Search Results (733)

Background and Objectives: Uveitis is an inflammatory condition of the uveal tract and has been associated with cigarette smoking. However, the relationship between uveitis and electronic cigarette (e-cigarette) use remains poorly understood. This review aims to give a brief overview of the current evidence regarding the association between uveitis and both conventional cigarette smoking and e-cigarette use. Materials and Methods: A narrative literature review was conducted using PubMed and Scopus databases. Relevant peer-reviewed publications were identified using the search terms “vaping,” “cigarette,” and “uveitis.” Results: Multiple studies have demonstrated a significant association between cigarette smoking and an increased risk of uveitis. In contrast, evidence examining the relationship between e-cigarette use and uveitis is limited. Conclusions: Uveitis is a potentially vision-threatening ophthalmologic condition, and improved understanding of its risk factors is essential for optimal patient care. While the association between conventional cigarette smoking and uveitis is well established, current evidence regarding e-cigarette use remains insufficient. Further research is needed to clarify the potential role of e-cigarette use in the development of uveitis. Full article

Background: This study was conducted to identify genetic risk variants associated with nicotine addiction in the CHRNA5, HTR2A, DRD4, and CYP2A6 genes among electronic cigarette users who also smoke combustible cigarettes (dual users), and to assess potential genotoxic and cytotoxic damage in the oral mucosal cells of the study population. Methods: We included dual e-cig users (ECIG, n = 70), combustible cigarette smokers (CCU, n = 24), and non-smokers and non-e-cig users (NS, n = 110). Genetic variants in CHRNA5, HTR2A, DRD4, and CYP2A6 were genotyped. Micronucleus analysis was performed on oral mucosal cells to detect cellular abnormalities. Results: The ECIG group demonstrated greater nicotine addiction on the Fagerström Test for Nicotine Dependence (FTND, 5.5 vs. 1, p = 0.023). Salivary cotinine levels were significantly higher in the ECIG group compared to the CCU group (39 vs. 12 ng/mL, p < 0.001). The carriers of the A allele (rs16969968/CHRNA5) had higher FTND scores, carriers of the C allele (rs1800955/DRD4) used electronic cigarettes more frequently each day, and carriers of the T allele (rs4105144/CYP2A6) started using nicotine products at a younger age. The number of micronuclei and cellular abnormalities in the oral mucosa was higher in the ECIG and CCU groups compared to the NS group. Conclusions: Salivary cotinine levels and FTND are higher in dual e-cigarette users than in combustible cigarette users. Dual users exhibit risk alleles in the CHRNA5, DRD4, and CYP2A6 genes, which are associated with traits linked to increased nicotine addiction. Dual e-cigarette use poses comparable genotoxic risks to combustible smoking. Full article

Background: Debate continues to swirl around the effectiveness of novel nicotine-delivery products such as snus and e-cigarettes as tobacco cessation aids. The purpose of this review is to quantify the state of research on modern products, including e-products, and established or developing pharmaceuticals on assisting nicotine users in achieving cessation. Methods: This study relied on a comprehensive assessment of research articles, clinical trials, drug approvals, and textbook material available via PubMed, Ovid Wolters Kluwer, and Wiley. We utilized Python 3.14.2, Anaconda3, the ShinyWeb App, and Py.Litstudy to investigate the selected literature. Our key study elements are product evolution and cessation behavior associated with e-cigarettes, snus, nicotine gum, nicotine dermal patches, bupropion, varenicline, and cytisine. Results: This manuscript assessed 144 manuscripts published between 1952 and 2025. E-cigarettes and snus, while containing some limited cessation benefit, were not identified to be effective enough at attaining cessation (when used exclusively) to be prescribed as cessation tools. Cytisine was identified as having very similar cessation outcomes to established pharmaceuticals such as varenicline. Conclusions: Since their iteration, e-cigarettes and snus products were marketed as cessation aids. This review found that there is scant evidence to support that modern snus and e-cigarette products work as cessation aids when used in exclusion of other more traditional approaches to cessative aid. Additionally, more modern pharmaceuticals such as cytisine may have benefit as solo cessation tools over novel nicotine-delivery products. Full article

