Search Results (79)

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

Electronic cigarette (ECIG) liquids are marketed with labeled nicotine concentrations and propylene glycol (PG) to vegetable glycerin (VG) ratios, yet quality control inconsistencies may alter vaping emissions. We quantified discrepancies between labeled and measured chemical content and evaluated how these differences affect emissions of particulate matter with an aerodynamic diameter of 2.5 µm or smaller (PM_2.5). Flavor-free liquids (n = 20) spanning nicotine labels of 0, 9, 18, and 48 mg/mL and PG content from 0% to 80% were purchased. Nuclear magnetic resonance spectroscopy measured nicotine, PG, and VG. Aerosols were generated using a standardized device in a controlled exposure chamber. PM_2.5 was measured using a pDR-1500 and SMPS/APS, with gravimetric correction factors calculated. Labeling inaccuracies were widespread: “nicotine-free” liquids contained 0.1 to 0.4 mg/mL nicotine, and labeled nicotine deviated by up to ±30%. PG/VG ratios were frequently incorrect; 70% of samples contained higher VG than labeled, including “100% VG” products with about 10% PG. Higher VG consistently increased PM_2.5 mass, while nicotine had a minimal effect. The pDR overestimated mass, whereas SMPS/APS underestimated due to volatilization losses. Overall, inaccurate ECIG liquid labeling can alter measured PM_2.5 emissions under controlled conditions. Full article

White-matter development during fetal life represents one of the most vulnerable processes to environmental disruption, as it relies on the precisely timed proliferation, migration, and differentiation of oligodendrocyte lineage cells. Among environmental threats, exposure to toxic compounds contained in tobacco smoke and vaping aerosols represents a major yet preventable risk during pregnancy. Despite growing awareness, tobacco smoking remains widespread, and a substantial proportion of the population—including pregnant women—continues to perceive electronic nicotine delivery systems (ENDS) as less harmful, a misconception that contributes to persistent prenatal exposure. These products expose the fetus to numerous substances that readily cross the placenta and reach the developing brain, including compounds with endocrine-disrupting activity, where they interfere with white-matter development. Epidemiological and neuroimaging studies consistently reveal microstructural alterations in white matter that correlate with long-term cognitive and behavioral impairments in offspring exposed in utero. These alterations may arise from both nicotine-specific pathways and the actions of other toxicants in cigarette smoke and ENDS aerosols that cross the placenta and disrupt white-matter emergence and maturation. Preclinical research provides mechanistic insight: nicotine acts directly on nicotinic acetylcholine receptors (nAChRs) in oligodendrocyte precursor cells, disrupting calcium signaling and differentiation, while additional constituents of smoke and vaping aerosols also affect astrocyte and microglial function and disturb the extracellular milieu required for proper myelination. Full article

The use of sweeteners in e-cigarette liquids has become increasingly common, aiming to enhance the sensory appeal of vaping products. Compounds like aspartame, saccharin, and sucralose are added to provide a sweet taste without any calories, especially in flavored e-liquids popular among younger users. However, recent studies suggest that these additives may pose significant health risks when vaporized and inhaled. Sucralose, in particular, can break down into potentially harmful chlorinated by-products at high temperatures typical of vaping devices. Moreover, there is growing concern about the synergistic effects of sweeteners like sucralose, one sweetener with another and when combined with other e-liquid components. It has been observed that the presence of sucralose may amplify oxidative stress; genotoxicity, including mutations; and overall toxicity, along with environmental impact. This is not limited to nicotine- and smoke-related harm, as it may strengthen the toxic effect of the substances used in e-liquids that are not present in traditional cigarettes. The combined exposure to these heated compounds can intensify cytotoxicity, potentially increasing the risk of respiratory, cardiovascular, and neurological effects over time. While marketed as safer alternatives to tobacco, e-cigarettes containing sweeteners like sucralose may introduce new and poorly understood toxicological hazards that deserve urgent regulatory attention. Full article

