Search Results (882)

Background/Objectives: E-cigarette use has increased substantially among university students in recent years, coinciding with a broader shift in nicotine consumption patterns globally. Despite initial perceptions of e-cigarettes as harm-reduction tools, growing evidence indicates significant health risks, misinformation, and limited awareness—especially within higher education environments. This structured literature review aims to synthesize peer-reviewed evidence on the health impacts, behavioral determinants, and the role of nursing in addressing e-cigarette use among university students. Methods: A literature search was conducted across five databases (PubMed, CINAHL, Scopus, Embase, Dialnet) between February and March 2025. Eligible studies were published between January 2020 and January 2025 in English or Spanish. A total of 43 studies were included. Data were synthesized narratively, and methodological quality was assessed using Joanna Briggs Institute checklists and The Scale for the Assessment of Narrative Reviews Articles. Results: E-cigarette use among university students showed wide variability in prevalence, with higher rates among males, students in non-health disciplines, and users of disposable devices. Key behavioral and social determinants included peer influence, curiosity, stress management, and social media exposure. Despite documented health risks—such as nicotine dependence, respiratory and cardiovascular impairment, and mental health concerns—misconceptions about safety and cessation efficacy were common, even among health science students. Nursing-led interventions hold great potential for prevention but remain underdeveloped within university settings. Conclusions: The findings underscore the urgent need for evidence-based prevention strategies—particularly those led by nurses—to reduce e-cigarette use, bridge knowledge gaps, and mitigate associated health risks in higher education. Future efforts should prioritize institutional policy reinforcement, improved health communication, and the integration of vaping-related education into nursing curricula and public health campaigns targeting emerging adults. Full article

Nicotine is a highly used addictive substance that has recently also become available through electronic cigarettes. Here we present a study of nicotine from e-cigarette liquids through reversed-phase (RP) and hydrophilic interaction (HILIC) liquid chromatography. Multiple aqueous mobile-phase additives are considered for the RP mechanism, focusing on chaotropic agents, mobile-phase concentrations and mixing ratios, and column temperature. Sample preparation was conducted by toluene liquid–liquid extraction of e-cigarette liquids diluted with aqueous 25 mM NaHCO₃/Na₂CO₃. Optimal RP results for retention and peak symmetry were obtained using aqueous 0.1% formic acid and 20 mM ammonium hexafluorophosphate with 0.1% formic acid in acetonitrile, using a gradient profile with a C18 column, exploited at 40 °C and a 1.5 mL/min flow rate. A dilute-and-shoot alternative with automated flow reversal after isocratic elution is presented. For HILIC, aqueous 100 mM ammonium formate and 0.1% formic acid in acetonitrile were used as mobile-phase components, using a gradient profile, on a Thermo Scientific™ Acclaim™ Mixed-Mode HILIC-1 column, operated at 25 °C with a 1 mL/min flow rate. UV detection was at 260 nm. Absolute limits of quantitation in the 1 μg/mL range were obtained for all tested alternatives, with 1 μL injection volumes. Full article

Background/Objectives: Nicotine-free electronic cigarettes (NFECs) are becoming increasingly popular, especially among youth and non-smokers, yet their effects on the gastrointestinal tract (GIT) remain poorly understood. This systematic review synthesizes available in vitro, in vivo, and limited human evidence on NFEC-associated changes in gastrointestinal health and function. Methods: Literature searches were conducted in Medline, Web of Science, Cochrane, and Scopus in July 2025, following PRISMA guidelines. Eligible studies examined NFEC effects on any GIT segment, including the oral cavity, liver, intestines, and microbiome. Data on study design, exposure characteristics, and main outcomes were extracted and narratively synthesized. Results: Of 111 identified records, 94 full-text articles were retrieved, and 21 studies met the inclusion criteria. Most were preclinical, with only one human pilot study. Evidence from oral cell and microbial models suggests that NFEC aerosols can induce pro-inflammatory cytokine production, impair cell viability, and disrupt microbial metabolism through their base constituents (propylene glycol, vegetable glycerine, and flavourings). Animal studies indicate possible hepatic oxidative stress, altered lipid metabolism, and gut barrier dysfunction, with some data suggesting more pronounced steatosis in nicotine-free exposures compared to nicotine-containing counterparts. Microbiome studies report reduced tight junction expression and altered neutrophil function. Conclusions: Current evidence is limited and predominantly preclinical but indicates that NFEC exposure can affect multiple aspects of gastrointestinal health. Robust longitudinal and interventional human studies are urgently needed to determine the clinical relevance of these findings and to inform regulation and public health policy. Full article

