This study compared the effects of cigarette smoke, e-cigarette vapor, and pure nicotine on cell viability using HeLa cells. Various concentrations of smoke and vapor condensates collected from a mechanical smoking system were applied to cells for 24 hours. An MTT assay then measured cell viability. Cigarette smoke exposure resulted in lower viability than e-cigarette vapor, but higher than pure nicotine. The results provide insight into the acute toxicity of these substances and whether e-cigarettes may be less harmful than cigarettes.
NYU College of Global Health - E-cigarette seminar - New YorkClive Bates
E-Cigarettes: The Tectonic Shift in Nicotine and Tobacco Consumption: Opportunity or Threat to Saving Lives?
Clive Bates
Friday, October 19, 2018
NYU School of Law, Greenberg Lounge
40 Washington Square South, New York, New York
Tobacco Harm Reduction - an introductionClive Bates
This document provides an introduction to tobacco harm reduction and alternative nicotine products such as e-cigarettes. It summarizes statements from public health organizations that find e-cigarettes to be much less harmful than combustible cigarettes. Research shows e-cigarettes help smokers quit at the population level and are effective cessation tools. The document argues for risk-proportionate regulation and taxation of nicotine products to incentivize smokers to switch to less harmful options and further reduce smoking rates.
Effects of alternative nicotine delivery systems on cigarette consumption and...Clive Bates
This document summarizes a presentation on the effects of alternative nicotine delivery systems like e-cigarettes on cigarette consumption and smoking prevalence. It discusses data showing declines in smoking rates in countries where vaping products are widely available and accepted like the US, UK, and Sweden. Studies suggest vaping helps increase smoking cessation rates at a population level. The rise of Juul products in the US may have accelerated declines in youth smoking rates there in recent years. Countries in Asia have also seen significant drops in cigarette sales as heat-not-burn tobacco and vaping products gain popularity. However, public health attitudes can influence how quickly reduced risk alternatives are adopted.
Vaping and tobacco: six things you need to know about harm reductionClive Bates
1. Smoking has not gone away
2. Technologies to obsolete cigarettes
3. Risks and risk (mis)perceptions
4. The public health mechanism and the pleasure principle
5. The youth vaping epidemic – a harder look
6. Policymaking and perverse consequences
Innovation for Consumers: E-cigarettes and novel tobacco products - Part of t...Clive Bates
This document discusses e-cigarettes and novel tobacco products. It argues that they are substantially less harmful than combustible cigarettes and have the potential to significantly reduce smoking rates and associated deaths. However, regulations should balance this potential benefit with preventing unintended consequences like perpetuating smoking or increasing youth uptake. The document proposes risk-proportionate regulations and taxes to incentivize switching from cigarettes, along with standards, marketing restrictions, and age limits, while ensuring products remain appealing to smokers trying to quit. The goal is harm reduction for populations according to the WHO framework convention on tobacco control.
This document summarizes information presented at a tobacco harm reduction conference on the public health benefits of tobacco harm reduction. It discusses estimates of the relative harm of nicotine products, value propositions for smokers to switch to lower-risk alternatives like e-cigarettes, real-world examples of smokers switching successfully to e-cigarettes, and projections of global cigarette consumption trends with and without the introduction of reduced-risk nicotine products. It also examines how moral panics have emerged around issues like e-cigarette poisoning, use by youth, hidden toxicants, and youth-oriented flavors.
Dr. Terry F. Pechacek, professor of health management and policy at the School of Public Health at Georgia State University, discusses strategies for tobacco control, including the impact of of e-cigarettes.
NYU College of Global Health - E-cigarette seminar - New YorkClive Bates
E-Cigarettes: The Tectonic Shift in Nicotine and Tobacco Consumption: Opportunity or Threat to Saving Lives?
Clive Bates
Friday, October 19, 2018
NYU School of Law, Greenberg Lounge
40 Washington Square South, New York, New York
Tobacco Harm Reduction - an introductionClive Bates
This document provides an introduction to tobacco harm reduction and alternative nicotine products such as e-cigarettes. It summarizes statements from public health organizations that find e-cigarettes to be much less harmful than combustible cigarettes. Research shows e-cigarettes help smokers quit at the population level and are effective cessation tools. The document argues for risk-proportionate regulation and taxation of nicotine products to incentivize smokers to switch to less harmful options and further reduce smoking rates.
Effects of alternative nicotine delivery systems on cigarette consumption and...Clive Bates
This document summarizes a presentation on the effects of alternative nicotine delivery systems like e-cigarettes on cigarette consumption and smoking prevalence. It discusses data showing declines in smoking rates in countries where vaping products are widely available and accepted like the US, UK, and Sweden. Studies suggest vaping helps increase smoking cessation rates at a population level. The rise of Juul products in the US may have accelerated declines in youth smoking rates there in recent years. Countries in Asia have also seen significant drops in cigarette sales as heat-not-burn tobacco and vaping products gain popularity. However, public health attitudes can influence how quickly reduced risk alternatives are adopted.
Vaping and tobacco: six things you need to know about harm reductionClive Bates
1. Smoking has not gone away
2. Technologies to obsolete cigarettes
3. Risks and risk (mis)perceptions
4. The public health mechanism and the pleasure principle
5. The youth vaping epidemic – a harder look
6. Policymaking and perverse consequences
Innovation for Consumers: E-cigarettes and novel tobacco products - Part of t...Clive Bates
This document discusses e-cigarettes and novel tobacco products. It argues that they are substantially less harmful than combustible cigarettes and have the potential to significantly reduce smoking rates and associated deaths. However, regulations should balance this potential benefit with preventing unintended consequences like perpetuating smoking or increasing youth uptake. The document proposes risk-proportionate regulations and taxes to incentivize switching from cigarettes, along with standards, marketing restrictions, and age limits, while ensuring products remain appealing to smokers trying to quit. The goal is harm reduction for populations according to the WHO framework convention on tobacco control.
This document summarizes information presented at a tobacco harm reduction conference on the public health benefits of tobacco harm reduction. It discusses estimates of the relative harm of nicotine products, value propositions for smokers to switch to lower-risk alternatives like e-cigarettes, real-world examples of smokers switching successfully to e-cigarettes, and projections of global cigarette consumption trends with and without the introduction of reduced-risk nicotine products. It also examines how moral panics have emerged around issues like e-cigarette poisoning, use by youth, hidden toxicants, and youth-oriented flavors.
Dr. Terry F. Pechacek, professor of health management and policy at the School of Public Health at Georgia State University, discusses strategies for tobacco control, including the impact of of e-cigarettes.
Seven insights into tobacco harm reductionClive Bates
1st Tobacco Harm Reduction Malaysia Scientific Meeting
21 November 2021.
1. The problem is smoking
2. Smoke-free alternatives
3. Quitting smoking with smoke-free alternatives
4. Health concerns
5. Youth vaping
6. Policy and unintended consequences
7. Innovation (and its enemies)
This document describes the methodology used to examine the availability, accessibility, usage and regulatory environment of novel and emerging tobacco, nicotine, and related products in the EU. The study involved a two-stage evidence review, key informant interviews, and a stakeholder survey. In the first stage, the researchers developed a typology of products by comprehensively searching various information sources. This typology guided a second, more targeted evidence review. Key findings of the evidence review, interviews, and survey are presented in subsequent chapters, with conclusions and options for addressing regulatory gaps discussed in the final chapter. The overall aim was to inform a possible revision of the EU Tobacco Products Directive.
This document discusses efforts to develop safer cigarettes through modifying tobacco and reducing tar and toxic compounds. In the 20th century, tobacco companies experimented with adding filters and other additives to cigarettes in attempts to make them less hazardous. One promising attempt involved adding palladium to tobacco, but this "Epic" brand was withheld from the market due to pressure from tobacco control groups and other companies. Later attempts in the 1970s by government and industry to develop "tobacco substitutes" and ultra-low tar cigarettes also failed commercially. Opponents argued safer cigarettes could deter quitting and mask the true risks of smoking. Overall, fully neutralizing the harms of smoking has proved very difficult due to the many toxic compounds produced from
The MRTP process - Seven provocations - FDLI webinar 30 July 2020Clive Bates
My presentation for a Food and Drug Law Institute webinar on the FDA's Modified Risk Tobacco Product process for making risk-related claims about tobacco and nicotine products
This document provides information on vaping and tobacco harm reduction. It discusses how smoking kills over 96,000 people annually in the UK and notes that median smokers lose 10 years of life expectancy. It then examines smoking prevalence data in different areas and populations in the UK. The document discusses evidence that vaping is substantially less harmful than smoking and may help smokers quit. It notes concerns that restrictive policies could perpetuate smoking. The summary concludes by outlining a framework for risk-proportionate regulation of tobacco and nicotine products.
