Combustible Cigarettes Research Articles

Physiologically Based Pharmacokinetic Modeling to Predict Nicotine Pharmacokinetics of Nicotine Pouches Under Naturalistic Use Conditions.

Adult users of traditional tobacco products like combustible cigarettes (CC) or moist smokeless tobacco (MST) products can reduce exposure to toxicants by switching to potentially less harmful alternatives such as tobacco-free nicotine pouches (NP). Nicotine exposure assessment is an important consideration to determine the switching potential of NPs. These measurements are often conducted using randomized clinical studies. However, characterizing nicotine exposure under real-world use conditions can further inform these assessments. We propose a framework based on physiologically based pharmacokinetic (PBPK) modeling that integrates typical use patterns and clinical pharmacokinetic (PK) data to predict nicotine exposure under actual use conditions. A tissue permeation model precedes the PBPK modeling and is characterized by two physiological parameters, nicotine diffusivity, and effective tissue thickness, which were determined and validated using literature data. A product-specific tissue uptake fraction was determined by regression of nicotine pharmacokinetics measured under controlled use conditions and applied consistently for alternative use scenario analyses. Nicotine PK profiles were predicted under various use scenarios for cigarette smoking or MST use and compared to that from the use of two NPs, namely on!® and on! PLUS™ NPs (Test Products). The nicotine PK parameters predicted under real-world use conditions were not higher for Test Products relative to cigarettes or MST. The proposed modeling here can further inform nicotine exposure under actual use conditions. PBPK modeling can be a fit-for-purpose tool for predicting nicotine exposure under various use scenarios.

Examining pathways between structural stigma and tobacco use: a comparison among young adults living in the United States by sexual orientation and gender identity

BackgroundSexual and gender minority young adult (SGM YA) populations use tobacco at higher rates than their non-SGM YA peers. Prior studies have identified significant correlations between interpersonal stigma and tobacco use, yet structural stigma may also influence tobacco use among SGM YA. This study aimed to assess the indirect effects of structural stigma on current tobacco use among SGM YA and non-SGM YA via depletion of economic resources, interpersonal discrimination, and perceived psychological stress.MethodsStructural Equation Modeling was used to conduct a secondary data analysis from a cross-sectional parent study. Eligible participants were 18–35 years old and currently residing in the U.S. (N = 2,649). Current use of combustible cigarettes and nicotine vapes was our dependent variable. Our independent variable of interest, structural stigma, was a latent variable comprised of three state-level indicator items: Attitudes toward SGM people, SGM protective policies (absence of), and SGM discriminatory policies (introduced or passed in 2022). We assessed three mediators of interest: Depletion of economic resources was a latent variable, which included two indicator items: food insecurity and financial strain. Interpersonal discrimination and perceptions of psychological stress were also assessed. Covariates included race/ethnicity, age, and educational attainment.ResultsStructural stigma was indirectly associated with current tobacco use via depletion of economic resources for SGM YA, but not non-SGM YA. Structural stigma was not indirectly associated with current tobacco use via interpersonal discrimination or psychological stress for either group.ConclusionsFuture tobacco intervention research should consider the role of structural stigma when working with SGM YA; specifically, how interventions promoting economic stability may influence tobacco use and cessation in this population.

The prevalence and predictors of vaping quit attempt among electronic cigarette users: findings from provincial version of Global Adult Tobacco Survey 2020 in Vietnam

BackgroundElectronic cigarette (e-cigarette) quit attempts among users have been a topic of increasing focus in high-income countries, but limited research exists in low- and middle-income countries (LMICs). This study aimed to determine the prevalence of e-cigarette quit attempts and investigate associated factors among e-cigarette users in a sample of 34 provinces in Vietnam.MethodsA country-specific provincial version of the Global Adult Tobacco Survey was conducted in 34 provinces of Vietnam in 2020 (n = 80,166). Among 557 current e-cigarette users (288 exclusive users and 269 dual users of e-cigarettes and conventional cigarettes) aged 15 years and above, sociodemographic characteristics, smoking-related variables, reasons for e-cigarette use, and motivations to quit e-cigarettes were assessed. Logistic regression models were employed to analyze the relationships between these factors and e-cigarette quit attempts.ResultsAmong e-cigarette users, 46.1% had made a quit attempt within the past 12 months, with 50.0% among exclusive users and 41.8% among dual users of e-cigarettes and combustible cigarettes. Perceiving e-cigarette use as more harmful than smoking cigarettes was associated with a higher likelihood of making an e-cigarette cessation attempt. Notably, smokers who had previously been unsuccessful in quitting cigarette smoking using e-cigarettes had a higher likelihood of quitting e-cigarettes. Conversely, using e-cigarettes as an alternative tobacco product when unable to smoke cigarettes was associated with a lower likelihood of attempting to quit e-cigarettes. The most common reasons for wanting to quit e-cigarettes included perceiving e-cigarettes as more harmful than combustible cigarettes, their cost, and friends’ or family members’ disapproval of e-cigarettes.ConclusionThis study provides novel information on the prevalence and factors associated with e-cigarette quit attempts among e-cigarette users in Vietnam. The findings highlight the importance of harm perception, cost, and social influence in motivating individuals to quit e-cigarettes.