Background: Cardiovascular morbidity and mortality are alarmingly high in Bulgaria, partly due to behavioral risk factors such as smoking. Purpose: This study aimed to assess and compare smoking habits, second-hand smoke exposure, and attitudes of Bulgarian and foreign medical students to better understand smoking behavior in this population. Methods: A cross-sectional survey was conducted among 1063 medical students at the Medical University of Plovdiv (60.8% women; 53% Bulgarian). Results: More Bulgarian students were active smokers and ever-smokers than foreign students (24.7% vs. 14% and 29.3% vs. 18.8%, p < 0.001). Bulgarian women smoked nearly as much as Bulgarian men (24.1% vs. 25.6% for active smokers, p > 0.05), whereas foreign women smoked less than foreign men (15.7% vs. 23.7%, p = 0.034). Women more often replaced classic cigarettes with tobacco heating systems (THSs) than men (40.7% vs. 25.3%, p = 0.020). Nearly 85% of the respondents started smoking by the age of 19. Exposure to second-hand smoke among friends, among colleagues, and in the family was associated with a higher risk of being an ever-smoker (ORs ~8.9; 3.4 and 3.7, respectively). About 20% of students were unsure or disagreed that smoking fewer cigarettes, THSs, or e-cigarettes posed health risks. The majority (61.3%) of active smokers acknowledged negative health effects. Conclusions: These findings highlight a concerning smoking prevalence among Bulgarian medical students and emphasize the need to strengthen medical education and health policies with updated tobacco risk information and targeted prevention programs to reduce smoking and improve future physicians’ cessation counseling skills. Smoking likely contributes significantly to Bulgaria’s high cardiovascular morbidity. Full article

This paper constitutes a preliminary study that evaluates the organic pollutants desorbed from “fresh” plastic litter, i.e., recently stranded items, on three beaches in Cadiz (SW Spain): Bajo de Guia, La Jara, and La Puntilla. Beach litter items were collected and classified in laboratory according to their composition and use. Leachates were obtained by stir bar sorptive extraction (SBSE) and analysed with gas chromatography–mass spectrometry (GC–MS). Fifty-five target organic compounds—including polycyclic aromatic hydrocarbons (PAHs), pesticides, fragrances, insect repellents, and UV filters—were quantified. Plastics accounted for the majority of litter by both number and weight. Cigarette butts and wipes were also prevalent and served as key sources of leachable PAHs. With respect to the main pollutants found in plastic films, hard plastics, and wipes, fragrances such as OTNE1 (1-Tetramethyl Acetyloctahydronaphthalene), OTNE2 (2-Tetramethyl Acetyloctahydronaphthalene), DEET (N, N-Diethyl-Meta-Toluamide), galaxolide, and tonalide were dominant, with concentrations exceeding 100 ng/g in some cases. DEET was the most common insect repellent detected. These findings underscore the role of beach litter, especially plastic waste, as a vector for persistent and emerging organic pollutants, highlighting the urgent need for improved waste management and monitoring practices to mitigate ecological risks associated with plastic pollution. Full article