Bad science - 10 insights for advocatesClive Bates
1. Science and evidence is often overrated, and intuitions come before strategic reasoning.
2. Arguments should be proportional to the issue; don't bring a knife to a gun fight.
3. Authority from experts can be leveraged; a quote from the Royal College of Physicians said e-cigarette risks are unlikely to exceed 5% of smoking risks, and may be lower.
Albania National Association of Public health - Harm Reduction ConferenceClive Bates
Seven insights into tobacco harm reduction (20 min version) 20th December 2021.
1.The problem is smoking
2. Smoke-free alternatives
3. Quitting smoking with smoke-free alternatives
4. Health concerns
5. Youth vaping
6. Policy and unintended consequences
7. Innovation (and its enemies)
This document outlines six insights on harm reduction:
1. Policies should focus on actual harm rather than products themselves. Harm from smoking, alcohol, drugs, gambling, etc. should be the focus.
2. Policies themselves can cause unintended harm, such as bans on e-cigarettes increasing smoking rates in some cases. The potential harms of policies must be considered.
3. Context is important when considering harm reduction policies. What works in one situation may not be effective in another due to differing contexts.
4. Policies should consider who is actually at risk rather than entire populations. For issues like obesity and salt, not all groups face the same degree of risk.
5. Appro
E-Cigarettes: Promise, Peril, and Probabilistic Population PredictionCertara
E-cigarettes, which deliver nicotine without carcinogenic tar, hold the promise to save the lives of many smokers who switch to them, but risks include failure to quit cigarettes (dual use), increased initiation to nicotine products among youth, relapse of former smokers to e-cigarettes, and e-cigarettes becoming a “gateway to smoking.” To capture these uncertainties and weigh benefits vs. risks, prediction of e-cigarette health impacts must use a broad range of probability-weighted scenarios.
India - Economic Times - Consumer Freedom Conclave - 24 Feb 2022Clive Bates
Tobacco harm reduction: the biggest public health win of the 21st Century?
1. Tobacco harm reduction
2. Risk communication
3. Policymaking
4. Cause of opposition
5. Innovation
Professor Robert West - E-Cigarette Summit 2014Neil Mclaren
- The document analyzes trends in electronic cigarette use in England based on monthly household surveys conducted by Robert West and colleagues at University College London.
- It finds that prevalence of e-cigarette use increased rapidly until late 2013 but has remained stable since, with 20% of smokers and 30% of recent ex-smokers now using e-cigarettes.
- E-cigarettes have become the most popular aid for quit attempts, and their increased use has been accompanied by rises in quit attempts and success rates at the population level.
This presentation was developed for our CLeaR (local government tobacco control standards) assessment in July 2014. It sets out our vision for tobacco control in Hertfordshire, summarises our strategies and current position and identifies our future work including commitment to harm reduction, getting positive gains from e-cigarettes and driving tobacco related harm down
Tobacco harm reduction in the UK: e-cigarettes (EC) are making a differenceClive Bates
The document discusses the success of e-cigarettes in helping smokers quit in Leicester City, UK. It notes that success rates were up to 20% higher using e-cigarettes compared to nicotine replacement therapy alone. A stop smoking service in Leicester City began offering free e-cigarette starter kits in 2014 and has seen consistently high quit rates each year since. Common myths about potential health harms, nicotine addiction, e-cigarettes not reflecting smoker preferences, gateway effects, and lack of evidence are addressed. Key organizations in the UK support e-cigarettes as much safer than smoking and effective for harm reduction.
A public lecture on Electronic Cigarettes delivered by Dr Lynne Dawkins of the Centre for Addictive Behaviours Research, London South Bank University on 14th November 2018.
A recording of the talk can be found here: https://youtu.be/VpetvlAmIaU
Following her successful public lecture on E-Cigarettes in 2013, Dr Dawkins re-visits the subject of e-cigarettes and vaping, drawing on the most recent evidence and updates since 2013. She describes the development in e-cigarette technology and current regulation and then brings the audience up to date with the latest research on usage patterns, smoking cessation and safety issues, addressing some of the common myths held around e-cigarettes and vaping.
1. The document discusses the potential for e-cigarettes and other reduced risk nicotine products to significantly reduce smoking-related harm and death on a global scale. It outlines scenarios where low-risk nicotine products could drive down the number of smokers from over 1 billion currently to just 5% of the global adult population by 2050.
2. However, it notes that an over-regulated environment that reduces product appeal and diversity could limit the public health benefits by decreasing the number of smokers who switch to less harmful alternatives. The document argues for a balanced, evidence-based approach that recognizes both the massive potential gains and relatively minor risks of low-risk nicotine products.
3. In conclusion, it advocates that
Respect Vapers Ireland - webinar on tobacco harm reductionClive Bates
This document summarizes six key things to know about tobacco harm reduction:
1. Smoking prevalence remains high despite efforts. New reduced risk nicotine products like e-cigarettes can help obsolete cigarettes.
2. Expert reviews find e-cigarettes are much less harmful than smoking and can help smokers quit. However, risk perceptions are often exaggerated.
3. The public health benefit comes from addicted smokers switching to less harmful options, not from promoting e-cigarette use alone.
4. Policies should balance appropriate youth protections with supporting harm reduction for adults. Overly restrictive policies can backfire by perpetuating smoking.
What is wrong (and right) about the Tobacco Products Directive approach to E-...Clive Bates
These are the visual aids for my talk on the truly dreadful European Union Tobacco Products Directive as it applies to e-cigarettes, and why Totally Wicked has a legal case against it.
E-cigarette Summit - The New Tobacco Wars - 7 December 2021Clive Bates
The presentation gives my take on the conflict raging in tobacco control. It looks at where things are going wrong in science, risk communication, policy, and youth politics. It then looks at causes: institutional and cultural inertia. And finally, finds hope in the basic processes of innovation.
This document discusses tobacco harm reduction strategies for engaging healthcare professionals in Nigeria. It defines harm reduction as improving lives without focusing solely on abstinence. Tobacco harm reduction aims to provide safer nicotine delivery alternatives to cigarettes like e-cigarettes and smokeless tobacco. Healthcare professionals can advocate for harm reduction, educate about reduced risk products, and support spiritual and physical wellbeing to help people quit smoking. Embracing harm reduction strategies is key to achieving global smoke-free goals.
This document reviews the scientific literature on electronic cigarettes (e-cigarettes) and vaping. It finds that while vaping may be less harmful than smoking, more research is still needed to understand the health effects of vaping. Regulations of e-cigarettes are currently controversial, as they are marketed as smoking cessation tools but cannot legally be classified as such. The medical community faces the challenge of advising patients on vaping given limited evidence; while vaping is likely less dangerous than smoking, physicians worry it could perpetuate nicotine addiction. More research is needed to establish the safety of e-cigarettes and their potential as a smoking alternative or cessation method.
Tobacco Harm Reduction by Somchai Bovornkitti* in Crimson Publishers: Telemedicine and e-Health open access journals
Cigarette smoke contain approximately 250 different chemicals known to be harmful to human health. Thousands of harmful chemical substances produce by the combustion of tobacco. The health impacts such as cancer and chronic lung disease are not only associated with smokers but also people who are exposed to secondhand smoke. Tobacco Harm Reduction is a concept to minimize the impacts of tobacco on the individual and on society at large. A key component of this strategy is using alternative source of nicotine as a substitute to tobacco cigarettes. Electronic cigarette and heated tobacco are alternatives that might have potential in reduce harm from smokes. This paper elaborates on available research associated with electronic cigarette and heated tobacco with harm reduction and risk perspective.
https://crimsonpublishers.com/tteh/fulltext/TTEH.000522.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more Articles on Telemedicine and e-Health open access journals
please click on link: https://crimsonpublishers.com/tteh/index.php
Please follow the below link for our LinkedIn page
https://www.linkedin.com/company/crimsonpublishers
Seven insights into tobacco harm reductionClive Bates
1st Tobacco Harm Reduction Malaysia Scientific Meeting
21 November 2021.
1. The problem is smoking
2. Smoke-free alternatives
3. Quitting smoking with smoke-free alternatives
4. Health concerns
5. Youth vaping
6. Policy and unintended consequences
7. Innovation (and its enemies)
This document describes the methodology used to examine the availability, accessibility, usage and regulatory environment of novel and emerging tobacco, nicotine, and related products in the EU. The study involved a two-stage evidence review, key informant interviews, and a stakeholder survey. In the first stage, the researchers developed a typology of products by comprehensively searching various information sources. This typology guided a second, more targeted evidence review. Key findings of the evidence review, interviews, and survey are presented in subsequent chapters, with conclusions and options for addressing regulatory gaps discussed in the final chapter. The overall aim was to inform a possible revision of the EU Tobacco Products Directive.
