International Journal of Environmental Research and Public Health

Research

10 pages, 324 KiB

Open AccessArticle

Antecedents of Self-Efficacy to Achieve Smoking-Behavior-Change Goals among Low-Income Parents Enrolled in an Evidence-Based Tobacco Intervention

by Mona L. Baishya, Bradley N. Collins and Stephen J. Lepore

Int. J. Environ. Res. Public Health 2022, 19(20), 13573; https://doi.org/10.3390/ijerph192013573 - 20 Oct 2022

Cited by 1 | Viewed by 1917

Abstract

Previous studies have shown that greater self-efficacy (SE) to modify smoking behaviors during treatment improves long-term post-treatment outcomes. Little is known about factors that might enhance SE for smoking abstinence and for reducing children’s tobacco smoke exposure (TSE). The present study investigated hypothesized [...] Read more.

Previous studies have shown that greater self-efficacy (SE) to modify smoking behaviors during treatment improves long-term post-treatment outcomes. Little is known about factors that might enhance SE for smoking abstinence and for reducing children’s tobacco smoke exposure (TSE). The present study investigated hypothesized predictors of end-of-treatment SE to abstain from smoking and to protect children from TSE by conducting secondary multiple regression analyses of data (N = 327) from the Kids Safe and Smokefree (KiSS) behavioral intervention trial. KiSS aimed to reduce parental smoking and child TSE in urban, low-income, and minority communities. The results showed that partner support and initiating a planned quit attempt during treatment were positively related to SE to abstain from smoking and to reduce children’s TSE (all p’s < 0.001) at the end of treatment (EOT). Further, lower baseline nicotine dependence and the use of nicotine replacement were related to higher SE to abstain from smoking at EOT (p < 0.01), whereas more restrictive residential smoking rules and lower children’s TSE at baseline was associated with higher SE to reduce children’s TSE at EOT (all p’s < 0.05). These findings inform theory and future intervention design, identifying individual and social-environmental factors that might enhance smoking-behavior-change SE. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

11 pages, 864 KiB

Open AccessArticle

Smoking Habits among College Students at a Public University in Riyadh, Saudi Arabia

by Khalid A. Bin Abdulrahman, Hatem Ali Alghamdi, Rayan Sulaiman Alfaleh, Waleed Saleh Albishri, Walid Bandar Almuslamani, Abdulelah Murdhi Alshakrah, Hamad Mohammed Alsuwailem and Sultan Ali Alkhelaiwi

Int. J. Environ. Res. Public Health 2022, 19(18), 11557; https://doi.org/10.3390/ijerph191811557 - 14 Sep 2022

Cited by 7 | Viewed by 5588

Abstract

Tobacco smoking is one of the leading risk factors for ill health and death worldwide. Adolescence is the starting age of smoking for most current smokers worldwide. This study aimed to explore the prevalence of tobacco, the habits of different types of former [...] Read more.

Tobacco smoking is one of the leading risk factors for ill health and death worldwide. Adolescence is the starting age of smoking for most current smokers worldwide. This study aimed to explore the prevalence of tobacco, the habits of different types of former smokers, and their relationship to other specialties and sociodemographic data. Methods: This cross-sectional study was conducted at Imam Mohammad Ibn Saud Islamic University (IMSIU), Saudi Arabia. An online questionnaire was sent to students’ emails to assess their smoking prevalence and tobacco and nicotine product habits. Results: Of the 895 students in IMSIU who participated in our survey, most reported having never used/tried tobacco, representing (76.4%). Most of the students who smoke began to smoke within the last five years (46.4%), which strongly indicates that they started to smoke when they entered the university. When students were asked about the time they like to smoke, most reported that they smoke when they feel stressed/under pressure (57.1%). There was a strong relationship between having a family member who smokes and being a smoker (53.1%). Conclusions: The prevalence of cigarettes, electronic cigarettes, and Shisha was 18.3%, 5%, and 11%, respectively. Anti-smoking regulations at the university level should be periodically reviewed to ensure the effectiveness and efficiency of tobacco control strategies. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

13 pages, 2460 KiB

Open AccessArticle

Anabasine and Anatabine Exposure Attributable to Cigarette Smoking: National Health and Nutrition Examination Survey (NHANES) 2013–2014

by Patrick B. Bendik, Sharyn M. Rutt, Brittany N. Pine, Connie S. Sosnoff, Benjamin C. Blount, Wanzhe Zhu, June Feng and Lanqing Wang

Int. J. Environ. Res. Public Health 2022, 19(15), 9744; https://doi.org/10.3390/ijerph19159744 - 8 Aug 2022

Cited by 7 | Viewed by 2628

Abstract

Anabasine and anatabine are minor alkaloids in tobacco products and are precursors for tobacco-specific nitrosamines (TSNAs). The levels of these two compounds have been used to differentiate tobacco product sources, monitor compliance with smoking cessation programs, and for biomonitoring in TSNA-related studies. The [...] Read more.

Anabasine and anatabine are minor alkaloids in tobacco products and are precursors for tobacco-specific nitrosamines (TSNAs). The levels of these two compounds have been used to differentiate tobacco product sources, monitor compliance with smoking cessation programs, and for biomonitoring in TSNA-related studies. The concentrations of urinary anabasine and anatabine were measured in a representative sample of U.S. adults who smoked cigarettes (N = 770) during the 2013–2014 National Health and Nutrition Examination Survey (NHANES) study cycle, which was the first cycle where urinary anabasine and anatabine data became available. Weighted geometric means (GM) and geometric least squares means (LSM) with 95% confidence intervals were calculated for urinary anabasine and anatabine categorized by tobacco-use status [cigarettes per day (CPD) and smoking frequency] and demographic characteristics. Smoking ≥20 CPD was associated with 3.6× higher anabasine GM and 4.8× higher anatabine GM compared with smoking <10 CPD. Compared with non-daily smoking, daily smoking was associated with higher GMs for urinary anabasine (1.41 ng/mL vs. 6.28 ng/mL) and anatabine (1.62 ng/mL vs. 9.24 ng/mL). Urinary anabasine and anatabine concentrations exceeded the 2 ng/mL cut point in 86% and 91% of urine samples from people who smoke (PWS) daily, respectively; in comparison, 100% of them had serum cotinine concentrations greater than the established 10 ng/mL cut point. We compared these minor tobacco alkaloid levels to those of serum cotinine to assess their suitability as indicators of recent tobacco use at established cut points and found that their optimal cut point values would be lower than the established values. This is the first time that anabasine and anatabine are reported for urine collected from a U.S. population-representative sample of NHANES study participants, providing a snapshot of exposure levels for adults who smoked during 2013–2014. The results of this study serve as an initial reference point for future analysis of NHANES cycles, where changes in the national level of urinary anabasine and anatabine can be monitored among people who smoke to show the effect of changes in tobacco policy. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

11 pages, 343 KiB

Open AccessArticle

Financial Insecurity and Food Insecurity among U.S. Children with Secondhand and Thirdhand Smoke Exposure

by E. Melinda Mahabee-Gittens, Keith A. King, Rebecca A. Vidourek and Ashley L. Merianos

Int. J. Environ. Res. Public Health 2022, 19(15), 9480; https://doi.org/10.3390/ijerph19159480 - 2 Aug 2022

Viewed by 1661

Abstract

Objectives: Smokers with financial and food insecurity may find it difficult to quit smoking and reduce their children’s tobacco smoke exposure (TSE). The objective was to examine the associations between child TSE and financial and food insecurity among U.S. school-aged children. Methods: We [...] Read more.

Objectives: Smokers with financial and food insecurity may find it difficult to quit smoking and reduce their children’s tobacco smoke exposure (TSE). The objective was to examine the associations between child TSE and financial and food insecurity among U.S. school-aged children. Methods: We examined the 2018–2019 National Survey of Children’s Health data on 17,484 children 6–11 years old. Children were categorized into TSE groups: (1) No TSE: did not live with a smoker; (2) thirdhand smoke (THS) exposure alone: lived with a smoker who did not smoke inside the home; or (3) secondhand smoke (SHS) and THS exposure: lived with a smoker who smoked inside the home. We conducted weighted logistic, ordinal, and linear regression analyses to assess the relationships between child TSE status and financial and food insecurity, adjusting for covariates. Results: Overall, 13.1% and 1.8% of children had THS exposure alone and SHS and THS exposure, respectively. Compared to children with no TSE, children with THS exposure alone were at 2.17 increased odds (95% CI = 1.83, 2.58, p < 0.001) and children with SHS and THS exposure were at 2.24 increased odds (95% CI = 1.57, 3.19, p < 0.001) of having financial insecurity. Children with THS exposure alone were at 1.92 increased odds (95% CI = 1.58, 2.33, p < 0.001) and children with SHS and THS exposure were at 2.14 increased odds (95% CI = 1.45, 3.16, p < 0.001) of having food insecurity. Conclusions: Children with TSE are at increased risk of experiencing financial and food insecurity. When developing tobacco interventions, a holistic approach to tobacco control that addresses ways to decrease financial and food hardships may improve outcomes. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

16 pages, 10070 KiB

Open AccessArticle

Nicotine Exerts Cytotoxic Effects in a Panel of Healthy Cell Lines and Strong Irritating Potential on Blood Vessels

by Doina Chioran, Adrian Sitaru, Ioana Macasoi, Iulia Pinzaru, Cristian Andrei Sarau, Cristina Dehelean, Stefania Dinu, Camelia Szuhanek, Irina Nicoleta Zetu, Andra Cristine Serafin, Mircea Rivis, Marioara Poenaru and Razvan Dragoi

Int. J. Environ. Res. Public Health 2022, 19(14), 8881; https://doi.org/10.3390/ijerph19148881 - 21 Jul 2022

Cited by 5 | Viewed by 4779

Abstract

The use of tobacco products is a major global public health issue, as it is the leading cause of preventable death worldwide. In addition, nicotine (NIC) is a key component of electronic and conventional cigarettes. Although nicotine’s addictive potential is well known, its [...] Read more.