Background/Objectives: Electronic cigarettes (e-cigarettes) have gained popularity among young adults globally, but only limited research exists on usage patterns in Saudi Arabia. This study investigated the prevalence, patterns, and factors associated with e-cigarette use initiation and transition to cigarette smoking among university students in Saudi Arabia. Methods: A cross-sectional survey was conducted among 537 university students in Al-Madinah city during the 2024–2025 academic year. Data were collected using a self-administered online questionnaire assessing e-cigarette use patterns, motivations, susceptibility to future cigarette smoking, and demographic characteristics. Multivariable logistic regression analysis was used to identify factors associated with e-cigarette use. Results: E-cigarette prevalence was substantial: 11.7% of participants were current users, 5.4% were former users, and 27.9% were ever-users, compared with 5.8% current cigarette smokers. Males had significantly higher use rates than females (20.9% vs. 4.6%; p < 0.001). Senior students showed the highest current use (21.1%). Among ever-users, the primary motivations were enjoyment (29.3%), the possibility of use where smoking is banned (26.1%), and social acceptability (21.7%). Most users (73.0%) used high-nicotine liquids (≥20 mg/mL), and 55.4% vaped daily. Multivariable logistic regression revealed that e-cigarette use was independently associated with male gender (adjusted OR = 4.0), higher academic year (OR = 1.24), current smoking (adjusted OR = 3.45; 95 CI: 1.54–7.82), and lower harm perception (adjusted OR = 1.69; 95 CI: 1.16–2.51). Susceptibility to future cigarette smoking was 18.9% overall but much higher among current e-cigarette smokers (59.5%; p < 0.001). Conclusions: E-cigarette use was prevalent among Saudi university students, particularly males and senior students, with patterns suggestive of nicotine dependence. Strong associations with cigarette smoking and high-concentration nicotine use raise concerns about dual use and addiction potential. Full article

Purpose: Smoking is a major preventable cause of illness and death. Quitting smoking can reduce related health complications. Numerous factors, including age, socioeconomic status, smoking habits, and availability of support, influence smoking cessation success. Despite anti-smoking measures and smoking cessation clinics in Saudi Arabia, smoking-related deaths are increasing. This study aimed to identify factors influencing successful smoking cessation among Saudi adults and examine the relationship between cessation methods and success rates. Patients and methods: A cross-sectional study was conducted through an online survey targeting Saudi adults who had attempted to quit smoking of all types, whether traditional cigarettes, e-cigarettes, shisha, or others. Success was defined as quitting for at least six months. The data collected included sociodemographic details, smoking history, and experiences with cessation. Logistic regression analysis was used to identify factors associated with successful cessation. Results: Of 364 participants, 18.4% were successful quitters, with a mean age of 34.94. Occupation was a key predictor; freelance workers had significantly higher odds of unsuccessful quitting (OR = 12.96, 95% CI: 2.08–80.79, p = 0.006). Those who continued smoking despite illness were less likely to quit successfully (OR = 2.33, 95% CI: 1.16–4.68, p = 0.018). Early initiation of smoking also negatively impacted cessation success (OR = 1.10, 95% CI: 1.03–1.17, p = 0.006). Successful quitters reported fewer adverse symptoms during their attempts (p = 0.018) and employed behavioral strategies, such as disposing of tobacco products (p < 0.001), avoiding smoking triggers (p = 0.002), and engaging in exercise (p < 0.001). Confidence in quitting significantly contributed to success (p < 0.001). Conclusions: This study highlights the role of individual, social, and environmental factors in smoking cessation. Tailored interventions that address socioeconomic, psychological, and lifestyle factors are crucial for enhancing cessation success among Saudi adults. Full article