This document discusses efforts to develop safer cigarettes through modifying tobacco and reducing tar and toxic compounds. In the 20th century, tobacco companies experimented with adding filters and other additives to cigarettes in attempts to make them less hazardous. One promising attempt involved adding palladium to tobacco, but this "Epic" brand was withheld from the market due to pressure from tobacco control groups and other companies. Later attempts in the 1970s by government and industry to develop "tobacco substitutes" and ultra-low tar cigarettes also failed commercially. Opponents argued safer cigarettes could deter quitting and mask the true risks of smoking. Overall, fully neutralizing the harms of smoking has proved very difficult due to the many toxic compounds produced from
The MRTP process - Seven provocations - FDLI webinar 30 July 2020Clive Bates
My presentation for a Food and Drug Law Institute webinar on the FDA's Modified Risk Tobacco Product process for making risk-related claims about tobacco and nicotine products
This document provides information on vaping and tobacco harm reduction. It discusses how smoking kills over 96,000 people annually in the UK and notes that median smokers lose 10 years of life expectancy. It then examines smoking prevalence data in different areas and populations in the UK. The document discusses evidence that vaping is substantially less harmful than smoking and may help smokers quit. It notes concerns that restrictive policies could perpetuate smoking. The summary concludes by outlining a framework for risk-proportionate regulation of tobacco and nicotine products.
Bad science - 10 insights for advocatesClive Bates
1. Science and evidence is often overrated, and intuitions come before strategic reasoning.
2. Arguments should be proportional to the issue; don't bring a knife to a gun fight.
3. Authority from experts can be leveraged; a quote from the Royal College of Physicians said e-cigarette risks are unlikely to exceed 5% of smoking risks, and may be lower.
Albania National Association of Public health - Harm Reduction ConferenceClive Bates
Seven insights into tobacco harm reduction (20 min version) 20th December 2021.
1.The problem is smoking
2. Smoke-free alternatives
3. Quitting smoking with smoke-free alternatives
4. Health concerns
5. Youth vaping
6. Policy and unintended consequences
7. Innovation (and its enemies)
This document outlines six insights on harm reduction:
1. Policies should focus on actual harm rather than products themselves. Harm from smoking, alcohol, drugs, gambling, etc. should be the focus.
2. Policies themselves can cause unintended harm, such as bans on e-cigarettes increasing smoking rates in some cases. The potential harms of policies must be considered.
3. Context is important when considering harm reduction policies. What works in one situation may not be effective in another due to differing contexts.
4. Policies should consider who is actually at risk rather than entire populations. For issues like obesity and salt, not all groups face the same degree of risk.
5. Appro
E-Cigarettes: Promise, Peril, and Probabilistic Population PredictionCertara
E-cigarettes, which deliver nicotine without carcinogenic tar, hold the promise to save the lives of many smokers who switch to them, but risks include failure to quit cigarettes (dual use), increased initiation to nicotine products among youth, relapse of former smokers to e-cigarettes, and e-cigarettes becoming a “gateway to smoking.” To capture these uncertainties and weigh benefits vs. risks, prediction of e-cigarette health impacts must use a broad range of probability-weighted scenarios.
India - Economic Times - Consumer Freedom Conclave - 24 Feb 2022Clive Bates
Tobacco harm reduction: the biggest public health win of the 21st Century?
1. Tobacco harm reduction
2. Risk communication
3. Policymaking
4. Cause of opposition
5. Innovation
Professor Robert West - E-Cigarette Summit 2014Neil Mclaren
- The document analyzes trends in electronic cigarette use in England based on monthly household surveys conducted by Robert West and colleagues at University College London.
- It finds that prevalence of e-cigarette use increased rapidly until late 2013 but has remained stable since, with 20% of smokers and 30% of recent ex-smokers now using e-cigarettes.
- E-cigarettes have become the most popular aid for quit attempts, and their increased use has been accompanied by rises in quit attempts and success rates at the population level.
This presentation was developed for our CLeaR (local government tobacco control standards) assessment in July 2014. It sets out our vision for tobacco control in Hertfordshire, summarises our strategies and current position and identifies our future work including commitment to harm reduction, getting positive gains from e-cigarettes and driving tobacco related harm down
Tobacco harm reduction in the UK: e-cigarettes (EC) are making a differenceClive Bates
The document discusses the success of e-cigarettes in helping smokers quit in Leicester City, UK. It notes that success rates were up to 20% higher using e-cigarettes compared to nicotine replacement therapy alone. A stop smoking service in Leicester City began offering free e-cigarette starter kits in 2014 and has seen consistently high quit rates each year since. Common myths about potential health harms, nicotine addiction, e-cigarettes not reflecting smoker preferences, gateway effects, and lack of evidence are addressed. Key organizations in the UK support e-cigarettes as much safer than smoking and effective for harm reduction.
A public lecture on Electronic Cigarettes delivered by Dr Lynne Dawkins of the Centre for Addictive Behaviours Research, London South Bank University on 14th November 2018.
A recording of the talk can be found here: https://youtu.be/VpetvlAmIaU
Following her successful public lecture on E-Cigarettes in 2013, Dr Dawkins re-visits the subject of e-cigarettes and vaping, drawing on the most recent evidence and updates since 2013. She describes the development in e-cigarette technology and current regulation and then brings the audience up to date with the latest research on usage patterns, smoking cessation and safety issues, addressing some of the common myths held around e-cigarettes and vaping.
1. The document discusses the potential for e-cigarettes and other reduced risk nicotine products to significantly reduce smoking-related harm and death on a global scale. It outlines scenarios where low-risk nicotine products could drive down the number of smokers from over 1 billion currently to just 5% of the global adult population by 2050.
2. However, it notes that an over-regulated environment that reduces product appeal and diversity could limit the public health benefits by decreasing the number of smokers who switch to less harmful alternatives. The document argues for a balanced, evidence-based approach that recognizes both the massive potential gains and relatively minor risks of low-risk nicotine products.
3. In conclusion, it advocates that
Respect Vapers Ireland - webinar on tobacco harm reductionClive Bates
This document summarizes six key things to know about tobacco harm reduction:
1. Smoking prevalence remains high despite efforts. New reduced risk nicotine products like e-cigarettes can help obsolete cigarettes.
2. Expert reviews find e-cigarettes are much less harmful than smoking and can help smokers quit. However, risk perceptions are often exaggerated.
3. The public health benefit comes from addicted smokers switching to less harmful options, not from promoting e-cigarette use alone.
4. Policies should balance appropriate youth protections with supporting harm reduction for adults. Overly restrictive policies can backfire by perpetuating smoking.
What is wrong (and right) about the Tobacco Products Directive approach to E-...Clive Bates
These are the visual aids for my talk on the truly dreadful European Union Tobacco Products Directive as it applies to e-cigarettes, and why Totally Wicked has a legal case against it.
E-cigarette Summit - The New Tobacco Wars - 7 December 2021Clive Bates
The presentation gives my take on the conflict raging in tobacco control. It looks at where things are going wrong in science, risk communication, policy, and youth politics. It then looks at causes: institutional and cultural inertia. And finally, finds hope in the basic processes of innovation.
This document discusses tobacco harm reduction strategies for engaging healthcare professionals in Nigeria. It defines harm reduction as improving lives without focusing solely on abstinence. Tobacco harm reduction aims to provide safer nicotine delivery alternatives to cigarettes like e-cigarettes and smokeless tobacco. Healthcare professionals can advocate for harm reduction, educate about reduced risk products, and support spiritual and physical wellbeing to help people quit smoking. Embracing harm reduction strategies is key to achieving global smoke-free goals.
This document reviews the scientific literature on electronic cigarettes (e-cigarettes) and vaping. It finds that while vaping may be less harmful than smoking, more research is still needed to understand the health effects of vaping. Regulations of e-cigarettes are currently controversial, as they are marketed as smoking cessation tools but cannot legally be classified as such. The medical community faces the challenge of advising patients on vaping given limited evidence; while vaping is likely less dangerous than smoking, physicians worry it could perpetuate nicotine addiction. More research is needed to establish the safety of e-cigarettes and their potential as a smoking alternative or cessation method.
Tobacco Harm Reduction by Somchai Bovornkitti* in Crimson Publishers: Telemedicine and e-Health open access journals
Cigarette smoke contain approximately 250 different chemicals known to be harmful to human health. Thousands of harmful chemical substances produce by the combustion of tobacco. The health impacts such as cancer and chronic lung disease are not only associated with smokers but also people who are exposed to secondhand smoke. Tobacco Harm Reduction is a concept to minimize the impacts of tobacco on the individual and on society at large. A key component of this strategy is using alternative source of nicotine as a substitute to tobacco cigarettes. Electronic cigarette and heated tobacco are alternatives that might have potential in reduce harm from smokes. This paper elaborates on available research associated with electronic cigarette and heated tobacco with harm reduction and risk perspective.
https://crimsonpublishers.com/tteh/fulltext/TTEH.000522.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more Articles on Telemedicine and e-Health open access journals
please click on link: https://crimsonpublishers.com/tteh/index.php
Please follow the below link for our LinkedIn page
https://www.linkedin.com/company/crimsonpublishers
This document discusses electronic cigarettes (ECs) and whether they are safer than combustible cigarettes. It summarizes that while ECs may expose users to fewer harmful chemicals than smoking, the long-term safety of ECs is still unknown. Studies have found potentially harmful chemicals in EC vapor, but in much lower amounts than in cigarette smoke. The regulation of ECs is also debated, as stricter rules may discourage innovation but make the products less appealing to youth and non-smokers. The evidence that ECs help smokers quit is also limited and inconclusive. More research is still needed to understand the public health impact of ECs.
