Search Results (387)

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns of EAC and ESCC from 2000 through 2022—stratified by age, sex, and race/ethnicity—and to place these in the context of changing behavioral exposures. Methods: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results SEER 21 registry data (covering 48% of the U.S. population). We included first-primary, histologically confirmed EAC (ICD-O-3 codes 8140–8576) and ESCC (8050–8084) in individuals aged ≥ 15 years diagnosed between 2000 and 2022. Age-adjusted incidence rates (per 100,000 person-years; 2000 U.S. standard) and annual percent changes (APCs) were estimated via Joinpoint regression models. Results: A total of 90,290 EAC and 47,916 ESCC cases were identified. EAC incidence increased from 2.3 to 2.8 per 100,000 (APC +0.90%; 95% CI, 0.45–1.35), with the largest relative rises in ages 15–39 years (APC +1.50%) and among women (APC +2.65%). Non-Hispanic Black and American Indian/Alaska Native populations experienced the most pronounced EAC increases. Overall ESCC incidence declined (APC −0.78%; 95% CI, −1.10 to −0.46), though Asian/Pacific Islander (+3.59%) and American Indian/Alaska Native (+1.58%) groups saw rising rates. Conclusions: EAC incidence continues to climb—especially in younger adults, women, and select racial/ethnic minorities—while ESCC declines are uneven. These histology-specific patterns highlight the urgency of tailored prevention, targeted early-detection efforts, and mechanistic studies on emerging exposures such as vaping. Full article

Introduction: Increased exposure to air pollution poses a burden to society and healthcare systems worldwide, with increased risk of morbidity and mortality. Indoor concentrations of air pollutants, such as particulate matter, are a public health concern because they can be present in higher concentrations than outside. Unlike the effects of indoor environmental tobacco smoke (ETS), there is a dearth of research that includes the impact of e-cigarettes on particulate matter concentrations in the home, which is the focus of this study. Method: Participant, household, and sensor information were obtained from 164 lower-income households located in Cornwall, South West of England. Daily sensor readings were obtained for PM_2.5 for one year. Descriptive statistics were used to describe study participant characteristics and health status. Mean indoor averages, median PM_2.5 measurements, and two-tailed tests were used to assess differences in concentrations of PM_2.5. Results: The 164 surveyed households included 315 residents (67% female) with a mean adult age of 57 (22–92). Half of all homes were in the 10% most deprived neighbourhoods in England. Thirty-four per cent of participants were current smokers, and of these 36% have asthma and had seen a doctor in the last year (cf. never smokers 14%, ex-smokers 25%). Mean annual PM_2.5 was highest in smoking households (14.07 µg/m³) and smoking and vaping households (9.18 µg/m³), and lower in exclusive vaping households (2.00 µg/m³) and smoke and vape-free households (1.28 µg/m³). Monthly levels of PM_2.5 fluctuated seasonally for all groups, with the highest recordings in winter and the lowest in summer. Discussion and Conclusion: In this preliminary study, we conducted secondary data analyses using monitoring data from a large health and housing study to assess factors leading to elevated indoor concentrations of particulate matter. Indoor concentrations appeared to be highest in homes where residents smoked indoors. The use of e-cigarettes in the home also appeared to modify concentrations of particulate matter, but levels were lower than in homes with tobacco smoke. We were not able to determine the relationship between smoking and/or vaping indoors and particulate matter, which supports the need for studies of larger sample sizes and more complex longitudinal monitoring. This will help assess the timing and extent of exposures resulting from smoking and vaping indoors, along with a range of other chemical and biological exposures and their corresponding health effects. Full article

Vaping tetrahydrocannabinol (THC), a cannabis derivative, using electronic cigarettes (e-cigarettes) could deregulate oral health and lead to oral candidiasis. This study aimed to investigate the effects of vaped THC on Candida albicans growth, metabolic activity, biofilm formation, and the expression of virulence genes. Exposure to e-cigarette aerosol with or without nicotine and with or without 10% or 15% THC increased C. albicans growth and metabolic activity; the effects were more pronounced when THC was present in the e-cigarette aerosol. Biofilm analyses showed that e-cigarette aerosol with THC significantly promoted C. albicans biofilm formation, with the higher THC concentration (15%) having the greater effect. Consistently, e-cigarette aerosol with THC increased the expression of the virulence genes EAP1, SAP2, SAP4, and SAP9. These findings suggested that exposure to vaped THC could contribute to the pathogenesis of oral candidiasis, which may lead to oral health problems. Full article