The use of tobacco products is a major global public health issue, as it is the leading cause of preventable death worldwide. In addition, nicotine (NIC) is a key component of electronic and conventional cigarettes. Although nicotine’s addictive potential is well known, its health effects are not entirely understood. Thus, the main objective of the present study was to evaluate its toxicological profile both in vitro, at the level of three healthy cell lines, and in ovo, at the level of the chorioallantoic membrane. Five different concentrations of nicotine were used in keratinocytes, cardiomyocytes, and hepatocytes for the purpose of evaluating cell viability, cell morphology, and its impact on nuclei. Additionally, the hen’s egg test on the chorioallantoic membrane (HET-CAM) method was used to assess the biocompatibility and irritant potential of the chorioallantoic membrane. Across all cell lines studied, nicotine was proven to be significantly damaging to cell viability, with the highest concentration tested resulting in less than 2% viable cells. Moreover, the morphology of cells changed dramatically, with alterations in their shape and confluence. Nicotine-induced cell death appears to be apoptotic, based on its impact on the nucleus. In addition, nicotine was also found to have a very strong irritating effect on the chorioallantoic membrane. In conclusion, nicotine has an extremely strong toxicological profile, as demonstrated by the drastic reduction of cell viability and the induction of morphological changes and nuclear alterations associated with cellular apoptosis. Additionally, the HET-CAM method led to the observation of a strong irritating effect associated with nicotine. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

9 pages, 744 KiB

Open AccessArticle

Passive Smoking Is Associated with Multiple Heavy Metal Concentrations among Housewives in Shanxi Province, China

by Huiting Chen, Jigen Na, Hang An, Ming Jin, Xiaoqian Jia, Lailai Yan, Nan Li and Zhiwen Li

Int. J. Environ. Res. Public Health 2022, 19(14), 8606; https://doi.org/10.3390/ijerph19148606 - 14 Jul 2022

Cited by 2 | Viewed by 2281

Abstract

Background: Passive smoking may increase the content of heavy metals in housewives. However, this association remains a subject of debate. Female passive smoking is widespread, particularly in Chinese rural areas. Objective: This study aimed to assess the association between heavy metal accumulation and [...] Read more.

Background: Passive smoking may increase the content of heavy metals in housewives. However, this association remains a subject of debate. Female passive smoking is widespread, particularly in Chinese rural areas. Objective: This study aimed to assess the association between heavy metal accumulation and passive smoking status among rural housewives. Methods: 405 women were recruited in Shanxi Province of Northern China, and 384 (94.8%, 384/405) participants were included in the final study, of whom 117 women were exposed to passive smoking. The information on their basic characteristics was collected via a structured questionnaire. We used inductively coupled plasma mass spectrometry (ICP-MS) to analyze the concentrations of nine heavy metals, including cadmium (Cd), germanium (Ge), arsenic (As), lead (Pb), titanium (Ti), copper (Cu), iron (Fe), cobalt (Co), and chromium (Cr), in hair samples. Results: The results indicated that higher As, Ge, Ti, and Fe concentrations were significantly associated with passive smoking. After adjusting for potential confounders, the adjusted odds ratios and the 95% confidence intervals of As, Ge, Ti, and Fe were (1.80 (1.13–2.90), p = 0.028), (1.78 (1.14–2.80), p = 0.007), (1.70 (1.09–2.67), p = 0.019), and (1.67 (1.07–2.63), p = 0.035), respectively. The statistically significant linear trend of the adjusted odds ratios at different levels further supported their association. Conclusion: Our research concluded that exposure to environmental tobacco smoke might contribute to As, Ge, Ti, and Fe accumulation among housewives. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

12 pages, 635 KiB

Open AccessArticle

Methylation in the Promoter Region of the Dopamine Transporter DAT1 Gene in People Addicted to Nicotine

by Jolanta Chmielowiec, Krzysztof Chmielowiec, Aleksandra Strońska-Pluta, Aleksandra Suchanecka, Kinga Humińska-Lisowska, Milena Lachowicz, Marta Niewczas, Monika Białecka, Małgorzata Śmiarowska and Anna Grzywacz

Int. J. Environ. Res. Public Health 2022, 19(14), 8602; https://doi.org/10.3390/ijerph19148602 - 14 Jul 2022

Cited by 6 | Viewed by 1938

Abstract

The dopaminergic system is a crucial element of the addiction processes. The dopamine transporter modulates the dynamics and levels of released dopamine in the synaptic cleft. Therefore, regulation of dopamine transporter (DAT1) gene expression is critical for maintaining homeostasis in the [...] Read more.

The dopaminergic system is a crucial element of the addiction processes. The dopamine transporter modulates the dynamics and levels of released dopamine in the synaptic cleft. Therefore, regulation of dopamine transporter (DAT1) gene expression is critical for maintaining homeostasis in the dopaminergic system. The aim of our study is evaluation of the methylation status of 33 CpG islands located in the DAT1 gene promoter region related to nicotine dependency. We investigated 142 nicotine-dependent subjects and 238 controls. Our results show that as many as 14 of the 33 CpG islands tested had statistically significantly higher methylation in the nicotine-dependent group compared to the control group. After applying Bonferroni correction, the total number of methylation sites was also significantly higher in the dependent subjects group. The analysis of the methylation status of particular CpG sites revealed a new direction of research regarding the biological aspects of nicotine addiction. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

11 pages, 336 KiB

Open AccessArticle

Electronic Cigarettes in Thailand: Behaviour, Rationale, Satisfaction, and Sex Differences

by Tamonwan Chankaew, Peeraporn Baiya, Dujrudee Chinwong, Voratima Yoodee and Surarong Chinwong

Int. J. Environ. Res. Public Health 2022, 19(14), 8229; https://doi.org/10.3390/ijerph19148229 - 6 Jul 2022

Cited by 5 | Viewed by 3143

Abstract

Electronic cigarettes (e-cigarettes) use is trending in Thailand. Electronic cigarettes are banned and illegally imported. This study aimed to investigate the behaviour, rationale, and satisfaction of e-cigarettes users and compared them between males and females. A cross-sectional study was conducted involving 1050 participants [...] Read more.

Electronic cigarettes (e-cigarettes) use is trending in Thailand. Electronic cigarettes are banned and illegally imported. This study aimed to investigate the behaviour, rationale, and satisfaction of e-cigarettes users and compared them between males and females. A cross-sectional study was conducted involving 1050 participants using e-cigarettes from December 2019 to February 2020. The participants were recruited by an online questionnaire posted on social media. The participants were current e-cigarettes users aged 18 years and older. Of 1050 participants, 936 were male (89.1%). The average age was 31.2 ± 8.4 years. The participants were from all regions of the country, but most (64.5%) were from central Thailand. Most e-cigarettes users comprised private employees (43.2%). The main source of e-cigarettes in Thailand is online sources such as social media. Tank-style e-cigarettes were popular among users. Amongst e-cigarettes users, the top three rationales for using e-cigarettes were fewer harmful effects from e-cigarettes than conventional cigarettes (81.0%), smoking cessation aids (80.6%), and their lack of attaching cigarette odour (58.2%). The top three reasons for satisfaction were using e-cigarettes as a conventional cigarette cessation aid (5.1 ± 1.3), lessening cravings for conventional cigarettes (5.1 ± 1.3), and reducing conventional cigarettes withdrawal symptoms (5.0 ± 1.3). Online purchase was the main source of e-cigarettes in Thailand. The general rationale for using electronic cigarettes was that they are less harmful and to quit conventional cigarettes. Thai users were satisfied to use e-cigarettes as a conventional cigarette cessation aid. Males and females differed in behaviour, rationale, and satisfaction of e-cigarettes. Public health organisations should provide accurate information about the harm of electronic cigarettes and their efficacy for tobacco cessation. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

12 pages, 349 KiB

Open AccessArticle

Abstinence Rate, Adverse Events and Withdrawal Symptoms after Varenicline Use and Predicting Factors of Smoking Abstinence: A Multicentre Single-State Study in Malaysia

by Shea Jiun Choo, Chee Tao Chang, Balamurugan Tangiisuran, Mohd Faiz Abdul Latif, Nor Aida Sanusi and Sabariah Noor Harun

Int. J. Environ. Res. Public Health 2022, 19(13), 7757; https://doi.org/10.3390/ijerph19137757 - 24 Jun 2022

Cited by 1 | Viewed by 1889

Abstract

(1) Background: Varenicline is a widely prescribed agent in smoking cessation. However, the abstinence rate, the incidence of adverse events and withdrawal symptoms, have not been widely studied locally. This study aimed to determine the prevalence of smoking abstinence, adverse events and withdrawal [...] Read more.