These are the slides for my talk delivered at the Lisbon Addictions conference October 2019 as part of the FuturiZe round table on safer drugs.
A recording of the presentation can be found on my YouTube channel 'Lynne Talks Vape': https://youtu.be/8jTQvoWu1Pk
E-cigarettes provide an alternative to nicotine delivery through vapor rather than smoke. While they may be less harmful than conventional cigarettes, there are still health risks and unknown long-term effects. The document discusses both sides of the debate around e-cigarettes. Some view them as a harm reduction tool that can help smokers quit, while others are concerned they could renormalize smoking behaviors and expose users to carcinogens. Long-term studies are still needed to fully understand the safety profile of e-cigarettes and their impacts on public health.
1) The document discusses electronic cigarettes (e-cigarettes) in Pakistan, including their rise in popularity as a potential smoking cessation method. It provides background information on e-cigarettes and reviews several studies on awareness and use in Pakistan and other countries.
2) The prevalence of smoking is high among youth and students in Pakistan. One study found 6.2% of medical students reported using e-cigarettes. However, data on e-cigarette prevalence and awareness in Pakistan is limited.
3) The COVID-19 pandemic has led to significant changes in smoking behaviors worldwide. Providing smoking cessation support, including for e-cigarette use, could help many motivated individuals quit successfully during the
MPs Advocate For More Relaxed E-cigarette Rules | Jenn Galandy Jenn Galandy, MA
MPs in the UK are advocating for more relaxed rules regarding e-cigarettes. They argue that vaping is less harmful than smoking normal cigarettes and can help people quit smoking. The report calls for more freedom in e-cigarette advertising, relaxed regulations and taxes on e-cigarettes, and annual reviews of the health effects of vaping. It also discusses allowing vaping in public places like public transport. The responses to the report were mixed, with health groups wary of marketing to youth but supportive of helping smokers quit, while the public expressed concerns about unknown health risks of vaping in public.
In the current write up, Supervisor Support has been used as one o.docxbradburgess22840
In the current write up, Supervisor Support has been used as one of the independent variable to explain OCB. But now Supervisor Support is used as mediator to explain OCB. The write up has captured almost everything and need to add few more paragraphs only how two independent variables (Leaders Moderation Orientation and People Orientation) lead to Supervisor Support that lead to OCB. Hence, the following changes are required as mentioned below:
1. Arguments to be developed for supervisor support as mediating variable under introduction, background, problem statement, objectives and research questions with relevant referencing. I have developed the research question and is highlighted in green for your reference in the attached document.
2. Under conceptual framework, it is required to write up the arguments showing the relationship between each independent variables (Leaders Moderation Orientation & People Orientation) with Supervisor Support with relevant referencing. The new diagram is attached and need to follow the diagram while making arguments.
3. Need to make changes in Methodology (chapter 3) as corrected.
I have attached the lists of tables and articles to help for the write up. Whatever corrections are made please highlight with green and no plagiarism
405
The Use and Abuse
of Tobacco
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Identify the most widely used forms of tobacco and the contents of tobacco
products that contribute to negative health outcomes.
▶ Describe the negative health and economic costs of cigarette and cigar smoking
and smokeless tobacco use.
▶ Describe secondhand smoke and identify the negative health consequences of
secondhand smoke exposure.
▶ Understand trends in the prevalence of tobacco use.
▶ Identify important factors contributing to recent reductions in tobacco use in the
United States.
▶ Describe efforts by the tobacco industry to maintain higher rates of smoking.
▶ Identify effective prevention and intervention approaches designed to reduce rates
of tobacco use.
C
o
n
c
e
p
t 1
8
Avoiding Destructive Behaviors ▶ Section VII
Tobacco use is the number one
cause of preventable disease and is
associated with the leading causes of
death in our culture.
cor22568_ch18_405-416.indd 405 9/21/12 7:32 PM
F
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E
R
,
C
E
D
R
I
C
1
6
9
2
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S
406 Section 7 ▶ Avoiding Destructive Behaviors
Smokeless chewing tobacco is as addictive (and
maybe more so) as smoking and produces the
same kind of withdrawal symptoms. Chewing
tobacco comes in a variety of forms, including loose leaf,
twist, and plug forms. Rather than being smoked, the
dip, chew, or chaw stays in the mouth for several hours,
where it mixes well with saliva and is absorbed into the
bloodstream. Smokeless tobacco contains about seven
times more nicotine than cigarettes, and more of it is
absorbed because of the length .
Tobacco harm reduction - meetings with Hill staff Clive Bates
This document discusses efforts to reduce smoking and associated harms. It notes that while 36.5 million Americans smoke, consuming 264 billion cigarettes in 2015, smoking causes over 480,000 deaths per year at a cost of over $300 billion. New reduced-risk nicotine products like e-cigarettes and heated tobacco have potential to significantly reduce smoking's toll if made accessible through sensible regulation rather than restrictive policies that protect the cigarette trade. The Royal College of Physicians reviewed evidence that e-cigarettes are much less harmful than smoking and effective for smoking cessation. Most youth e-cigarette use involves just flavors without nicotine. Banning flavors could undermine harm reduction efforts. The proposed Cole-Bishop bill offers a responsible
Islam prohibits smoking cigarettes due to the serious health risks. Cigarettes contain over 4,000 chemicals, including at least 50 that cause cancer. When burned, cigarettes release toxic chemicals like formaldehyde, ammonia, arsenic, and hydrogen cyanide. While electronic cigarettes may contain fewer harmful chemicals, their long term effects are still unknown and they remain unregulated. Islam teaches preserving one's health and avoiding intoxicants, so Muslims should refrain from both traditional and electronic cigarettes.
This document provides an overview of electronic cigarettes (e-cigarettes) and discusses associated health risks and environmental impacts. It summarizes that while e-cigarettes were introduced as a safer alternative to regular cigarettes, research shows they may pose similar or additional health hazards. Exposure to e-cigarette vapor can damage lung tissue and impair the immune system. The liquid and vapor contain toxic chemicals like nicotine, formaldehyde, and heavy metals. Regulations are needed to restrict e-cigarette advertising and sales to youth and prevent disposal hazards from batteries and liquid waste. More research is still required to understand long-term health effects.
The document discusses electronic cigarettes (e-cigarettes), how they work, their components, and benefits compared to traditional cigarettes. It works by vaporizing a liquid solution when the user inhales. The vapor produced contains nicotine but none of the toxins in cigarette smoke. E-cigarettes are presented as less harmful and more socially acceptable than traditional cigarettes. The document also provides background information on Mizoram state in India, including its high tobacco consumption rates, and discusses marketing of e-cigarettes.
Efficacy of Nicotine Replacement Therapy (NRT) to Aid Cigarette Sm.docxtoltonkendal
Efficacy of Nicotine Replacement Therapy (NRT) to Aid Cigarette Smoking Cessation amongst Adults in United Kingdom
Introduction
Tobacco smoking is a major contributor to many serious diseases that eventually lead to death in the United Kingdom (UK). According to Office of National Statistics (ONS) (2017), 7.4 million of United Kingdom’s population are smokers and 19.7 percent of these smokers are adult with age-range of 25 to 34 years. Tobacco cigarettes contain nicotine. Nicotine changes the balance of two chemicals namely noreadrenaline and dopamine which are found in human the brain. The sudden change on the levels of these chemicals after inhalation may result in changes in mood which could result in reduction of stress, anxiety and increase in pleasure (National Health Service (NHS), 2018a). Transmission of nicotine by inhalation of tobacco is the fastest way of distributing nicotine into the bloodstream according to Action on Smoking and Health (ASH) (2019). Therefore, these facts indicate that smoking cigarettes could be profoundly addictive due to the rapid delivery of the desired effects to its users without taking into consideration any adverse effects on the human body and health.
Cigarette smoking harms human health; and stopping has proven hard to do alone. According to Health and Social Care Information Centre (HSCIC) (2017), in 2017 there were 146,234 people who started to try to quit smoking, only 49 percent successfully managed to stay away from using cigarretes and 33 percent of the individuals who successfully managed to stop smoking utilised licensed nicotine containing products. The government came up with tobacco control plan for England to assist its people to stop smoking; the elements of the plan include making tobacco more expensive, restraining tobacco related publicity, efficient control of tobacco products, developing alertness on harm caused by smoking and lowering the instance to be exposed to second-hand smoke (Public Health England, 2015).