This study evaluated the effectiveness of a youth-developed vaping intervention created by the Airdrie Board of Youth Affairs (ABYA) in changing Grade 7 and 8 students’ knowledge, attitudes, and harm perceptions regarding e-cigarette use. The vaping video trial followed a preceding local education program on smoking harms. A total of 107 students were randomly assigned to either the intervention group (ABYA video) or the control group (expert-developed video). Four instruments were used: the Video Survey, Personal Information Questionnaire, Knowledge and Attitudes Regarding E-cigarette Ingredients, Safety, and Addictive Properties (KAS), and the E-cigarette Harm Perception and Reduction (EHI). Pre- and post-intervention data were analyzed using t-tests and Mann–Whitney U tests. Compared with controls, the intervention group showed a significantly larger mean decrease in total EHI scores (mean change 9.05 vs. 2.06; t(105) = 3.34, p = 0.001; Cohen’s d = 0.65), indicating that the youth-developed video increased the perceived risk of vaping relative to cigarettes to a greater extent than the expert-developed video. Students also rated the ABYA video significantly higher on a 5-point scale for overall enjoyment (3.13 vs. 2.33; p < 0.001; Cohen’s d = 0.81) and for perceived increase in knowledge about vaping (3.34 vs. 2.84; p = 0.023; Cohen’s d = 0.44). The KAS instrument showed low internal consistency in this sample, so item-level KAS findings were treated as exploratory. Notably, unlike the expert-developed video, which explicitly acknowledged uncertainty, the ABYA video conveyed a clearer and more direct message, which may have contributed to its greater appeal while also carrying a risk of overstating absolute risk of e-cigarettes relative to cigarettes. Overall, these findings suggest that grassroots, youth-led interventions may be an effective approach for adolescent vaping education and may offer advantages over traditional expert-developed messaging in some contexts. Full article

Background: The increasing use of e-cigarettes among adolescents is a growing public health concern in Thailand, where they are prohibited but remain accessible. This study aimed to examine the psychosocial correlates of preventive behaviors regarding e-cigarettes among adolescents in central Thailand. Methods: A cross-sectional correlational study was conducted with 383 secondary school students (Grades 7–12) selected through proportionate stratified random sampling from two government schools in Ongkharak District, Thailand. Data were collected using a validated self-administered online questionnaire assessing attitudes toward e-cigarettes, peer influence, family attachment, and preventive behaviors. Item analysis, confirmatory factor analysis (CFA), and factor-score regression with bootstrapped indirect-association analysis (k = 5000) were performed to examine direct and indirect associations. Results: The four-factor measurement model demonstrated acceptable absolute fit (SRMR = 0.069) but weaker incremental fit (CFI = 0.70), expected given the large number of ordinal indicators estimated via maximum likelihood, with standardized factor loadings ranging from 0.621 to 0.926 (p < 0.001). The structural model explained 44.2% of the variance in preventive behaviors (R² = 0.442). Family attachment showed the strongest total association (β = 0.456), including both direct and indirect associations through attitudes (β = 0.116) and peer influence (β = 0.162), consistent with a pattern of statistically significant indirect associations. Conclusions: Family attachment was associated with self-reported e-cigarette preventive behavior, with statistically significant indirect associations through attitudes and peer influence. Given the cross-sectional design, these findings should be interpreted as model-consistent associations rather than causal mediation, and may inform future family- and peer-oriented prevention research in comparable settings. Full article