Sex and gender in relation to use of e-cigarette product characteristics in united states datasets: a systematic review.

Electronic cigarette (e-cigarette) product characteristics impact appeal, addictive potential, toxicity, and/or harm reduction potential. We conducted a systematic review to characterize sex and gender differences in e-cigarette product characteristics used in the United States (US). Included studies used US population representative datasets to assess sex/gender differences, sex-specific findings, or differences by sexual or gender minority (SGM) status in relation to e-cigarette product characteristics (e.g., flavors, nicotine (i.e., nicotine in e-liquid), cannabis vaping (i.e., cannabis in e-liquid), device types, other). Additionally, articles had to be written in English and published in peer-reviewed journals. Searches were conducted in PubMed on March 9, 2024 and in PsycInfo and Medline on February 23, 2025. The 52 included papers used 7 datasets and addressed flavor (N=28), nicotine (N=14), cannabis vaping (N=15), device (N=6), and other characteristics (N=3; 1 package size; 2 other toxicant exposure). Samples included youth (N=23) and/or adults (N=32). Although data are somewhat mixed, taken together findings indicate that while prevalence of e-cigarette use is higher in males, within those who use e-cigarettes, prevalence of flavor use is higher in females, prevalence of nicotine and cannabis vaping and open (adjustable) device type use is higher in males. E-cigarette product characteristics are a tractable target for regulation. Understanding e-cigarette product characteristics used by males and females in the US could shed light on sex and gender differences in the course of e-cigarette use and the addictive potential, appeal, or harm reduction potential of e-cigarette products. There are sex and gender differences in the use and cessation of tobacco products like combustible cigarettes. E-cigarettes have become more popular and characteristics such as flavors, nicotine, cannabis vaping (i.e., cannabis in e-liquid), and device types impact appeal and addiction potential. This review is the first to synthesize the literature on sex and gender in relation to e-cigarette characteristics among United States youth and adults and highlight gaps where more research is needed. This information can help guide that regulation and other efforts related to e-cigarette so they are as effective as possible across sex and gender groups.

Does cannabis and electronic nicotine delivery system (ENDS) use interfere with cigarette smoking cessation in young adulthood?

Does cannabis and electronic nicotine delivery system (ENDS) use interfere with cigarette smoking cessation in young adulthood?

Examining Vaping Policies in Substance Use Disorder Treatment Facilities.

Unlike combustible cigarettes, vaping does not produce smoke, creating ambiguity around indoor vaping policies. Vaping policies in substance use disorder treatment facilities may directly impact how an individual engages with treatment. To examine associated factors with vaping policies within substance use disorder treatment facilities in the United States. This cross-sectional study used data from the National Substance Use and Mental Health Services Survey to examine data from substance use disorder treatment facilities. Other data included the state percentage of adults who use e-cigarettes from the Behavioral Risk Factor Surveillance System, and state-level indoor e-cigarette restriction policies from the State Tobacco Activity Tracking and Evaluations System. A total of N = 16042 substance use disorder treatment facilities in 2022 were included. Factors that were examined include [a] state percentages of adults who vape, [b] state indoor vaping restrictions, [c] tobacco use screening in facilities, [d] smoking/tobacco education and counseling in facilities, [e] availability of nicotine pharmacotherapies in facilities, [f] facility smoking policies, [g] availability of outpatient or non-hospital residential treatment, and [h] availability of a treatment program specifically for adolescents or young adults. Facility vaping policies is the outcome variable in this study with three values: [a] vaping is restricted, [b] vaping in designated outdoor area(s), and [c] permissive vaping policies (anywhere outside, designated indoor areas, anywhere inside, anywhere without restriction). Vaping policies across all treatment facilities include 45.9% restricted vaping, 45.9% permitted vaping in designated outdoor area(s), and 8.2% had a permissive vaping policy. State-level percentage of adults who use e-cigarettes, state indoor e-cigarette restrictions, facility smoking policies, and services provided by facilities were associated with different vaping policies, ranging from restrictive to permissive policies. Various vaping policies exist in substance use disorder treatment facilities. Different vaping policies may have varied impacts on individuals' treatment goals.