Smoking cessation services and interventions are being offered by the NHS. Affirmed by National Institute for Health and Care Excellence (NICE) (2019), there are few evidenced-based interventions for smoking available in the UK for adults which include behavioural support, bupropion, nicotine replacement therapy (NRT), varenicline and very brief advices (VBA). These interventions are available to individuals who seek help through their general practitioner and to those who are being referred to health professionals for assistance; some of the interventions are combined to be able to achieve the desired goal which is to ultimately forgo smoking tobacco.
This paper will discuss the different kinds of NRT available for adults in the United Kingdom. Nicotine replacement therapy (NRT) includes few ways to supplement smoking. It helps to fight the urge to consume or inhale tobacco and also to reduce the effects of withdrawal. In addition, it will help individuals to slowly redu.
This document reviews the effects of cigarette smoking on fertility. It discusses how cigarette smoke contains thousands of toxic compounds that can damage the reproductive system at all stages, from folliculogenesis to embryo implantation and development. Both low and high levels of nicotine dependency from smoking are associated with increased infertility risk. The negative impacts of smoking on fertility should be considered when educating health care providers given the physical, mental, social, and economic burdens of infertility.
Little over a decade since their launch, electronic cigarettes (ECs) today represent a global
industry with sales exceeding US$6 billion last year. Yet the devices have increasingly
generated heated debate surrounding their safety, efficacy and regulatory control, while
advocates of the immediate formal use of ECs opine their usefulness in reducing the
burden of smoking-related disease – other experts urge caution until more information
and better evidence become available. Dr Robert Combes reports.
Bareham et al E-Cigarettes Controversies within the controversyDavid Bareham
E-cigarettes have been controversial since being introduced over 10 years ago. There are ongoing debates around their potential health risks, effectiveness for smoking cessation, appropriate regulation, and the involvement of tobacco companies. Studies have shown mixed results on whether e-cigarettes help smoking cessation and their long-term health effects are still unclear due to lack of research and conflicting reports. Various organizations and experts disagree on the appropriate regulatory approach and how the risks of e-cigarettes compare to conventional cigarettes. The controversies surrounding e-cigarettes are complex with arguments on both sides and no consensus on important issues related to public health.
- The document discusses nicotine testing methods and their use in various contexts like insurance, employment, schools, and research. It also covers nicotine metabolism and the differences between nicotine and its metabolite cotinine.
- The Nano-Check Rapid Nicotine Test is described as an immunoassay that detects cotinine in urine at cutoff levels of 200ng/ml or 500ng/ml to determine tobacco use. It provides results in 5-10 minutes and is intended for professional use.
- The test works by detecting cotinine in a urine sample via monoclonal antibodies on a test strip, with positive or negative results depending on whether or not a test line appears within the timeframe.
1. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
A COMPARISON OF THE
EFFECTS OF E-
CIGARETTE VAPOUR AND
CIGARETTE SMOKE ON
THE VIABILITY OF HELA
CELLS
CIGARETTES VS. E-CIGARETTES – THE ACUTE
EFFECTS
Paige Heath, 2016
BSc Biomedical Science
Leeds Beckett University
A thesis submitted in partial fulfilment of the requirements of Leeds Beckett
University for the degree BSc (Hons) in Biomedical Science with Human Biology
2. Leeds Beckett University.
Faculty of Health
Health Sciences
Research Project Module,
Statement of authenticity
I, Paige Heath, declare that this project is my own original work
(except where referenced) and does not infringe copyright.
Signed………………………………………………..
Date…………………………………………………..
3. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 1
Acknowledgements
I would firstly like to thank my tutor John Skamarauskas and the lab technicians at Leeds Beckett
University, for their continued support throughout the months that have been dedicated to this
research. I would also like to thank my parents, family and friends for their constant interest in
my work and supporting me throughout.
4. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 2
Abstract
The use of electronic cigarettes (e-cigarettes) has rapidly increased since their introduction to
the UK in 2008. They are now the most common method used in the aid of smoking cessation,
with the product being viewed as a safer option than mainstream cigarettes by many. However,
regulations surrounding the production of the liquids used in e-cigarettes are not currently in
place, leaving the safety of the devices questionable - both to the user and surrounding people
that may be subjected to inhalation of the product. I exposed HeLa cells to a variety of
concentrations of vapours collected from an electronic cigarette using a mechanical smoking
system designed specifically for the study. HeLa cells were also exposed to a variety of
concentrations of cigarette smoke, collected in the same way, and different concentrations of
pure nicotine to compare the results on cell viability for each variable. The extracted
condensates were applied to a monolayer of cultured HeLa cells by contaminating with fresh
media and carrying out a standard media change. Cells were exposed for 24 hours in a 96-well,
flat bottomed, culture plate and incubated at 37°C, 5% CO2. An MTT viability assay was carried
out after this time period. The viability of cells exposed to mainstream cigarette smoke was
found to be lower than that of cells exposed to e-cigarette vapour but higher than the viability
of cells exposed to pure nicotine. Many factors can effect this; the following paper will discuss
these factors and what the results can suggest about the effects of e-cigarettes in the real world.
6. PAGE | 1
Keywords:
Electronic Cigarette; Smoking simulation system; viability; passaging; MTT assay; nicotine.
1. Introduction
The research carried out in this study aims to compare cigarette smoke and e-cigarette vapours
on a quantitative level, based solely on their effects on cell survival. Health risks associated with
e-cigarettes are currently slightly ambiguous which can prove worrying for the general public –
this emphasises the need for further research in this area and shows just how useful this data
could be. It can provide results focusing on the acute effects of side stream smoke, that allow a
determination as to whether a transition from cigarettes to e-cigarettes is a beneficial one.
The prevalence of cigarette smoking in England is now (Nov 2015) at around a sixth of the UK
adult population, compared with a value of around 25% in January 2008. (Action on Smoking
and Health, Nov 2015) Smoking holds a massive strain on the National Health Service – In
2013/14 the cost of the net ingredients used in the prescription of items aiding smoking
cessation was almost £48.8 million. There was also over 1.6million hospital admissions where
primary diagnosis of diseases directly related to smoking were made. (Eastwood, P., 2013)The
figure below from March 2015 shows how much of a positive impact that e-cigarettes could have
in aiding the revival of the NHS if proven to be as beneficial as they are currently thought to be
in comparison to cigarettes. In this figure it can be seen that the use of e-cigarettes in quit
attempts has taken over Nicotine Replacement Therapy (NRT) and ‘NHS stop smoking service’
with a massive 30.1% compared with 11% and 2% respectively. (Fig 1. (West, R. and Brown, J.,
2012)). Such a statistic suggests that quitting smoking with the use of e-cigarettes is a method
preferred by many and could also be suggested as the most effective due to this. However, the
confirmation that e-cigarettes are safer than cigarettes in all aspects has still not been provided.
It could also be said that such research is reluctant to be carried out due to the growing
popularity of e-cigarettes across the globe, ‘It’s a booming, billion-dollar industry -- on track to
outsell tobacco products within a decade.’ (Griffin, 2016)
7. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 2
Figure 1. ‘Support used in quit attempts’ (West, R. and Brown, J., 2012)
One of the biggest dangers of smoking that is often forgotten about, is the danger associated
with the smoke or vapour as a concern for surrounding people – especially children – that are
subjected to inhalation of the substances on a secondary basis. Since 1964, around 2.5 million
people have been killed as a result of second hand smoke. (US Department of Health and
Human Services, 2014.)
Tobacco smoke contains over 4000 chemicals, some of which have marked irritant properties
and over fifty are known to be carcinogenic (US Department of Health and Human Services,
2006.) These chemicals are known to have a fairly obvious acute effect on cells – the presence of
carbon monoxide in tobacco smoke leads to a decreased function of the alveoli, leading to a
decreased amount of oxygen available in the blood and therefore the chance of premature cell
death due the lack of oxygen needed for respiration. (Abpischools.org.uk) ‘Studies show that
nicotine, present in tobacco smoke is the most potent stimulant and addictive agent in the
world’. It is already common knowledge that increased blood pressure and heart rate are results
0%
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8. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 3
of the presence of nicotine, however this study will provide an insight to the effects of nicotine
on a cellular level and also a suggestion as to whether it is simply the presence of nicotine
which results in an effect or if it is due to the combination of nicotine with other harmful
substances in the cigarette/e-cigarette. (US Department of Health and Human Services, 2010.)
The harmful effects of toxicants found in cigarette smoke are quite well documented which has
led to restrictions put in place such as no smoking in public places in 2007, and the recently
established law which states the smoking of a cigarette in a car containing anybody under the
age of 18 became illegal as of 1st October 2015. These laws are based upon facts such as the
recent statement that passive smoking kills up to 11,000 people a year in the UK. (Moore et al.
