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OBJECTIVES: The study compared clinical characteristics and caries risk assessments between tobacco heating system (THS) smokers, cigarette smokers and non-smokers. MATERIALS AND METHODS: General data, data regarding fluoridation, smoking and dietary habits was obtained through a questionnaire. Caries experience was assessed by the DMFT index; the amount of biofilm by the Full mouth plaque score index; the amount of salivation by the quantum of stimulated salivation test; salivary pH with pH indicator strips and salivary number of S.mutans and Lactobacilli by cultivation on agar plates. The Cariogram method was used to assess caries risk. RESULTS: No differences between the groups was detected regarding education level, average daily number of meals, fluoridation programs, systemic diseases, and caries experience. The groups significantly differed in the amount of salivary S.mutans and Lactobacilli (p < 0.001), accumulated biofilm (p = 0.034), salivation quantum (p < 0.001), and saliva pH (p = 0.009). Exposure to tobacco smoke and heated tobacco aerosol increased the accumulation of biofilm and decreased salivary pH. Smoking increased S. mutans, while THS consumption decreased salivation and Lactobacilli the most. The Cariogram analysis found no differences in chances of avoiding new caries lesions between the groups, but a significant difference in developing caries lesions due to dietary habits was detected (p < 0.001) with non-smokers having higher risk than smokers, but not than THS consumers. CONCLUSIONS: THS and cigarette smoking were related to clinical characteristics that affect caries activity even though the caries risk assessment revealed no significant difference in the chances of avoiding new caries lesions between the groups. CLINICAL RELEVANCE: THS and cigarette smokers could have higher caries activity than non-smokers. The clinical study protocol has been registered on ClinicalTrials.gov under the ID number: NCT06314100.

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OBJECTIVE: This study utilized a socioecological approach to prospectively identify intrapersonal, familial, and environmental factors associated with single nicotine product use (NPU) and multiple NPU among U.S. youth. METHODS: Participants were 10,029 youths (ages 12-17 years) who had completed the Population Assessment of Tobacco Health study's Wave 1 (2013-2014) and Wave 4 (2016-2018) assessments and data on past 30-day nicotine product use. Multinomial logistic regression was fit for the 3-level outcome (no use, single NPU, multiple NPU) to estimate adjusted associations between the predictors and the outcome. RESULTS: The current study found that intrapersonal (sex, age, race/ethnicity, internalizing symptoms, sensation seeking, harm perceptions, lifetime history of using two or more tobacco products), familial (parental discussion about not using tobacco and living with someone who uses tobacco products) and environmental factors (exposure to tobacco advertising) commonly associated with tobacco use differentiated between individuals who later reported past 30-day NPU (either multiple or single NPU) from those who did not report past 30-day NPU. One familial factor only differentiated between lifetime users who were single NPUs from those who reported no NPU: non-combustible tobacco product use allowed anywhere in the home. Intrapersonal factors differentiated multiple NPU from single NPU: older age, being male, lifetime history of using nicotine product and less harm perceptions. CONCLUSIONS: This study identified factors that may be studied to prevent any NPU, along with factors that may be studied to promote harm reduction by preventing escalation of single NPU to problematic patterns of multiple NPU.

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Introduction: E-cigarettes (ECs) portable battery-operated devices developed as a strategy for tackling tobacco-related harm are now becoming a global threat to human health. Objectives: This integrative review aims to throw some light on the effect of ECs on human health and determine the safety of ECs with or without nicotine with long-term usage. Methods: This integrative review includes findings from Randomized and non-randomized clinical trials, and laboratory-based Human studies; published in the English language in the last four years. Literature search sources were online databases such as PubMed, Medline, EMBASE, Web of Science, Google Scholar. Results: Following systematic search using inclusion and exclusion criteria, 21 articles were included in the final review. ECs result in an acute increase in cardiac Sympathetic Nerve Activity (SNA), pronounced as Electrocardiogram (ECG) changes resulting in a greater risk of sudden death for those with co-morbidities. ECs with or without nicotine can adversely affect lung function and can precipitate obstructive pulmonary diseases. ECs may also adversely affect oral health due to increased bacterial pathogenicity and periodontitis. At last, these nicotine-containing ECs can yield nicotine comparable to Traditional cigarettes (TCs) and sometimes to a much greater extent, thus posing the threat of the user becoming nicotine dependent. Conclusion: Although ECs are less harmful than TCs in combustible inhaled constituents, their long-term safety can still not be ascertained due to the scarcity of long-term studies and conflicting results.