Characterization of a novel oronasal-restricted nicotine vaping self-administration model in mice.

Characterization of a novel oronasal-restricted nicotine vaping self-administration model in mice.

Emissions from conventional and electronic waterpipes relative to cigarettes and a heated tobacco product

Harms associated with the use of smoked tobacco products, including waterpipes, are due to inhalational exposure to toxicants either present in tobacco or formed during the process of combustion. We assessed levels of 37 toxicants in aerosol emissions from conventional waterpipe heated with different charcoals and also with a heat management device (HMD), from the IQOS heated tobacco product (HTP), and the ‘OOKA’ electronic waterpipe. We also utilised literature data on toxicant yields in 3R4F reference cigarette smoke. When taking use patterns into account, toxicant yields were substantially lower in conventional waterpipe aerosol compared with cigarette smoke. Toxicant yields in electronic waterpipe aerosol were substantially lower than those in conventional waterpipe aerosol, both on a per session basis and when taking typical use patterns into account. Numerous toxicants in conventional waterpipe aerosol were absent in electronic waterpipe aerosol. In summary, during typical use conventional waterpipe emits fewer, and lower levels of, a number of toxicants relative to combustible cigarette smoke. In addition, electronically heating shisha further reduces toxicant levels, and many toxicants are absent in OOKA electronic waterpipe aerosol. These findings have important implications concerning toxicant exposure among waterpipe users, and for understanding how to potentially reduce health risks associated with waterpipe use.

Acute and Persistent Cardiovascular Effects of Menthol E-Cigarettes in Mice.

Although e-cigarettes provide an alternative to conventional smoking, the cardiovascular impacts of e-cigarette use are unresolved. The popularity of menthol e-cigarettes has surged recently and may escalate further with bans on combustible menthol cigarettes and e-cigarette flavors other than menthol and tobacco. Despite recent evidence in mice that menthol e-cigarettes acutely induce cardiac arrhythmias, the impacts of repeated menthol e-cigarette use on cardiovascular function and the cardiac proteome remain unclear. We therefore investigated the acute and persistent cardiovascular effects of menthol e-cigarettes in a mouse model. Adult C57BL/6J mice with ECG and blood pressure radiotransmitters were exposed to e-cigarette aerosols (180-270 puffs/day; n=4-8/group). One-day exposures to nicotine-containing e-cigarette aerosols depressed heart rate variability regardless of flavor, but menthol e-cigarette aerosols uniquely increased heart rate and urine epinephrine and elicited spontaneous ventricular premature beats. Menthol e-cigarette aerosols consistently increased blood pressure acutely, and this effect recurred throughout the 20-day regimen. Pretreatment with atenolol abolished e-cigarette-induced arrhythmias, suggesting the involvement of β1-adrenoceptors. After 4 weeks of exposure to JUUL Menthol aerosol, mice had basal sinus bradycardia that persisted up to 3 weeks after exposure cessation. After cessation, e-cigarette-exposed mice also exhibited an altered chronotropic response to restraint stress and prolonged ventricular repolarization (corrected QT interval). Integrated proteomic and phosphoproteomic analysis of cardiac tissue harvested from mice exposed to menthol e-cigarette aerosols for 5 and 20 days revealed molecular signatures of dilated and arrhythmogenic cardiomyopathy. Exposure to menthol e-cigarette aerosols induces persistent cardiovascular autonomic imbalance invivo. These findings raise the possibility of similar effects in humans using mentholated e-cigarettes.