(1) Background: Varenicline is a widely prescribed agent in smoking cessation. However, the abstinence rate, the incidence of adverse events and withdrawal symptoms, have not been widely studied locally. This study aimed to determine the prevalence of smoking abstinence, adverse events and withdrawal symptoms associated with varenicline use, as well as possible factors contributing to successful smoking abstinence. (2) Methods: This was a retrospective, cohort study conducted in twenty-two government-operated smoking cessation clinics across the state of Perak, Malaysia. The medical records of adult smokers (age ≥ 18 years old) who were prescribed with varenicline between January 2017 and June 2018 were traced. The medical records of smokers who used pharmacotherapy other than varenicline, those who received less than four weeks of varenicline treatment, and with missing data were excluded. (3) Results: Sixty-eight out of 114 subjects (59.6%) successfully achieved smoking abstinence. Probable varenicline-induced chest pain was documented in three subjects. Altered behaviour (n = 2) and auditory hallucinations (n = 1) were also reported. Varenicline treatment duration is a significant predictive factor for successful smoking abstinence (odds ratio (OR) = 2.45; 95% confidence interval (CI) 1.74–3.45; p < 0.001), followed by age (OR = 1.25; 95% CI 1.005–1.564; p = 0.045), the presence of adverse events (OR = 0.096; 95% CI 0.014–0.644; p = 0.016) and withdrawal symptoms (OR = 0.032; 95% CI 0.016–0.835; p = 0.032). (4) Conclusion: Almost two-thirds of the subjects achieved smoking abstinence with varenicline. The duration of the treatment, as well as the patients’ ages had a significant influence on successful smoking abstinence. Rare cases of cardiovascular and neuropsychiatric-related adverse events were reported, warranting continuous surveillance and adverse drug reaction reporting. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

12 pages, 579 KiB

Open AccessArticle

Tobacco Use and Exposure to Environmental Tobacco Smoke amongst Pregnant Women in the United Arab Emirates: The Mutaba’ah Study

by Mohammed Nagdi Taha, Zaki Al-Ghumgham, Nasloon Ali, Rami H. Al-Rifai, Iffat Elbarazi, Fatima Al-Maskari, Omar El-Shahawy, Luai A. Ahmed and Tom Loney

Int. J. Environ. Res. Public Health 2022, 19(12), 7498; https://doi.org/10.3390/ijerph19127498 - 18 Jun 2022

Cited by 1 | Viewed by 2668

Abstract

Self-reported tobacco use is high in the male adult Emirati population (males ~36% vs. females ~3%); however, there are minimal data on tobacco use or exposure to environmental tobacco smoke (ETS) during pregnancy in the United Arab Emirates (UAE). This study investigated the [...] Read more.

Self-reported tobacco use is high in the male adult Emirati population (males ~36% vs. females ~3%); however, there are minimal data on tobacco use or exposure to environmental tobacco smoke (ETS) during pregnancy in the United Arab Emirates (UAE). This study investigated the prevalence of, and factors associated with, tobacco use and exposure to environmental tobacco smoke (ETS) amongst pregnant women in the UAE. Baseline cross-sectional data were analysed from the Mutaba’ah Study. Expectant mothers completed a self-administered questionnaire collecting sociodemographic information, maternal tobacco use, and ETS exposure during antenatal visits at three hospitals in Al Ain (UAE; May 2017–February 2021). Amongst 8586 women included in the study, self-reported tobacco use during pregnancy was low (0.7%), paternal tobacco use was high (37.9%), and a third (34.8%) of expectant mothers were exposed to ETS (28.0% at home only). Pregnant women who were employed (adjusted odds ratio (aOR): 1.35, 95% confidence interval (CI): 1.19–1.52), with childbirth anxiety (aOR 1.21, 95% CI 1.08–1.36), and with an increased number of adults living in the same household (aOR 1.02 95% CI 1.01–1.03) were independently more likely to be exposed to ETS. Pregnant women with higher education levels (aOR 0.84, 95% CI 0.75–0.94) and higher gravidity (aOR 0.95, 95% CI 0.92–0.99) were less likely to be exposed to ETS. Public health efforts targeting smoking cessation amongst husbands and promoting smoke-free homes are warranted to help reduce prenatal ETS exposure in the UAE. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

16 pages, 9875 KiB

Open AccessArticle

Geometric Mean Serum Cotinine Concentrations Confirm a Continued Decline in Secondhand Smoke Exposure among U.S. Nonsmokers—NHANES 2003 to 2018

by Kevin T. Caron, Wanzhe Zhu, John T. Bernert, Lanqing Wang, Benjamin C. Blount, Kristin Dortch, Ronald E. Hunter, Tia Harmon, J. Ricky Akins, James Tsai, David M. Homa, James L. Pirkle and Connie S. Sosnoff

Int. J. Environ. Res. Public Health 2022, 19(10), 5862; https://doi.org/10.3390/ijerph19105862 - 11 May 2022

Cited by 4 | Viewed by 3382

Abstract

The objective of this study was to examine long-term trends in serum cotinine (COT) concentrations, as a measure of secondhand smoke (SHS) exposure, in U.S. nonsmokers using data from the National Health and Nutrition Examination Surveys (NHANES) from 2003 to 2018. We analyzed [...] Read more.

The objective of this study was to examine long-term trends in serum cotinine (COT) concentrations, as a measure of secondhand smoke (SHS) exposure, in U.S. nonsmokers using data from the National Health and Nutrition Examination Surveys (NHANES) from 2003 to 2018. We analyzed NHANES serum COT results from 8 continuous NHANES 2 year cycles from 2003 to 2018 using a liquid chromatography–tandem mass spectrometry assay that has been maintained continuously at the Centers for Disease Control and Prevention (CDC) since 1992. Serum COT concentrations (based on the geometric means) among nonsmokers in the U.S. decreased by an average of 11.0% (95% confidence interval (CI) [8.8%, 13.1%]; p < 0.0001) every 2 year cycle. From 2003 to 2018, serum COT concentrations in U.S. nonsmokers declined by 55.0%, from 0.065 ng/mL in 2003–2004 to 0.029 ng/mL in 2017–2018 (p < 0.0001). Significant decreases in serum COT concentrations were observed in all demographic groups. While disparities between these groups seems to be shrinking over time, several previously observed disparities in SHS exposure remain in 2017–2018. Serum COT concentrations of the non-Hispanic Black population remained higher than those of non-Hispanic Whites and Mexican Americans (p < 0.0001). Additionally, serum COT concentrations were significantly higher for children aged 3–5 years than other age groups (p ≤ 0.0002), and men continued to have significantly higher serum COT concentrations than women (p = 0.0384). While there is no safe level of exposure to SHS, the decrease in serum COT concentrations in the U.S. population as well as across demographic groupings represents a positive public health outcome and supports the importance of comprehensive smoke-free laws and policies for workplaces, public places, homes, and vehicles to protect nonsmokers from SHS exposure. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

13 pages, 355 KiB

Open AccessArticle

Disparities in Neighborhood Characteristics among U.S. Children with Secondhand and Thirdhand Tobacco Smoke Exposure

by E. Melinda Mahabee-Gittens, Rebecca A. Vidourek, Keith A. King and Ashley L. Merianos

Int. J. Environ. Res. Public Health 2022, 19(7), 4266; https://doi.org/10.3390/ijerph19074266 - 2 Apr 2022

Cited by 7 | Viewed by 2333

Abstract

(1) Background: Home tobacco smoke exposure (TSE) and negative neighborhood characteristics adversely affect children’s overall health. The objective was to examine the associations of child TSE status and neighborhood characteristics among U.S. school-aged children. (2) Methods: We conducted a secondary analysis of the [...] Read more.

(1) Background: Home tobacco smoke exposure (TSE) and negative neighborhood characteristics adversely affect children’s overall health. The objective was to examine the associations of child TSE status and neighborhood characteristics among U.S. school-aged children. (2) Methods: We conducted a secondary analysis of the 2018–2019 National Survey of Children’s Health (NSCH) data including 17,300 U.S. children ages 6–11 years old. We categorized children’s home TSE status into: (a) no TSE: child did not live with a smoker; (b) thirdhand smoke (THS) exposure alone: child lived with a smoker who did not smoke inside the home; and (c) secondhand smoke (SHS) and THS exposure: child lived with a smoker who smoked inside the home. We conducted a series of weighted linear and logistic regression analyses to assess the associations between child TSE status and neighborhood characteristics, adjusting for covariates. (3) Results: Overall, 13.2% and 1.7% of children were exposed to home THS alone and home SHS and THS, respectively. Compared to children with no TSE, children with home THS exposure alone and children with home SHS and THS exposure had a significantly lower total number of neighborhood amenities and children with SHS and THS exposure had a significantly higher total number of detracting neighborhood elements. (4) Conclusions: Children with TSE demonstrate disparities in the characteristics of the neighborhood in which they live compared to children with no TSE. TSE reduction interventions targeted to children with TSE who live in these neighborhoods are warranted. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

11 pages, 337 KiB

Open AccessArticle

Exposure to Tobacco Smoking in Vehicles, Indoor, and Outdoor Settings in Germany: Prevalence and Associated Factors

by Martin Mlinarić, Sabrina Kastaun and Daniel Kotz

Int. J. Environ. Res. Public Health 2022, 19(7), 4051; https://doi.org/10.3390/ijerph19074051 - 29 Mar 2022

Cited by 4 | Viewed by 2276

Abstract

Little is known on whether secondhand smoke (SHS) exposure in vehicles, indoor, and outdoor settings is similarly patterned in terms of different socio-epidemiological indicators in Germany. This study aims to estimate the current national-level prevalence and associated socio-epidemiological indicators of SHS exposure in [...] Read more.