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This study examines the demographic factors associated with youths' first product tried (i.e., cigarettes, e-cigarettes, cigars, hookah, or smokeless tobacco). This study also evaluates whether the first product tried is associated with future nicotine product use (i.e., no use, single product use, and multiple product use) and nicotine dependence. Participants were 1999 youths (ages 12-17 years) who had ever tried a nicotine product and completed the Population Assessment of Tobacco Health study's Wave 1 (2013-2014) and Wave 4 (2016-2018) assessments. Two separate multinomial logistic regression models examined the association between 1) demographic factors and the first product tried at Wave 1 and 2) the first product tried at Wave 1 and past-30-day product use status at Wave 4. A two-part multivariable model examined the association between the first product tried and nicotine dependence, with part 1 modeling the presence (or absence) of any symptom of dependence and part 2 modeling the degree of dependence among those with any symptom of dependence. The first product tried was associated with sex, race, urbanicity, and parent education. First trying smokeless tobacco (vs. e-cigarettes) was associated with a greater likelihood of multiple product use (vs. no use and vs. single product use). Regarding the degree of nicotine dependence (n = 713), first trying smokeless tobacco (vs. e-cigarettes) was associated with higher nicotine dependence scores among those with any symptom of dependence. Youths who first try smokeless tobacco (vs. e-cigarettes) may be at higher risk for future multiple product use and more symptoms nicotine dependence. Research should explore tailored interventions for smokeless tobacco users.

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OBJECTIVE: To investigate the biological effects of electronic cigarette (e-cigarette) and heated tobacco product extracts respect to tobacco smoke extract on human gingival fibroblasts and human oral keratinocytes analysing cell viability, morphology, migration, apoptosis, cell cycle and epithelial-mesenchymal transition (EMT). DESIGN: Human gingival fibroblasts and human oral keratinocytes viability was analysed by MTT assay, cell morphology using scanning electron microscope (SEM) and cell migration by Scratch assay, a method that mimics the cell migration during wound healing in vivo. Apoptosis and cell cycle were analysed with flow cytometry and the related-gene expression of TP53, BCL2, CDKN2A and CDKN1A was indagated using real-time polymerase chain reaction. EMT process was analysed through expression of specific markers: CDH1, SNAI2, TWIST1, MMP2, FN1 and VIM. All investigations were evaluated after 24 h an in vitro exposure. RESULTS: Undiluted tobacco smoke extract induced significant inhibition of cell viability and cell migration, caused morphological alterations and induced an increase in cell death. No alterations or damage were observed after treatment with e-cigarette extracts. Heated tobacco product extract induced proliferation as highlighted by an increase of cell viability, cell migration and alterations of cycle analysis. CONCLUSIONS: Comparing the different cigarette extracts, tobacco smoke turns out to be the most harmful, e-cigarette did not determine morphological and functional alterations and heated tobacco product must be carefully investigated for its possible clinical effects on oral cell populations.

