Emerging tobacco products in Spanish health surveys

Although smoking is a known risk factor for problem gambling, the relationship between heated tobacco products (HTPs), emerging tobacco products that are widely used in Japan, and problem gambling has not yet been examined. This study investigated the association between smoking behaviour, including HTP use, and problem gambling. We conducted a cross-sectional study using data from a large-scale online survey conducted from January 24 to February 27, 2024. Respondents who reported gambling within the past year were included in this study. Exclusive cigarette use, exclusive HTP use, and dual use were defined as smoking variables based on current smoking patterns in Japan. Problem gambling was defined as a score of 8 or higher on the Problem Gambling Severity Index. Multivariable weighted logistic regression models were fitted to examine the adjusted odds ratios (AORs) of smoking status for problem gambling. In total, 12,222 respondents (7,649 men and 4,573 women) were included in the study. The proportion of problem gambling differed; it was 4.6% among individuals who did not use tobacco products, 13.8% among those who exclusively used combustible cigarettes, 15.2% among those who exclusively used HTP, and 41.9% among those who used both. Compared to non-use/non-current use of tobacco products, exclusive combustible cigarette use (AOR, 2.89 [95% CI, 2.36-3.53]), exclusive HTP use (AOR, 2.34 [95% CI, 1.81-2.99]), and dual use (AOR, 10.52 [95% CI, 8.89-12.47]) were associated with problem gambling. Smoking behaviours, including heated tobacco product use, were associated with problem gambling.

The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology.

Smoking negatively impacts aerobic capacity, primarily by reducing V̇O2max, the gold standard measure of cardiorespiratory fitness. While smoking cessation is known to improve vascular function, exercise performance, and oxygen uptake, its specific impact on V̇O2max remains underexplored. Specifically, no research has yet evaluated V̇O2max changes following a switch to electronic cigarettes (ECs) or heated tobacco products (HTPs). This is a secondary analysis of the CEASEFIRE trial, a 12-weeks randomized controlled switching trial comparing the impact of ECs or HTPs on changes in smoking behaviour. The trial offers a unique opportunity to prospectively examine the relationship between smoking behavior and aerobic capacity, and to examine—for the first time—the specific impact of exclusive EC or HTP use on V̇O2max. Changes in VO₂max were analized across three smoking phenotypes: continuous smokers, those who reduced smoking, and those who abstained from smoking Additionally, VO2max was also evaluated specifically in participants who completely abstained from smoking tobacco cigarettes, evaluating outcomes in exclusive EC and HTP users. Quitters showed the greatest improvement in VO2max at both week 4 (2.4 ± 1.7 mL kg−1 min−1) and week 12 (2.7 ± 1.9 mL kg−1 min−1). Reducers also exhibited significant VO2max increases (1.3 ± 1.9 mL kg−1 min−1 at week 4: 1.9 ± 1.8 mL kg−1 min−1 at week 12), while Failures (i.e. those who continued smoking) showed no change. Exclusive use of EC and HTP resulted in statistically significant and clinically relevant improvements in V̇O2max. Compared to baseline, V̇O2max significantly increased at week 4 (EC: 38.4 ± 5.9 to 41.0 ± 6.1 mL kg−1 min−1; HTP: 39.2 ± 6.7 to 41.4 ± 6.4 mL kg−1 min−1, both p < 0.0001) and week 12 (EC: 38.4 ± 5.9 to 41.4 ± 6.3; HTP: 39.2 ± 6.7 to 41.6 ± 6.5 mL kg−1 min−1, both p < 0.0001). No significant differences between EC and HTP were observed at either time point. Rapid improvements in V̇O2max can happen when healthy smokers switch to exclusive use of ECs or HTPs. These findings reinforce the potential cardiorespiratory benefits of smoking cessation and harm reduction strategies.