Little is known on whether secondhand smoke (SHS) exposure in vehicles, indoor, and outdoor settings is similarly patterned in terms of different socio-epidemiological indicators in Germany. This study aims to estimate the current national-level prevalence and associated socio-epidemiological indicators of SHS exposure in vehicles, indoor, and outdoor settings in the German population, using current data from a representative household survey. We used cross-sectional data (N = 3928 respondents aged 14–99 years) from two waves of the DEBRA survey (German Study on Tobacco Use), conducted between January and March 2020. The reported prevalence of SHS exposure during the last seven days was 19% in vehicles, 25% in indoor settings, and 43% in outdoor settings. We found that younger age and current smoking were consistently associated with higher SHS exposure. Furthermore, people with low education were more likely to be exposed to SHS in vehicles and indoor settings than people with high education. This study found that the prevalence of SHS exposure in vehicles, indoor, and outdoor settings is a relevant feature of everyday life in Germany, especially for younger people and people with lower education, leading to potentially persistent socioeconomic and tobacco-attributable inequalities in morbidity and mortality. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

18 pages, 921 KiB

Open AccessArticle

Nicotine Exposure in the U.S. Population: Total Urinary Nicotine Biomarkers in NHANES 2015–2016

by Shrila Mazumder, Winnie Shia, Patrick B. Bendik, Honest Achilihu, Connie S. Sosnoff, Joseph R. Alexander, Zuzheng Luo, Wanzhe Zhu, Brittany N. Pine, June Feng, Benjamin C. Blount and Lanqing Wang

Int. J. Environ. Res. Public Health 2022, 19(6), 3660; https://doi.org/10.3390/ijerph19063660 - 19 Mar 2022

Cited by 2 | Viewed by 2392

Abstract

We characterize nicotine exposure in the U.S. population by measuring urinary nicotine and its major (cotinine, trans-3′-hydroxycotinine) and minor (nicotine 1′-oxide, cotinine N-oxide, and 1-(3-pyridyl)-1-butanol-4-carboxylic acid, nornicotine) metabolites in participants from the 2015–2016 National Health and Nutrition Examination Survey. This is one of [...] Read more.

We characterize nicotine exposure in the U.S. population by measuring urinary nicotine and its major (cotinine, trans-3′-hydroxycotinine) and minor (nicotine 1′-oxide, cotinine N-oxide, and 1-(3-pyridyl)-1-butanol-4-carboxylic acid, nornicotine) metabolites in participants from the 2015–2016 National Health and Nutrition Examination Survey. This is one of the first U.S. population-based urinary nicotine biomarker reports using the derived total nicotine equivalents (i.e., TNEs) to characterize exposure. Serum cotinine data is used to stratify tobacco non-users with no detectable serum cotinine (−sCOT), non-users with detectable serum cotinine (+sCOT), and individuals who use tobacco (users). The molar concentration sum of cotinine and trans-3′-hydroxycotinine was calculated to derive the TNE2 for non-users. Additionally, for users, the molar concentration sum of nicotine and TNE2 was calculated to derive the TNE3, and the molar concentration sum of the minor metabolites and TNE3 was calculated to derive the TNE7. Sample-weighted summary statistics are reported. We also generated multiple linear regression models to analyze the association between biomarker concentrations and tobacco use status, after adjusting for select demographic factors. We found TNE7 is positively correlated with TNE3 and TNE2 (r = 0.99 and 0.98, respectively), and TNE3 is positively correlated with TNE2 (r = 0.98). The mean TNE2 concentration was elevated for the +sCOT compared with the −sCOT group (0.0143 [0.0120, 0.0172] µmol/g creatinine and 0.00188 [0.00172, 0.00205] µmol/g creatinine, respectively), and highest among users (33.5 [29.6, 37.9] µmol/g creatinine). Non-daily tobacco use was associated with 50% lower TNE7 concentrations (p < 0.0001) compared with daily use. In this report, we show tobacco use frequency and passive exposure to nicotine are important sources of nicotine exposure. Furthermore, this report provides more information on non-users than a serum biomarker report, which underscores the value of urinary nicotine biomarkers in extending the range of trace-level exposures that can be characterized. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

14 pages, 362 KiB

Open AccessArticle

Perceived Disease Risk of Smoking, Barriers to Quitting, and Cessation Intervention Preferences by Sex Amongst Homeless Adult Concurrent Tobacco Product Users and Conventional Cigarette-Only Users

by Haleem A. Brown, Rachel D. Roberts, Tzuan A. Chen, Michael S. Businelle, Ezemenari M. Obasi, Darla E. Kendzor and Lorraine R. Reitzel

Int. J. Environ. Res. Public Health 2022, 19(6), 3629; https://doi.org/10.3390/ijerph19063629 - 18 Mar 2022

Cited by 4 | Viewed by 2373

Abstract

Adults experiencing homelessness smoke conventional cigarettes and engage in concurrent tobacco product use at very high rates; however, little is known about how use patterns, perceived disease risk, barriers to quitting smoking, and smoking cessation intervention preferences differ by sex in this group. [...] Read more.

Adults experiencing homelessness smoke conventional cigarettes and engage in concurrent tobacco product use at very high rates; however, little is known about how use patterns, perceived disease risk, barriers to quitting smoking, and smoking cessation intervention preferences differ by sex in this group. Participants comprised a convenience sample of 626 adult conventional cigarette smokers experiencing homelessness. Participants self-reported their sex, smoking history, mental health and substance use diagnosis history, other concurrent tobacco product use (CU), disease risk perceptions, perceived barriers to quitting smoking, and preferences regarding tobacco cessation interventions via a computer-administered survey. CU rates were 58.1% amongst men and 45.3% amongst women smokers. In both sexes, CUs started smoking earlier (p-values < 0.001) and were more likely to have been diagnosed with a non-nicotine substance use disorder (p-values < 0.014) relative to cigarette-only users. Among men only, CUs were younger, smoked more cigarettes per day and were more likely to identify as non-Hispanic White (p-values < 0.003) than cigarette-only users. Additionally, male CUs reported a greater risk of developing ≥1 smoking-related disease if they did not quit for good; were more likely to endorse craving cigarettes, being around other smokers, habit, stress/mood swings, and coping with life stress as barriers for quitting smoking; and were less likely to prefer medications to quit smoking relative to male cigarette-only users (p-values < 0.04). On the other hand, female CUs reported a greater risk of developing ≥1 smoking-related disease even if they quit for good; were more likely to endorse stress/mood swings and coping with life stress as barriers for quitting smoking relative to female cigarette-only users (p-values < 0.05); and did not differentially prefer one cessation medication over another. Overall, findings confirm high rates of CU among both sexes, characterize those who may be more likely to be CUs, and reveal opportunities to educate men and women experiencing homeless on the benefits of evidence-based interventions for smoking cessation. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

15 pages, 366 KiB

Open AccessArticle

Guest Support for Outdoor Smoke-Free Policies within a Homeless Shelter

by Jayda Martinez, Midhat Z. Jafry, Tzuan A. Chen, Michael S. Businelle, Darla E. Kendzor, Maggie Britton, Maya Vijayaraghavan and Lorraine R. Reitzel

Int. J. Environ. Res. Public Health 2022, 19(4), 2408; https://doi.org/10.3390/ijerph19042408 - 19 Feb 2022

Cited by 2 | Viewed by 3312

Abstract

Roughly 70–80% of adults experiencing homelessness smoke cigarettes. Smoke-free living/workplace policies are an empirically-supported tobacco control intervention. However, homeless shelters may be reluctant to implement smoke-free policies due to fears of it discouraging current/potential shelter guests from taking refuge there. The current study [...] Read more.

