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Special Issue "Electronic Cigarette Use and Public Health"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (15 December 2017)

Special Issue Editors

Guest Editor
Dr. Konstantinos Farsalinos

Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece
Website | E-Mail
Phone: +306977454837
Interests: electronic cigarettes; tobacco harm reduction; cardiovascular imaging
Guest Editor
Prof. Dr. Walton Sumner

Department of Internal Medicine, School of Medicine, Washington University School of Medicine
Website | E-Mail

Special Issue Information

Dear Colleagues,

Electronic cigarettes continue to gain popularity and acceptance by consumers, but the public health community is divided on the potential benefits or adverse effects from their use. Contradictory opinions on safety/risk assessment and population effects dominate the discussion. Despite all this, research on electronic cigarettes is intense and continuously growing. Important issues to be addressed include characterizing aerosol chemistry and the risk difference compared to smoking, improving the quality of products, assessing population effects in both adults and youth, evaluating the impact on the smoking status of users, examining use by never-smokers, and, of course, defining appropriate regulatory decisions since they are expected to affect population perceptions, acceptability and adoption of use. Additional issues such as the proper definition of current use and dual use, and the importance of determining frequency of use are vital in assessing the overall population effects. Electronic cigarettes remain an exciting field of research.

The International Journal of Environmental Research and Public Health invited me to be the Guest Editor for this Special Issue, titled “Electronic Cigarette Use and Public Health”. I invite you to submit your research, analyses and opinion, in order to better understand and explore the e-cigarette phenomenon, and advance the scientific debate and knowledge.

Dr. Konstantinos Farsalinos
Prof. Dr. Walton Sumner
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Electronic cigarettes

  • Public Health

  • Nicotine

  • Tobacco

  • Smoking

Published Papers (15 papers)