2015) There are currently no laws in place that prohibit the use of electronic cigarettes in public
places. (Gov.uk, 2015) However there has been little research conducted regarding the health-
risks associated with vapour from e-cigarettes. With an estimated 2.6 million e-cigarette users
in Great Britain as of March 2015, better documentation of the health risks associated with the
use of e-cigarettes is becoming vital. (Action on Smoking and Health, May 2015) Although e-
cigarette vapour is thought to be less toxic than cigarette smoke, e-cigarette vapour ‘increase(s)
the exposure of non-smokers and bystanders to nicotine and a number of toxicants’ (World
Health Organization, 2014.) The research I intend to carry out is proposed to extend the current
research based knowledge on the acute effects of e-cigarette vapour.
A lack in knowledge proves to be one 0f the main issues associated with the use of e-cigarettes
– there is currently little known about the liquid component of the e-cigarette, specifically
when inhaled. This recently been questioned due to the common use of food additives and
flavourings in the electronic cigarette liquids. It is currently known that the flavourings used in
e-cigarettes are perfectly safe for consumption in food, however when inhaled the agents could
prove to have a very different effect and be harmful to users. The first case where this was
recognised was with the use of the flavouring agent Diacetyl, which is used in popcorn to give
the buttery taste, was found to be the cause of a respiratory system now known as ‘popcorn
lung’. This was characterised by irreversible scarring of the alveoli. (Kovacic, P. and Cooksy,
A.L., 2010) Further research into the flavouring agent showed that diacetyl was found in over
75% of e-cigarette liquids tested by researchers in a study. (Harvard Gazette, 2015)
9. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 4
The study will look directly into the effect of different concentrations of extracted cigarette
smoke condensate, extracted e-cigarette vapour condensate and nicotine dilutions and how the
application of each variable directly effects the viability of cells, allowing a determination of the
toxicity of each variable. It will also discuss other ways in which the effects of each variable on
cells can be analysed and how these results could further the results already being discussed.
In order to provide a quantitative result, an MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-
diphenyltetrazolium bromide), assay will be used to provide a cell viability value in the form of
absorbance. (Riss, T.L., 2004) The MTT assay is based on redox potential and uses a dye called
formazan – the quantity of which is measured using an absorbance reading at 570nm and is
directly proportional to the number of viable cells. (Johnson, M.D., Schilz, J., Djordjevic, M.V.,
Rice, J.R. and Shields, P.G., 2009) Viable cells are able to actively metabolise MTT into
formazan which after an incubation period of 1-4 hours appears a deep purple colour. Cells that
have died, or in this case been killed due to toxicity, are unable to metabolise MTT and this
therefore results in a reduced purple colour and a lower absorbance reading. The formazan is
produced as a precipitate on the surface of the cells and therefore must be solubilised in order
for the colour to show. In this study isopropanol will be used as a solubilising agent as it is
convenient and requires a short incubation time of just 1 hour.
2. Methodology
2.1 Cigarette and E-Cigarette vapour collection
For the purpose of this study, e-cigarette liquids from VIP Electronic Cigarette were used with a
standard ‘ego style’ Electronic Cigarette. The chosen flavour was USA Kentucky Tobacco, which
was also purchased from the VIP Electronic Cigarettes, in order to reduce the number of
variables when comparing with mainstream cigarettes. The vapours were collected from a
liquid with 0% nicotine. VIP is quality approved company – they use UKAS accredited
laboratories to detect harmful compounds including Ethylene glycol, Diethylene glycol,
Diacetyl, Acetoin and Acetyl propionyl. None of which were detected in the liquid used in this
10. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 5
study. (Vipelectroniccigarette.co.uk, 2015) The cigarettes used were Lambert and Butler
original which were purchased from Morrisons supermarket.
In order to collect condensate from the vapours of the e-cigarette and smoke of the cigarettes, a
mechanical smoking system was set up. This had been designed in a pilot study that was carried
out prior to this research. The system consisted of a quick fit 100ml V condenser flask
submerged in a salt water and ethanol mix at a temperature of between -15°C and -5 °C.
Connected to each exit of the flask were silicone tubes to allow transportation of smoke and
vapours produced and a small KNF LABOPORT® vacuum pump used to demonstrate the act of
inhalation. (Fig 2.) Note that in this specific study, the induced air flow rate of the pump was
not recorded with a flow meter.
The quick fit 100ml V condenser flasks were weighed before condensate collection to allow a
calculation of the amount collected. For collection of the e-cigarette condensate, the pump was
used on full power for 15 minutes. The e-cigarette was connected to one tube leading to the
submerged quick fit 100ml V condenser flask, and another tube going from the flask to the
pump allowing the vacuum pump to pull the vapours from the e-cigarette through the
condenser flask demonstrating the act of inhalation. The low temperature created by the
beaker with a salt water – ethanol mixture allows the vapours ‘inhaled’ from the e-cigarette to
condense in the condenser flask for use in dilutions at a later stage in the study. The
temperature of the water-bath was maintained at an average of -7°C/-8°C throughout. A total of
0.79g of condensate was collected in the quick fit 100ml V condenser flask. The flask was then
washed with 50ml Phosphate Buffered Saline (PBS) – this was used to form the start of the
serial dilution. PBS was made up of 160g NaCl, 4.0g KCl, 28.8g Na2HPO4 ad 4.8g KH2PO4. This
produces a 10x solution which was diluted to 1x before use. This composition is the same for all
solutions of PBS used throughout. All of the above was carried out inside a MACH-AIRE
CRITERION® fume cupboard for health and safety reasons.
In the case of the collection of cigarette smoke condensate, a total of 10 cigarettes were burnt
using the mechanical smoking system until the cigarette was completely burnt out – in this
case each cigarette took an average of 2 minutes and 40 seconds. The filter end of the cigarette
was placed into the rubber tubing connected to the condenser flask. The opposite end of the
11. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 6
cigarette was lit with a candle lighter and the induced air flow pump was turned on to simulate
the act of inhalation. A trial run was carried out and it was discovered that the induced air flow
pump must be used at a reduced rate due to the quick burning of the cigarette making the trial
unrealistic. The burning of 10 cigarettes resulted in the collection of 3.65g of condensate from
the cigarettes. The condenser flask was then washed with 50ml PBS and transferred to a falcon
tube – this was used to form the start of the serial dilution and served as the 10-1 concentration.
Figure 2. Set up of smoking simulation system
2.2 Cell Culture
HeLa cells were cultured in VWR® 25ml tissue culture flasks from a stock of cell lines available
in the lab with 5ml of complete media containing Dulbecco’s Modified Eagle Medium
(DMEM), 10% fetal bovine serum, 1% non-essential amino acids and 2Mm Glutamine. From
here cells had continuous media changes and passaging until a sufficient amount of healthy
cells were available for exposure to extracted condensates.
Cells were observed under an inverted microscope to check for confluency. A simple media
change was carried out every 1-2 days in order to ensure cells had plentiful nutrients (available
Pear shaped flask
Silicone tubing
Salt-water ice bath
Vacuum pump
12. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 7
in the complete medium) to grow and multiply continuously. In order to carry out a simple
media change, the appropriate amount of media for the number of tissue culture flasks is
heated in a water bath at 37°C for 5 minutes, with enough for 5ml of fresh media in each t-25
flask or 15ml for a t-75 flask. This is to ensure that the application of cold media does not shock
the cells and kill them. T-75 flasks were used when t-25 flasks became confluent as one t-75
flask can provide enough cells for a 96 well plate. Flasks containing the first culture of HeLa
cells are removed from incubation tank ensuring aseptic technique is used at all times, this
included techniques such as spraying gloves and anything else that enters the cell culture hood
(the hood used in this study was ESCO® AirstreamMAX Class 2 Biosafety cabinet) with a light
mist of 70% ethanol, and ensuring every step of culturing is carried out under a cell culture
hood. Media change requires removal of cell culture medium with a pipette, followed by
washing of the monolayer culture with 5Ml of pre heated 1x PBS (also heated for 5 minutes at
37°C in a water bath). Fresh, pre-heated media is added to the flask, volume of 5ml, using a 10ml
pipette and the flasks are then incubated in a Forma ™ Scientific CO2 incubator at 37°c and 5%
CO2 to increase enzyme activity and optimise cell growth.