Oral health effects of non-combustible nicotine products: protocol for a systematic review and network meta-analysis

BackgroundTobacco use is a global issue, and non-combustible nicotine products (NCNPs) like electronic nicotine delivery systems, nicotine pouches, snus, and nicotine replacement therapies offer potential risk/harm reduction for smokers unable or unwilling to quit. Although NCNPs are less harmful than tobacco smoking, their impact on oral health remains unclear. A systematic review and network meta-analysis will be conducted to answer the research question: What are the oral signs and symptoms associated with NCNPs as both monotherapies and combination therapies compared to each other, placebo, standard care, no drug treatment, and combustible cigarette smoking?MethodsWe will search PubMed and Scopus databases, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to August 2024. This review will focus on randomized controlled trials (RCTs) with a minimum follow-up period of 1 month, comparing any NCNPs versus placebo, standard care, no drug treatment, combustible cigarette smoking or to each other in adult smokers. Our primary outcomes will be the number of participants reporting any oral side effect, aphthous ulcers, dry mouth and mouth irritation. Studies will be excluded if they involve: non-smokers, pregnant women, individuals with mental health or neurological disorders, participants consuming alcohol or other substances. Data will be analyzed using a network meta-analysis framework, estimating odds ratios with 95% confidence intervals. Risk of bias will be determined using the Cochrane risk of bias tool-version 2.0 for included RCTs and the Confidence In Network Meta-Analysis tool will be employed to assess the confidence of evidence contributing to each network estimate.DiscussionOur findings will provide critical insights into the oral health implications of NCNPs, informing clinical and public health decisions. Results are expected by May 2025 and will be disseminated through publications and presentations to guide tobacco harm reduction strategies.Systematic review registrationPROSPERO CRD42024565118.

Nicotine and Toxicant Exposure among Individuals using both Combustible Cigarettes and E-cigarettes Based on Level of Product Use.

Dual use of combustible cigarettes and e-cigarettes is the most common multiple tobacco-use behavior in the United States, but its long-term health impact remains unclear. Biomarkers of exposure (BOE) can help identify potential health risks of dual use. We analyzed data from 2,679 adult participants from Wave 5 of the Population Assessment on Tobacco and Health Study, a U.S. nationally representative study, including individuals reporting current exclusive cigarette use (n = 1,913), exclusive e-cigarette use (n = 316), and dual use (n = 450). Eight subgroups were created based on self-reported high/low (above/below mean) cigarettes per day (CPD) and days of e-cigarette use in past the 30 days (ECIG). Adjusted geometric mean concentrations were compared for total nicotine equivalents, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), three volatile organic compounds (VOCs), and heavy metals (lead and cadmium). Individuals reporting dual use did not differ from those reporting exclusive cigarette use on CPD (13.1 vs. 11.8, respectively). Dual-use groups with high CPD had higher levels of NNAL and VOCs compared to those with low CPD (eg, NNAL for high CPD/high ECIG: 257.07ng/mg creatinine vs. low CPD/high ECIG: 64.57ng/mg creatinine, p < .001; high CPD/low ECIG: 312.02ng/mg creatinine vs. low CPD/low ECIG: 144.11ng/mg creatinine, p < .001). Cigarette use (dual or exclusive use) was generally associated with higher BOE than exclusive e-cigarette use, though metal exposure did not differ between groups. Dual use and exclusive cigarette use are associated with higher toxicant exposure compared to exclusive e-cigarette use. In this population-based cross-sectional study, individuals reporting dual use appear to have nicotine and toxicant exposure at least at the same level as those using cigarettes alone and higher than exclusive e-cigarette use (except for metals). Given the adverse health consequences of dual use, including potential cancer risk, our findings highlight the need for clinicians and public health practitioners to increase awareness of the potential risks associated with dual use.

Sugars in Tobacco Products: Toxicity Research and Implications for Tobacco Product Regulation.

Sugars are naturally present in tobacco plants and are introduced as additives during the manufacturing of various tobacco- and nicotine-containing products. Product palatability and appeal are the primary reasons for manufacturers' attention to the sugar content in tobacco and nicotine products. However, because of the complex chemistry of sugars and their thermal decomposition, these versatile constituents are also contributing to the toxicity profile of tobacco and nicotine products. Using published empirical data, this non-systematic review summarizes the state of knowledge on the toxicologically relevant chemical transformations of sugars and artificial sweeteners in tobacco and nicotine products, including waterpipe tobacco, combustible and electronic cigarettes, heated tobacco products, and smokeless tobacco, and available research on the associated health effects of sugar-derived toxicants. Implications of sugar and sweetener content for abuse liability of various tobacco products are also discussed. Based on the findings of this review, research gaps are identified and policy recommendations are made for regulating sugars and artificial sweeteners in tobacco and nicotine products, including adding sugars and artificial sweeteners to the list of harmful and potentially harmful constituents (HPHCs).

Association of psychological and behavioural economic factors with cigarette, water pipe, e-cigarette and heated tobacco use in Israel

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,...

Urge Coping Mediates the Relationship Between Physical Activity and Smoking Outcomes in a Sample of Premenopausal Women Intending to Quit Smoking.