Roughly 70–80% of adults experiencing homelessness smoke cigarettes. Smoke-free living/workplace policies are an empirically-supported tobacco control intervention. However, homeless shelters may be reluctant to implement smoke-free policies due to fears of it discouraging current/potential shelter guests from taking refuge there. The current study was meant to characterize guest support for on-property smoke-free policies within a homeless shelter with an extant indoor tobacco use ban amongst never smokers, former smokers, and current smokers to provide data on this point. Participants comprised a convenience sample of adult guests of a homeless shelter in Texas (N = 394, 28.2% women; 10.2% former; and 75.9% current smokers). Participant sociodemographics, smoking status, behavioral health diagnoses, and support for two versions of an on-property outdoor courtyard smoke-free policy (one partial, one complete) were assessed. Data were collected in two waves in a repeated cross-sectional design. Overall, 64.0% of participants supported a partial, and 32.0% a full smoking ban. Logistic regressions, controlling for wave of data collection, age, sex, and any additional significant predictors from a semi-adjusted model, examined associations between participant characteristics and policy support. Older participants (OR = 1.024, CI_0.95 = 1.005–1.044), non-veterans (OR = 2.523, CI_0.95 = 1.156–5.506), former smokers (OR = 2.730, CI_0.95 = 1.191–6.258), and those without severe mental illness (OR = 1.731, CI_0.95 = 1.061–2.824) had significantly greater odds of supporting a partial smoking ban. Relative to current smokers, never smokers (OR = 3.902, CI_0.95 = 2.133–7.137) and former smokers (OR = 8.257, CI_0.95 = 3.951–17.258) had significantly greater odds of supporting a complete smoking ban. The implementation of smoke-free living/workplace policies in homeless shelters may enjoy more support from guests—specifically, non-smokers—than anticipated by shelter administrators. Aside from reducing ambient smoke exposure for never and former smokers, these policies can help to reduce ubiquitous smoking cues for those who may want to quit, are undergoing a quit attempt, or are trying to maintain abstinence. Interventionists might partner with shelter guests, particularly smokers, to inform the roll-out of such policies for maximal acceptance and adoption. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

16 pages, 607 KiB

Open AccessArticle

Trends in Smoking Prevalence and Intensity between 2010 and 2018: Implications for Tobacco Control in China

by Guoting Zhang, Jiajia Zhan and Hongqiao Fu

Int. J. Environ. Res. Public Health 2022, 19(2), 670; https://doi.org/10.3390/ijerph19020670 - 7 Jan 2022

Cited by 35 | Viewed by 4059

Abstract

Background: China is the world’s largest producer and consumer of cigarettes. Since 2010, the Chinese government has implemented many policies to combat the tobacco epidemic, yet little is known about their overall impacts. This study aims to investigate the trends in smoking prevalence [...] Read more.

Background: China is the world’s largest producer and consumer of cigarettes. Since 2010, the Chinese government has implemented many policies to combat the tobacco epidemic, yet little is known about their overall impacts. This study aims to investigate the trends in smoking prevalence and intensity between 2010 and 2018. Methods: We use five waves of data from China Family Panel Studies (CFPS), a nationally representative survey, to examine the trends in smoking prevalence and intensity. We use the chi-square test and t-test to examine differences across waves. Binary logistic regressions and linear regressions are applied to examine the association between smoking behaviors and risk factors. Results: The current smoking prevalence dropped from 30.30% in 2010 (90% CI 29.47–31.31) to 28.69% (90% CI 27.69–29.69) in 2018. As for smoking intensity, the average daily cigarettes consumption decreased steadily from 16.96 cigarettes (90% CI 16.55–17.36) in 2010 to 15.12 cigarettes (90% CI 15.07–15.94) in 2018. Smoking risk factors for men included marriage status, education level, employment status, alcohol consumption, and physical activities. The smoking risk was higher for women with a lower education level, lower household income, unemployment status, and alcohol consumption behavior. Conclusions: Our study shows declined trends in both smoking prevalence and intensity between 2010 and 2018, suggesting some positive progress in tobacco control in China. Nonetheless, to achieve the goal of reducing smoking prevalence among people aged 15 and above to less than 20% by 2030, the Chinese government needs to take stronger anti-tobacco measures. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

10 pages, 1191 KiB

Open AccessArticle

Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students

by Anca Maria Pop, Raluca Coroș, Alexandra Mihaela Stoica and Monica Monea

Int. J. Environ. Res. Public Health 2021, 18(24), 13246; https://doi.org/10.3390/ijerph182413246 - 16 Dec 2021

Cited by 13 | Viewed by 3728

Abstract

The presence of micronuclei in oral epithelial cells is considered a marker of genotoxicity, which can be identified using exfoliative cytology. The aim of this study was to investigate cytotoxic damage through the evaluation of micronuclei in the oral mucosa of smokers and [...] Read more.

The presence of micronuclei in oral epithelial cells is considered a marker of genotoxicity, which can be identified using exfoliative cytology. The aim of this study was to investigate cytotoxic damage through the evaluation of micronuclei in the oral mucosa of smokers and e-cigarette users compared to nonsmokers. We obtained smears from the buccal mucosa of 68 participants divided in 3 groups (smokers, e-cigarette users and nonsmokers), which were further processed with Papanicolaou stain. The frequencies of micronuclei and micronucleated cells were recorded and statistically analyzed at a level of significance of p < 0.05. The mean micronuclei values per 1000 cells were 3.6 ± 1.08 for smokers, 3.21 ± 1.12 for e-cigarette users and 1.95 ± 1.05 for nonsmokers. The mean values of micronucleated cells per 1000 cells were 2.48 ± 0.91 for smokers, 2.39 ± 1.07 for e-cigarette users and 1.4 ± 0.68 for nonsmokers. Smokers and e-cigarette users had significantly higher values of micronuclei and micronucleated cells compared to nonsmokers, but there were no significant differences between smokers and e-cigarette users. We concluded that the micronuclei count can be used as an early indicator for alterations of oral mucosa and exfoliative cytology represents an accessible tool which could be applied for mass screening. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

12 pages, 354 KiB

Open AccessArticle

Comparison of Levels of Three Tobacco Smoke Exposure Biomarkers in Children of Smokers

by E. Melinda Mahabee-Gittens, Georg E. Matt, Lili Ding and Ashley L. Merianos

Int. J. Environ. Res. Public Health 2021, 18(22), 11803; https://doi.org/10.3390/ijerph182211803 - 10 Nov 2021

Cited by 9 | Viewed by 2237

Abstract

Objectives: Cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and N-oxides are biomarkers of tobacco smoke exposure (TSE) used to assess short- and longer-term TSE. The objective of this study was to assess the associations between these TSE biomarkers, sociodemographics, parental smoking, and child TSE patterns among [...] Read more.

Objectives: Cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and N-oxides are biomarkers of tobacco smoke exposure (TSE) used to assess short- and longer-term TSE. The objective of this study was to assess the associations between these TSE biomarkers, sociodemographics, parental smoking, and child TSE patterns among 0–17-year-olds. Methods: A convenience sample of 179 pediatric patients (mean (SD) age = 7.9 (4.3) years) who lived with ≥1 smoker and who had parental assessments completed and urine samples analyzed for the three TSE biomarkers of interest were included. Biomarker levels were log-transformed, univariate regression models were built and Pearson correlations were assessed. Results: In total, 100% of children had detectable levels of cotinine and >96% had detectable NNAL and N-oxide levels. The geometric means of cotinine, NNAL, and N-oxide levels were 10.1 ng/mL, 25.3 pg/mL, and 22.9 pg/mL, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.6 (6.0) cigarettes. Child age negatively correlated with urinary cotinine (r = −0.202, p = 0.007) and log NNAL levels (r = −0.275, p < 0.001). The highest log-cotinine levels were in children who were younger, of African American race, and whose parents had a lower education, an annual income ≤USD15,000, and no smoking bans. The highest log-NNAL and N-oxide levels were in children whose parents had a lower education, had no smoking bans, and were around higher numbers of cigarettes. Conclusion: Children of smokers who were younger, African American, and had no smoking bans had the highest TSE biomarker levels. Targeted interventions are needed to reduce TSE levels among high-risk children. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

13 pages, 3292 KiB

Open AccessArticle

Effect of Water-Pipe Smoking on the Normal Development of Zebrafish

by Zain Zaki Zakaria, Shaima Ahmad Aladwi, Fatiha Benslimane, Enas S. Al-Absi, Mashael Al-Shafai, Huseyin C. Yalcin, Ashraf Khalil, Ala-Eddin Al Moustafa and Maha Al-Asmakh

Int. J. Environ. Res. Public Health 2021, 18(21), 11659; https://doi.org/10.3390/ijerph182111659 - 6 Nov 2021

Cited by 1 | Viewed by 2521

Abstract

Background: Among all types of tobacco consumption, Water-Pipe Smoking (WPS) is the most widely used in the Middle East and second-most in several other countries. The effect of WPS on normal development is not yet fully understood, thus the aim of this study [...] Read more.

Background: Among all types of tobacco consumption, Water-Pipe Smoking (WPS) is the most widely used in the Middle East and second-most in several other countries. The effect of WPS on normal development is not yet fully understood, thus the aim of this study is to explore the acute toxicity effects of WPS extract on zebrafish larvae. Methods: In this study, we compared the effects of WPS smoke condensates at concentrations varying from 50 to 200 µg/mL on developmental, cardiac, and behavioural (neurotoxicity) functions. Gene expression patterns of cardiac biomarkers were also evaluated by RT-qPCR. Results: Exposing zebrafish embryos to 50, 100, 150 and 200 µg/mL WPS for three days did not affect the normal morphology of Zebrafish embryos, as the tail flicking, behavioural and locomotion assays did not show any change. However, WPS deregulated cardiac markers including atrial natriuretic peptide (ANP/NPPA) and brain natriuretic peptide (BNP/NPPB). Furthermore, it induced apoptosis in a dose-dependent manner. Conclusion: Our data demonstrate that WPS can significantly affect specific cardiac parameters during the normal development of zebrafish. Further investigations are necessary to elucidate the pathogenic outcome of WPS on different aspects of human life, including pregnancy. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Graphical abstract

15 pages, 613 KiB

Open AccessArticle

Implementation and Outcomes of a Train-the-Trainer Program at Behavioral Health Treatment Centers as a Mechanism to Maintain Organizational Capacity to Address Tobacco Use Disorder

by Vijay Nitturi, Tzuan A. Chen, Isabel Martinez Leal, Virmarie Correa-Fernández, Kelli Drenner, Bryce Kyburz, Teresa Williams, Ezemenari M. Obasi, Maggie Britton, Molly Howard, Rogelio Rangel, Jeni Sharp, Shelley Smith and Lorraine R. Reitzel

Int. J. Environ. Res. Public Health 2021, 18(21), 11635; https://doi.org/10.3390/ijerph182111635 - 5 Nov 2021

Cited by 10 | Viewed by 4179

Abstract

Despite prior successful implementation of Taking Texas Tobacco Free (TTTF), an evidence-based tobacco-free workplace program, in local mental health authorities (LMHAs), post-implementation employee attrition necessitated continuing education on tobacco-free policies and tobacco treatment practices. Here, we report on the outcomes of a train-the-trainer [...] Read more.

