Electronic cigarette

Abstract: Importance Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco. Objective To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). Design, Setting, and Participants Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. Exposure Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. Main Outcomes and Measures Six- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3). Results Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI, 3.38-6.96]), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI, 3.16-5.74]) averaged across the 2 follow-up periods. Conclusions and Relevance Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.

Abstract: Background: Electronic cigarettes (e-cigarettes) are becoming increasingly popular with smokers worldwide. Users report buying them to help quit smoking, to reduce cigarette consumption, to relieve tobacco withdrawal symptoms, and to continue having a ‘smoking’ experience, but with reduced health risks. Research on e-cigarettes is urgently needed in order to ensure that the decisions of regulators, healthcare providers and consumers are based on science. Methods ECLAT is a prospective 12-month randomized, controlled trial that evaluates smoking reduction/abstinence in 300 smokers not intending to quit experimenting two different nicotine strengths of a popular e-cigarette model (‘Categoria’; Arbi Group Srl, Italy) compared to its non-nicotine choice. GroupA (n=100) received 7.2 mg nicotine cartridges for 12 weeks; GroupB (n=100), a 6-week 7.2 mg nicotine cartridges followed by a further 6-week 5.4 mg nicotine cartridges; GroupC (n=100) received no-nicotine cartridges for 12 weeks. The study consisted of nine visits during which cig/day use and exhaled carbon monoxide (eCO) levels were measured. Smoking reduction and abstinence rates were calculated. Adverse events and product preferences were also reviewed. Results: Declines in cig/day use and eCO levels were observed at each study visits in all three study groups (p,0.001 vs baseline), with no consistent differences among study groups. Smoking reduction was documented in 22.3% and 10.3% at week-12 and week-52 respectively. Complete abstinence from tobacco smoking was documented in 10.7% and 8.7% at week-12 and week-52 respectively. A substantial decrease in adverse events from baseline was observed and withdrawal symptoms were infrequently reported during the study. Participants’ perception and acceptance of the product under investigation was satisfactory. Conclusion: In smokers not intending to quit, the use of e-cigarettes, with or without nicotine, decreased cigarette consumption and elicited enduring tobacco abstinence without causing significant side effects. Trial Registration: ClinicalTrials.gov NCT01164072

Abstract: Aims To assess the profile, utilization patterns, satisfaction and perceived effects among users of electronic cigarettes (‘e-cigarettes’). Design and Setting Internet survey in English and French in 2010. Measurements Online questionnaire. Participants Visitors of websites and online discussion forums dedicated to e-cigarettes and to smoking cessation. Findings There were 3587 participants (70% former tobacco smokers, 61% men, mean age 41 years). The median duration of electronic cigarette use was 3 months, users drew 120 puffs/day and used five refills/day. Almost all (97%) used e-cigarettes containing nicotine. Daily users spent $33 per month on these products. Most (96%) said the e-cigarette helped them to quit smoking or reduce their smoking (92%). Reasons for using the e-cigaretteincludedtheperceptionthatitwaslesstoxicthantobacco(84%),todealwithcravingfortobacco(79%)and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%). Most ex-smokers (79%) feared they might relapse to smoking if they stopped using the e-cigarette. Users of nicotine-containing e-cigarettes reported better relief of withdrawalandagreatereffectonsmokingcessationthanthoseusingnon-nicotinee-cigarettes.Conclusions E-cigarettes were used much as people would use nicotine replacement medications: by former smokers to avoid relapse or as an aid tocutdownorquitsmoking.Furtherresearchshouldevaluatethesafetyandefficacyof e-cigarettesforadministration of nicotine and other substances, and for quitting and relapse prevention.

