Introduction The 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors other than menthol in cigarettes but did not restrict their use in other forms of tobacco (e.g., ...smokeless, cigars, hookah, e-cigarettes). Methods A cross-sectional analysis of Wave 1 data from 45,971 U.S. adults and youth, aged ≥12 years in the Population Assessment of Tobacco and Health (PATH) Study collected in 2013–2014, was conducted in 2016. This study examined (1) the prevalence and reasons for use of flavored tobacco products; (2) the proportion of ever tobacco users reporting that their first product was flavored; and (3) correlates of current flavored tobacco product use. Results Current flavored (including menthol) tobacco product use was highest in youth (80%, aged 12–17 years); and young adult tobacco users (73%, aged 18–24 years); and lowest in older adult tobacco users aged ≥65 years (29%). Flavor was a primary reason for using a given tobacco product, particularly among youth. Eighty-one percent of youth and 86% of young adult ever tobacco users reported that their first product was flavored versus 54% of adults aged ≥25 years. In multivariable models, reporting that one’s first tobacco product was flavored was associated with a 13% higher prevalence of current tobacco use among youth ever tobacco users and a 32% higher prevalence of current tobacco use among adult ever users. Conclusions These results add to the evidence base that flavored tobacco products may attract young users and serve as starter products to regular tobacco use.
•Nicotine concentrations of e-cigarettes may influence their public health impact.•Average nicotine concentrations in U.S. e-cigarettes increased from 2013 to 2018.•0% nicotine products accounted for ...<1% of market share across all years analyzed.•5% or more nicotine products accounted for >66% of market share in 2018.•Findings reinforce importance of efforts to prevent youth access to e-cigarettes.
Considerable declines in cigarette smoking have occurred in the U.S. over the past half century. Yet emerging tobacco products, including e-cigarettes, have increased in popularity among U.S. youth and adults in recent years. Nicotine content is an important factor in weighing the potential benefits and risks of e-cigarettes on individual and population level health. This study examined how nicotine concentrations of e-cigarette products sold have changed from 2013 to 2018.
E-cigarette sales data aggregated in 4-week periods from March 2, 2013 to September 8, 2018 (66 months total) from convenience store and mass market channels were obtained from Nielsen. Internet and vape shop sales were not available. Internet searches were used to supplement information for nicotine concentration and flavor. Products were categorized by nicotine concentration, flavor, type (disposable or rechargeable), and brand. Dollar sales, unit sales, and average nicotine concentration were assessed.
During 2013–2018, the average nicotine concentration in e-cigarettes sold increased overall, for all flavor categories, and for rechargeable e-cigarettes. The proportion of total dollar sales comprised of higher nicotine concentration e-cigarettes (>4% mg/mL) increased from 12.3% to 74.7% during 2013–2018, with a similar increase in unit share. Zero-nicotine products accounted for less than 1% of dollar market share across all years analyzed.
E-cigarettes with higher nicotine concentrations comprise a substantial and increasing portion of U.S. e-cigarette sales. Higher nicotine concentrations may influence patterns of e-cigarette use, including harms from e-cigarette initiation among youth and potential health benefits for adult smokers switching completely to e-cigarettes.
Heated tobacco products (HTPs) are a form of nicotine delivery intended to provide an alternative to traditional cigarettes. The aim of this systematic review was to present the current state of ...knowledge on HTPs with an emphasis on the potential impact of HTP use on human health. During the preparation of this systematic review, the literature on HTPs available within Medline/PubMed, EMBASE, CINAHL, ScienceDirect, and Google Scholar was retrieved and examined. In the final review, 97 research papers were included. The authors specifically assessed the construction and operation of HTPs, as well as the chemical composition of HTP tobacco sticks and the generated aerosol, based on evidence from experimental animal and cellular studies, and human-based studies.Heated tobacco products were found to generate lower concentrations of chemical compounds compared to traditional cigarettes, except for water, propylene glycol, glycerol, and acetol. The nicotine levels delivered to the aerosol by HTPs were 70-80% as those of conventional combustion. The results of in vitro and in vivo assessments of HTP aerosols revealed reduced toxicity, but these were mainly based on studies sponsored by the tobacco industry. Independent human-based studies indicated that there was a potentially harmful impact of the active and passive HTP smoking on human health. Currently, a large body of knowledge on HTP exposures and health effects is provided by the tobacco industry (52% of identified studies). Based on the available evidence, HTPs produce lower levels of toxic chemicals, compared to conventional cigarettes, but they are still not risk-free. Int J Occup Med Environ Health. 2019;32(5):595-634.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
ObjectivesA heat-not-burn (HNB) tobacco product, IQOS, was first launched in Japan and Italy as test markets and is currently in commerce in 30 countries. Using two data sources, we examined interest ...in HNB tobacco (IQOS, Ploom and glo), its prevalence, predictors of its use and symptoms from exposure to secondhand HNB tobacco aerosol in Japan, where HNB tobacco has been sold since 2014.MethodsPopulation interest in HNB tobacco was explored using Google search query data. Prevalence of HNB tobacco current use (ie, use in the previous 30 days) was calculated using a longitudinal internet survey of 8240 individuals (15–69 years old in 2015) followed up to 2017. Rates of perceived symptoms from exposure to exhaled aerosol of others’ HNB tobacco were also calculated.ResultsThe largest internet search volume for IQOS occurred in April 2016 in the week after a popular national entertainment TV show introduced IQOS. For Ploom and glo, search volumes have remained limited since their launch. Prevalence of IQOS users increased from 0.3% in January–February 2015 to 0.6% in January–February 2016 and up to 3.6% in January–February 2017, while estimated rates of use of other HNB tobacco products remained low in 2017. Respondents who had seen the TV programme in 2016 were more likely to have used IQOS than those who had not seen it (10.3% vs 2.7%). Among never-smokers who had been exposed to secondhand HNB tobacco aerosol, nearly half reported at least one acute symptom, although these symptoms were not serious.ConclusionsA popular TV programme triggered IQOS diffusion in Japan. Extrapolating from survey results to the general population, around 3.1 million people currently use IQOS in Japan. Tobacco control organisations and governments should closely monitor HNB tobacco and consider how to regulate it.