To evaluate the prevalence of and factors associated with experimentation with and current use of water pipes and e-cigarettes among medical students. This was a cross-sectional multicentric study involving a convenience sample of students from medical schools in most Brazilian geographic regions. Information about experimentation with and current use of conventional cigarettes, water pipes, and e-cigarettes; beliefs and attitudes toward tobacco products; religiosity; and demographics were collected by means of an online structured questionnaire. We used descriptive statistics and logistic regression to analyze the association of those factors. Our sample comprised 700 individuals from four Brazilian regions. Prevalence of experimentation with and current use of cigarettes, water pipes, and e-cigarettes were, respectively, 39.1% and 7.9%; 42.6% and 11.4%; and 13.1% and 2.3%. Water pipe experimentation was higher among those who had a sibling (adjusted OR = 2.64; 95% CI, 1.24-5.61) or friends (adjusted OR = 2.33; 95% CI, 1.63-3.31) who smoke. The same occurred regarding e-cigarette experimentation: siblings (adjusted OR = 2.76; 95% CI, 1.17-6.50) and friends (adjusted OR = 2.47; 95% CI, 1:45-4.22). Curiosity and scent/taste were the major reasons for water pipe use and e-cigarette experimentation. Although 93% of the responders learned about health damages of smoking during medical school classes, 51.4% reported having experimented with at least one of these tobacco products. Most responders who reported feeling the presence of God/the Holy Spirit in their lives were never experimenters of water pipes (59.2%) or e-cigarettes (55.3%). There is a high prevalence of experimentation with tobacco products among medical students whose siblings or friends smoke, despite their knowledge about smoking harms.

BACKGROUND: Since electronic cigarettes (E-Cigs) were introduced to the United States (US) in 2007 its use has increased. Like other tobacco products, E-Cigs too pose health risks. Studies have shown a correlation between pain and tobacco use, with the association being bidirectional. However, there is limited data on the effect of E-Cig use on chronic pain, as well as its association with opioid use. OBJECTIVES: To evaluate the use of tobacco products, including E-Cigs in a chronic pain population. STUDY DESIGN: This study was designed as a cross sectional survey. SETTING: This study was set in an urban academic teaching center. METHODS: After IRB approval, surveys of established chronic pain patients were conducted over 4 months. The survey and results were anonymous, without the collection of any identifiable information. The adult patients who had been treated in the pain practice for over 3 months were included in this study. The survey collected the patients’ age, gender, history of tobacco usage, cigarette smoking, E-Cig and opioid use. RESULTS: A total of 312 patients were surveyed. 198 women (63.5%) and 114 men (36.5%). The average age was 58.2; ~59 years for men and ~58 years for women. Eighty-four patients (26.9%) were managing pain using chronic opioids; 46 women and 38 men. Nine women (4.5%) had tried E-Cigs in the past, but none (0%) were active users. Eighteen men (15.8%) had tried E-Cigs in the past with 9 (7.8%) being active users. Among the opioid managed patients, 6 (9.1%) had and were active users of E-Cigs and all 6 were men (20%). LIMITATIONS: The anonymous results collected through the survey may not be accurate as they cannot be validated. In addition to the small sample size, the entire study population is from an urban academic center which may not be generalizable to all chronic pain patients. Finally, the study does not evaluate the impact of tobacco or E-Cig use on pain level or functional status. CONCLUSION: In this study of chronic pain patients, cigarette smoking and E-Cig use was similar to the reported use in the general adult population in the US. The study showed a strong correlation between tobacco use, especially cigarettes and E-Cigs, and opioid use. As the use of E-Cigs becomes more mainstream, the association between E-Cig use, chronic pain, and opioid use should be monitored. KEY WORDS: Tobacco use, electronic cigarettes, E-Cig, E-cigarette, opioid use, chronic pain

Background: Emerging nicotine and tobacco products such as Electronic Nicotine Delivery Systems (ENDS) and Heated Tobacco Products (HTPs) have become popular worldwide. This study aimed to measure the knowledge, attitude, and practice of medical students and physicians at Ain Shams University (ASU) toward ENDS and HTPs and to identify the factors associated with their use.Methods: A cross-sectional study was conducted among 407 undergraduate medical students and 111 physicians at ASU. The data was collected using an electronic questionnaire including socio-demographic characteristics, knowledge, attitude, and practice of participants toward ENDS and HTPs, and factors associated with their use.Results: The mean age of the studied participants was (22.7±5.39), (63.5%) were females, and (7.3%) were current smokers. Among participants, (84.4%) and (19.5%) had previously heard of ENDS and HTPs respectively, and the most commonly reported source of information about ENDS and HTPs was friends (61.6%) and (63.4%), respectively. More than half of the participants agreed that ENDS and HTPs encourage smoking initiation in those who have never smoked. Furthermore, (4.6%) and (11.9%) of participants who had previously heard of ENDS and HTPs had used them, respectively. Physicians were more knowledgeable about ENDS than medical students (P = 0.008).Conclusion: Most participants had a negative attitude toward ENDS and HTPs. As all ENDS smokers were medical students rather than physicians who were more knowledgeable about ENDS and HTPs, health education programs should be provided to medical students in general. Counseling should be specifically started for ENDS and HTPs users.