Background: Vaping has become one of the most prevalent risk behaviors among adolescents and young adults worldwide. Although electronic cigarettes (ECs) are often perceived as safer than conventional tobacco, concerns regarding their impact on oral health are increasing. This systematic review aimed to critically evaluate and synthesize the available evidence regarding the association between e-cigarette use and oral health outcomes in adolescents and young adults. Methods: A systematic search of PubMed/MEDLINE, EMBASE, Scopus, and EBSCOhost databases was conducted for observational studies published within the last ten years. Studies evaluating oral health outcomes among adolescents and young adults were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies, and certainty of evidence was graded using the GRADE approach. Results: Eight observational studies met the inclusion criteria and were included in the qualitative synthesis. E-cigarette use was associated with increased caries risk, higher prevalence of gingival inflammation, alterations in salivary flow and pH, changes in oral microbiota—including increased levels of Porphyromonas gingivalis—and elevated frequencies of micronuclei in oral mucosal cells. Four studies were rated as having low risk of bias and four as moderate risk. The overall certainty of evidence was low for all outcomes due to methodological limitations, heterogeneity in outcome assessment, and inadequate control of confounding factors, including dual use of combustible tobacco products. Conclusions: Current evidence may suggest a possible association between e-cigarette use and adverse oral health alterations in adolescents and young adults. However, given the low certainty of evidence, residual confounding, and the predominance of cross-sectional designs, causal relationships cannot be established. Well-designed longitudinal studies that clearly differentiate exclusive e-cigarette users from dual users and adequately adjust for behavioral confounders are required to clarify the independent impact of vaping on oral health in this vulnerable population. Full article

Electronic cigarettes are widely used as alternatives to conventional cigarettes. However, the relationships among e-liquid formulation, nicotine volatility, and nicotine delivery remain insufficiently investigated due to limited data on nicotine vapor pressure in e-liquid systems. This study aimed to investigate the effects of e-liquid formulations on nicotine vapor pressure, explore the underlying mechanisms, and establish correlations with nicotine delivery and pharmacokinetics. A headspace method was applied to measure nicotine vapor pressure at 37 °C, with variables including nicotine concentration, PG/VG ratio, organic acid type and ratio, and water content. The results showed that nicotine vapor pressure increased linearly with free-base nicotine fraction and decreased monotonically with increasing PG/VG ratio, acid-to-nicotine molar ratio, and water content. In addition, nicotine vapor pressure followed the order: free-base e-liquids > nicotine salt e-liquids > conventional cigarettes. Then, a correlation analysis was conducted between nicotine vapor pressure and nicotine pharmacokinetics. Lower vapor pressure correlated with deeper lung deposition, higher plasma nicotine, and greater potential toxicity, while higher vapor pressure correlated with more deposition in the upper respiratory tract and potential local irritation. Overall, nicotine vapor pressure can serve as an indicator for predicting nicotine delivery, supporting the rational regulation of e-liquid formulations and health risk assessment. Full article

Introduction: Electronic nicotine delivery systems (ENDSs), also known as e-cigarettes or vapes, have shown popularity among the adolescent population. Compared to adults, less is known regarding the impacts of ENDS and nicotine on the adolescent brain. Adolescent research related to nicotine and other illicit substances can be difficult due to the requirement of parent/guardian consent, adolescent hesitancy for disclosure of product use, and the continually evolving vaping and nicotine products on the market. Despite these challenges, further research is needed to explore the impact of ENDS on the developing adolescent brain. The objective of the study was to evaluate reward sensitivity and cognitive flexibility in the adolescent population using functional magnetic resonance imaging (fMRI) through a probabilistic reversal learning task. Methods: This pilot study recruited participants aged 13–19 years old to complete fMRI testing. We specifically adapted a probabilistic reversal learning task that was previously used to measure reward sensitivity and cognitive flexibility in adults (including nicotine users). We were unable to recruit enough ENDS users to complete the planned analysis; therefore, we evaluated non-users as proof of concept for the use of the probabilistic reversal learning task in adolescents to support future research. Participants completed four blocks of a probabilistic reversal learning task, each lasting 6 min. During each block of the task, blood-oxygenation-level-dependent (BOLD) fMRI images were collected. The reward sensitivity and cognitive flexibility contrasts of parameter estimates were entered into a group analysis model. Due to the small sample size and exploratory nature of the study, we were interested in computing population-level estimates of brain activation that could be attributed to reward sensitivity (win-stay minus lose-stay trials) and cognitive flexibility (lose-shift trials minus lose-stay trials). Results: A total of twelve participants completed fMRI testing—ten non-users, one intermittent user, one regular user. Four of these participants (three non-users and one intermittent user) were excluded from the fMRI analysis due to excessive head movement and/or poor task performance. With the seven remaining non-users, we found no evidence of significant BOLD activation when strictly controlling the Type I error rate. Using a more liberal statistical threshold that did not control the Type I error rate, both contrasts resulted in suprathreshold clusters in occipital and posterior parietal regions, and the reward sensitivity contrast also resulted in suprathreshold clusters in the prefrontal cortex (bilateral middle occipital gyrus). Discussion/Conclusions: We did not find statistically significant BOLD activation, which is likely due to the small sample size. Suprathreshold clusters using the liberal statistical threshold may be feasible for use as regions of interest in future studies using this task. Notably, the prefrontal regions where the reward sensitivity contrast exceeded the liberal statistical threshold in our study were similar to those observed in previous studies of reward sensitivity in adults (including nicotine users) and adolescents. This pilot study explores the use of an fMRI reward-learning paradigm in the adolescent population, which can serve as a catalyst for future research related to nicotine use. Full article