Background/Objectives: Electronic cigarettes (e-cigarettes) have gained popularity among young adults globally, but only limited research exists on usage patterns in Saudi Arabia. This study investigated the prevalence, patterns, and factors associated with e-cigarette use initiation and transition to cigarette smoking among university students in Saudi Arabia. Methods: A cross-sectional survey was conducted among 537 university students in Al-Madinah city during the 2024–2025 academic year. Data were collected using a self-administered online questionnaire assessing e-cigarette use patterns, motivations, susceptibility to future cigarette smoking, and demographic characteristics. Multivariable logistic regression analysis was used to identify factors associated with e-cigarette use. Results: E-cigarette prevalence was substantial: 11.7% of participants were current users, 5.4% were former users, and 27.9% were ever-users, compared with 5.8% current cigarette smokers. Males had significantly higher use rates than females (20.9% vs. 4.6%; p < 0.001). Senior students showed the highest current use (21.1%). Among ever-users, the primary motivations were enjoyment (29.3%), the possibility of use where smoking is banned (26.1%), and social acceptability (21.7%). Most users (73.0%) used high-nicotine liquids (≥20 mg/mL), and 55.4% vaped daily. Multivariable logistic regression revealed that e-cigarette use was independently associated with male gender (adjusted OR = 4.0), higher academic year (OR = 1.24), current smoking (adjusted OR = 3.45; 95 CI: 1.54–7.82), and lower harm perception (adjusted OR = 1.69; 95 CI: 1.16–2.51). Susceptibility to future cigarette smoking was 18.9% overall but much higher among current e-cigarette smokers (59.5%; p < 0.001). Conclusions: E-cigarette use was prevalent among Saudi university students, particularly males and senior students, with patterns suggestive of nicotine dependence. Strong associations with cigarette smoking and high-concentration nicotine use raise concerns about dual use and addiction potential. Full article

Electronic nicotine delivery systems (vapes) are the most used nicotine products among U.S. adolescents, with usage increasing significantly from 2017 to 2019. School-based prevention programs are a critical strategy for curbing youth vaping. This study utilized a retrospective pre/post survey to evaluate the effectiveness of a two-year school-based vaping prevention program utilizing a condensed version of the Stanford University Tobacco Prevention Toolkit. The program was implemented in-person and online across two years in a southeastern U.S. state. In year one, evalua-tion data were collected from 4252 youths from 20 rural counties who completed the in-person survey during the 2018–2019 program year. In year two, 1347 youths from 13 rural and urban counties completed the survey during the program year of 2019–2020. The key findings indicate significant increases in knowledge about vaping risks post-program. The findings from year one indicate that increases in knowledge about e-cigarettes were negatively related to the frequency of vaping, but this was not replicated in year two. Moreover, knowledge did not influence vaping frequency if youths had already started vaping, while pre-program knowledge did not predict the frequency of vaping in either year. These results suggest that vaping prevention education outcomes among youths are mixed. Full article

The term ‘vaping’ refers to the use of electronic cigarettes or other devices to inhale a variety of heated and aerosolized substances. Vaping has been promoted as a less harmful and potentially oncogenic alternative to nicotine cigarettes, particularly to help heavy smokers quit. While vaping products do not produce the same carcinogenic substances—such as polycyclic aromatic hydrocarbons—generated by the combustion of tobacco, and while their fluids lack tobacco-related carcinogens like nitrosamines, it is now well established that they still generate harmful and potentially oncogenic byproducts. Several mechanisms have been proposed to explain the potential oncogenic effects of vaping fluids, including direct chemical action, epithelial–mesenchymal transition induction, redox stress, mitochondrial toxicity, and DNA damage. In addition to cancer risk, there have been reports of adverse effects on cardiovascular health, reproductive function, and non-oncologic lung injuries. These include exogenous lipoid pneumonia, diffuse alveolar hemorrhage with proven alveolar injury, and vaping-associated bronchiolitis obliterans. The aim of this review is to examine vaping devices, their potential role in lung carcinogenesis, vaping-associated lung injury, and other clinical implications, including impacts on cardiovascular, cerebrovascular, and respiratory diseases, and also pregnancy and fetus health. Full article

Vaping, particularly the use of nicotine vaping products (NVPs), has emerged as a public health concern. The regulatory environment surrounding NVPs in Australia has rapidly evolved, shifting from a prescription-only model to availability through community pharmacies. Pharmacists play a critical role in addressing vaping-related health concerns. This study explores Australian pharmacists’ perspectives on their professional roles and the support needed to manage vaping-related enquiries. Qualitative semi-structured interviews were conducted with 25 practicing pharmacists using a topic guide developed from the current literature and team expertise. The interviews were transcribed verbatim and analysed thematically using an inductive approach to identify key themes. Key themes included risk perception, professional vaping health-related services, professional practice and other support-related needs. Pharmacists expressed significant uncertainty about the risks and harms associated with vaping. There was apprehension around the regulatory complexity of supplying NVPs, and participants called for greater education and support, particularly around NVP’s place in smoking cessation and potential vaping cessation services. Effective public health messaging and risk communication about vaping are crucial. At the centre of recent legislative changes, pharmacists require training and professional support to address vaping-related scenarios and provide counselling that aligns with individual risk perceptions, ensuring NVP use is clinically appropriate. Full article