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Open AccessArticle Qualitative Analysis of E-Liquid Emissions as a Function of Flavor Additives Using Two Aerosol Capture Methods
Int. J. Environ. Res. Public Health 2018, 15(2), 323; doi:10.3390/ijerph15020323
Received: 13 December 2017 / Revised: 8 February 2018 / Accepted: 9 February 2018 / Published: 13 February 2018
Cited by 1 | PDF Full-text (891 KB) | HTML Full-text | XML Full-text
Abstract
This work investigates emissions sampling methods employed for qualitative identification of compounds in e-liquids and their resultant aerosols to assess what capture methods may be sufficient to identify harmful and potentially harmful constituents present. Three popular e-liquid flavors (cinnamon, mango, vanilla) were analyzed
[...] Read more.
This work investigates emissions sampling methods employed for qualitative identification of compounds in e-liquids and their resultant aerosols to assess what capture methods may be sufficient to identify harmful and potentially harmful constituents present. Three popular e-liquid flavors (cinnamon, mango, vanilla) were analyzed using qualitative gas chromatography-mass spectrometry (GC-MS) in the un-puffed state. Each liquid was also machine-puffed under realistic-use flow rate conditions and emissions were captured using two techniques: filter pads and methanol impingers. GC-MS analysis was conducted on the emissions captured using both techniques from all three e-liquids. The e-liquid GC-MS analysis resulted in positive identification of 13 compounds from the cinnamon flavor e-liquid, 31 from mango, and 19 from vanilla, including a number of compounds observed in all e-liquid experiments. Nineteen compounds were observed in emissions which were not present in the un-puffed e-liquid. Qualitative GC-MS analysis of the emissions samples identify compounds observed in all three samples: e-liquid, impinge, and filter pads, and each subset thereof. A limited number of compounds were observed in emissions captured with impingers, but were not observed in emissions captured using filter pads; a larger number of compounds were observed on emissions collected from the filter pads, but not those captured with impingers. It is demonstrated that sampling methods have different sampling efficiencies and some compounds might be missed using only one method. It is recommended to investigate filter pads, impingers, thermal desorption tubes, and solvent extraction resins to establish robust sampling methods for emissions testing of e-cigarette emissions. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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Open AccessArticle A Descriptive Longitudinal Study of Changes in Vape Shop Characteristics and Store Policies in Anticipation of the 2016 FDA Regulations of Tobacco Products, Including E-Cigarettes
Int. J. Environ. Res. Public Health 2018, 15(2), 313; doi:10.3390/ijerph15020313
Received: 5 December 2017 / Revised: 27 January 2018 / Accepted: 6 February 2018 / Published: 11 February 2018
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Abstract
After proposing the “Deeming Rule” in 2014, the U.S. Food and Drug Administration (FDA) began regulating the manufacturing, marketing, and sales of electronic cigarette (e-cigarette) products as tobacco products in 2016. The current study conducted vape shop store observations and surveyed Los Angeles–area
[...] Read more.
After proposing the “Deeming Rule” in 2014, the U.S. Food and Drug Administration (FDA) began regulating the manufacturing, marketing, and sales of electronic cigarette (e-cigarette) products as tobacco products in 2016. The current study conducted vape shop store observations and surveyed Los Angeles–area shop employees (assessing their beliefs, awareness, and perceptions of e-cigarettes and related FDA regulations) at two time points one year apart to better understand what vape shop retailers would do given FDA’s soon-to-be-enacted Deeming Rule. The study also compared retailer beliefs/awareness/actions and store characteristics immediately after the Deeming Rule proposal versus a year after the Rule had been proposed, right before its enactment. Two data collection waves occurred before the Deeming Rule enactment, with Year 1 surveying 77 shops (2014) and Year 2 surveying 61 shops (2015–2016). Between the data collection points, 16 shops had closed. Among the shops that were open at both time points, the majority (95% in Year 1; 74% in Year 2) were aware of some FDA regulations or other policies applying to vape shops. However, overall awareness of FDA regulations and state/local policies governing e-cigarettes significantly decreased from Year 1 to Year 2. At both time points, all shops offered customers free puffs of nicotine-containing e-liquids (prohibited by the then upcoming Deeming Rule). Perceptions of e-cigarette safety also significantly decreased between the years. Exploring vape shop retailer perceptions and store policies (i.e., free puffs/samples displays, perceptions of e-cigarette safety, etc.) over time will help the FDA assess the needs of the vape shop community and develop more effective retailer education campaigns and materials targeted to increase compliance with the newly enacted regulations. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
Open AccessArticle A Longitudinal Study of Predictors for Adolescent Electronic Cigarette Experimentation and Comparison with Conventional Smoking
Int. J. Environ. Res. Public Health 2018, 15(2), 305; doi:10.3390/ijerph15020305
Received: 14 December 2017 / Revised: 1 February 2018 / Accepted: 6 February 2018 / Published: 9 February 2018
PDF Full-text (2423 KB) | HTML Full-text | XML Full-text
Abstract
Little is known of the predictors of electronic cigarette (e-cigarette) use among adolescents, even though the use is increasing. We studied here the predictors for e-cigarette experimentation (tried and tried more than twice) and compared them with predictors for conventional smoking. A baseline
[...] Read more.