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JUSTIFICACIÓN: el tabaquismo es una epidemia mundial que mata cada año más de 8 millones de personas por lo que su erradicación se ha convertido en una prioridad para la mejora de la salud pública. El farmacéutico comunitario tiene un papel fundamental en la disminución de su consumo a través de educación sanitaria, programas de cesación tabáquica, etc. En general, todas estas campañas van dirigidas al consumidor, pero se habla poco de los riesgos generados por el humo de segunda mano (mezcla del humo exhalado directamente por los pulmones y el humo emitido por la pipa).OBJETIVO: estudiar la evidencia científica actual sobre los riesgos asociados a la exposición al humo de segunda mano como para evaluar la necesidad de la actuación del farmacéutico comunitario.MATERIAL Y MÉTODOS: estudio bibliográfico en PubMed empleando la estrategia de búsqueda "Tobacco Smoke Pollution"[Mesh] AND "Smoking Devices"[Mesh] que arroja 487 artículos. Se aplican filtros temporales (últimos 2 años) 103 y de idioma (inglés y español) 101. Se revisan manualmente y se seleccionan y revisan 57 artículos. Se completa la revisión con una nueva búsqueda en Google académico realizando una búsqueda en inglés “Second hand smoke” y otra en español “Humo de segunda mano”, seleccionando artículos publicados en el último año, añadiendo 10 artículos más a la revisión.RESULTADOS: los pacientes expuestos presentan altas concentraciones de metales pesados, como cadmio y plomo, sustancias que alteran la composición de la leche materna, y puede afectar a los niveles de estradiol en mujeres, y alterar la fertilidad y retrasar el crecimiento y desarrollo de los recién nacidos. (AU)

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INTRODUCCIÓN: las campañas anti-tabaco van dirigidas al consumidor. Sin embargo, se habla poco de la posibilidad de que los contaminantes emitidos al fumar generen daños incluso después de haber cesado el consumo. Son residuos de estos contaminantes que permanecen en las superficies y en el polvo tras haber fumado, que puede ser un factor de riesgo importante de padecer cáncer de pulmón y otras enfermedades relacionadas con el tabaquismo. Este es el humo de tercera mano. Si esto es así, el farmacéutico comunitario puede tener un papel relevante en la prevención a su exposición.OBJETIVO: estudio previo de la evidencia científica existente sobre los daños producidos por la exposición al humo de tercera mano.MATERIAL Y MÉTODOS: estudio bibliográfico en PubMed con la búsqueda "Tobacco Smoke Pollution"[Mesh] AND "Smoking Devices"[Mesh] que arroja 487 artículos. Se aplican filtros temporales (últimos 2 años) 103 y de idioma (inglés y español) 101. Tras revisión manual, se selecciona un único artículo. Además, se busca en Google académico con los términos “Third hand smoke” y “Humo de tercera mano”, seleccionando los publicados en el último año, añadiendo 4 artículos más a la revisión.RESULTADOS: la evidencia científica que existente sobre el humo de tercera mano es menor que sobre el humo de segunda mano. Contiene entre otras sustancias, nicotina, cotitina y nitrosaminas que son depositadas en superficies mientras se fuma en casa. En el año 2009 se describe por primera vez la posibilidad de la existencia del humo de tercera mano, aunque un reciente estudio desvela que ya en 1991 la empresa americana Philip Morris sabía que los contaminantes del humo del tabaco como la nicotina y el carcinógeno 4-(metillnitrosamino)-1-(3- piridil)-1-butanona (NNK) se quedan adheridos en la alfombra, cortinas y papel, hasta 50 días después de la exposición al humo. (AU)

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OBJECTIVES: The aim of this work is to investigate the biological effects of IQOS smoking on human gingival fibroblasts and human keratinocytes analysing cell viability, morphology, migration, apoptosis and cell cycle. BACKGROUND: Electronic cigarettes and tobacco heating systems have been marketed to reduce smoking damages caused by combustion. METHODS: Human gingival fibroblasts and human keratinocytes viability was determined by a colorimetric assay measuring mitochondrial dehydrogenase activity (MTT assay); after an in vitro exposure of 24 h, cell morphology was analysed with scanning electron microscope and cell migration was tested by Scratch assay, a method to mimic the migration of the cells during wound healing in vivo. Apoptosis and cell cycle were analysed with flow cytometry, and the expression of related genes (p53, Bcl2, p16 and p21) was indagated using real-time polymerase chain reaction. RESULTS: IQOS extracts increased both cell viability (23%-41% with fibroblasts and 30%-79% with keratinocytes) and migration. No morphological alterations were observed. IQOS extracts did not induced an increase in cell death, but rose the number of S- and G2/M-phase cells. IQOS extracts also significantly increased p53 expression by fibroblasts (undiluted and 6.25% dilution, 2- and 3.6-fold higher, respectively) and reduced both Bcl2 (about two- and fivefold, respectively) and p21 expressions (about twofold with both extracts), while on keratinocytes both undiluted and 6.25% dilution extracts increased Bcl2 expression (about four- and threefold higher, respectively) and reduced p53 expression (about two- and fivefold, respectively). CONCLUSION: IQOS smoke seemed to induce proliferation as highlighted by a viability assay, and migration and cell cycle analysis. The increased cell proliferation induced by IQOS devices must be carefully investigated for its possible clinical effects on oral cell populations.