Background and Objectives: Nicotine is the most well-studied toxic substance in cigarette smoke and e-cigarette vape. However, smoke and vape are composed of other components that have a negative impact on health. The objective of this study is to investigate whether nicotine has a distinctive impact on molecular mechanisms in stem cells. Methods: The cellular impact of nicotine on the regenerative capacity of human dental pulp stem cells (DPSCs) and the microRNA (miRNA) profile was examined. Bioinformatic analysis was performed to identify miRNA-regulated cellular pathways associated with nicotine exposure. These pathways were then compared to those induced by cigarette smoke condensate (CSC). Results: Prolonged exposure to nicotine significantly impaired the regeneration of DPSCs and changed the expression of miRNAs. Nicotine upregulated the expression of hsa-miR-7977, hsa-miR-3178, and hsa-miR-10400-5p compared to vehicle control. Interestingly, nicotine did not change the expression of hsa-miR-29b-3p, hsa-miR-199b-5p, hsa-miR-26b-5p, or hsa-miR-26a-5p compared to the control. However, the expressions of these miRNAs were significantly altered when compared to CSC treatment. Further analysis revealed that nicotine was distinctively associated with certain miRNA-targeted pathways including apoptosis, ErbB, MAPK signaling, PI3K-Akt, TGF-b signaling, and Wnt signaling. Conclusions: Our work provides evidence on the distinctive miRNA signature induced by nicotine. The information will be important for identifying the unique molecular pathways downstream of nicotine from smoking and vaping in different individuals, providing a new direction for personalized disease prevention, prognosis, and treatment. Full article

Once marketed as smoking cessation tools, e-cigarettes are used by adolescents mainly for entertainment, driven by aggressive marketing, appealing flavors, and safer alternatives to smoking. This study analyzes data from the National Youth Tobacco Survey (NYTS) to explore trends in adolescent perceptions and usage patterns of e-cigarettes from 2011 to 2023, focusing on their dual roles as cessation aids and recreational products. Cross-sectional data from the NYTS over four years (2011: N = 18,866; 2015: N = 17,711; 2019: N = 19,018; 2023: N = 22,069) formed the foundation of this study. This study investigated demographic trends, usage frequency, initial and future use patterns, and quitting behavior. Descriptive statistics and latent class analysis (LCA) were employed to examine adolescent e-cigarette use patterns, with statistical significance determined at p < 0.05. The reasons for using e-cigarettes have changed significantly over the years because of family or friends. In all years (2015–2023), use for smoking cessation dropped significantly (2.33% in 2023 vs. 6.95% in 2015). In 2023, 38% wanted to quit using e-cigarettes within 30 days, and 25% attempted to quit at least 10 times. Flavored e-cigarette users were more than twice as likely to consider quitting compared to those not interested in flavors (OR = 2.64). Our findings highlight a significant decrease in the use of e-cigarettes for cessation, with a corresponding increase in recreational use over time. These trends emphasize the urgency of implementing interventions to mitigate nicotine addiction and its associated health risks among adolescents. Adolescent e-cigarette use has transitioned from being primarily driven by cessation efforts to recreational purposes, largely influenced by appealing flavors and social factors such as peer influence, showing the need for stricter marketing regulations and targeted educational campaigns. Full article

Background: Youth tobacco use remains a significant public health concern, particularly in urban communities disproportionately burdened by health disparities. In Baltimore City, where tobacco-related harms are elevated, understanding the relationship between tobacco use—including e-cigarettes—and mental health among high school students is essential for guiding equitable prevention and cessation strategies. The CEASE (Communities Engaged and Advocating for a Smoke-free Environment) program, in collaboration with the American Lung Association’s Not On Tobacco (N-O-T) initiative, developed an online school-based survey to inform community-responsive interventions. Aims: This study aimed to examine the associations between cigarette use, including conventional cigarette use, and self-rated mental health among high school students in Baltimore City. Methods: High school students in Baltimore City completed an anonymous online survey that assessed demographic characteristics, tobacco knowledge and use, mental health, and related behaviors. Self-rated mental health was dichotomized as poor versus fair/good. Tobacco use categories included current use of e-cigarettes and conventional cigarettes. Logistic regression models were used to examine associations between tobacco use and self-rated mental health, adjusting for age, gender, race, and parental education. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results: No statistically significant associations were found between self-rated mental health and e-cigarette use and conventional tobacco use after adjusting for covariates. Conclusions: The absence of a significant association may reflect unique aspects of the social context in Baltimore City, where youth may not use tobacco products as a coping mechanism for mental health challenges. Alternatively, it may be due to limitations in measurement, particularly the use of a single-item mental health assessment. These findings should be considered preliminary. Future research using more comprehensive mental health measures and larger samples is warranted to further explore these complex relationships. Full article

