Impacts of COVID-19 on Electronic Cigarette Purchasing, Use and Related Behaviors

Soule, Eric K.; Mayne, Shannon; Snipes, William; Guy, Mignonne C.; Breland, Alison; Fagan, Pebbles

doi:10.3390/ijerph17186762

Cited by 37 publications

(52 citation statements)

References 34 publications

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“…The most commonly reported reasons for increased use were stress, more time available to use tobacco (e.g., working from home), and boredom while quarantined. Other reports have found similar reasoning for increased cigarette [30] and e-cigarette use during the pandemic [31]. While many increased their tobacco use, others indicated attempting to quit in response to the pandemic, with seven (7/291; 2.4%) achieving cessation.…”

Section: Discussionmentioning

confidence: 63%

Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic

Yingst

Krebs

Bordner

et al. 2021

IJERPH

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COVID-19 has become a global pandemic, with over 81 million cases worldwide. To assess changes in tobacco use as a result of the pandemic, we surveyed a convenience sample of current tobacco users between April and June 2020. The sample was taken from a tobacco user research registry (n = 3396) from the Penn State College of Medicine in Hershey, Pennsylvania, USA. Participants who responded to the survey and were eligible for this study (n = 291) were 25.6% male, 93% white, and had a mean age of 47.3 (SD = 11.6) years. There were no reports of participants testing positive for COVID-19, but 21.7% reported experiencing symptoms associated with the virus. Most participants (67%) believed that their risk of contracting COVID-19 was the same as non-tobacco users, but 57.7% believed that their risk of serious complications, if infected, was greater compared to non-tobacco users. A total of 28% reported increasing their cigarette use during the pandemic. The most common reasons for increased use were increased stress, more time at home, and boredom while quarantined. Nearly 15% reported decreasing their tobacco use. The most common reasons for reduced use were health concerns and more time around non-smokers (including children). A total of 71 (24.5%) users reported making a quit attempt. Characterizing these pandemic-related changes in tobacco use may be important to understanding the full scope of subsequent health outcomes resulting from the pandemic. Tobacco cessation resources should be tailored to allow for safe, appropriate access for those interested in quitting.

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Section: Discussionmentioning

confidence: 63%

Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic

Yingst

Krebs

Bordner

et al. 2021

IJERPH

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“…The question of how e-cigarette use impacts health has come to the forefront since the 2019-2020 EVALI epidemic in the United States (Bozier et al, 2020). Now, with the COVID-19 pandemic and its related lung damage (ARDS and ALI), the potential associated risk of smoking and vaping at increasing the susceptibility to develop a life-threatening SARS-CoV-2 infection has brought up the interest of researchers in the field (Dai et al, 2020;McAlinden et al, 2020;Soule et al, 2020;The Lancet Respiratory Medicine, 2020). Some research groups have looked at overall changes induced by e-cigarette aerosols by transcriptomics studies, most of them FIGURE 3 | ACE2 expression is upregulated in E-cig exposed mice and correlates with immune status.…”

Section: Discussionmentioning

confidence: 99%

“…with ACE2 and are considered part of the ACE2 gene network (Dai et al, 2020;Soule et al, 2020; The Lancet Respiratory Medicine, 2020). SLC proteins can physically bind to ACE2 and may affect viral entry mechanisms (The Lancet Respiratory Medicine, 2020).…”

Section: Ace2 Expression Is Upregulated Bymentioning

confidence: 99%

Chronic E-Cigarette Aerosol Inhalation Alters the Immune State of the Lungs and Increases ACE2 Expression, Raising Concern for Altered Response and Susceptibility to SARS-CoV-2