Background/Objectives: Electronic cigarette (e-cigarette or vape) use is increasing, especially among young adults. Since there is no data on e-cigarette use among dental students in Costa Rica, this observational study aimed to evaluate the awareness and use of vapes in students at the Faculty of Dentistry, University of Costa Rica, and identify factors that influence their use. Methods: A cross-sectional online questionnaire was administered to a sample of dental students, and their responses were assessed. A total of 244 students, with a mean age of 21.38 ± 3.29 years, were recruited between October 2024 and May 2025. Multivariate binary logistic regression was employed to analyze factors influencing ever use of e-cigarettes. Results: Of the participants, 99.17% were aware of e-cigarettes, and 60.66% had used them at least once in their lifetime, with 8.61% being current users. Sixth-year students were more likely than first-year students to believe that e-cigarettes contain carcinogenic substances (p < 0.001). Participants that were unsure if vapes are more addictive than traditional tobacco cigarettes had lower odds of ever using them (OR = 0.092, 95% CI: 0.009–0.491, p = 0.004). Fourth-year dental students had higher odds of e-cigarette use compared to first-year students (AOR = 3.050, 95% CI: 1.102–8.804, p = 0.032). The survey showed that 23.84% of the participants learned about e-cigarettes from parents, friends, or classmates, and 19.94% learned about them from social media platforms like WhatsApp, Facebook, and Instagram. Conclusions: Most of the dental students demonstrated awareness of the health impacts of vaping. While more than half of the respondents had tried e-cigarettes, current use was low. Vaping behavior was influenced by academic level and perceptions of risk and addictiveness, with social networks and peers serving as primary information sources. These findings highlight the importance of integrating targeted educational interventions into dental curricula to strengthen awareness and promote evidence-based attitudes toward vaping. Full article

Background/Objectives: Electronic cigarettes (e-cigarettes) are an important public health concern, particularly amongst young individuals. This study aimed to assess the attitudes and factors, including mental distress, that influence e-cigarette use amongst university students in Southern Thailand, including in armed conflict areas. Methods: A cross-sectional survey was conducted at the Prince of Songkla University across two campuses: Hat yai and Pattani. Data on demographics, attitudes towards e-cigarettes, usage patterns, and mental health (using the 21-item Depression, Anxiety, and Stress Scale) were collected and analysed using R software. Results: Amongst 901 participants (236 men and 665 women), the prevalence of e-cigarette use was 6.9%. Men (OR = 2.65; 95% CI = [1.28, 5.46]), tobacco users (OR = 97.56; 95% CI = [26.77, 355.66]), and those living alone (OR = 13.48; 95% CI = [1.21, 150.47]) were more likely to engage in e-cigarette use. Additionally, Islamic students reported lower usage rates than their Buddhist counterparts (OR = 0.32; 95% CI = [0.11, 0.9]). Conclusions: E-cigarette users exhibited higher scores on the depression, anxiety, and stress subscales than non-users. Smokers perceived e-cigarettes as a means of reducing tobacco consumption, alleviating stress, and enhancing their image. Moreover, non-smokers believed that e-cigarettes should be ‘illegal’ in Thailand. Full article