Passaging takes place once a confluent monolayer (70-80%) of cells can be observed under an
inverted microscope. The process involves the same steps of removing media and washing of
cell monolayer, followed by the addition of 1ml 0.25% trypsin-EDTA solution which has been
heated in a water bath at 37°C to allow ‘lifting’ of cells from the flask. The culture flask
containing trypsin-EDTA is incubated for 5 minutes in the CO2 incubator to allow this process
to occur efficiently. The flasks are then observed under an inverted microscope to observe the
lifting of the cells where they appear to move around if the flask is tapped gently. This is
opposed to them being firmly attached to the bottom of the flask with no movement before
trypsinisation. 5ml of complete media is then added to deactivate the trypsin ensuring no
further break down of the cells occurs and all of the media (containing the cells) is removed
into a 50ml falcon tube using a 10ml pipette. Cells are counted using a haemocytometer and the
media is diluted into 2 new tissue culture flasks to give a concentration of 10-100 thousand cells
per ml. This process is repeated until enough flasks of cells are available for the study. In the
case of this study, two costar® 96-well cell culture cluster plates (flat bottomed with lid) were
needed which means 2-3 t-75 flask are required with a confluent culture of HeLa cells. The cells
13. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 8
are then passaged using the same technique as above but this time transferred the media
containing the cells into 96 well, flat-bottomed, culture plates to allow for ease of exposure to
extracted condensate at different concentrations. Each well contains 100µl of complete media.
2.3 Exposure of condensate to cells
A 1 in 10 serial dilution is carried out to dilute the extracted cigarette smoke condensate,
extracted e-cigarette vapour condensate and nicotine. The collection of cigarette condensate
resulted in a yield of 3.654g in the flask which when washed with 50ml PBS provided a cigarette
smoke condensate with a concentration of 0.731mg/ml. When looking at the e-cigarette
condensate that had been collected, the total yield was 0.207g, which when also washed in 50ml
PBS provided a condensate with a concentration of 0.0415mg/ml. The initial concentration of
the pure nicotine was 990mg/ml. Serial dilutions were carried out in microfuge tubes with
0.45ml PBS in each tube. 50µl of the original condensate was added to the 10-2 microfuge tube
for each variable and this was repeated to 10-6 ensuring the solution was mixed well after each
step. Once cell containing media has been passaged into 96-well plates and left for 24 hours
after a fresh media change, another media change is carried out in the 96- well plates. This
involves complete removal of media in all wells, after which each well is filled with 90µl of
media and 10µl of the appropriately diluted variable. The different concentrations of the
different condensates are added to a full column of well which are pre-labelled A-H. It can be
advised to not use wells A and H as experimental wells, therefore providing 6 replicates of each
dilution in wells B-G which can later provide an average result and therefore increases
reliability.
Cells exposed to the condensate were incubated for 24 hours at 37°C, 5% CO2.
2.4 Analysis of cell viability.
In order to evaluate the effects of each variable on cell viability, an assay using Thiazolyl Blue
Tetrazolium Blue (MTT) was performed. MTT reagent was prepared according to protocol,
preparing a 12Mm stock of MTT by adding 1ml PBS to a 5mg vile of MTT. After cells had been
14. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 9
incubated with media and condensate, 10µl of MTT reagent was added to each well. The cells
were then incubated for 4 hours at 37°C, 5% CO2. After incubation, all media including MTT
reagent was removed and discarded and the cells in each well were washed with 50µl PBS. PBS
was then removed and 50µl 2-propanol (isopropanol) was added to each well and left at room
temperature for a further 2 hours. The isopropanol acts as a solubilisation solution, reducing
the MTT and giving the visibly purple colour. Plates were then inserted to a Thermo
Varioskan™ LUX multimode microplate reader and absorbance was read at 550n using SkanIt™
software. (Riss et al. 2004)
2.5 Statistical tests
Unpaired t-tests were used throughout with statistical significance being portrayed with * and #
that resemble different values in each figure.
3. Results
A variety of concentrations of each variable were added to HeLa cells and viability was recorded
as a % of the control variable (DMEM only) when looking at absorbance readings at 550nm. In
order to compare the effects of cigarette smoke condensate, e-cigarette vapour condensate and
nicotine with positive and negative controls, a graph was constructed which looked at the
concentration of each variable that were most similar to each other. Although this does not
provide a conclusive result due to the differences in concentration, the comparison represents
the truest conclusion that can be drawn with the data produced.
15. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 10
Figure 3. The effects of extracted cigarette smoke condensate concentration (diluted in PBS) on
HeLa cell viability as a % of the control variable (DMEM alone). Results were provided that when
using an unpaired t-test, show that the concentration values marked ‘#’ are similar to each other
with p < 0.02. A second test compared all values to a cigarette smoke condensate of 0.0731mg/ml
where statistical significance was defined by: * p<0.1; ** p<0.5; ***p>0.5.
As the concentration of extracted cigarette smoke condensate that was applied to the HeLa
cells changes, overall there appears to be very little change in cell viability between 1x10-
6
mg/mL and 1x10-1
mg/mL but at concentrations higher than this there appears to be a
significant decrease in cell viability with the probability of 0.0196 that marked values ‘#’ are
similar. This suggests that condensate of concentrations over this value are particularly toxic to
HeLa cells and that here a difference in concentration provides a change in viability that is
significant. Using a t-test also allows statistical evidence that there is little change in viability
between 1x10-6mg/mL and 1x10-1mg/mL due to the probability of values being different >0.5
which suggests that the difference in concentration between these two values is insignificant to
the viability of HeLa cells.
16. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
PAGE | 11
Figure 4. The effects of extracted e-cigarette vapour condensate concentration (diluted in PBS)
on HeLa cell viability as a % of the control variable (DMEM alone). An unpaired t-test was carried
out comparing all results to the viability of HeLa cells when the above condensate of
concentration 0.0415mg/ml was applied where, in this figure only, statistical significance is
defined by: # p < 0.01; ## p < 0.1; ### p < 0.3
Here a clearer pattern can be seen with an increase in extracted e-cigarette condensate
concentration generally following a trend of reduced cell viability. The use of an unpaired t-test
shows that for concentrations below 1x10-4mg/ml, a reduction in concentration is statistically
significant to an increase in cell viability. This is compared with concentrations above 1x10-
4mg/ml where there seems to be little change in viability and a probability >0.2 suggests that
between these values, a change in concentration is statistically insignificant to HeLa cell
viability.
17. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
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Figure 5. The effect of nicotine concentration (diluted in PBS) on HeLa cell viability as a % of the
control variable (DMEM only). An unpaired t-test was carried out which compared all results to
the viability of HeLa cells when nicotine of concentration 990mg/ml was applied where, in this
figure only, statistical significance was defined by: # =p < 0.01; ##= p > 0.5
When looking at the concentration of nicotine it can be seen that a difference in concentrations
between 0.01mg/ml and 1mg/ml has little effect of the viability of HeLa cells. However, it can be
seen that after this point an increase in concentration leads to a visible decrease in cell viability
with a probability <0.01 which suggests that nicotine concentrations higher than 1mg/ml have
an effect on HeLa cell viability that is statistically significant. Although a concentration of
100mg/ml provides a HeLa cell viability that is seen to follow the trend observed above, there is
a probability >0.5 that this value are similar to those seen when a concentration of 990mg/ml
was used. This suggests that between a nicotine concentration of 100mg/ml and 1000mg/ml
there is little change in the effect on HeLa cell viability and there is no significant difference
between the two variances in concentration.
18. Cigarettes vs. E-cigarettes – the acute effects | Paige Heath
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Figure 6 - A comparison of cell viability for each variable using the concentration in mg/mL that
are most similar to each other. Here the most similar concentrations of e-cigarette vapour
condensate and cigarette smoke (10-4 dilution and 10-5 dilution respectively) condensate are
compared with a 10-6
dilution of pure nicotine, and also compared with complete media and
distilled water. An unpaired t-test was carried out where an asterisk provides a statistical
significance value when compared to cigarette smoke condensate and the use of a hash mark
provides a statistical significance when values are compared with e-cigarette vapour condensate.
For figure 6 these values are defined as: #,* p<0.01; ##,** p<0.025; ###,*** p<0.05; ####,****
p<0.25.
When looking at all variables together, it can be seen that extracted cigarette smoke
condensate leads to a lower cell viability when applied to HeLa cells compared with the
application of e-cigarette vapour condensate on average. However when looking at results of an
unpaired t-test, the results of the two tests are similar with a p=0.208. This suggests that
although cells exposed to extracted e-cigarette vapour generally showed higher viability, the
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result cannot be conclusive as the difference between the values is not significant as p is not
<0.05 and therefore there is a more than 1% probability that the results are due to chance.
Figure 6 also shows that the application of nicotine to HeLa cells reduces viability to a lower %
of the control value than both cigarette smoke condensate and e-cigarette vapour condensate.
When compared to cigarettes, the effect of nicotine had little statistical significance, with a p
value of 0.205, suggesting the effect on viability between the two variables is insignificant.
However, when comparing nicotine to the effect of extracted e-cigarette vapour condensate on
HeLa cells, the two variables were similar with a p = 0.022 which suggests that the difference in
viability of HeLa cells exposed to nicotine and e-cigarette vapour condensate separately is
statistically significant and that the difference between variables has a <1% probability of being
due to chance.