Aims
To measure carbonyl emissions from a heated tobacco product (IQOS) in comparison with an e‐cigarette (Nautilus Mini) and a commercial tobacco cigarette (Marlboro Red).
Design
Regular and menthol ...variants of the heated tobacco product were tested. A tank‐type atomizer was tested with a tobacco‐flavoured liquid at 10 and 14 W. Aerosol and smoke were collected in impingers containing 2,4‐dinitrophenylhydrazine. Health Canada Intense and two more intense puffing regimens were used.
Setting
Analytical laboratory in Greece.
Measurements
Carbonyl levels in the aerosol and smoke.
Findings
At the Health Canada Intense regimen, heated tobacco products emitted 5.0–6.4 μg/stick formaldehyde, 144.1–176.7 μg/stick acetaldehyde, 10.4–10.8 μg/stick acrolein, 11.0–12.8 μg/stick propionaldehyde and 1.9–2.0 μg/stick crotonaldehyde. Compared with the tobacco cigarette, levels were on average 91.6% lower for formaldehyde, 84.9% lower for acetaldehyde, 90.6% lower for acrolein, 89.0% lower for propionaldehyde and 95.3% lower for crotonaldehyde. The e‐cigarette emitted 0.5–1.0 μg/12 puffs formaldehyde, 0.8–1.5 μg/12 puffs acetaldehyde and 0.3–0.4 μg/12 puffs acrolein, but no propionaldehyde and crotonaldehyde. At more intense puffing regimens, formaldehyde was increased in heated tobacco products, but levels were three–fourfold lower compared with the tobacco cigarette. Based on the findings from Health Canada Intense puffing regimen, use of 20 heated tobacco sticks would result in approximately 85% to 95% reduced carbonyl exposure compared with smoking 20 tobacco cigarettes; the respective reduction in exposure from use of 5 g e‐cigarette liquid would be 97% to > 99%.
Conclusions
The IQOS heated tobacco product emits substantially lower levels of carbonyls than a commercial tobacco cigarette (Marlboro Red) but higher levels than a Nautilus Mini e‐cigarette.
The chemical composition, in vitro genotoxicity, and cytotoxicity of the mainstream aerosol from the Tobacco Heating System 2.2 (THS2.2) were compared with those of the mainstream smoke from the 3R4F ...reference cigarette. In contrast to the 3R4F, the tobacco plug in the THS2.2 is not burnt. The low operating temperature of THS2.2 caused distinct shifts in the aerosol composition compared with 3R4F. This resulted in a reduction of more than 90% for the majority of the analyzed harmful and potentially harmful constituents (HPHCs), while the mass median aerodynamic diameter of the aerosol remained similar. A reduction of about 90% was also observed when comparing the cytotoxicity determined by the neutral red uptake assay and the mutagenic potency in the mouse lymphoma assay. The THS2.2 aerosol was not mutagenic in the Ames assay. The chemical composition of the THS2.2 aerosol was also evaluated under extreme climatic and puffing conditions. When generating the THS2.2 aerosol under “desert” or “tropical” conditions, the generation of HPHCs was not significantly modified. When using puffing regimens that were more intense than the standard Health Canada Intense (HCI) machine-smoking conditions, the HPHC yields remained lower than when smoking the 3R4F reference cigarette with the HCI regimen.
•Mainstream aerosol characterization of the Tobacco Heating System 2.2 (THS2.2).•Comparison of the THS2.2 aerosol with the smoke of the 3R4F reference cigarette.•The majority of the toxicant yields were reduced by more than 90% in the THS2.2•The THS2.2 in vitro genotoxic and cytotoxic potencies were reduced by about 90%.•The particle sizes of THS2.2 aerosol and cigarette smoke were similar.