et al. 2021

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Conventional smoking is known to both increase susceptibility to infection and drive inflammation within the lungs. Recently, smokers have been found to be at higher risk of developing severe forms of coronavirus disease 2019 (COVID-19). E-cigarette aerosol inhalation (vaping) has been associated with several inflammatory lung disorders, including the recent e-cigarette or vaping product use-associated lung injury (EVALI) epidemic, and recent studies have suggested that vaping alters host susceptibility to pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To assess the impact of vaping on lung inflammatory pathways, including the angiotensin-converting enzyme 2 (ACE2) receptor known to be involved in SARS-CoV-2 infection, mice were exposed to e-cigarette aerosols for 60 min daily for 1–6 months and underwent gene expression analysis. Hierarchical clustering revealed extensive gene expression changes occurred in the lungs of both inbred C57BL/6 mice and outbred CD1 mice, with 2,933 gene expression changes in C57BL/6 mice, and 2,818 gene expression changes in CD1 mice (>abs 1.25-fold change). Particularly, large reductions in IgA and CD4 were identified, indicating impairment of host responses to pathogens via reductions in immunoglobulins and CD4 T cells. CD177, facmr, tlr9, fcgr1, and ccr2 were also reduced, consistent with diminished host defenses via decreased neutrophils and/or monocytes in the lungs. Gene set enrichment (GSE) plots demonstrated upregulation of gene expression related to cell activation specifically in neutrophils. As neutrophils are a potential driver of acute lung injury in COVID-19, increased neutrophil activation in the lungs suggests that vapers are at higher risk of developing more severe forms of COVID-19. The receptor through which SARS-CoV-2 infects host cells, ACE2, was found to have moderate upregulation in mice exposed to unflavored vape pens, and further upregulation (six-fold) with JUUL mint aerosol exposure. No changes were found in mice exposed to unflavored Mod device-generated aerosols. These findings suggest that specific vaping devices and components of e-liquids have an effect on ACE2 expression, thus potentially increasing susceptibility to SARS-CoV-2. In addition, exposure to e-cigarette aerosols both with and without nicotine led to alterations in eicosanoid lipid profiles within the BAL. These data demonstrate that chronic, daily inhalation of e-cigarette aerosols fundamentally alters the inflammatory and immune state of the lungs. Thus, e-cigarette vapers may be at higher risk of developing infections and inflammatory disorders of the lungs.

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“…Although we did not find a significant correlation between survey responses and time between when the stay-at-home order was issued and survey completion, it is still possible that responses to the lifestyle change questions may have differed depending on when they were given the survey, as restrictions may have eased and respondents may be more accustomed to the “new normal”. In addition, our study was focused on consumption of combustible cigarettes and it is possible that patterns of e-cigarette/vaping use may have increased during the pandemic [ 14 , 31 ]. Moreover, there is evidence of increased coping-related alcohol consumption early in the COVID-19 pandemic [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

The Perceived Impact of COVID-19 among Treatment-Seeking Smokers: A Mixed Methods Approach

Rosoff-Verbit

Logue-Chamberlain

Fishman

et al. 2021

IJERPH

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The consequences of the COVID-19 pandemic on behavioral health, including tobacco use, are not fully known. The current study sought to measure the perceived impact of COVID-19 and the resulting stay-at-home orders in Philadelphia, Pennsylvania and Buffalo, New York on smokers enrolled in four smoking cessation trials between March 2020 and July 2020. The survey collected quantitative data regarding life changes due to COVID-19, health/exposure status, and the impact on their cessation attempt (e.g., motivation to quit, change in triggers). The questionnaire collected qualitative data to better understand how such changes could explain changes in smoking behavior. Of the 42 participants surveyed, approximately half indicated that COVID-19 changed their motivation and ability to quit or remain quit. Among those who reported that it was easier to quit following the stay-at-home orders (n = 24), most attributed this to concerns regarding the severity of COVID-19 among smokers. Among those who reported more difficulty quitting (n = 15), most attributed this to their increased stress due to the pandemic and the inability to access activities, places, or people that could help them manage triggers. Given public health warnings of continued surges in COVID-19, these data provide insight into who may benefit from further smoking cessation support should existing restrictions or new stay-at-home orders be enacted.

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Impacts of COVID-19 on Electronic Cigarette Purchasing, Use and Related Behaviors

Cited by 37 publications

References 34 publications

Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic

Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic

Chronic E-Cigarette Aerosol Inhalation Alters the Immune State of the Lungs and Increases ACE2 Expression, Raising Concern for Altered Response and Susceptibility to SARS-CoV-2

The Perceived Impact of COVID-19 among Treatment-Seeking Smokers: A Mixed Methods Approach

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