Background/Objectives: A sub-anesthetic dose of ketamine has shown promise in reducing craving, withdrawal symptoms, and use of drugs such as alcohol, cocaine, and opioids among individuals with substance use disorders. Ketamine’s therapeutic potential for tobacco use is unknown. Here, we investigated a single sub-anesthetic dose among adults with tobacco use disorder who were not interested in changing their smoking behavior. Methods: Utilizing a randomized, within-subject crossover, double-blinded, counter-balanced, midazolam-controlled design, participants (n = 18) received a 0.71 mg/kg infusion of ketamine and a 0.025 mg/kg infusion of midazolam (i.e., active placebo) at least two weeks apart. Participants were asked to abstain from smoking after the infusions until the post-infusion sessions, 1 day following infusion, where participants completed measures of smoking behavior, craving, and withdrawal symptoms. Participants continued to record their smoking behavior over the 7 days following infusion. Participants also completed a semi-structured qualitative interview regarding their experiences. Results: Compared to midazolam, ketamine infusion led to a non-significant reduction (p = 0.10, η_p² = 0.153) in the number of cigarettes smoked during the requested abstinence period. Following this period, there were no significant differences in ad lib smoking. Ketamine showed no effect on craving or withdrawal symptoms. Participants reported more intense psychological experiences following ketamine infusion (p < 0.001, η_p² = 0.830) and about half reported it felt easier to abstain from smoking after the ketamine infusion. Conclusions: While well tolerated, these findings suggest ketamine has little to no direct effect on quantitative measures of cigarette smoking, craving, or withdrawal. However, the qualitative measures suggest ketamine improves mood and reduces craving in some individuals for several days. Future studies should investigate whether ketamine can indirectly support smoking cessation among individuals with comorbid psychiatric indications for ketamine treatment. Full article

Although increasing numbers of young people are trying to quit e-cigarettes, personalized tools to support vaping cessation remain limited. We aimed to build a machine learning model to predict individual probability of short-term relapses and identify person-specific barriers to successful cessation. Data were taken from the “Stop Vaping Challenge” smartphone app. We included past 30-day e-cigarette users aged 15–35 years (n = 311) who completed 387 quit challenges. Feature selection minimized number of predictors while maximizing predictive ability. We built multiple GBM survival models with different sets of predictors to predict time to vaping relapse. The five-feature model yielded the best performance (C-index 0.751), thereby was selected as the final model. These five features were: self-confidence in quitting, intention to quit, average e-liquid used per week, time to first vape and mood trend during challenge. We stratified the challenges by the individual relapse risk by 7 days into low-, medium-, and high probability of quit success. This approach can inform tailored quit plans for vaping cessation. SHAP analysis demonstrated individual-level barriers to cessation, which can guide the development of personalized, predictor-centric, adaptive behavioral interventions. However, future research is needed to implement the model in real-world settings and evaluate its effectiveness and generalizability. Full article

Adolescent vaping has become a persistent health and behavioural challenge in schools, yet many institutions lack reliable tools to detect and respond to concealed e-cigarette use. This study addresses this problem by evaluating the real-world performance of a low-cost “Internet of Things” (IoT) vape detection system deployed across 37 high-risk restroom and change-room locations at a large Australian Independent school. The aim was to determine whether an IoT-based environmental monitoring platform could accurately identify vaping events, support timely staff intervention, and provide actionable insights into student behaviour patterns. A longitudinal case study design was used, collecting continuous particulate matter (PM_2.5 and PM₁₀) data at one-minute intervals over an 18-month period, where PM_2.5 and PM₁₀ refer to particulate matter with aerodynamic diameters ≤ 2.5 µm and ≤10 µm, respectively, reported in micrograms per cubic metre (µg/m³. Threshold-based alerting, cloud-based data processing, and school-led Closed-circuit television (CCTV) verification were combined to assess detection accuracy, temporal trends, and operational responses. The system recorded more than 300 vaping-related incidents, with clusters aligned to predictable times of day and higher prevalence among senior students. Operational detection performance was high, with alert events characterised by rapid, concurrent PM_2.5 and PM₁₀ excursions consistent with vaping-related aerosol profiles, although staff responsiveness declined over time due to alert fatigue and competing priorities. A major environmental smoke event demonstrated the need for context-aware logic to reduce false positives. The findings demonstrate that real-time aerosol monitoring is not only technically reliable but also highly effective in detecting vaping within school environments. These perspectives help explain why user engagement, alert fatigue, and institutional follow-through are as critical as sensor accuracy itself. Ultimately, the effectiveness of vape detection relies on strong organisational commitment, well-defined response workflows, and alignment with broader wellbeing and policy strategies. When these elements are in place, such systems can evolve from simple detection tools into intelligent, integrated components of school health governance. Full article