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BACKGROUND: Emergence of electronic cigarettes (e-cigarettes) in the past decade has the potential to undermine the global tobacco control efforts and undo the successes achieved to date. There are also concerns that e-cigarettes may become a gateway for future tobacco use and its use is increasing globally. There is no published evidence on this issue from Myanmar. Hence, we aimed to assess prevalence of e-cigarette use among tobacco smokers and its associated socio-demographic factors in six states and regions of Myanmar. METHODS: This was a secondary analysis of data collected as part of a programme evaluation conducted by the National Tobacco Control Programme of Myanmar in 2018, which involved sampling 100 smokers from each state/region. We used modified Poisson regression to measure associations. RESULTS: There were 629 tobacco smokers included in the programme evaluation. Among them, 246 (39.2%, 95% CI: 24.0%-56.7%) smokers reported that they had heard of e-cigarettes and 73 (11.6%, 95% CI: 5.1%-24.3%) reported having ever used e-cigarettes. There was no e-cigarette use among female smokers. The prevalence of e-cigarette use was significantly higher among males, students, young adults aged 18-29 years, heavy smokers (greater than 20 cigarettes per day) and those who lived in the Mandalay region. CONCLUSION: Our study provides preliminary evidence about e-cigarette use in Myanmar and fills an important knowledge gap. One limitation was small sample size, which is reflected by wide confidence intervals around the estimate. We recommend a national survey to obtain precise and nationally representative information.

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Tobacco use continues to damage the health of Filipinos. In Hawai'i, Filipinos have the second highest rate of smoking among adults and they are the fastest growing minority population. Electronic smoking devices are becoming popular and accessible. This study explored attitudes and practices of Filipinos in Hawai'i who use electronic smoking devices (ESDs), as well their knowledge of the effect of smoking and/or vaping on health and their awareness and motivations use smoking cessation programs. A convenience sample of 178 Filipinos who reported that they smoked and/or vaped responded to the online survey from January to March 2018. Reasons for starting to use ESDs included liking the different flavors (43%), being curious about vaping (38%), and viewing vaping as healthier than cigarettes (30%). Among respondents, 12% said they would like to quit smoking and 11% wanted to quit vaping, and very few felt that smoking and/or vaping behaviors impacted their health. They also demonstrated limited knowledge of cessation methods and products. Tobacco and vaping cessation programs for the Filipino community in Hawai'i are much needed because this population is at risk of developing smoking-related diseases.

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Aerosol measurements were carried out in a model room where both combustion (conventional and hand-rolled cigarettes, a cigar and tobacco pipe) and non-combustion (e-cigarette and IQOS®) devices were smoked. The data were used to estimate the dose of particles deposited in the respiratory systems of individuals from 3months to 21years of age using the multiple-path particle dosimetry (MPPD) model. Regardless of the smoking device, the highest doses were received by infants, which reached 9.88×108particles/kg bw during a cigar smoking session. Moreover, 60% to 80% of the particles deposited in the head region of a 3-month-old infant were smaller than 100nm and could be translocated to the brain via the olfactory bulb. The doses due to second-hand smoke from electronic devices were significantly lower, below 1.60×108particles/kg bw, than those due to combustion devices. Dosimetry estimates were 50% to 110% higher for IQOS® than for e-cigarettes.

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