Characteristics, use patterns and perceptions of electronic cigarette users who were never traditional cigarette smokers

Different Times Call for Different Measures: Using Retail Sales to Monitor the Tobacco Product Landscape

ObjectivesTo provide a consensus from a panel of international experts about electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP).DesignCross-sectional survey.MethodsA Delphi survey was conducted among international experts in...

Combined expectancies of alcohol and e-cigarette use relate to higher alcohol use

Background Electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs) are noncombustible tobacco products which have been found to generate aerosols containing lower levels of Harmful and Potentially Harmful Constituents (HPHCs) in comparison to conventional cigarettes. Objective: This quasi experimental study measured and compared the end tidal carbon monoxide (eCO) levels of participants after use of ENDS, HTPs and conventional cigarettes. Methods: In total 45 smokers, each smoking at least 10 conventional cigarettes per day for 5 years participated in the study. Based on their preference, participants used only one of the tobacco products (ENDS, HTPs, or conventional cigarette) and were briefed about the product use based on manufacturer’s instructions. The eCO levels were obtained at baseline, followed by 5, 10, 15, 30 and 45 min respectively after the product use. Results: There was significant increase in eCO levels for conventional cigarettes as compared to other modes. Peak eCO levels of 20.2 ± 0.86 ppm, 8.8 ± 1.56 ppm and 6.0 ± 1.36 ppm was achieved at 30 min, 15 min and 10 min for conventional cigarettes, ENDS and HTPs respectively. However, the levels were significantly lower in ENDS and HTPs. Conclusion: Even though ENDS and HTPs may have produced significantly lower eCO than conventional cigarettes, the significantly increasing levels over time from baseline which was not shown before is a cause of concern. As of now, their use as an alternate to cigarettes needs to be considered under regulatory framework.

IntroductionIdentifying behavioural factors related to tobacco may provide a better understanding of what drives this behaviour and thus may inform more effective tobacco control programmes and policies. In this study,...

Aim: Electronic cigarettes (eCig) and heated tobacco products (HTP), that heat a solution (e-liquid) to create vapour and tobacco at a temperature below the point of combustion, respectively, are emerging forms of smoking device widely diffused. The aim of this study was to investigate knowledge, attitudes and behaviour toward HTP among young people in Italy. Methods: The Smoking E-CigaRette and HEat-noT-burn products (SECRHET) study was an online survey carried out in April 2019 using the platform Skuola.net, a platform where 2.5 million students are registered. Questions were related to knowledge about new generation smoking products, such as “Do you know what happens to tobacco when you use a heat-not-burn product?”, “Do you think electronic cigarettes create addiction?”, “Are products that use heated tobacco harmful to health?”, “Are electronic cigarettes harmful to health?”, “Have you ever heard of products that use heated tobacco?”, “Is nicotine present in products that use heated tobacco?” Results: A total of 13882 people completed the questionnaire, of which 8056 (58%) were females. Regarding smoking habits, 3393 (24.4%) declared to be current cigarette smokers, while 802 (5.8%) and 3173 (22.9%) were current and former e-cigarette smokers, respectively. Moreover, 715 (5.2%) and 1148 (8.3%) declared to be current and former heat-not-burn cigarette smokers. The variables associated to both eCig and HTP use were current smoking, age over 18 years, male gender, and residence in Central and Southern Regions. Concerning knowledge issues, almost half of respondents believe that electronic cigarettes are addictive and are harmful to health. Moreover, most of respondents do not know what happens to tobacco when using a heated tobacco device and if heated tobacco products are harmful to health. Conclusion: The prevalence of eCig and HTP use is higher among young people in Italy compared to adults and older people, and requires adequate public health interventions.