Abstract: Metal and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol Monique Williams 1 , Amanda Villarreal 1 , Krassimir Bozhilov 2 , Sabrina Lin 1 , Prue Talbot 1 * 1 Department of Cell Biology and Neuroscience, University of California Riverside, Riverside, California, United States of America, 2 Central Facility for Advanced Microscopy and Microanalysis, University of California Riverside, Riverside, California, United States of America Abstract Background: Electronic cigarettes (EC) deliver aerosol by heating fluid containing nicotine. Cartomizer EC combine the fluid chamber and heating element in a single unit. Because EC do not burn tobacco, they may be safer than conventional cigarettes. Their use is rapidly increasing worldwide with little prior testing of their aerosol. Objectives: We tested the hypothesis that EC aerosol contains metals derived from various components in EC. Methods: Cartomizer contents and aerosols were analyzed using light and electron microscopy, cytotoxicity testing, x-ray microanalysis, particle counting, and inductively coupled plasma optical emission spectrometry. Results: The filament, a nickel-chromium wire, was coupled to a thicker copper wire coated with silver. The silver coating was sometimes missing. Four tin solder joints attached the wires to each other and coupled the copper/silver wire to the air tube and mouthpiece. All cartomizers had evidence of use before packaging (burn spots on the fibers and electrophoretic movement of fluid in the fibers). Fibers in two cartomizers had green deposits that contained copper. Centrifugation of the fibers produced large pellets containing tin. Tin particles and tin whiskers were identified in cartridge fluid and outer fibers. Cartomizer fluid with tin particles was cytotoxic in assays using human pulmonary fibroblasts. The aerosol contained particles .1 m m comprised of tin, silver, iron, nickel, aluminum, and silicate and nanoparticles (,100 nm) of tin, chromium and nickel. The concentrations of nine of eleven elements in EC aerosol were higher than or equal to the corresponding concentrations in conventional cigarette smoke. Many of the elements identified in EC aerosol are known to cause respiratory distress and disease. Conclusions: The presence of metal and silicate particles in cartomizer aerosol demonstrates the need for improved quality control in EC design and manufacture and studies on how EC aerosol impacts the health of users and bystanders. Citation: Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P (2013) Metal and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol. PLoS ONE 8(3): e57987. doi:10.1371/journal.pone.0057987 Editor: Stephen J. Johnson, University of Kansas, United States of America Received August 31, 2012; Accepted January 30, 2013; Published March 20, 2013 Copyright: s 2013 Willliams et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was supported by grants from the Tobacco-Related Disease Research Program (TRDRP) to PT, a Cornelius Hopper Award to MW, a MARC National Institutes of Health (NIH) fellowship to AV, and a TRDRP Postdoctoral Fellowship to SL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: talbot@ucr.edu As EC have evolved, the atomizer and cartridge have often been combined into a single unit called a ‘‘cartomizer’’ [6]. Recent studies have shown that EC can deliver nicotine to users, although not always as effectively as conventional cigarettes [7,8]. EC may help smokers overcome nicotine addiction and/or serve as nicotine delivery devices that are safer than tobacco burning cigarettes [9,10]. EC have helped some smokers stop using conventional brands and either quit smoking entirely or switch to the presumably safer EC [11,12]. Their effectiveness in this regard may be aided by the hand-mouth motion that the EC provides, unlike nicotine patches and gum. Some users have reported to us that EC have helped them break nicotine addiction, but not the hand-mouth addiction associated with smoking. Because EC do not burn tobacco, they do not produce the numerous chemicals found in conventional tobacco smoke. For Introduction Electronic cigarettes (EC) are generally manufactured in China and are rapidly gaining acceptance in many countries [1,2]. In the United States, EC are available on the Internet, in malls, and in local shops. They have become an integral part of the environment without much information regarding the quality control used in their manufacture or their health effects [3]. EC deliver aerosolized nicotine to users and may serve as a surrogate for conventional tobacco-containing cigarettes [4,5]. Puffing an EC activates a battery that in turn heats liquid containing flavoring, a humectant(s) such as propylene glycol or vegetable glycerin, and nicotine. Some models, such as the one used in this study, do not contain nicotine. Early models of EC had separate atomizers for heating and cartridges for holding fluid [3]. PLOS ONE | www.plosone.org March 2013 | Volume 8 | Issue 3 | e57987