Background/Objectives: There is limited research on vaping during pregnancy and the postpartum period. Amid the legalization of cannabis in Canada, and evolving patterns of nicotine use, there is a growing need to understand how women experience using nicotine and cannabis vaping during pregnancy and postpartum. This information is essential to inform both women and healthcare providers (HCPs) and to develop resources and best practices for supporting women and healthcare services. Methods: In this descriptive study, a sample of 111 women who vaped nicotine and/or cannabis during pregnancy/postpartum was recruited via social media to answer survey questions on reasons for vaping, perceptions of the risks to fetal and maternal health, attitudes toward vaping, and reasons for consulting HCPs regarding vaping during pregnancy. Results: Among the 111 women, 51.4% vaped nicotine, 27.9% vaped cannabis, and 20.7% vaped both. Of the respondents, 63.1% were currently pregnant, while 36.9% were postpartum. Most participants (64.9%) reported vaping daily, followed by 15.3% with an inconsistent pattern, 9.9% vaping 1–2 days a week, and 9% vaping 5–6 days a week. Flavor preferences were prevalent, with fruit flavors being the most popular, followed by menthol/mint and candy, dessert, or sweet flavors. The primary reasons for vaping were relaxation, managing anxiety/depression, enjoyment, and the belief that vaping is less harmful than smoking. Women commonly consulted HCPs about potential harm to their pregnancy, fetal health, and their child’s health. Conclusions: The findings suggest that vaping among pregnant and postpartum women, particularly cannabis vaping, is perceived as healthier than smoking and is often used to manage mental and physical symptoms. These findings were used to create knowledge products to help guide HCPs’ conversations with women and provide evidence-based information on vaping. Full article

Background and Objectives: Tobacco smoking is the most important cause of chronic diseases and premature death worldwide. Very brief advice (VBA) and brief advice (BA) represent evidence-based interventions designed to increase quit attempts. These are appropriate for all smokers, regardless of their motivation to quit, and involve several steps regarding the assessment, advice, and action. This review aimed to evaluate the effectiveness of these brief interventions offered by general practitioners (GPs) in smoking cessation. Materials and Methods: A systematic search for articles that presented these interventions as an aid to support smoking cessation was conducted. The rate of successful smoking cessation was evaluated following interventions offered by general practitioners, regardless of the patients’ present motivation to quit. Results: We have checked if these interventions can be used as an innovative method to help active smokers make an informed decision regarding their behaviour. Conclusions: Assisted/supported/guided by a general practitioner, current cigarette smokers can decide to quit smoking and identify the best way of cessation. We processed relevant data where brief interventions were used as the main counselling method to aid smoking cessation, regardless of using nicotine replacement therapy (NRT), heated tobacco products (HTPs), or vaping. Full article

This study of 18–24-year-old young adults (YAs) in Australia who use, or used to use, nicotine vape products (NVPs) sought to explore their experiences when attempting to quit vaping to understand the barriers and identify facilitators of cessation. We analysed data from a survey (n = 532) of 422 YAs who vape and 110 YAs who used to vape, as well as interactive workshops (n = 12) and semi-structured interviews (n = 3), which included 7 YAs using and 8 no longer using NVPs. Social Cognitive Theory informed the data collection, with open-ended questions exploring how personal, environmental and behavioural factors shaped vaping cessation. Qualitative analyses revealed 11 themes shaping vaping cessation, including the normalisation of vaping, easy access and a desire to fit in. Vaping cessation was complicated by using NVPs to manage symptoms of mental ill-health. Additionally, former vapers reported using combustibles to replace vaping, highlighting the risk of health impacts from smoking. Potential support sources included friends and general practitioners, or family doctors. Support service development must consider de-normalising vaping, addressing underlying mental health issues and providing effective campaigns around the health risks of vaping and smoking. The findings highlight the need to invest in vaping cessation, and they can inform the design of vaping cessation programs to better support those trying to quit and ensure the success of their quit attempts. Full article

New-generation disposable e-cigarettes have become increasingly popular among young adults in the USA since the FDA’s partial flavor ban. This study aims to examine longitudinal changes in health risks among young adults who adopted these novel products, as well as the health effects of device types beyond the effects of other important e-cigarette characteristics. This study recruited e-cigarette users via voluntary response sampling from three college campuses in the USA to respond to four-wave online surveys conducted in four consecutive semesters. Among the participants who adopted disposables during the study, their health risks (dependence symptoms, respiratory symptoms, combustible tobacco use) and e-cigarette consumption characteristics (use frequency, nicotine concentration and flavors) before and after the adoption were compared using paired-sample t- or McNemar’s tests. Generalized linear mixed models with a random intercept were conducted on data from the entire sample to investigate the effects of device type (tank, cartridge/pod, disposable) on health risks, controlling for other e-cigarette consumption characteristics. The study sample of 650 e-cigarette users were, on average, 20 years old, with 49% being male, 70% being White, and 13% being Hispanic. Adopting disposables may increase secondary dependence motives (t = 2.42, p < 0.05) and the use of higher levels of nicotine concentration (t = 2.09, p < 0.05) and sweet flavors (x² = 22.53, p < 0.05) but decrease the number of times of vaping per day (t = −2.18, p < 0.05) and the use of menthol flavors (x² = 4.57, p < 0.05). Tank use is associated with a higher level of primary dependence motives (b = 0.1998, p < 0.05) and a greater odds of using combustible tobacco (b = 0.4772, p < 0.05). Although disposable use is not associated with the likelihood of using combustible tobacco, it is associated with higher levels of both primary (b = 0.2158, p < 0.05) and secondary (b = 0.2533, p < 0.05) dependence motives. It is not the device type, but rather the frequency of vaping, that affects respiratory symptoms (b = 0.0602, p < 0.05). The findings indicate that when young adults switch to disposables, their e-cigarette dependence and use of sweet-flavored e-liquids increase. Even after controlling for use frequency, nicotine concentration and flavors, using disposables is related to not only instrumental motives that are influenced by psychological and environmental contexts but also heavy, automatic use that can operate without environmental cues. Given the health risks associated with disposable e-cigarettes, more comprehensive tobacco product regulations that consider the impact of device types may be needed. Full article