Little is known of the predictors of electronic cigarette (e-cigarette) use among adolescents, even though the use is increasing. We studied here the predictors for e-cigarette experimentation (tried and tried more than twice) and compared them with predictors for conventional smoking. A baseline school survey was conducted in the Helsinki metropolitan area, Finland, in 2011 for seventh graders (12 to 13-year-olds). Response rate was 73%. The same students were followed up in 2014 (9th grade, 15 to 16-year-olds), N = 5742. Generalized linear mixed models controlling for school clustering were used. In the follow-up, 43.3% of boys and 25.6% of girls had tried e-cigarettes and 21.9% and 8.1% correspondingly more than twice. The strongest predictors for both genders were conventional smoking, drunkenness and energy drink use. Furthermore, poor academic achievement predicted e-cigarette experimentation for both genders, and for boys, participation in team sports was a predictor. The predictors for experimenting and for experimenting more than twice were very similar, except for boys’ participation in team sports. They were also similar compared to the predictors of conventional smoking but the associations were weaker. To conclude, smoking and other addictive behaviors predict adolescents’ experimentation with e-cigarettes. Family’s socioeconomic background had little significance. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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Open AccessArticle A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence
Int. J. Environ. Res. Public Health 2018, 15(2), 297; doi:10.3390/ijerph15020297
Received: 15 December 2017 / Revised: 19 January 2018 / Accepted: 27 January 2018 / Published: 9 February 2018
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Abstract
E-cigarettes are the most popular method of quitting smoking in England and most are purchased in specialist vape shops. This qualitative study explores how the vape shop environment is experienced by quitters to support smoking abstinence. Semi-structured qualitative interviews were conducted to elicit
[...] Read more.
E-cigarettes are the most popular method of quitting smoking in England and most are purchased in specialist vape shops. This qualitative study explores how the vape shop environment is experienced by quitters to support smoking abstinence. Semi-structured qualitative interviews were conducted to elicit experiences of e-cigarette use, including experiences of vape shops, in 40 people who had used e-cigarettes in a quit attempt. Observations of six shops in a range of locations were also undertaken. Interview and observation data were analysed using inductive thematic analysis and triangulated. At an individual level, smoking abstinence was supported through shop assistants’ attempts to understand customers’ smoking preferences in order to: (i) tailor advice about the most appropriate product; and (ii) offer an ongoing point of contact for practical help. At an interpersonal level, shops offered opportunity to socialise and reinforce a vaping identity, although the environment was perceived as intimidating for some (e.g., new and female users). At a structural level, shops ensured easy access to products perceived to be good value by customers and had adapted to legislative changes. Vape shops can provide effective behavioural support to quitters to maintain smoking abstinence. Health professionals could capitalise on this through partnership working with shops, to ensure best outcomes for clients wanting to use e-cigarettes to quit smoking. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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Open AccessArticle An Online Survey of New Zealand Vapers
Int. J. Environ. Res. Public Health 2018, 15(2), 222; doi:10.3390/ijerph15020222
Received: 6 December 2017 / Revised: 22 January 2018 / Accepted: 24 January 2018 / Published: 29 January 2018
PDF Full-text (295 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Using electronic cigarettes (vaping) is controversial, but is increasingly widespread. This paper reports the results of an electronic survey of vapers in New Zealand, a country where the sale and supply of e-liquids containing nicotine is illegal, although vapers can legally access e-liquids
[...] Read more.
Using electronic cigarettes (vaping) is controversial, but is increasingly widespread. This paper reports the results of an electronic survey of vapers in New Zealand, a country where the sale and supply of e-liquids containing nicotine is illegal, although vapers can legally access e-liquids from overseas. An on-line survey was conducted, using vaper and smoking cessation networks for recruitment, with follow up surveys conducted 1 and 2 months after the initial survey. 218 participants were recruited. Almost all had been smokers, but three quarters no longer smoked, with the remainder having significantly reduced their tobacco use. Three participants were non-smokers before starting to vape, but none had gone on to become smokers. The overriding motivation to begin and continue vaping was to stop or to reduce smoking. The results were consistent with a progression from initially both vaping and smoking using less effective electronic cigarette types, then moving to more powerful devices, experimentation with flavors and nicotine strengths—all resulting in reducing or stopping tobacco use. Lack of access to nicotine and lack of support for their chosen cessation method were the main problems reported. Vaping had resulted in effective smoking cessation for the majority of participants. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
Open AccessArticle Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes
Int. J. Environ. Res. Public Health 2018, 15(1), 12; doi:10.3390/ijerph15010012
Received: 24 November 2017 / Revised: 19 December 2017 / Accepted: 21 December 2017 / Published: 23 December 2017
Cited by 1 | PDF Full-text (655 KB) | HTML Full-text | XML Full-text
Abstract
(1) Background: Many smokers completely switch to vaping (switchers), whereas others use e-cigarettes (e-cigs) alongside tobacco cigarettes (dual users). To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point
[...] Read more.
