokers, and former smokers with MHC were more likely to report using ENDS during past smoking quit attempts than those without MHC. Among participants who had not tried ENDS, former smokers with MHC were especially susceptible to future ENDS use. The potential advantage of ENDS for cessation purposes should be balanced with the risk of attracting former smokers with MHC to ENDS. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

311 KiB

Open AccessArticle

Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions

by Ratika Sharma, Britta Wigginton, Carla Meurk, Pauline Ford and Coral E. Gartner

Int. J. Environ. Res. Public Health 2017, 14(1), 7; https://doi.org/10.3390/ijerph14010007 - 22 Dec 2016

Cited by 53 | Viewed by 16311

Abstract

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

254 KiB

Open AccessArticle

Identification of Vape Shops in Two North Carolina Counties: An Approach for States without Retailer Licensing

by Joseph G. L. Lee, Heather D’Angelo, Jaleel D. Kuteh and Ryan J. Martin

Int. J. Environ. Res. Public Health 2016, 13(11), 1050; https://doi.org/10.3390/ijerph13111050 - 27 Oct 2016

Cited by 17 | Viewed by 6351

Abstract

Stores that sell electronic nicotine delivery systems (ENDS) as their primary product are a new phenomenon and often termed “vape shops”. While vape shops are now regulated by state and federal agencies, not all states maintain lists of vape shops in operation. Standard ways of identifying tobacco retailers through off-premise alcohol permits and business listing services may not identify vape shops. We used four online business listing services (i.e., Google Maps, ReferenceUSA, YellowPages.com, Yelp) to identify vape shops in two counties in North Carolina (NC). In one county, we also assessed four vaping web sites. We drove primary and secondary roads to physically validate the identified stores and attempt to identify stores not listed online. To assess the accuracy of the online searches, we calculated sensitivity and positive predictive values (PPVs). This research was conducted in spring and summer 2016 and identified 28 vape shops online. We confirmed 16 vape shops (seven in Pitt County, NC, USA, and nine in Durham County, NC, USA). Online searches ranged in sensitivity, 62.5%–81.3%, and PPVs ranged from 73.3% to 92.3%. Because of the range of sensitivity found among the business listing services, state policymakers should consider uniform licensing requirements for vape and tobacco retailers to more easily track retailers and ensure compliance with regulations. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

293 KiB

Open AccessArticle

Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample

by Monica Webb Hooper and Stephanie K. Kolar

Int. J. Environ. Res. Public Health 2016, 13(10), 1009; https://doi.org/10.3390/ijerph13101009 - 14 Oct 2016

Cited by 37 | Viewed by 5767

Abstract

The prevalence of e-cigarette use is increasing, yet few studies have focused on its use in racial/ethnic minority populations. We examined associations between race/ethnicity and e-cigarette use, plans to continue using e-cigarettes, and reasons for use among current/former smokers. Participants (285 in total; 29% non-Hispanic White, 42% African American/Black, and 29% Hispanic) were recruited between June and November 2014. Telephone-administered surveys assessed demographics, cigarette smoking, e-cigarette use, plans to continue using, and reasons for use. Analyses of covariance (ANCOVAs) and multivariable logistic regressions were conducted. African Americans/Blacks were significantly less likely to report ever-use compared to Whites and Hispanics (50% vs. 71% and 71%, respectively; p < 0.001). However, African American/Black ever users were more likely to report plans to continue using e-cigarettes compared to Whites and Hispanics (72% vs. 53% and 47%, respectively, p = 0.01). African American/Black participants were more likely to use e-cigarettes as a cessation aid compared to both Whites (p = 0.03) and Hispanics (p = 0.48). White participants were more likely to use e-cigarettes to save money compared to Hispanics (p = 0.02). In conclusion, racial/ethnic differences in e-cigarette use, intentions, and reasons for use emerged in our study. African American ever users may be particularly vulnerable to maintaining their use, particularly to try to quit smoking. These findings have implications for cigarette smoking and e-cigarette dual use, continued e-cigarette use, and potentially for smoking-related disparities. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

616 KiB

Open AccessArticle

Social Interactions as a Source of Information about E-Cigarettes: A Study of U.S. Adult Smokers

by Marissa G. Hall, Jessica K. Pepper, Jennifer C. Morgan and Noel T. Brewer

Int. J. Environ. Res. Public Health 2016, 13(8), 788; https://doi.org/10.3390/ijerph13080788 - 05 Aug 2016

Cited by 16 | Viewed by 4759

Abstract

The novelty of e-cigarettes and ambiguity about their effects may foster informal sharing of information, such as through social interactions. We aimed to describe smokers’ social interactions about e-cigarettes and their recommendations that others use e-cigarettes. Data were collected from 2149 adult smokers in North Carolina and California who participated in a study of the impact of pictorial cigarette pack warnings. In the previous month, almost half of participants (45%) reported talking to at least one person about e-cigarettes and nearly a third of participants (27%) recommended e-cigarettes to someone else. Smokers recommended e-cigarettes to cut back on smoking (57%), to quit smoking (48%), for health reasons (36%), and for fun (27%). In adjusted analyses, more frequent e-cigarette use, positive views about typical e-cigarette users, and attempting to quit smoking in the past month were associated with recommending e-cigarettes for health reasons (all p < 0.05). Social interactions appear to be a popular method of information-sharing about e-cigarettes among smokers. Health communication campaigns may help to fill in the gaps of smokers’ understanding of e-cigarettes and their long-term effects. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

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336 KiB

Open AccessEssay

A Risk Assessment Matrix for Public Health Principles: The Case for E-Cigarettes

by Daniela Saitta, Azim Chowdhury, Giancarlo Antonio Ferro, Federico Giuseppe Nalis and Riccardo Polosa

Int. J. Environ. Res. Public Health 2017, 14(4), 363; https://doi.org/10.3390/ijerph14040363 - 31 Mar 2017

Cited by 13 | Viewed by 11743

Abstract

Besides nicotine replacement therapies, a realistic alternative for smoking cessation or for smoking substitution may come from electronic cigarettes (ECs), whose popularity has been steadily growing. As for any emerging behaviour associated with exposure to inhalational agents, there is legitimate cause for concern and many health organizations and policy makers have pushed for restrictive policy measures ranging from complete bans to tight regulations of these products. Nonetheless, it is important to reframe these concerns in context of the well-known harm caused by cigarette smoking. In this article, we discuss key public health principles that should be considered when regulating ECs. These include the concept of tobacco harm reduction, importance of relative risk and risk continuum, renormalization of smoking, availability of low-risk product, proportionate taxation, and reassessment of the role of non-tobacco flavours. These public health principles may be systematically scrutinized using a risk assessment matrix that allows: (1) to determine the measure of certainty that a risk will occur; and (2) to estimate the impact of such a risk on public health. Consequently, the ultimate goal of responsible ECs regulation should be that of maximizing the favourable impact of these reduced-risk products whilst minimizing further any potential risks. Consumer perspectives, sound EC research, continuous post-marketing surveillance and reasonable safety and quality product standards should be at the very heart of future regulatory schemes that will address concerns while minimizing unintended consequences of ill-informed regulation. Full article

(This article belongs to the Special Issue E-Cigarettes: Epidemiology, Policy and Public Health)

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