Atrial septal defect (ASD) has become increasingly common in the USA and now affects 1 in 11.3 children in some places, but space–time analysis has not been applied to this emerging trend. ASD rate (ASDR) data were obtained from the National Birth Defects Prevention Network 2003–2020. Substance (cigarettes, alcohol, cannabis, analgesics, cocaine) use data were obtained from the National Survey of Drug Use and Health. Income data were obtained from the US Census. Analysis was limited to the Non-Hispanic White population by technical factors. Time-sequential univariate and bivariate maps were prepared for both covariates and outcomes and their combinations. Spatial regression of the ASDR was performed using the R package splm. A total of 7.6% of data was interpolated by linear regression. A total of 110,107 ASD cases were identified amongst 17,751,437 live births in 27 US states across 10 reporting periods. Time series maps showed that ASDR showed concordant patterns with indices of cannabis use rather than other substances. This was confirmed by multivariate spatial regression where cannabis and cannabinoids alone were found to significantly relate to ASDR, with p = 0.00002 for cannabidiol. Cannabis legal status similarly tracked with ASDR. Compared to states where cannabis was not legal, ASDR was more prevalent in cannabis-legal states (OR = 2.73 (2.66, 2.80); E-Value 4.90 (lower C.I. 4.76)). Twenty-seven of 34 (79.4%) E-values were >9 (high range) and 34/34 were > 1.25 (causal threshold). Data show that cannabis, including cannabis legalization, is driving the US ASD epidemic. While most high-ASDR states have high rates of cannabis use, Midwestern states where cannabis is farmed, such as Kentucky, Tennessee and Missouri, do not, suggesting other routes of exposure, potentially implicating environmental contamination. ASD is a bellwether marker for cannabinoid teratogenicity, indicating that communities should carefully control cannabinoid exposure and limit transgenerational cannabinoid genotoxicity more generally. Full article

Background: E-cigarette use has risen sharply among young never-smokers, largely driven by the availability of several thousand appealing flavours. This narrative review synthesises evidence on the health effects of vaping, flavour toxicology and attractiveness, designs and outcomes of flavour bans, and complementary measures. Methods: Peer-reviewed publications and institutional reports (up to January 2026) were retrieved from PubMed, Web of Science, Google Scholar, and reference lists of included articles. Evidence from about 200 references was synthesised by a multidisciplinary working group. Results: Although flavouring substances are generally considered safe for ingestion, their inhalation toxicity remains uncertain. In vitro and in vivo studies have reported oxidative stress, inflammation, cytotoxicity, impaired ciliary function, transcriptomic changes, genotoxicity, and DNA damage. These findings—along with the strong youth appeal of fruit/sweet flavours, the inconclusive effects of flavours on smoking cessation, and persisting uncertainties—support banning non-tobacco e-cigarette flavours under the precautionary principle. Flavour bans can reduce e-cigarette use and initiation, especially among young adults, although partial substitution towards combustible cigarettes has been reported in some U.S. states. Policy success requires effective enforcement, prevention of industry circumvention, curbing cross-border sales, and closing regulatory loopholes—ideally at the international level (e.g., EU-wide). Conclusions: E-cigarette flavours may increase vaping toxicity and strongly appeal to youth, justifying flavour bans to prioritise youth protection. To maximise effectiveness, accompanying measures and sustained investment in tobacco prevention, youth education, and accessible evidence-based smoking cessation support are essential. Full article