(1) Background: Many smokers completely switch to vaping (switchers), whereas others use e-cigarettes (e-cigs) alongside tobacco cigarettes (dual users). To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use; (2) Methods: Using an online questionnaire we assessed behavioral, cognitive and attitudinal aspects of e-cig use in smoking and ex-smoking vapers; (3) Results: Our sample consisted of 19% dual users and 81% switchers. Before e-cig initiation, both groups smoked on average 22 cigarettes per day (CPD). After e-cig initiation, dual users decreased tobacco consumption by 82% and were low-to-moderately cigarette dependent. Both groups had been vaping for on average 22 months, were highly e-cig dependent, used state-of-the-art e-cigs, nicotine concentrations of 4–8 mg/mL and often flavors other than tobacco. Dual users used substantially less e-liquid per week than switchers but reported a similar number of puffs/day, experienced less e-cig efficacy, more practical problems, more negative and less positive consequences, and endorsed smoking reduction (rather than quitting) as a more important reason to start vaping. For both groups, e-cig risk perception was low and little stigmatization was experienced. Dual users preferred tobacco cigarettes in stressful situations and when rapid nicotine uptake is required. E-cigs were preferred where cigarettes are prohibited and to reduce second-hand smoke; (4) Conclusions: Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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Open AccessArticle Quit Methods Used by American Smokers, 2013–2014
Int. J. Environ. Res. Public Health 2017, 14(11), 1403; doi:10.3390/ijerph14111403
Received: 4 October 2017 / Revised: 2 November 2017 / Accepted: 15 November 2017 / Published: 17 November 2017
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Abstract
This report describes the quit methods used in the past 12 months by current and former smokers in the baseline Population Assessment of Tobacco and Health (PATH) Study during 2013–2014. Descriptive statistics were used to report the use of single and two or
[...] Read more.
This report describes the quit methods used in the past 12 months by current and former smokers in the baseline Population Assessment of Tobacco and Health (PATH) Study during 2013–2014. Descriptive statistics were used to report the use of single and two or more quit methods; survey weights were used to compute population estimates. Logistic regression was used to estimate the association between past year former smokers and single quit method, including individual characteristics. Results: Of 11,402 current smokers and 4919 former smokers, 4541 had tried and 839 had quit in the past 12 months. Unaided quit attempts were the most common; the number was almost as high as all single methods combined (n = 1797 and n = 1831 respectively). The most frequently used single method was help from friends and family (n = 676) followed by e-cigarettes (n = 587). Use of e-cigarettes was the only method with higher odds of users being a former smoker than unaided attempts (OR = 1.42, 95% CI 1.12–1.81). Current use of e-cigarettes among current (34%) and former (54%) smokers was significantly higher than current use of nicotine replacement therapy (NRT). Conclusions: In 2013–2014 e-cigarettes were used by American adult smokers as quit-smoking aids more frequently than NRT products or prescription drugs. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
Open AccessArticle Electronic Cigarette Use in Students and Its Relation with Tobacco-Smoking: A Cross-Sectional Analysis of the i-Share Study
Int. J. Environ. Res. Public Health 2017, 14(11), 1345; doi:10.3390/ijerph14111345
Received: 7 August 2017 / Revised: 30 October 2017 / Accepted: 2 November 2017 / Published: 5 November 2017
PDF Full-text (528 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
While young adults often try e-cigarettes, little is known about its use and the reasons for experimentation, particularly in relation with tobacco-smoking. In 2016, data were collected from 2720 French-speaking students participating in a web-based study on students’ health: the internet-based Students Health
[...] Read more.
While young adults often try e-cigarettes, little is known about its use and the reasons for experimentation, particularly in relation with tobacco-smoking. In 2016, data were collected from 2720 French-speaking students participating in a web-based study on students’ health: the internet-based Students Health Research Enterprise (i-Share) project. Univariate analyses and multivariable logistic regressions were performed to study the relationship between e-cigarette use and smoking status. Two out of five students declared having tried e-cigarettes and 3.6% were current users. Former smokers were more likely than current smokers to use e-cigarettes currently. Among those who had never smoked, 13.5% had tried e-cigarettes. Very few (0.3%) were current users, alternating e-liquids with and without nicotine. The three main reasons for trying e-cigarettes were curiosity, offer to try by someone, and attractiveness of e-liquid flavors. Among current smokers, previous attempts to quit smoking and a strong desire to stop tobacco were reported more in e-cigarette current users than in former users. In this large sample of French students, findings were consistent with the possibility that e-cigarettes might be used as smoking cessation or reduction aids by some young adults whereas other young never-smokers could be exposed to nicotine. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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Open AccessArticle Symptoms during Adolescents’ First Use of Cigarettes and E-Cigarettes: A Pilot Study
Int. J. Environ. Res. Public Health 2017, 14(10), 1260; doi:10.3390/ijerph14101260
Received: 7 August 2017 / Revised: 11 October 2017 / Accepted: 16 October 2017 / Published: 20 October 2017
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Abstract
Symptoms adolescents experience during their first time using a cigarette predict their current use, but little is known regarding the symptoms experienced during first e-cigarette use. We conducted a pilot study to understand the symptoms adolescents experience when they first tried cigarettes and
[...] Read more.