This study compared the cytotoxicity of IQOS aerosols to smoke from Marlboro Red (MR) and 3R4F reference cigarettes. Aerosol/smoke solutions were tested as the gas vapor phase (GVP), particulate ...phase (total particulate matter or TPM), or whole aerosol/smoke (WA), the latter being what smokers actually inhale. Cytotoxicities were evaluated using the LDH, MTT and neutral red uptake (NRU) assays in conjunction with eight different cell types, mainly from the respiratory system. Most test solutions did not compromise the plasma membranes of cells (LDH). However, mitochondrial activity (MTT) and dye uptake/lysosomal activity (NRU) were equally depressed by IOQS aerosols and cigarette smoke solutions at the high concentrations. Our NRU data with mouse NIH/3T3 transformed fibroblasts were similar to those previously reported by the IQOS manufacturer and showed little cytotoxicity in the NRU assay. In both studies with NIH/3T3 cells, the results were significantly different from 3RF4 cigarette smoke, suggesting reduced toxicity with IQOS. However, by expanding evaluations to a broader spectrum of cells that included respiratory system cells and by including higher concentrations of GVP, as well as WA, cytotoxicity equivalent to that of Marlboro Red and 3R4F cigarettes was frequently observed with IQOS aerosols in the MTT and NRU assays.
•Cytotoxicities of vapor, particulate and whole IQOS aerosols were compared for eight cell types.•IQOS aerosols did not produce cytotoxicity in the NRU assay with mouse 3T3 fibroblasts.•However, human cells from the respiratory system were adversely affected by IQOS aerosols•The sensitivity of six respiratory system cells to IQOS aerosols varied with cell type.•In some cases, IQOS aerosol was as cytotoxic as smoke from commercial and research cigarettes.
Background and Aims
In addition to some electronic cigarettes (e‐cigarettes), new heat‐not‐burn tobacco products Ploom and iQOS have recently begun to be sold by tobacco companies. These products are ...regulated differently in Japan, depending on whether the contents are liquid or tobacco leaf. Our objective was to estimate percentages of awareness and use of e‐cigarettes and heat‐not‐burn tobacco products among the Japanese population, including minors.
Design and Setting
An internet survey (randomly sampled research agency panellists) with a propensity score adjustment for “being a respondent in an internet survey” using a nationally representative sample in Japan.
Participants
A total of 8240 respondents aged 15–69 years in 2015 (4084 men and 4156 women).
Measurements
Adjusted percentages of awareness and use of e‐cigarettes (nicotine or non‐nicotine e‐cigarettes) and heat‐not‐burn products among total participants; product types and percentages ever used among e‐cigarettes ever users.
Findings
Of respondents in Japan, 48% 95% confidence interval (CI) = 47–49 were aware of e‐cigarettes and heat‐not‐burn tobacco products, 6.6% (95% CI = 6.1–7.1) had ever used, 1.3% (95% CI = 1.0–1.5) had used in the last 30 days and 1.3% (95% CI = 1.1–1.6) had experience of > 50 sessions. Seventy‐two per cent (95% CI = 69–76) of ever users used non‐nicotine e‐cigarettes, while 33% (95% CI = 30–37) of them used nicotine e‐cigarettes, which has the majority share world‐wide; 7.8% (95% CI = 5.5–10.0) and 8.4% (95% CI = 6.1–10.7) of them used the new devices, Ploom and iQOS, respectively, with a relatively higher percentage among the younger population.
Conclusions
Approximately half the respondents in a Japanese internet survey were aware of e‐cigarettes and heat‐not‐burn tobacco products, 6.6% had ever used. More than 70% of ever users used non‐nicotine e‐cigarettes, the sale of which is not legally prohibited, even to minors, in Japan, and 33% of them used nicotine e‐cigarettes; 3.5% of never smoking men and 1.3% of never smoking women had ever used e‐cigarettes. Corresponding figures for use in the last 30 days were 0.6% and 0.3%, predominantly non‐nicotine e‐cigarettes.
According to a 2013–2014 survey of nearly 46,000 U.S. adults and youths, 28% of adults were current users of tobacco and 9% of youths had used tobacco in the previous 30 days. Approximately 40% of ...users used multiple products, with cigarettes plus e-cigarettes the most common combination.
Smoking is responsible for more U.S. deaths annually than the acquired immunodeficiency syndrome, use of alcohol and illegal drugs, motor vehicle accidents, murders, and suicides combined.
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With recent data suggesting higher smoking-attributable mortality than previously estimated,
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the medical community is urged to make tobacco control a high priority.
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The prevalence of current use of cigarettes has declined during the past 50 years, from 42% of adults in 1965 to less than 20% in 2014,
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,
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but disparities in cigarette smoking across demographic subgroups (particularly according to race or ethnic group, educational attainment, and socioeconomic status) have widened during the past . . .
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