Despite prior successful implementation of Taking Texas Tobacco Free (TTTF), an evidence-based tobacco-free workplace program, in local mental health authorities (LMHAs), post-implementation employee attrition necessitated continuing education on tobacco-free policies and tobacco treatment practices. Here, we report on the outcomes of a train-the-trainer program which trained “champions” to deliver tobacco cessation education at their LMHAs. Three LMHAs participated in program implementation via 10 champions, iteratively trained and coached by TTTF. Measures administered evaluated four goals: (1) increase champions’ self-efficacy in delivering trainings, (2) achieve program fidelity via TTTF staff evaluation of trainer effectiveness and knowledge increases among attending employees, (3) achieve stakeholder program acceptability, and (4) achieve program adoption via an increase in follow-up trainings. Champions’ self-efficacy increased throughout TTTF training. TTTF staff ratings of champion-led trainings met the targeted range for trainer effectiveness; employees had a 28.71% knowledge increase over baseline post-training (p < 0.001). Employees rated champions’ training delivery “very good” to “excellent”, on average; both champions and employees were, on average, “satisfied” to “extremely satisfied” with the curriculum and training received. There was an increase over baseline in trainings delivered during follow-up, and trainings increased in length and topic coverage. Ultimately, the train-the-trainer program achieved the intended goals, although not all changes were statistically significant, likely at least partially attributable to small sample sizes. Overall, these results suggest that TTTF’s train-the-trainer program was successful in its delivery and intention to build capacity for the provision of in-house tobacco education trainings to behavioral health employees/providers. However, further evaluation in additional settings, with more champions, et cetera, is necessary to validate these findings, ensure their replicability, link program implementation with reduced patient tobacco use rates, and assess long-term sustainability. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

10 pages, 1363 KiB

Open AccessArticle

A Low-Cost, High-Throughput Digital Image Analysis of Stain Patterns on Smoked Cigarette Filter Butts to Estimate Mainstream Smoke Exposure

by Clifford H. Watson, Jane Yan, Stephen Stanfill, Liza Valentin-Blasini, Roberto Bravo Cardenas and Benjamin C. Blount

Int. J. Environ. Res. Public Health 2021, 18(19), 10546; https://doi.org/10.3390/ijerph181910546 - 8 Oct 2021

Viewed by 2246

Abstract

Standard machine smoking protocols provide useful information for examining the impact of design parameters, such as filter ventilation, on mainstream smoke delivery. Unfortunately, their results do not accurately reflect human smoke exposure. Clinical research and topography devices in human studies yield insights into [...] Read more.

Standard machine smoking protocols provide useful information for examining the impact of design parameters, such as filter ventilation, on mainstream smoke delivery. Unfortunately, their results do not accurately reflect human smoke exposure. Clinical research and topography devices in human studies yield insights into how products are used, but a clinical setting or smoking a cigarette attached to such a device may alter smoking behavior. To better understand smokers’ use of filtered cigarette products in a more natural environment, we developed a low-cost, high-throughput approach to estimate mainstream cigarette smoke exposure on a per-cigarette basis. This approach uses an inexpensive flatbed scanner to scan smoked cigarette filter butts and custom software to analyze tar-staining patterns. Total luminosity, or optical staining density, of the scanned images provides quantitative information proportional to mainstream smoke-constituent deliveries on a cigarette-by-cigarette basis. Duplicate sample analysis using this new approach and our laboratory’s gold-standard liquid chromatography/tandem mass spectrometry (LC/MS/MS) solanesol method yielded comparable results (+7% bias) from the analysis of 20 commercial cigarettes brands (menthol and nonmentholated). The brands varied in design parameters such as length, filter ventilation, and diameter. Plots correlating the luminosity to mainstream smoked-nicotine deliveries on a per-cigarette basis for these cigarette brands were linear (average R² > 0.91 for nicotine and R² > 0.83 for the tobacco-specific nitrosamine NNK), on a per-brand basis, with linearity ranging from 0.15 to 3.00 mg nicotine/cigarette. Analysis of spent cigarette filters allows exposures to be characterized on a per-cigarette basis or a “daily dose” via summing across results from all filter butts collected over a 24 h period. This scanner method has a 100-fold lower initial capital cost for equipment than the LC/MS/MS solanesol method and provides high-throughput results (~200 samples per day). Thus, this new method is useful for characterizing exposure related to filtered tobacco-product use. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

9 pages, 700 KiB

Open AccessFeature PaperArticle

Assessment of Severe COVID-19 Outcomes Using Measures of Smoking Status and Smoking Intensity

by E. Melinda Mahabee-Gittens, Angelico Mendy and Ashley L. Merianos

Int. J. Environ. Res. Public Health 2021, 18(17), 8939; https://doi.org/10.3390/ijerph18178939 - 25 Aug 2021

Cited by 9 | Viewed by 3256

Abstract

Objective: Smoking status does not indicate the amount or length of tobacco use, and thus, it is an imperfect measure to assess the association between cigarette smoking and severe coronavirus disease 2019 (COVID-19) outcomes. This investigation assessed whether cigarette smoking status, intensity of [...] Read more.

Objective: Smoking status does not indicate the amount or length of tobacco use, and thus, it is an imperfect measure to assess the association between cigarette smoking and severe coronavirus disease 2019 (COVID-19) outcomes. This investigation assessed whether cigarette smoking status, intensity of smoking (i.e., average daily packs of cigarettes smoked), duration of smoking, and pack-years of smoking are associated with severe outcomes among adults diagnosed with COVID-19. Methods: We conducted a retrospective, cross-sectional study in which we identified consecutive patients diagnosed with COVID-19 at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020 who had complete information on smoking status, severe COVID-19 outcomes, and covariates (i.e., demographics and comorbidities). We used logistic regression to evaluate the associations of smoking status and intensity of smoking with COVID-19 severity, defined as hospitalization, admission to intensive care unit (ICU), or death, adjusting for sociodemographics and comorbidities. Results: Among the 4611 COVID-19 patients included in the analysis, 18.2% were current smokers and 20.7% were former smokers. The prevalence of COVID-19 outcomes was 28.9% for hospitalization, 9.8% for ICU admission, and 1.4% for death. In the adjusted analysis, current smoking (AOR: 1.23, 95% CI: 1.02–1.49), former smoking (AOR: 1.28, 95% CI: 1.07–1.54), and pack-years of smoking (AOR: 1.09, 95% CI: 1.02–1.17) were associated with a higher prevalence of hospitalization. Average daily packs of cigarettes smoked was associated with a higher prevalence of hospitalization (AOR: 1.30, 95% CI: 1.10–1.53) and ICU admission (AOR: 1.23, 95% CI: 1.04–1.44). Conclusions: Smoking status, pack-years, and intensity of smoking were associated with hospitalizations in patients with COVID-19 and intensity of smoking was associated with ICU admission. The findings underscore the need for detailed information beyond smoking status when evaluating smokers with COVID-19 so that the potential for adverse sequelae may be optimally managed in at-risk patients. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

11 pages, 571 KiB

Open AccessArticle

Home Smoking Bans and Urinary NNAL Levels to Measure Tobacco Smoke Exposure in Chinese American Household Pairs

by Emiley Chang, Melanie Dove, Anne Saw, Janice Y. Tsoh, Lei-Chun Fung and Elisa K. Tong

Int. J. Environ. Res. Public Health 2021, 18(14), 7682; https://doi.org/10.3390/ijerph18147682 - 20 Jul 2021

Viewed by 2245

Abstract

Home smoking bans can reduce tobacco smoke exposure, but little is known about the impact for Chinese American household pairs. In this study of 202 household pairs with low acculturation, 53.9% reported a home smoking ban, 31.7% had inconsistent reports, and 14.4% reported [...] Read more.