When comparing the negative control (distilled water) to both cigarette smoke condensate and
e-cigarette vapour condensate, a significant difference can be seen with both variables where
p=0.004 and p=0.001 respectively. The graph shows the addition of distilled water only to HeLa
cells to provide the lowest cell viability when compared to all other variables.
4. Discussion
Although the results discussed above provide a basis upon which conclusions can be made
there are many aspects to the study that reduce its validity in stating that extracted cigarette
smoke has a more toxic effect on HeLa cells then extracted e-cigarette vapour.
The methods used in the study provided the development of a simple system that allowed the
collection of condensate from both cigarettes and e-cigarettes very easily and quickly. The
system was cheap to run and used basic equipment that can be found easily in university
science lab. However the simplicity of the system resulted in some variables being very difficult
to control. This included things such as maintaining a constant temperature in the water bath
and the ability to reproduce this exact temperature again when repeating the study with the
different variables.
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Another variable that was difficult to control given the simplicity of the system was the induced
air flow rate of the pump that was used to simulate inhalation of the cigarette and e-cigarette. It
was found that when the vacuum pump was used with its maximum flow rate, cigarettes burnt
out completely within 5-10 seconds which was very unrealistic. This meant that the pipe
attaching the vacuum pump to the rubber tubing (as seen in figure 2) had to be slightly
restricted with a clamp in order to slow down the burning process of the cigarette. Because of
this, the induced flow rate used during the ‘inhalation’ of the cigarettes was different to that of
e-cigarettes and this is something that I would focus on controlling in further studies by
introducing apparatus that allows the measurement of induced flow rate produced by the
vacuum pump such as a flow meter.
This difficulty in the ‘inhalation’ process made the prediction and measurement of the mass of
condensate collected from each variable difficult as there was a large range in the yield of
condensate from each cigarette. It was found that in the same amount of time, cigarettes
produced a much larger mass of condensate compared with e-cigarettes. This meant that when
the flasks used to collect condensates from both variables were washed with PBS, the
concentration of the cigarette smoke condensate was over 17 times more concentrated than
that of the e-cigarette vapour condensate. Timing restrictions meant that condensates could
not be re-collected and it was therefore necessary to perform a serial dilution for each variable
and use the most similar concentrations for comparison purposes. This again provides a
problem for the reproducibility of the study and reduces the validity of conclusions made.
In order to further this study I would repeat the application process but ensure that the
condensates that the cells are being exposed to are of equal concentrations for both variables
and also of equal concentration to the nicotine that was applied to the HeLa cells.
It is also possible that the method used to collect e-cigarette vapours was not similar to that of a
typical ‘vaper’. The e-cigarette liquid was burnt for 10 minutes under constant suction from the
vacuum pump. This could affect the results as the levels of pyrolysis within the e-cigarette are
at a very high level due to the constant burning compared to the burning of liquid in short puffs
when used by the public. In order to make this process more accurate I would carry out further
works in which the average ‘puff length’ for an e-cigarette user is discovered and use this to
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create a more realistic system. It should also be noted that the condensates that were applied to
the cells were of a diluted form (cigarette condensate was diluted to 10-5 and e-cigarette
condensate was diluted to 10-4) which could suggest that the toxicity of the substances from
both variables could be increased in a real life situation due to the inhalation of a more
concentrated product than is discussed in this study.
In order to further this study I would look into the possibility of selecting a specific component
found in both e-cigarette vapour and cigarette smoke and base the concentrations of each
variable applied to cells on the specific concentration of that component to provide a more
specific conclusion when comparing . This could provide results with a conclusion that is more
detailed and also show which components of the smoke and/or vapour have the most toxic
effect. This is similar to the comparison of the effects of pure nicotine when compared with the
e-cigarette vapour condensate and the cigarette smoke condensate where a statistically
significant difference can be seen between nicotine and e-cigarette vapour but not between
nicotine and cigarette smoke. This is likely due to the 0% nicotine content of the e-liquid used
in the study when compared to 0.9mg of nicotine found in one lambert and butler cigarette
that was used. (Statistic available on packaging of cigarette) In order to investigate the
significance of nicotine presence further I would repeat the same study but also including an e-
liquid with higher concentrations of nicotine and if possible expose cells to e-liquid vapour
condensate and to cigarette smoke condensate and ensure that each variable contains the same
concentration of nicotine. Other studies that have looked into the effect of nicotine levels on
cells have provided results which suggest the application to endothelial cells of nicotine
containing e-liquid, results in cellular changes that suggest an increase in stress levels when
compared to the application of nicotine free e-liquid. (Lerner et al. 2015)It could be suggested
that to continue this study, further tests be carried out that use a variety of intercellular assays
to look for the different effects on cells such as oxidative stress levels. This is something that
would have been completed in this study if more time was available.
The use of different assays would provide a more reliable result as there are several assays
available for cell viability. In the early stages of this study it was the aim that both an MTT assay
and a trypan blue assay be carried out to provide a more reliable value for cell viability, however
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timing restriction meant that this could not be done. MTT was chosen due to the cheap cost
and also due to the colour of the dye being of an advantage when used in tobacco smoke
studies. (Johnson et al. 2009)
In terms of cell culture, problems were encountered with obtaining cell lines which led to the
use of HeLa cells for this study opposed to epithelial cells which would have provided a more
accurate representation of the cells that are exposed to these vapours in the human body. The
use of HeLa cells made the cell culture process slightly easier for a first time cell culture
scientist due to their durability and ability to survive and resist apoptosis. (AccessScience
Editors, 2014) In order to provide a more accurate basis upon which conclusions can be made, I
would use bronchial endothelial cells in a further study allowing results to be more relevant to
the general public.
Looking at results in figure 3, it can be said that above concentrations of 0.1mg/ml, an increase
in cigarette smoke condensate is proportional to a decrease in cell viability and therefore
suggesting an increase in cytotoxicity as concentration increases. Another study carried out
involving the exposure of Human lung epithelial cells to commercial filtered cigarette smoke,
used an MTT assay to show that cytotoxicity was dependent upon dosage and exposure time.
(Das, A., Bhattacharya, A. and Chakrabarti, G., 2009.) This supports the conclusion that a
higher concentrations of cigarette smoke has a higher toxic effect on a variety of cells, not just
HeLa. It also suggests that exposure time can also lead to a change in toxicity and therefore
provides an area for this study to be furthered, investigating the exposure of cells for different
amounts of time and comparing the results.
When comparing this with the effects of e-cigarette vapour concentration, a much clearer trend
is seen with an increase in concentration leading to a reduction in cell viability. This suggests
that concentration is directly proportional to toxicity when applied to HeLa cells. It is also
important to note that the e-liquids used in this study were purchased from a company that
ensure several harmful compounds are not present in their liquids, as mentioned in the
methods section. It would therefore be possible that other liquids bought from cheaper high
street stores could have a different components and therefore have different effect on cell
viability. In further works I would look into a variety of e-liquid brands and compare their
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effects on epithelial cell viability whilst also comparing the difference in ingredients between
brands.
5. Conclusion
The data produced in this study suggests that when comparing e-cigarettes to cigarettes in
terms of their effect on cell viability, cigarette smoke condensate was seen to be more toxic to
HeLa cells than the condensate of extracted e-cigarette vapour. However, when looking at the
reliability and reproducibility of results, problems with concentration control and collection of
condensate mean the results are somewhat inconclusive. It can be seen that, other than DMEM
alone, e-cigarette vapour condensate led to the highest % HeLa cell viability, when compared to
other variables, the viability of HeLa cells exposed to cigarette smoke was 13.99% less. Whilst
this is a substantial difference, statistical values showed that in this study, the difference
between cigarette smoke condensate and e-cigarette smoke condensate was insignificant.
It must however be remembered that the concentration of each variable added to the HeLa
cells were not identical and the concentration of cigarette condensate was almost twice the
concentration of the e-cigarette condensate that was shown in figure 6.
Nicotine showed to be the variable that resulted in the lowest HeLa cell viability, excluding the
negative control distilled water, with statistics that show a higher degree of significance when
compared with the other two variables than when comparing cigarette condensate and e-
cigarette condensate with each other. This can lead to the conclusion that it is clearly visible
that high concentrations of nicotine are toxic to HeLa cells and this could be a main factor
when comparing cigarettes with e-cigarettes. The e-liquid used in this study contained 0mg/ml
of nicotine but many liquids on the market contain concentrations of up to 24mg/ml compared
with the 0.9mg of nicotine found in a standard lambert and butler cigarette. It could therefore
be suggested that the exposure of cells to nicotine containing e-cigarette condensate would
lead to lower viability than when compared with nicotine free e-cigarette condensate. From the
results in this study it can therefore be suggested that whilst e-cigarettes may show a lower
toxicity to cells when compared with cigarettes, an increase in nicotine levels in the e-liquids is
proportional to the toxicity of its vapours on human cells.
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