Symptoms adolescents experience during their first time using a cigarette predict their current use, but little is known regarding the symptoms experienced during first e-cigarette use. We conducted a pilot study to understand the symptoms adolescents experience when they first tried cigarettes and e-cigarettes and the associations between these symptoms and current use. Participants were 41 adolescents in two U.S. cities who had tried cigarettes or e-cigarettes. We asked adolescents to recall the symptoms they experienced during their first cigarette or e-cigarette and categorized symptoms as negative (felt bad, coughing/chest pain, bad taste, upset stomach, dizzy/lightheaded) or positive (felt relaxed, rush/buzz). Adolescents reported fewer negative symptoms for first e-cigarette than first cigarette use (all p < 0.05). Current cigarette smoking was associated with endorsing fewer negative symptoms (OR = 0.49, 95% CI = [0.25, 0.95]) and more positive symptoms (OR = 7.11, 95% CI = [1.47, 34.33]) at first cigarette use. First e-cigarette use symptoms were not associated with current e-cigarette use. Adolescents reported fewer negative symptoms from first e-cigarette than from first cigarette, and e-cigarette symptoms did not influence use as they do for cigarettes. Additional research is needed to confirm these findings in longitudinal studies. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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Open AccessArticle A Novel Vaping Machine Dedicated to Fully Controlling the Generation of E-Cigarette Emissions
Int. J. Environ. Res. Public Health 2017, 14(10), 1225; doi:10.3390/ijerph14101225
Received: 28 July 2017 / Revised: 5 October 2017 / Accepted: 6 October 2017 / Published: 14 October 2017
Cited by 1 | PDF Full-text (1725 KB) | HTML Full-text | XML Full-text
Abstract
The accurate study of aerosol composition and nicotine release by electronic cigarettes is a major issue. In order to fully and correctly characterize aerosol, emission generation has to be completely mastered. This study describes an original vaping machine named Universal System for Analysis
[...] Read more.
The accurate study of aerosol composition and nicotine release by electronic cigarettes is a major issue. In order to fully and correctly characterize aerosol, emission generation has to be completely mastered. This study describes an original vaping machine named Universal System for Analysis of Vaping (U-SAV), dedicated to vaping product study, enabling the control and real-time monitoring of applied flow rate and power. Repeatability and stability of the machine are demonstrated on flow rate, power regulation and e-liquid consumption. The emission protocol used to characterize the vaping machine is based on the AFNOR-XP-D90-300-3 standard (15 W power, 1 Ω atomizer resistance, 100 puffs collected per session, 1.1 L/min airflow rate). Each of the parameters has been verified with two standardized liquids by studying mass variations, power regulation and flow rate stability. U-SAV presents the required and necessary stability for the full control of emission generation. The U-SAV is recognised by the French association for standardization (AFNOR), European Committee for Standardization (CEN) and International Standards Organisation (ISO) as a vaping machine. It can be used to highlight the influence of the e-liquid composition, user behaviour and nature of the device, on the e-liquid consumption and aerosol composition. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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Open AccessFeature PaperArticle The Prevalence and Characteristics of E-Cigarette Users in the U.S.
Int. J. Environ. Res. Public Health 2017, 14(10), 1200; doi:10.3390/ijerph14101200
Received: 4 July 2017 / Revised: 23 September 2017 / Accepted: 6 October 2017 / Published: 11 October 2017
PDF Full-text (318 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Studies have examined the characteristics of individuals who use e-cigarettes, including sociodemographic and smoking characteristics, and the relationship of e-cigarette use to tobacco control policies. While most studies consider a subset of these characteristics with weak measures of regular e-cigarette use, this study
[...] Read more.
Studies have examined the characteristics of individuals who use e-cigarettes, including sociodemographic and smoking characteristics, and the relationship of e-cigarette use to tobacco control policies. While most studies consider a subset of these characteristics with weak measures of regular e-cigarette use, this study uses a large, recent U.S. survey to simultaneously consider the association of each of these factors with different use measures. Data from the May 2014 Tobacco Use Supplement-Current Population Survey is supplemented with information on tobacco control policies. The prevalence of ever, current (at least 1 of the last 30 days), and regular (at least 20 of the last 30 days) e-cigarette use were 7.7%, 2.1% and 0.9%, implying that 27.0% of ever users were current users of which 45.3% were regular users. E-cigarette use varied by socio-demographic characteristics and by smoking status, and depended on the measure of use adopted. However, regardless of measures, e-cigarette use was higher among those smokers who smoked more cigarettes. The association with policies was generally weak, but we found more regular use by smokers in low tax and low tobacco control spending states. The results indicate that the user characteristics differ depending on the e-cigarette use measure. The measure of use should be carefully considered in analyzing how e-cigarette use affects cigarette use. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
Open AccessArticle Young People’s Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015–2017
Int. J. Environ. Res. Public Health 2017, 14(9), 973; doi:10.3390/ijerph14090973
Received: 2 August 2017 / Revised: 18 August 2017 / Accepted: 23 August 2017 / Published: 29 August 2017
Cited by 8 | PDF Full-text (935 KB) | HTML Full-text | XML Full-text
Abstract