Home smoking bans can reduce tobacco smoke exposure, but little is known about the impact for Chinese American household pairs. In this study of 202 household pairs with low acculturation, 53.9% reported a home smoking ban, 31.7% had inconsistent reports, and 14.4% reported no ban. With decreasing home smoking ban enforcement, more nonsmokers had tobacco smoke exposure (66.1%–86.2%) as measured by the tobacco-specific nitrosamine biomarker urine NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol). Despite reported bans, about one-quarter of nonsmokers still reported tobacco smoke exposure at home (23.6%–30%) within the past 2 months and three-quarters reported outdoor exposure. In adjusted regression analyses of geometric mean NNAL ratios, nonsmokers in households with no ban had over two times higher levels than nonsmokers in households with a ban: adjusted log NNAL ratio = 2.70 (95% CI 1.21, 6.03). Higher smoker NNAL level and nonsmoker English fluency were also significantly associated with nonsmoker NNAL levels. Nonsmoker levels in households with an inconsistent ban were not significantly different compared to those with a ban. Although home smoking bans were generally associated with lower NNAL levels, tobacco smoke exposure in this immigrant population with low English proficiency was higher than that of the general population. From a health equity standpoint, there is a need for broader implementation and enforcement of comprehensive smoke-free policies. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

12 pages, 341 KiB

Open AccessArticle

Associations between Biomarkers of Exposure and Lung Cancer Risk among Exclusive Cigarette Smokers in the Golestan Cohort Study

by Brian L. Rostron, Jia Wang, Arash Etemadi, Sapna Thakur, Joanne T. Chang, Deepak Bhandari, Julianne Cook Botelho, Víctor R. De Jesús, Jun Feng, Mitchell H. Gail, Maki Inoue-Choi, Reza Malekzadeh, Akram Pourshams, Hossein Poustchi, Gholamreza Roshandel, Meredith S. Shiels, Qian Wang, Yuesong Wang, Baoyun Xia, Paolo Boffetta, Paul Brennan, Christian C. Abnet, Antonia M. Calafat, Lanqing Wang, Benjamin C. Blount, Neal D. Freedman and Cindy M. Chang Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(14), 7349; https://doi.org/10.3390/ijerph18147349 - 9 Jul 2021

Cited by 5 | Viewed by 3064

Abstract

Biomarkers of tobacco exposure are known to be associated with disease risk but previous studies are limited in number and restricted to certain regions. We conducted a nested case–control study examining baseline levels and subsequent lung cancer incidence among current male exclusive cigarette [...] Read more.

Biomarkers of tobacco exposure are known to be associated with disease risk but previous studies are limited in number and restricted to certain regions. We conducted a nested case–control study examining baseline levels and subsequent lung cancer incidence among current male exclusive cigarette smokers in the Golestan Cohort Study in Iran. We calculated geometric mean biomarker concentrations for 28 matched cases and 52 controls for the correlation of biomarker levels among controls and for adjusted odds’ ratios (ORs) for lung cancer incidence by biomarker concentration, accounting for demographic characteristics, smoking quantity and duration, and opium use. Lung cancer cases had higher average levels of most biomarkers including total nicotine equivalents (TNE-2), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and 3-hydroxyfluorene (3-FLU). Many biomarkers correlated highly with one another including TNE-2 with NNAL and N-Acetyl-S-(2-cyanoethyl)-L-cysteine (2CYEMA), and N-Acetyl-S-(4-hydroxy-2-buten-1-yl)-L-cysteine (t4HBEMA) with N-Acetyl-S-(3-hydroxypropyl-1-methyl)-L-cysteine (3HMPMA) and N-Acetyl-S-(4-hydroxy-2-methyl-2-buten-1-yl)-L-cysteine (4HMBEMA). Lung cancer risk increased with concentration for several biomarkers, including TNE-2 (OR = 2.22, 95% CI = 1.03, 4.78) and NNN (OR = 2.44, 95% CI = 1.13, 5.27), and estimates were significant after further adjustment for demographic and smoking characteristics for 2CYEMA (OR = 2.17, 95% CI = 1.03, 4.55), N-Acetyl-S-(2-carbamoylethyl)-L-cysteine (2CAEMA) (OR = 2.14, 95% CI = 1.01, 4.55), and N-Acetyl-S-(2-hydroxypropyl)-L-cysteine (2HPMA) (OR = 2.85, 95% CI = 1.04, 7.81). Estimates were not significant with adjustment for opium use. Concentrations of many biomarkers were higher at the baseline for participants who subsequently developed lung cancer than among the matched controls. Odds of lung cancer were higher for several biomarkers including with adjustment for smoking exposure for some but not with adjustment for opium use. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

13 pages, 941 KiB

Open AccessArticle

Genetic Variants in Smoking-Related Genes in Two Smoking Cessation Programs: A Cross-Sectional Study

by Gloria Pérez-Rubio, Luis Alberto López-Flores, Ana Paula Cupertino, Francisco Cartujano-Barrera, Luz Myriam Reynales-Shigematsu, Mariana Ramírez, Edward F. Ellerbeck, Rosibel Rodríguez-Bolaños and Ramcés Falfan-Valencia

Int. J. Environ. Res. Public Health 2021, 18(12), 6597; https://doi.org/10.3390/ijerph18126597 - 19 Jun 2021

Cited by 4 | Viewed by 2765

Abstract

Previous studies have identified variants in genes encoding proteins associated with the degree of addiction, smoking onset, and cessation. We aimed to describe thirty-one single nucleotide polymorphisms (SNPs) in seven candidate genomic regions spanning six genes associated with tobacco-smoking in a cross-sectional study [...] Read more.

Previous studies have identified variants in genes encoding proteins associated with the degree of addiction, smoking onset, and cessation. We aimed to describe thirty-one single nucleotide polymorphisms (SNPs) in seven candidate genomic regions spanning six genes associated with tobacco-smoking in a cross-sectional study from two different interventions for quitting smoking: (1) thirty-eight smokers were recruited via multimedia to participate in e-Decídete! program (e-Dec) and (2) ninety-four attended an institutional smoking cessation program on-site. SNPs genotyping was done by real-time PCR using TaqMan probes. The analysis of alleles and genotypes was carried out using the EpiInfo v7. on-site subjects had more years smoking and tobacco index than e-Dec smokers (p < 0.05, both); in CYP2A6 we found differences in the rs28399433 (p < 0.01), the e-Dec group had a higher frequency of TT genotype (0.78 vs. 0.35), and TG genotype frequency was higher in the on-site group (0.63 vs. 0.18), same as GG genotype (0.03 vs. 0.02). Moreover, three SNPs in NRXN1, two in CHRNA3, and two in CHRNA5 had differences in genotype frequencies (p < 0.01). Cigarettes per day were different (p < 0.05) in the metabolizer classification by CYP2A6 alleles. In conclusion, subjects attending a mobile smoking cessation intervention smoked fewer cigarettes per day, by fewer years, and by fewer cumulative pack-years. There were differences in the genotype frequencies of SNPs in genes related to nicotine metabolism and nicotine dependence. Slow metabolizers smoked more cigarettes per day than intermediate and normal metabolizers. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

11 pages, 319 KiB

Open AccessArticle

Smoke-Free Home Rules and Association with Child Secondhand Smoke Exposure among Mother–Child Dyad Relationships

by Westley L. Fallavollita, Elizabeth K. Do, Julia C. Schechter, Scott H. Kollins, Junfeng (Jim) Zheng, Jian Qin, Rachel L. Maguire, Cathrine Hoyo, Susan K. Murphy and Bernard F. Fuemmeler

Int. J. Environ. Res. Public Health 2021, 18(10), 5256; https://doi.org/10.3390/ijerph18105256 - 14 May 2021

Cited by 4 | Viewed by 2951

Abstract

Smoke-free home rules restrict smoking in the home, but biomarkers of secondhand smoke exposure are needed to help understand the association between smoke-free homes and child secondhand smoke exposure. Participants (n = 346) were majority Black/African American mother–child dyads from a longitudinal [...] Read more.

Smoke-free home rules restrict smoking in the home, but biomarkers of secondhand smoke exposure are needed to help understand the association between smoke-free homes and child secondhand smoke exposure. Participants (n = 346) were majority Black/African American mother–child dyads from a longitudinal study in North Carolina. Mothers completed questionnaires on household smoking behaviors and rules, and child saliva samples were assayed for secondhand smoke exposure. Regression models used smoke-free home rules to predict child risk for secondhand smoke exposure. Children in households with smoke-free home rules had less salivary cotinine and risk for secondhand smoke exposure. After controlling for smokers in the household, home smoking rules were not a significant predictor of secondhand smoke exposure. Compared to children in households with no smokers, children in households with at least one smoker but a non-smoking mother (OR 5.35, 95% CI: 2.22, 13.17) and households with at least one smoker including a smoking mother (OR 13.73, 95% CI: 6.06, 33.28) had greater risk for secondhand smoke exposure. Results suggest smoke-free home rules are not sufficient to fully protect children from secondhand smoke exposure, especially in homes with smokers. Future research should focus on how household members who smoke can facilitate the prevention of child secondhand smoke exposure. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

10 pages, 582 KiB

Open AccessArticle

Psychometric Analysis of a Microenvironment Secondhand Smoke Exposure Questionnaire

by Teresa DeAtley, Suzanne M. Colby, Melissa A. Clark, Alexander Sokolovsky, Rachel L. Denlinger-Apte, Patricia A. Cioe, Rachel Cassidy, Eric C. Donny and Jennifer W. Tidey

Int. J. Environ. Res. Public Health 2021, 18(7), 3753; https://doi.org/10.3390/ijerph18073753 - 3 Apr 2021

Cited by 3 | Viewed by 3026

Abstract

Background: We conducted a psychometric analysis of an adapted secondhand smoke (SHS) questionnaire by testing the three-component structure of the original scale that measures SHS exposure in home, work and social environments. Methods: The 15-item questionnaire was administered to 839 daily smokers participating [...] Read more.