Background and Clinical Significance: The recreational use of semisynthetic cannabinoids (SSCs) is increasing, and SSCs account for more than 40% of all new substances reported at the European level. Although designed to mimic the effects of tetrahydrocannabinol (THC), the primary psychoactive compound in cannabis, evidence suggests that certain SSCs may elicit stronger, prolonged and unintended pharmacological effects. SSCs are easily accessible, particularly via online retailers, but in some countries, SSCs are also sold in convenience stores or specialty stores selling legal low-THC or cannabidiol (CBD) products. Often, SSCs are sold as “legal highs” and are found in various forms, including herbal mixtures (spice), vape products, and edibles such as cookies and candies, specifically targeting young users, including children. The products are frequently mislabeled and sold as souvenirs or aromatic potpourri to bypass regulations. Case Presentation: We present a case of a male in his early forties who was admitted to the Emergency Department due to noticeable deficits in alertness and responsiveness after recreational ingestion of two cannabis cookies labeled to contain 40 mg “CC9” and a bite of a gummy with unknown contents. The patient experienced vomiting and visual problems, and suffered from nine days of cognitive and physical impairment. HHC-C9, a novel SSC, was detected in blood through forensic toxicological analysis. Conclusions: Recreational use of HHC-C9 can cause vomiting, visual disturbances, and drowsiness, potentially requiring hospital treatment. Potency, clinical effects, and toxicity of SSCs can vary significantly, and in combination with easy accessibility, SSCs pose a potential risk of intoxication to unaware consumers. Full article

Background: Since the emergence of e-cigarettes on the market in the early 2000s, the prevalence of e-cigarette use has increased globally. The health risks of using e-cigarettes have been increasingly revealed; however, the health effects on non-users exposed to e-cigarettes are less known. Methods: A systematic review was conducted of peer-reviewed articles from 2004 to October 2024 from PubMed and Embase. We focused on the studies that described health outcome measures among non-smokers/vapers exposed to secondhand e-cigarettes. We excluded animal studies and those that did not include human participants. We also omitted studies with financial conflicts of interest with the tobacco industry. Results: Of the 8635 studies we found in our search, 16 were included in the final review. Study designs included in our review included a case study, a cohort, eight experimental, four cross-sectional studies, and two observational studies. Health outcome measures were self-reported health symptoms and biomarkers. Ten out of fourteen studies examined respiratory health risks, six described immunological effects, two examined cardiovascular risks, and one explored mental health effects. Self-reported health symptoms such as bronchitis, shortness of breath, asthma, throat irritations, ear infections, and mental health disorders were observed among secondhand e-cigarette exposures when compared with controls. Biomarker measures varied among studies, except for cotinine concentrations of non-smokers/vapers exposed to secondhand e-cigarettes, which were likely to be higher than non-exposed. However, all studies encountered potential limitations. Conclusions: Our review found that secondhand e-cigarette exposure is not harmless and may have negative health consequences. However, higher-quality prospective studies remain essential to examine long-term secondhand exposure. Full article

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

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

Background: School-based tobacco control policies are critical for preventing youth tobacco use. While many districts adopt formal policies to create smoke- and vape-free environments, the degree to which these policies are enforced at the school level may vary, influencing their effectiveness. Little is known about how consistently such policies are implemented across schools within urban school districts. Objectives: This study aimed to examine the existence and enforcement of school-level tobacco control policies in an urban public school system, using Baltimore City schools as a case example. Methods: We conducted a survey of school personnel from 20 high schools in Baltimore City in 2024. The survey instrument assessed the presence and enforcement of policies related to tobacco use prevention, communication, signage, disciplinary actions, and institutional support. Descriptive statistics (frequencies and percentages) were used to summarize responses. Spearman correlations were also used for bivariate correlations. Additional school-level and neighborhood-level contextual data were collected from the internet (neighborhood socioeconomic status and school performance). Results: While many policies existed across the 20 participating schools, their enforcement was widely inconsistent. Most schools reported the existence of policies prohibiting tobacco use in school buildings (60%) and vehicles (55%). However, few schools had visible tobacco-free signage (35%) or offered cessation programs (15%). Communication of policies to students (70%) and staff (65%) was the most commonly enforced aspect of tobacco control policies. Conclusions: Findings suggest that while tobacco control policies may be adopted across urban school systems, their enforcement at the school level remains uneven. Greater attention may be needed to support policy implementation and to reduce variability in school-level practices. Baltimore City serves as a useful case study to understand these challenges and identify opportunities for strengthening school-based tobacco prevention efforts. Full article

Cannabis vaping, particularly involving cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), rapidly delivers highly concentrated cannabinoids to the brain, potentially affecting the hippocampus. This study examined differential expression of long noncoding RNAs (lncRNAs) and mRNAs in the hippocampus after acute exposure to vaporized CBD or THC. Male ICR mice were exposed to vaporized CBD or THC (50 mg, n = 5/group), and hippocampal tissues were collected at 1, 3, and 14 days post-exposure. Total RNA sequencing was conducted on day 1 samples, and selected transcripts were validated using qRT-PCR across multiple time points. CBD led to significant up- or downregulation of L3mbtl1, Wnt7a, and Camk2b at day 1. However, Wnt7a showed gradual recovery at days 3 and 14. In the THC group, Grin2a, Gria3, and Golga2 were significantly upregulated, while Drd1, Drd2, Gnal, and Adcy5 were significantly downregulated at day 1. Time-course analysis showed that Drd2 expression returned to baseline by day 14, whereas Adcy5 remained persistently downregulated through days 3 and 14. In the CBD group, NONMMUT069014.2 was upregulated, while NONMMUT033147.2 and NONMMUT072606.2 were downregulated at day 1; notably, NONMMUT072606.2 showed a transient increase at day 3 before returning to baseline. In the THC group, NONMMUT085523.1 and NONMMUT123548.1 were upregulated, whereas NONMMUT019734.2, NONMMUT057101.2, and NONMMUT004928.2 were downregulated, with most showing gradual recovery by day 14. Correlation analysis revealed that THC-responsive lncRNAs—including NONMMUT004928.2, NONMMUT057101.2, and NONMMUT019734.2—were strongly associated with downregulated mRNAs such as Drd2 and Adcy5. These findings highlight cannabinoid-specific hippocampal transcriptomic responses and suggest potential regulatory roles for lncRNA–mRNA interactions in cannabinoid-induced neural changes. 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

This article focuses on an advocacy campaign for a complete ban on vaping in Kazakhstan led by the Smokefree Kazakhstan Coalition. Initiated in 2021, the campaign aimed to address the growing public health concerns about vaping among adolescents, which was reflected in a sharp increase in vape use among young people—from 1.6% in 2014 to 5.8% in 2022. Despite facing strong opposition from the vaping industry and political lobbyists, the Coalition gained support from key political figures, public health leaders, and NGOs. Over 32 months, the campaign achieved several key milestones, including the inclusion of criminal liabilities for those involved in the vaping industry, and, in 2024, it eventually joined a number of countries such as Thailand, Qatar, Japan, Singapore, and India in approving a vaping ban. The advocacy efforts relied on public engagement, social media, and coordinated civil society mobilization—including petitions, public meetings, awareness campaigns, and coalition-building among NGOs and health advocacy groups—to overcome industry resistance toward official vaping market ban approvals. This article uses the case study approach with the Power Prism framework to describe and evaluate the advocacy campaign’s strategic plan, its political challenges, and the significant impact of public health advocacy in shaping national health policy. The significance of the article lies in the success of the vaping ban in the Kazakhstani context, which may serve as a model for other countries facing similar public health issues, political instability, and industry resistance. 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

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

Since the 2018 Farm Bill legalized hemp, semi-synthetic cannabinoids, typically derived from hemp-extracted CBD, have been marketed as offering a “legal high”, raising concerns about consumer safety, labeling, and regulation. Consequently, the potency analysis of these compounds has become increasingly important. To address this need, an LC-DAD method was developed for the quantification of seventeen cannabinoids, selected based on the synthetic pathways of semi-synthetic cannabinoids. These included naturally occurring compounds, semi-synthetic derivatives, and byproducts (CBC, CBD, CBDV, CBG, CBN, CBN-O-acetate, CBT, 9(R)-HHC, 9(S)-HHC, 9(R)-HHC-O-acetate, 9(S)-HHC-O-acetate, Δ⁸-THC, Δ⁹-THC, Δ^9,11-THC, Δ⁸-THC-O-acetate, Δ⁹-THC-O-acetate, and Δ⁹-THCV), using abnormal CBD as an internal standard. The method was validated according to ISO 17025 guidelines, demonstrating a linear calibration range from 0.1 to 50 µg/mL. The method was further applied to the potency analysis of one Δ⁸-THC, two THC-O-acetate, two HHC, and one HHC-O-acetate vaping oil sample. Using an innovative method to recover the contents of vaping cartridges, cannabinoids were extracted using methanol, diluted to a concentration of 50 µg/mL, and analyzed using the validated LC-DAD method, which provided a quantifiable range of 0.1 to 100% (w/w). Method specificity was evaluated using ESI/TOFMS and showed minimal interference, despite the presence of other isomers of the semi-synthetic cannabinoids in the samples. Full article