Concern has been expressed about the use of e-cigarettes among young people. Our study reported e-cigarette and tobacco cigarette ever and regular use among 11–16 year olds across the UK. Data came from five large scale surveys with different designs and sampling strategies
[...] Read more.
Concern has been expressed about the use of e-cigarettes among young people. Our study reported e-cigarette and tobacco cigarette ever and regular use among 11–16 year olds across the UK. Data came from five large scale surveys with different designs and sampling strategies conducted between 2015 and 2017: The Youth Tobacco Policy Survey; the Schools Health Research Network Wales survey; two Action on Smoking and Health (ASH) Smokefree Great Britain-Youth Surveys; and the Scottish Schools Adolescent Lifestyle and Substance Use Survey. Cumulatively these surveys collected data from over 60,000 young people. For 2015/16 data for 11–16 year olds: ever smoking ranged from 11% to 20%; regular (at least weekly) smoking between 1% and 4%; ever use of e-cigarettes 7% to 18%; regular (at least weekly) use 1% to 3%; among never smokers, ever e-cigarette use ranged from 4% to 10% with regular use between 0.1% and 0.5%; among regular smokers, ever e-cigarette use ranged from 67% to 92% and regular use 7% to 38%. ASH surveys showed a rise in the prevalence of ever use of e-cigarettes from 7% (2016) to 11% (2017) but prevalence of regular use did not change remaining at 1%. In summary, surveys across the UK show a consistent pattern: most e-cigarette experimentation does not turn into regular use, and levels of regular use in young people who have never smoked remain very low. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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Open AccessArticle Online Vape Shop Customers Who Use E-Cigarettes Report Abstinence from Smoking and Improved Quality of Life, But a Substantial Minority Still Have Vaping-Related Health Concerns
Int. J. Environ. Res. Public Health 2017, 14(7), 798; doi:10.3390/ijerph14070798
Received: 8 May 2017 / Revised: 28 June 2017 / Accepted: 12 July 2017 / Published: 17 July 2017
Cited by 1 | PDF Full-text (285 KB) | HTML Full-text | XML Full-text
Abstract
(1) Background: Characteristics and usage patterns of vapers (e-cigarette users) have mainly been studied in web-based convenience samples or in visitors of brick-and-mortar vape shops. We extended this by targeting customers of one particular online vape shop in the Netherlands; (2) Methods: Customers
[...] Read more.
(1) Background: Characteristics and usage patterns of vapers (e-cigarette users) have mainly been studied in web-based convenience samples or in visitors of brick-and-mortar vape shops. We extended this by targeting customers of one particular online vape shop in the Netherlands; (2) Methods: Customers were questioned on their smoking history, current smoking and vaping status, reasons for vaping, perceived harmfulness, and potential health changes due to vaping; (3) Results: Almost everyone (99%, 95% CI 0.96, 1.00) smoked before they started vaping. A great majority agreed that unlike with other smoking-cessation aids, they could quit smoking (81%, 95% CI 0.79, 0.90) due to vaping. Almost all customers were regular vapers (93.6%, 95% CI 0.89, 0.96) who used state-of-the-art open system devices without modifications and e-liquid with 10 mg/mL nicotine on average. Vapers reported using e-cigs to quit smoking, because e-cigs are healthier, and for financial reasons. The majority (52.6%, 95% CI 0.46, 0.60) perceived vaping as not that harmful to not harmful at all, but one fifth (21.8%, 95% CI 0.16, 0.28) believed vaping to be harmful. More than half (57.8%, 95% CI 0.50, 0.65) reported gaining more pleasure from vaping than from smoking. A substantial majority (84.2%, 95% CI 0.78, 0.89) agreed that their health had improved since they started vaping; (4) Conclusions: Findings are similar to those obtained in other vape shop studies, but also to the results of convenience samples of less-well-defined populations. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
Open AccessArticle Why Don’t More Smokers Switch to Using E-Cigarettes: The Views of Confirmed Smokers
Int. J. Environ. Res. Public Health 2017, 14(6), 647; doi:10.3390/ijerph14060647
Received: 21 April 2017 / Revised: 8 June 2017 / Accepted: 13 June 2017 / Published: 16 June 2017
Cited by 1 | PDF Full-text (285 KB) | HTML Full-text | XML Full-text
Abstract
Whilst e-cigarettes have been characterised by Public Health England as being around 95% less harmful than combustible tobacco products, only a minority of current smokers (around 16% within the UK) are using these devices. In this paper we report the results of an
[...] Read more.
Whilst e-cigarettes have been characterised by Public Health England as being around 95% less harmful than combustible tobacco products, only a minority of current smokers (around 16% within the UK) are using these devices. In this paper we report the results of an online survey of 650 smokers in contact with a smokers’ rights group in the UK. A total of 91% of the smokers surveyed were smoking on a daily basis. Fifty nine percent reported having used electronic nicotine delivery systems, the majority of whom reported having used e-cigarettes. Those smokers that had not used these devices principally explained this in terms of the pleasure they derived from smoking. The features smokers’ liked most about e-cigarette had to do with the range of settings in which they could be used, the lack of an offensive smell associated with their use, the available flavours and the reduced level of harm. The elements which smokers liked least about e-cigarettes had to do with the vaping experience, the technology, the chemical nature of e-liquids and the complex technology that was associated with these devices. If a greater number of smokers are to be encouraged to take up e-cigarettes, it will be necessary not only to convey accurate information on the relative harm of these devices (compared to combustible tobacco products), but to ensure that they are able to be used in a wider range of settings than those within which smoking can currently occur and that the vaping experience more closely resembles the smoking experience. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)

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Open AccessBrief Report Generally Recognized as Safe: Uncertainty Surrounding E-Cigarette Flavoring Safety
Int. J. Environ. Res. Public Health 2017, 14(10), 1274; doi:10.3390/ijerph14101274
Received: 22 September 2017 / Revised: 17 October 2017 / Accepted: 21 October 2017 / Published: 23 October 2017
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Abstract
Despite scientific uncertainty regarding the relative safety of inhaling e-cigarette aerosol and flavorings, some consumers regard the U.S. Food and Drug Administration’s “generally recognized as safe” (GRAS) designation as evidence of flavoring safety. In this study, we assessed how college students’ perceptions of
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Despite scientific uncertainty regarding the relative safety of inhaling e-cigarette aerosol and flavorings, some consumers regard the U.S. Food and Drug Administration’s “generally recognized as safe” (GRAS) designation as evidence of flavoring safety. In this study, we assessed how college students’ perceptions of e-cigarette flavoring safety are related to understanding of the GRAS designation. During spring 2017, an online questionnaire was administered to college students. Chi-square p-values and multivariable logistic regression were employed to compare perceptions among participants considering e-cigarette flavorings as safe and those considering e-cigarette flavorings to be unsafe. The total sample size was 567 participants. Only 22% knew that GRAS designation meant that a product is safe to ingest, not inhale, inject, or use topically. Of participants who considered flavorings to be GRAS, the majority recognized that the designation meant a product is safe to ingest but also considered it safe to inhale. Although scientific uncertainty on the overall safety of flavorings in e-cigarettes remains, health messaging can educate the public about the GRAS designation and its irrelevance to e-cigarette safety. Full article
(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)
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