Background Tobacco smoke is a major risk factor to noncommunicable disease (NCD) and its role is under study in the Joint Action PreventNCD. This study assessed the impact of new tobacco and nicotine products, i.e., electronic cigarettes (e-cig) and heated tobacco products (HTP), on smoking prevalence in the adult population residing in Italy. Methods Istituto Superiore di Sanità (ISS) uses behavioral surveillance systems for monitoring purpose in PreventNCD. PASSI surveillance system data 2008-2023 amount 532,115 interviews on adults (aged 18-69) residing in Italy. From the weighted monthly series on smokers’ prevalence, interrupted time series (ITS) were analysed, with generalized least squares, accounting for autocorrelation (ARMA matrix). January 2024 (introduction of e-cig in data collection) was used as “first-interruption” month, and January 2018 (introduction of HTP) as “second-interruption” month. The analysis shows the difference between what occurred after the intervention and expected outcome in the hypothesis of no intervention. The exclusive or combined use of the three products was also evaluated. Results Cigarettes smokers trend decreased from 30% to 24%, but the ITS analysis shows how the introduction of new tobacco and nicotine products and consuming shift, mostly combined, interrupted the declining trend in cigarettes use in Italy. There is no reduction in the total amount of nicotine addict or tobacco users: since PASSI started investigating new electronic devices, we observe a constant decrease in the number of exclusive traditional cigarettes users (from 25% in 2014 to 20% in 2023), in favor of an increase in both traditional cigarettes and electronic devices (from 1.5% in 2014 to 4.4% in 2023) users. Exclusive electronic devices users also slowly increased, from 0.4% in 2014 to 3.3% in 2023. Conclusions Exclusive use of cigarettes decreased as combined use with e-cig increased; exclusive use of electronic devices slowly increased. Key messages • Combined use of traditional cigarettes and electronic devices represents a challenge for public health, as it increases health risks caused by exposure to higher nicotine and harmful chemicals levels. • Tobacco and nicotine users did not decrease with the introduction of new electronic devices.

Background:Concurrent use of tobacco products such as cigarettes and water pipes may be associated with increased risk of nicotine dependence and smoking-related complications. Accurate statistics are not available regarding the prevalence of water pipe use or concurrent use of cigarettes and water pipe in the Iranian population. Thus, this study sought to assess the prevalence of concurrent use of cigarettes and water pipes and their related factors in Iran.Materials and Methods:This cross-sectional study was conducted on Tehran residents over 15 years of age, who were selected via cluster, multi-stage randomized sampling, from different geographical districts of Tehran between November and December 2014. The data were collected using the water pipe section of the Global Adult Tobacco Survey (GATS) questionnaire.Results:A total of 1,830 individuals participated in this study, 243 (13.3%) of which exclusively used water pipes, 76 (4.2%) used both cigarettes and water pipes, and 120 (6.6%) exclusive smoked cigarettes. Of those who used both cigarettes and water pipes, 86.8% were men and 13.2% were women (P < 0.001). The mean age of those who only used water pipes was 28.01 ± 8.7 years while the mean age of those who used both water pipes and cigarettes was 33.1 ± 1.1 (P < 0.001). Male sex (adj. OR: 3.8) and older age (adj. OR: 1.06) increased the odds of using both tobacco products.Conclusion:The prevalence of concurrent use of cigarettes and water pipes and that of exclusive water pipe use were 4.2% and 13.3%, respectively. The prevalence of exclusive cigarette smoking was 6.1%. Those who smoked both cigarettes and water pipes had a higher mean age than those who exclusively used water pipes and they were mostly men. Among those who used cigarettes and water pipes, the mean age at which they began using water pipes was lower than the mean age at which they began smoking cigarettes. In other words, dual smokers started water pipe smoking sooner than cigarette smoking. Future studies with different methodologies are required to further scrutinize the relationship between water pipe and cigarette smoking. Smoking cessation programs must specifically target dual smokers.