Background: We conducted a psychometric analysis of an adapted secondhand smoke (SHS) questionnaire by testing the three-component structure of the original scale that measures SHS exposure in home, work and social environments. Methods: The 15-item questionnaire was administered to 839 daily smokers participating in a multi-site randomized controlled trial. Following parallel analysis, we conducted a confirmatory factor analysis specifying a three-factor structure. Cronbach’s alphas and fit indices were calculated to assess internal consistency. Criterion validity was assessed by comparing the Social environments subscale to the Brief Wisconsin Inventory of Smoking Dependence Motives Social/Environmental Goads subscale. Predicative validity of the questionnaire was assessed using linear regressions and tobacco biomarkers of harm; NNAL, expired carbon monoxide and total cotinine. Results: Five items did not load onto any factor and were dropped, resulting in a 10-item questionnaire. The Cronbach’s alphas were (0.86), (0.77) and (0.67) for the Work, Social, and Home subscales, respectively. The WISDM subscale was moderately correlated with scores on the Social subscale (r = 0.57, p < 0.001). The questionnaire demonstrated predictive validity of smoke exposure above individual’s own reported use as measured by cigarettes smoked per day. Conclusions: Three constructs emerged; results indicate that a shortened 10-item scale could be used in future studies. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

14 pages, 2485 KiB

Open AccessArticle

Adhesion and Removal of Thirdhand Smoke from Indoor Fabrics: A Method for Rapid Assessment and Identification of Chemical Repositories

by Giovanna L. Pozuelos, Peyton Jacob III, Suzaynn F. Schick, Esther E. Omaiye and Prue Talbot

Int. J. Environ. Res. Public Health 2021, 18(7), 3592; https://doi.org/10.3390/ijerph18073592 - 30 Mar 2021

Cited by 6 | Viewed by 6247

Abstract

Thirdhand smoke (THS) is an environmental contaminant that may cause adverse health effects in smokers and nonsmokers. Currently, time-consuming analytical methods are necessary to assess chemicals in THS repositories, like upholstered furniture and clothing. Our goal was to develop a rapid, accessible method [...] Read more.

Thirdhand smoke (THS) is an environmental contaminant that may cause adverse health effects in smokers and nonsmokers. Currently, time-consuming analytical methods are necessary to assess chemicals in THS repositories, like upholstered furniture and clothing. Our goal was to develop a rapid, accessible method that can be used to measure THS contamination in common household fabrics and to evaluate remediation. Cotton, terry cloth, polyester, and wool were exposed to THS for various times in a controlled laboratory environment and then extracted in various media at room temperature or 60 °C to develop an autofluorescent method to quantify THS. Concentrations of nicotine and related alkaloids in the extracts were determined using liquid chromatography–tandem mass spectrometry (LC-MS/MS) and high-performance liquid chromatography (HPLC). The autofluorescence of extracts was proportional to the time and amount of THS exposure received by cotton and terry cloth. Extracts of polyester and wool did not show autofluorescence unless heat was applied during extraction. Nicotine, nicotine alkaloids, and TSNA concentrations were higher in THS extracts from cotton and terry cloth than extracts of polyester and wool carpet, in agreement with the autofluorescence data. For fabrics spiked with 10 mg of nicotine, extraction efficiency was much higher from terry cloth (7 mg) than polyester (0.11 mg). In high relative humidity, nicotine recovery from both cotton and polyester was 80% (~8 mg). Our results provide a simple, rapid method to assess THS contaminants in household fabrics and further show that THS extraction is influenced by fabric type, heat, and humidity. Thus, remediation of THS environments may need to vary depending on the fabric reservoirs being treated. Understanding the dynamics of THS in fabrics can help set up appropriate remediation policies to protect humans from exposure. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

13 pages, 3551 KiB

Open AccessArticle

Ethnic Differences of Urinary Cadmium in Cigarette Smokers from the Multiethnic Cohort Study

by Shannon S. Cigan, Sharon E. Murphy, Bruce H. Alexander, Daniel O. Stram, Dorothy K. Hatsukami, Loic Le Marchand, Sungshim L. Park and Irina Stepanov

Int. J. Environ. Res. Public Health 2021, 18(5), 2669; https://doi.org/10.3390/ijerph18052669 - 6 Mar 2021

Cited by 3 | Viewed by 2499

Abstract

The Multiethnic Cohort Study (MEC) has demonstrated racial/ethnic differences in smoking-associated lung cancer risk. As part of the ongoing effort to characterize exposure to cigarette smoke constituents and better understand risk differences, we evaluated Cd exposure as it is a known lung carcinogen. [...] Read more.

The Multiethnic Cohort Study (MEC) has demonstrated racial/ethnic differences in smoking-associated lung cancer risk. As part of the ongoing effort to characterize exposure to cigarette smoke constituents and better understand risk differences, we evaluated Cd exposure as it is a known lung carcinogen. We quantified urinary cadmium (Cd) by inductively coupled plasma mass spectrometry in a subset of 1956 current smokers from MEC. Ethnic-specific geometric means (GM) were compared adjusting for age at urine collection, sex, creatinine (natural log), education, and smoking (urinary total nicotine equivalents [TNE] and smoking duration). Self-reported questionnaire data, including occupation, were also considered. Latinos and Native Hawaiians had the highest GM urinary Cd (0.871 and 0.836 ng/mL, respectively) followed by Japanese Americans and African Americans (0.811 ng/mL and 0.807, respectively) and Whites (0.736 ng/mL). Patterns in race/ethnicity were consistent by sex such that females had the highest GM urinary Cd. When further adjusting for categorical occupational Cd exposure, racial/ethnic differences of Cd remained (p = 0.009). Findings suggest differences in urinary Cd among smokers across different racial/ethnic groups exist and highlight the importance in considering environmental sources of Cd exposure beyond smoking. These finding lay ground for future studies of individual characteristics that are associated with lower risk for cancer despite higher carcinogenic exposures. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Figure 1

Review

Jump to: Research, Other

13 pages, 1631 KiB

Open AccessReview

Lung Damage Caused by Heated Tobacco Products and Electronic Nicotine Delivery Systems: A Systematic Review

by Omar Andrés Bravo-Gutiérrez, Ramcés Falfán-Valencia, Alejandra Ramírez-Venegas, Raúl H. Sansores, Guadalupe Ponciano-Rodríguez and Gloria Pérez-Rubio

Int. J. Environ. Res. Public Health 2021, 18(8), 4079; https://doi.org/10.3390/ijerph18084079 - 13 Apr 2021

Cited by 39 | Viewed by 13529

Abstract

The tobacco industry promotes electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) as a safer alternative to conventional cigarettes with misleading marketing sustained by studies with conflict of interest. As a result, these devices sell without regulations and warnings about their [...] Read more.

The tobacco industry promotes electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) as a safer alternative to conventional cigarettes with misleading marketing sustained by studies with conflict of interest. As a result, these devices sell without regulations and warnings about their adverse effects on health, with a growing user base targeting young people. This systematic review aimed to describe the adverse effects on the respiratory system in consumers of these devices. We conducted a systematic review and bibliometric analysis of 79 studies without conflict of interest evaluating ENDS and HTP effects in the respiratory system in experimental models, retrieved from the PubMed database. We found that the damage produced by using these devices is involved in pathways related to pulmonary diseases, involving mechanisms previously reported in conventional cigarettes as well as new mechanisms particular to these devices, which challenges that the tobacco industry’s claims. The present study provides significant evidence to suggest that these devices are an emerging public health problem and that they should be regulated or avoided. Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

► Show Figures

Graphical abstract

Other

Jump to: Research, Review

2 pages, 275 KiB

Open AccessReply

Reply to Takeshita, W.M.; Ribeiro, D.A. Comment on “Pop et al. Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students. Int. J. Environ. Res. Public Health 2021, 18, 13246”

by Anca Maria Pop, Raluca Coroș, Alexandra Mihaela Stoica and Monica Monea

Int. J. Environ. Res. Public Health 2022, 19(7), 3845; https://doi.org/10.3390/ijerph19073845 - 24 Mar 2022

Viewed by 1329

Abstract

Thank you for your interest [...] Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

2 pages, 269 KiB

Open AccessComment

Comment on Pop et al. Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students. Int. J. Environ. Res. Public Health 2021, 18, 13246

by Wilton Mitsunari Takeshita and Daniel Araki Ribeiro

Int. J. Environ. Res. Public Health 2022, 19(6), 3713; https://doi.org/10.3390/ijerph19063713 - 21 Mar 2022

Cited by 1 | Viewed by 1971

Abstract

We read the manuscript recently published in International Journal of Environmental Research and Public Health titled “Early diagnosis of oral mucosal alterations in smokers and e-cigarette users based on micronuclei count: a cross-sectional study among dental students” by Pop et al. [...] Full article

(This article belongs to the Special Issue Tobacco Smoke Exposure and Tobacco Product Use)

Journal Menu

Journal Browser

Tobacco Smoke Exposure and Tobacco Product Use

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Related Special Issue

Published Papers (33 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI