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Article ; Online: Commentary on Tattan-Birch et al.: How might the rise in popularity of disposable vapes among young adults impact policy in the United Kingdom?

Khouja, Jasmine N / Munafò, Marcus R

2022 Volume 118, Issue 2, Page(s) 387–388

MeSH term(s)	Humans ; Young Adult ; Vaping ; Betula ; United Kingdom ; Smoking Cessation ; Policy
Language	English
Publishing date	2022-11-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1141051-6
ISSN	1360-0443 ; 0965-2140
ISSN (online)	1360-0443
ISSN	0965-2140
DOI	10.1111/add.16067
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Article ; Online: Estimating the health impact of nicotine exposure by dissecting the effects of nicotine versus non-nicotine constituents of tobacco smoke: A multivariable Mendelian randomisation study.

Khouja, Jasmine N / Sanderson, Eleanor / Wootton, Robyn E / Taylor, Amy E / Church, Billy A / Richmond, Rebecca C / Munafò, Marcus R

PLoS genetics

2024 Volume 20, Issue 2, Page(s) e1011157

Abstract: The detrimental health effects of smoking are well-known, but the impact of regular nicotine use without exposure to the other constituents of tobacco is less clear. Given the increasing daily use of alternative nicotine delivery systems, such as e- ... ...

Abstract	The detrimental health effects of smoking are well-known, but the impact of regular nicotine use without exposure to the other constituents of tobacco is less clear. Given the increasing daily use of alternative nicotine delivery systems, such as e-cigarettes, it is increasingly important to understand and separate the effects of nicotine use from the impact of tobacco smoke exposure. Using a multivariable Mendelian randomisation framework, we explored the direct effects of nicotine compared with the non-nicotine constituents of tobacco smoke on health outcomes (lung cancer, chronic obstructive pulmonary disease [COPD], forced expiratory volume in one second [FEV-1], forced vital capacity [FVC], coronary heart disease [CHD], and heart rate [HR]). We used Genome-Wide Association Study (GWAS) summary statistics from Buchwald and colleagues, the GWAS and Sequencing Consortium of Alcohol and Nicotine, the International Lung Cancer Consortium, and UK Biobank. Increased nicotine metabolism increased the risk of COPD, lung cancer, and lung function in the univariable analysis. However, when accounting for smoking heaviness in the multivariable analysis, we found that increased nicotine metabolite ratio (indicative of decreased nicotine exposure per cigarette smoked) decreases heart rate (b = -0.30, 95% CI -0.50 to -0.10) and lung function (b = -33.33, 95% CI -41.76 to -24.90). There was no clear evidence of an effect on the remaining outcomes. The results suggest that these smoking-related outcomes are not due to nicotine exposure but are caused by the other components of tobacco smoke; however, there are multiple potential sources of bias, and the results should be triangulated using evidence from a range of methodologies.
MeSH term(s)	Humans ; Electronic Nicotine Delivery Systems ; Genome-Wide Association Study ; Lung Neoplasms/genetics ; Nicotine/adverse effects ; Nicotine/analysis ; Pulmonary Disease, Chronic Obstructive/genetics ; Smoking/adverse effects ; Smoking/genetics ; Tobacco Products ; Tobacco Smoke Pollution ; Mendelian Randomization Analysis
Chemical Substances	Nicotine (6M3C89ZY6R) ; Tobacco Smoke Pollution
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2186725-2
ISSN	1553-7404 ; 1553-7390
ISSN (online)	1553-7404
ISSN	1553-7390
DOI	10.1371/journal.pgen.1011157
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Article ; Online: Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study.

Khouja, Jasmine N / Dyer, Maddy L / Havill, Michelle A / Dockrell, Martin J / Munafò, Marcus R / Attwood, Angela S

Harm reduction journal

2024 Volume 21, Issue 1, Page(s) 90

Abstract: Background: Although electronic cigarettes (e-cigarettes) appear to be effective in helping people who smoke to stop smoking, concerns about use of e-cigarettes among young people have led to restrictions on non-tobacco flavoured e-liquids in some ... ...

Abstract	Background: Although electronic cigarettes (e-cigarettes) appear to be effective in helping people who smoke to stop smoking, concerns about use of e-cigarettes among young people have led to restrictions on non-tobacco flavoured e-liquids in some countries and some US states. These restrictions could reduce the appeal of these products to non-smoking youth but could have negative consequences for people who smoke or use e-cigarettes. Methods: In this mixed methods study, we recruited UK adults who smoked or used to smoke and subsequently vaped to explore their opinions of unflavoured e-liquids and their beliefs about how they would be impacted by hypothetical e-liquid flavour restrictions. Participants trialled an unflavoured e-liquid instead of their usual nicotine product for four hours and completed a survey and an online interview. Results: Using Interpretive Phenomenological Analysis and graphically presented data, we found differences in participants' opinions of unflavoured e-liquid. If only unflavoured, tobacco flavoured, and menthol flavoured e-liquids remained on the UK market, some people who smoke or vape may be unaffected, but some may relapse to smoking or continue smoking. Despite most wanting to prevent young people from initiating vaping, participants had varying opinions on whether flavour restrictions would be an effective method. Conclusions: The findings highlight that people who smoke and vape could be impacted by flavour restrictions in a range of ways, some of which could have a potential adverse impact on harm reduction efforts in the UK (e.g., by making smoking more appealing than vaping).
MeSH term(s)	Humans ; Female ; Male ; United Kingdom ; Electronic Nicotine Delivery Systems ; Adult ; Smoking Cessation/methods ; Smoking Cessation/psychology ; Flavoring Agents ; Vaping/psychology ; Young Adult ; Middle Aged ; Adolescent ; Recurrence
Chemical Substances	Flavoring Agents
Language	English
Publishing date	2024-05-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/s12954-024-01003-z
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Article ; Online: Associations between reasons for vaping and current vaping and smoking status: Evidence from a UK based cohort.

Khouja, Jasmine N / Taylor, Amy E / Munafò, Marcus R

Drug and alcohol dependence

2020 Volume 217, Page(s) 108362

Abstract: Background: This study aimed to discover which young adults vape, the reasons given for vaping, and which reasons for vaping are associated with continued vaping/smoking.: Methods: In a UK cohort of 3,994 young adults, we explored the association of ... ...

Abstract	Background: This study aimed to discover which young adults vape, the reasons given for vaping, and which reasons for vaping are associated with continued vaping/smoking. Methods: In a UK cohort of 3,994 young adults, we explored the association of retrospectively-recalled reasons for vaping by 23 years (collected between 2015 and 2016) with vaping/smoking status at 24 years (collected between 2016 and 2017). Using logistic regression, we assessed the association with vaping behaviour among ever vapers who had ever smoked (n = 668), and with smoking behaviour among individuals who regularly smoked prior to vaping (n = 412). Results: Vaping to quit smoking was associated with higher likelihood of vaping (odds ratio [OR] = 3.51, 95 % confidence interval [95 % CI] = 2.29-5.38), but lower likelihood of smoking at 24 years (OR = 0.50, 95 %CI = 0.32 to 0.78). Vaping to cut down smoking was associated with higher likelihood of vaping (OR = 2.90, 95 % CI = 1.87-4.50) and smoking at 24 years (OR = 1.62, 95 % CI = 1.02-2.58). Vaping out of curiosity was associated with lower likelihood of vaping at 24 years (OR = 0.41, 95 %CI = 0.26 to 0.63) but higher likelihood of smoking at 24 years (OR = 1.66, 95 % CI = 1.04-2.65). Conclusions: Intention to quit appears important for young adults to stop smoking using e-cigarettes. Public health strategies that encourage vaping specifically for smoking cessation may encourage quitting among young adults.
MeSH term(s)	Cohort Studies ; Electronic Nicotine Delivery Systems ; Female ; Humans ; Intention ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Smokers ; Smoking/epidemiology ; Smoking Cessation ; Tobacco Smoking ; United Kingdom/epidemiology ; Vaping ; Young Adult
Language	English
Publishing date	2020-10-19
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2020.108362
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Article ; Online: Reporting and methodological quality of studies that use Mendelian randomisation in UK Biobank: a meta-epidemiological study.

Gibson, Mark J / Spiga, Francesca / Campbell, Amy / Khouja, Jasmine N / Richmond, Rebecca C / Munafò, Marcus R

BMJ evidence-based medicine

2022 Volume 28, Issue 2, Page(s) 103–110

Abstract: Objectives: To identify whether Mendelian randomisation (MR) studies are appropriately conducted and reported in enough detail for other researchers to accurately replicate and interpret them.: Design: Cross-sectional meta-epidemiological study.: ... ...

Abstract	Objectives: To identify whether Mendelian randomisation (MR) studies are appropriately conducted and reported in enough detail for other researchers to accurately replicate and interpret them. Design: Cross-sectional meta-epidemiological study. Data sources: Web of Science, EMBASE, PubMed and PsycINFO were searched on 15 July 2022 for literature. Eligibility criteria: Full research articles that conducted an MR analysis exclusively using individual-level UK Biobank data to obtain a causal estimate of the exposure-outcome relationship (for no more than ten exposures or outcomes). Methods and analysis: Data were extracted using a 25-item checklist relating to reporting and methodological quality (based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-MR reporting guidelines and the guidelines for performing MR investigations). Article characteristics, such as 2021 Journal Impact Factor, publication year, journal word limit/recommendation, whether the MR analysis was the primary analysis, open access status and whether reporting guidelines were followed, were also extracted. Descriptive statistics were calculated for each item, and whether article characteristics predicted overall article completeness was investigated with linear regression. Results: 116 articles were included in this review. The proportion of articles which reported complete information/adequate methodology ranged from 3% to 100% across the different items. Palindromic variants, variant replication, missing data, associations of the instrumental variable with the exposure or outcome and bias introduced by two-sample methods used on a single sample were often not completely addressed (<11%). There was no clear evidence that article characteristics predicted overall completeness except for primary analysis status. Conclusions: The results identify areas in which the reporting and conducting of MR studies needs to be improved and also suggest researchers do not make use of supplementary materials to sufficiently report secondary analyses. Future research should focus on the quality of code and analyses, attempt direct replications and investigate the impact of the STROBE-MR specifically. Study registration: https://osf.io/nwrdj.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Biological Specimen Banks ; Causality ; Checklist ; United Kingdom
Language	English
Publishing date	2022-12-08
Publishing country	England
Document type	Review ; Journal Article
ISSN	2515-4478
ISSN (online)	2515-4478
DOI	10.1136/bmjebm-2022-112006
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Article: Associations between COVID-19 Risk Perceptions and Mental Health, Wellbeing, and Risk Behaviours.

Dyer, Maddy L / Sallis, Hannah M / Khouja, Jasmine N / Dryhurst, Sarah / Munafò, Marcus R

Journal of risk research

2022 Volume 25, Issue 11-12, Page(s) 1372–1394

Abstract: Background: Mental health has worsened, and substance use has increased for some people during the coronavirus (COVID-19) pandemic. Some cross-sectional studies suggest that higher COVID-19 risk perceptions are related to poorer mental health and ... ...

Abstract	Background: Mental health has worsened, and substance use has increased for some people during the coronavirus (COVID-19) pandemic. Some cross-sectional studies suggest that higher COVID-19 risk perceptions are related to poorer mental health and greater risk behaviours (e.g., substance use). However, longitudinal and genetic data are needed to help to reduce the likelihood of reverse causality. Methods: We used cross-sectional, longitudinal, and polygenic risk score (PRS; for anxiety, depression, wellbeing) data from the Avon Longitudinal Study of Parents and Children (ALSPAC). We examined cross-sectional and prospective longitudinal associations between COVID-19 risk perceptions (i.e., cognitive, affective, self, other, and a combined 'holistic' measure) and mental health (i.e., anxiety, depression), wellbeing, and risk behaviours. Pandemic (April-July 2020) and pre-pandemic (2003-2017) data (ns = 233-5,115) were included. Results: Higher COVID-19 risk perceptions (holistic) were associated with anxiety (OR 2.78, 95% confidence interval [CI] 2.20 to 3.52), depression (OR 1.65, 95% CI 1.24 to 2.18), low wellbeing (OR 1.76, 95% CI 1.45 to 2.13), and increased alcohol use (OR 1.46, 95% CI 1.24 to 1.72). Higher COVID-19 risk perceptions were also associated with self-isolating given a suspected COVID-19 infection (OR 1.74, 95% CI 1.13 to 2.68), and less face-to-face contact (OR 0.83, 95% CI 0.70 to 0.98) and physical contact (OR 0.83, 95% CI 0.68 to 1.00). Pre-pandemic anxiety (OR 1.64, 95% CI 1.29 to 2.09) and low wellbeing (OR 1.41, 95% CI 1.15 to 1.74) were associated with higher COVID-19 risk perceptions. The depression PRS ( Conclusions: Poorer mental health and wellbeing are associated with higher COVID-19 risk perceptions, and longitudinal and genetic data suggest that they may play a causal role in COVID-19 risk perceptions.
Language	English
Publishing date	2022-11-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2021006-1
ISSN	1466-4461 ; 1366-9877
ISSN (online)	1466-4461
ISSN	1366-9877
DOI	10.1080/13669877.2022.2127849
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Article ; Online: Do Flavour Descriptions Influence Subjective Ratings of Flavoured and Unflavoured E-Liquids among Non-Smoking and Non-Vaping UK Adolescents?

Dyer, Maddy L / Suddell, Steph F / Khouja, Jasmine N / Havill, Michelle A / Blackwell, Anna K M / Maynard, Olivia M / Munafò, Marcus R / Attwood, Angela S

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco

2024

Abstract: Introduction: Youth use of electronic cigarettes (e-cigarettes) is rising globally and is associated with health harms. Flavour descriptions on e-liquid packaging may contribute to the appeal of e-cigarettes among youth. This study compared subjective ... ...

Abstract	Introduction: Youth use of electronic cigarettes (e-cigarettes) is rising globally and is associated with health harms. Flavour descriptions on e-liquid packaging may contribute to the appeal of e-cigarettes among youth. This study compared subjective ratings of e-liquid packaging flavour descriptions among non-smoking and non-vaping UK adolescents. Methods: This was an online observational study in a UK sample of non-smoking and non-vaping adolescents aged 11-17 years. The primary analyses compared flavoured versus unflavoured descriptions and the secondary analyses compared candy/sweet flavour versus fruit flavour descriptions. Outcomes were packaging appraisal, packaging receptivity, perceived harm, and perceived audience. Results: The survey was completed by 120 participants (74% female). Packaging appraisal ratings were higher for e-liquids with flavoured descriptions than unflavoured descriptions (mean difference 5.9, 95% CI 4.2 to 7.6, p<.001). Similarly, packaging receptivity ratings were higher for e-liquids with flavoured descriptions than unflavoured descriptions (mean difference 4.2, 95% CI 2.8 to 5.6, p<.001). Participants also perceived e-liquids with flavoured (versus unflavoured) descriptions as less 'grown-up' (mean difference -5.2, 95% CI -7.3 to -3.1, p<.001). However, ratings of perceived harm were similar for flavoured and unflavoured descriptions (mean difference -1.0, 95% CI -2.6 to 0.5, p=.189). Conclusions: Although this study found differences in subjective ratings of e-liquids with flavoured and unflavoured descriptions, non-smoking and non-vaping UK adolescents generally had low appraisal and receptivity for e-liquids and they perceived them as being 'grown-up' and harmful. Implications: Youth use of electronic cigarettes (e-cigarettes) is increasing globally, leading to concerns about health harms. This study compared adolescents' ratings of e-liquids with flavoured versus unflavoured descriptions and e-liquids with candy/sweet flavour versus fruit flavour descriptions. This study adds to previous studies that have compared adolescents' ratings of e-liquids with tobacco flavour versus non-tobacco flavour descriptions. Although packaging appraisal and receptivity ratings were higher (more positive) for e-liquids with flavoured versus unflavoured descriptions, overall, adolescents who do not smoke or vape had low appraisal and receptivity for e-liquids, and they perceived them as being 'grown-up' and harmful.
Language	English
Publishing date	2024-03-12
Publishing country	England
Document type	Journal Article
ZDB-ID	1452315-2
ISSN	1469-994X ; 1462-2203
ISSN (online)	1469-994X
ISSN	1462-2203
DOI	10.1093/ntr/ntae054
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Article ; Online: Association of genetic liability to smoking initiation with e-cigarette use in young adults: A cohort study.

Khouja, Jasmine N / Wootton, Robyn E / Taylor, Amy E / Davey Smith, George / Munafò, Marcus R

PLoS medicine

2021 Volume 18, Issue 3, Page(s) e1003555

Abstract: Background: Tobacco smoking and e-cigarette use are strongly associated, but it is currently unclear whether this association is causal, or due to shared factors that influence both behaviours such as a shared genetic liability. The aim of this study ... ...

Abstract	Background: Tobacco smoking and e-cigarette use are strongly associated, but it is currently unclear whether this association is causal, or due to shared factors that influence both behaviours such as a shared genetic liability. The aim of this study was to investigate whether polygenic risk scores (PRS) for smoking initiation are associated with ever use of e-cigarettes. Methods and findings: Smoking initiation PRS were calculated for young adults (N = 7,859, mean age = 24 years, 51% male) of European ancestry in the Avon Longitudinal Study of Parents and Children, a prospective birth cohort study initiated in 1991. PRS were calculated using the GWAS & Sequencing Consortium of Alcohol and Nicotine use (GSCAN) summary statistics. Five thresholds ranging from 5 × 10-8 to 0.5 were used to calculate 5 PRS for each individual. Using logistic regression, we investigated the association between smoking initiation PRS and the main outcome, self-reported e-cigarette use (n = 2,894, measured between 2016 and 2017), as well as self-reported smoking initiation and 8 negative control outcomes (socioeconomic position at birth, externalising disorders in childhood, and risk-taking in young adulthood). A total of 878 young adults (30%) had ever used e-cigarettes at 24 years, and 150 (5%) were regular e-cigarette users at 24 years. We observed positive associations of similar magnitude between smoking initiation PRS (created using the p < 5 × 10-8 threshold) and both smoking initiation (odds ratio (OR) = 1.29, 95% CI 1.19 to 1.39, p < 0.001) and ever e-cigarette use (OR = 1.24, 95% CI 1.14 to 1.34, p < 0.001) by the age of 24 years, indicating that a genetic predisposition to smoking initiation is associated with an increased risk of using e-cigarettes. At lower p-value thresholds, we observed an association between smoking initiation PRS and ever e-cigarette use among never smokers. We also found evidence of associations between smoking initiation PRS and some negative control outcomes, particularly when less stringent p-value thresholds were used to create the PRS, but also at the strictest threshold (e.g., gambling, number of sexual partners, conduct disorder at 7 years, and parental socioeconomic position at birth). However, this study is limited by the relatively small sample size and potential for collider bias. Conclusions: Our results indicate that there may be a shared genetic aetiology between smoking and e-cigarette use, and also with socioeconomic position, externalising disorders in childhood, and risky behaviour more generally. This indicates that there may be a common genetic vulnerability to both smoking and e-cigarette use, which may reflect a broad risk-taking phenotype.
MeSH term(s)	Cohort Studies ; Electronic Nicotine Delivery Systems/statistics & numerical data ; England/epidemiology ; Humans ; Risk Factors ; Smoking/genetics ; Tobacco Smoking/epidemiology ; Vaping/epidemiology ; Young Adult
Language	English
Publishing date	2021-03-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2185925-5
ISSN	1549-1676 ; 1549-1277
ISSN (online)	1549-1676
ISSN	1549-1277
DOI	10.1371/journal.pmed.1003555
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Article ; Online: Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis.

Khouja, Jasmine N / Suddell, Steph F / Peters, Sarah E / Taylor, Amy E / Munafò, Marcus R

Tobacco control

2020

Abstract: Objective: The aim of this review was to investigate whether e-cigarette use compared with non-use in young non-smokers is associated with subsequent cigarette smoking.: Data sources: PubMed, Embase, Web of Science, Wiley Cochrane Library databases, ... ...

Abstract	Objective: The aim of this review was to investigate whether e-cigarette use compared with non-use in young non-smokers is associated with subsequent cigarette smoking. Data sources: PubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts. Study selection: All studies of young people (up to age 30 years) with a measure of e-cigarette use prior to smoking and an outcome measure of smoking where an OR could be calculated were included (excluding reviews and animal studies). Data extraction: Independent extraction was completed by multiple authors using a preprepared extraction form. Data synthesis: Of 9199 results, 17 studies were included in the meta-analysis. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR: 4.59, 95% CI: 3.60 to 5.85) when the results were meta-analysed in a random-effects model. However, there was high heterogeneity ( Conclusions: Although the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.
Language	English
Publishing date	2020-03-10
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1146554-2
ISSN	1468-3318 ; 0964-4563
ISSN (online)	1468-3318
ISSN	0964-4563
DOI	10.1136/tobaccocontrol-2019-055433
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Article ; Online: Corrigendum to Effects of acute alcohol consumption on emotion recognition in social alcohol drinkers.

Khouja, Jasmine N / Attwood, Angela S / Penton-Voak, Ian S / Munafò, Marcus R

Journal of psychopharmacology (Oxford, England)

2020 Volume 34, Issue 5, Page(s) 586–587

Language	English
Publishing date	2020-02-03
Publishing country	United States
Document type	Journal Article ; Published Erratum
ZDB-ID	639313-5
ISSN	1461-7285 ; 0269-8811
ISSN (online)	1461-7285
ISSN	0269-8811
DOI	10.1177/0269881120902710
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