Electronic nicotine delivery systems (vapes) are the most used nicotine products among U.S. adolescents, with usage increasing significantly from 2017 to 2019. School-based prevention programs are a critical strategy for curbing youth vaping. This study utilized a retrospective pre/post survey to evaluate the effectiveness of a two-year school-based vaping prevention program utilizing a condensed version of the Stanford University Tobacco Prevention Toolkit. The program was implemented in-person and online across two years in a southeastern U.S. state. In year one, evalua-tion data were collected from 4252 youths from 20 rural counties who completed the in-person survey during the 2018–2019 program year. In year two, 1347 youths from 13 rural and urban counties completed the survey during the program year of 2019–2020. The key findings indicate significant increases in knowledge about vaping risks post-program. The findings from year one indicate that increases in knowledge about e-cigarettes were negatively related to the frequency of vaping, but this was not replicated in year two. Moreover, knowledge did not influence vaping frequency if youths had already started vaping, while pre-program knowledge did not predict the frequency of vaping in either year. These results suggest that vaping prevention education outcomes among youths are mixed. Full article

There is limited understanding of what influences vaping cessation, especially as vaping regulations change, and different jurisdictions have different regulations. This study involves 281 ex-vapers (16–24 years) from Nova Scotia, Canada. A content analysis was used to understand and compare youth and young adults’ (YA) experiences of quitting vaping. Both helpful and unhelpful factors for quitting vaping were identified; each category had five themes and twenty-one sub-themes. Helpful factors were consistent across both age categories and included planned and unplanned vaping control interventions, health concerns, social support, evidence-based support, and unassisted quitting methods. Similarly, the five themes identified as unhelpful factors were consistent for both age groups: negative personal implications, negative social influences, planned and unplanned vaping control interventions, the side effects of previous use, and simultaneous and alternative substance use. Policies that limit access and raise awareness about lung health and well-being can help youth quit vaping. For YAs, increasing awareness about social support and health concerns is crucial. Raising e-cigarette costs and reducing vaping normalization supports quitting for YAs. Stress reduction and training to handle social pressure could aid youth, while YAs might benefit from treatment for other substance use to help with nicotine quitting. Full article

The paper titled “Methods for a Non-Targeted Qualitative Analysis and Quantification of Benzene, Toluene, and Xylenes by Gas Chromatography-Mass Spectrometry of E-Liquids and Aerosols in Commercially Available Electronic Cigarettes in Mexico” was submitted in compliance with all the requirements of the editorial and journal in question, as evidenced by the dates and the respective backup documentation [...] Full article

Tobacco control policies have aimed to reduce the global prevalence of smoking. Unfortunately, the recent survey data shows that about 24% of Europeans still smoke. Although combustible cigarettes remain the most used tobacco product, the tendency made evident in the prevalence of smoking-alternative nicotine-containing products increases. Studies that can objectively assess the long-term health effects of the latter products are lacking, so assessing toxic substances associated with smoking-alternative products and comparing them to substances from combustible cigarettes could inform future public health efforts. The manufacturers of these alternative products claim that the use of alternatives to combustible cigarettes reduces exposure to toxic compounds, but the reality is unclear. This study compares the concentrations of toxic substances in generated aerosols and performs calculations based on mainstream cigarette smoke and aerosols from smoking-alternative products. It summarizes the amounts of harmful and potentially harmful constituents per single puff. Alternative smoking products are undoubtedly harmful to non-smokers. Still, based on the analysis of the latest independent studies’ empirical data, the concentrations of inhaled HPHCs using heated tobacco products or e-cigarettes are reduced up to 91–98%, respectively; therefore, for those who cannot quit, these could provide a less harmful alternative. However, more well-designed studies of alternative product emissions are needed, including an analysis of the compounds that are not present in conventional tobacco products (e.g., thermal degradation products of propylene glycol, glycerol, or flavorings) to evaluate possible future health effects objectively. Full article