Heated tobacco products (HTPs) are newly developed nicotine delivery systems via the inhalation of mainstream aerosols generated during the heating of tobacco leaf materials. Previous studies have shown that the amount of chemicals generated is much lower than that generated by conventional combustible cigarettes. However, little attention has been paid to formate, a conjugated base of formic acid with potentially toxic effects on human health. This study aims to understand the actual emission levels and behaviour of formate in mainstream aerosols produced by commercially available HTP devices in Japan. Aerosols were generated from four types of devices with regular and menthol-type flavours using a vaping machine following the CRM 81 puffing protocol. Formate was tapped in 5 mM sodium carbonate solution and subsequently analysed using ion chromatography. The results showed that the total emission amount of formate ranged from 0.0027 ± 0.0031 to 0.27 ± 0.055 mg L⁻¹, varying with heating temperature and flavour type. Moreover, the majority of formate existed in a particulate form due to the weak-basic property of the aerosol, and the formate emission level was much greater than the workplace exposure limit for the direct inhalation of mainstream aerosols. The formate in the mainstream aerosol can be considered a health concern, when using “high-temperature type” HTPs over a long period. Full article

Despite the popularity of electronic cigarettes (e-cigs) among adolescent never-smokers and adult smokers seeking a less pernicious substitute for tobacco cigarettes, the long-term health impact of vaping is largely unknown. Like cigarette smoke, e-cig vapor contains harmful and potentially harmful compounds, although in fewer numbers and at substantially lower concentrations. Many of the same constituents of e-cig vapor and cigarette smoke induce epigenetic changes that can lead to the dysregulation of disease-related genes. MicroRNAs (MiRNAs) are key regulators of gene expression in health and disease states. Extensive research has shown that miRNAs play a prominent role in the regulation of genes involved in the pathogenesis of smoking-related diseases. However, the use of miRNAs for investigating the disease-causing potential of vaping has not been fully explored. This review article provides an overview of e-cigs as a highly consequential electronic nicotine delivery system, describes trends in e-cig use among adolescents and adults, and discusses the ongoing debate on the public health impact of vaping. Highlighting the significance of miRNAs in cell biology and disease, it summarizes the published and ongoing research on miRNAs in relation to gene regulation and disease pathogenesis in e-cig users and in vitro experimental settings. It identifies gaps in knowledge and priorities for future research while underscoring the need for empirical evidence that can inform the regulation of tobacco products to protect youth and promote public health. Full article

Rates of cannabis initiation among teenagers and young adults are increasing. Further, the use of various forms of cannabis (smoked or vaped) with nicotine (dual use) is increasingly common among young people. The health effects of dual use are lesser known, particularly in the context of high-potency cannabis products and across different routes of administration, which is ominous in terms of predicting future health outcomes. There is a long history of cannabis use being associated with decreased activity and increased snacking, both of which could portend an increased risk of metabolic and cardiovascular disease, particularly when these habits begin during formative years. However, modern forms of cannabis may not have these same effects. Here, we assess whether cannabis use alone and dual use of cannabis with nicotine impact dietary and exercise habits in young people. An anonymous, social media-based survey was designed based on the UC San Diego Inhalant Questionnaire and published diet and exercise questionnaires. A total of 457 surveys were completed. Young sole cannabis users represented 29% of responders, 16% were dual users of cannabis and nicotine, and 55% were non-users of either drug. Although the sole use of cannabis was not associated with dietary or activity differences relative to non-users, dual users of cannabis and nicotine reported higher consumption of unhealthy sugars. This novel finding of dual use being associated with increased sugar intake in young people raises concerns for an increased risk of metabolic syndrome and cardiovascular disease in this population. Full article