Physical activity (PA), urge coping, and menstrual phase may all influence combustible cigarette smoking cessation yet have never been examined concurrently. Therefore, we examined the effects of physical activity (PA) and urge coping on smoking outcomes among women who were randomly assigned to quit smoking based on their menstrual phase. Participants were randomized to quit smoking during the follicular menstrual phase (FP; quit date set 6-8 days post onset of menses) or to standard-of-care condition (SC; no menstrual timing of quit date). Smoking-related outcomes at end of treatment (EOT; i.e., 7-day abstinence and cigarettes/day) were regressed on baseline levels of PA stratified by randomization. Mediation analysis examined whether urge coping mediated the relationship between PA and smoking outcomes. Participants (FP: n=58, SC: n=60) were, on average, 33.4 years old and smoked 13.8 cigarettes/day at baseline. Total volume of PA was significantly associated with better urge coping (β= 0.09, 95% CI [0.001, 0.18], p= 0.05). Urge coping was associated with fewer cigarettes/day at EOT (β= -0.37, 95% CI [-0.57, -0.18], p< 0.001) and greater likelihood of smoking abstinence (β= 0.28, 95% CI [0.13, 0.42], p< 0.001). When PA was analyzed by intensity, vigorous PA, but not walking or moderate PA, significantly predicted better urge coping (β= 0.28, 95% CI [0.06, 0.49], p= 0.01) and, in turn, greater likelihood of smoking abstinence (β= 0.50, 95% CI [0.13, 0.87], p= 0.01). Vigorous PA may be an effective strategy to support urge coping and smoking cessation in premenopausal women. This study provides evidence that vigorous-intensity physical activity, but not walking or moderate physical activity, may play a significant role in improving urge coping, reducing smoking, and improving the likelihood of successful smoking cessation among women of reproductive age, regardless of menstrual timing. Findings did not vary between those who were randomized to quit smoking during the follicular phase versus those who quit regardless of menstrual cycle timing. Findings suggest that incorporating PA in smoking cessation programs in a sequential behavioral change approach (i.e., focusing on adopting vigorous PA before setting a quit day) may be beneficial.

Correction to: Differential Associations of Cigar, Pipe, and Smokeless Tobacco Use Versus Combustible Cigarette Use With Subclinical Markers of Inflammation, Thrombosis, and Atherosclerosis: The Cross-Cohort Collaboration-Tobacco Working Group.

Correction to: Differential Associations of Cigar, Pipe, and Smokeless Tobacco Use Versus Combustible Cigarette Use With Subclinical Markers of Inflammation, Thrombosis, and Atherosclerosis: The Cross-Cohort Collaboration-Tobacco Working Group.

Evaluating the human abuse potential of concurrent use of electronic cigarettes and low nicotine cigarettes among adults who smoke.

The U.S. Food and Drug Administration has stated its intention to reduce the nicotine content of combustible cigarettes to render them less addictive. This study evaluated the impact of providing adults who smoke with both very low nicotine content cigarettes (VLNCCs) and electronic cigarettes (ECs) of varying nicotine content on measures of human abuse potential. Participants (n = 213) were adult combustible cigarette users. They smoked their usual brand cigarettes (UBCs) during Phase 1 (baseline; week 1) and were provided with and encouraged to exclusively use VLNCCs during Phase 2 (weeks 2-4). During dual-product Phases 3 (weeks 5-7) and 4 (weeks 8-10), participants received both VLNCCs and ECs (assigned to one of two EC devices in higher or lower nicotine concentrations and choice of flavor), with instructions to use them freely in Phases 3 and 4. Assessments included product use, exposure, acceptability, risk perception, and withdrawal-related measures. Results indicated that participants used significantly fewer UBCs during the VLNCC and dual-product phases and smoked fewer VLNCCs during the dual-product phases than the VLNCC-only phase. Neither EC liquid nicotine concentration nor flavor influenced product use. The three study product phases resulted in less product liking and more withdrawal symptoms than the UBC phase. These results suggest that adults who smoke are able to switch much of their tobacco product use from UBCs to VLNCCs and will substitute combustible UBCs and VLNCCs with noncombustible nicotine-containing ECs, but most remain dual users, at least in the short term. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

New-generation nicotine delivery products require new approaches to research.

Toxicological and epidemiological studies suggest that new-generation nicotine delivery products will reduce the harmful exposures associated with combustible cigarettes and toxic forms of smokeless tobacco products. However, enhanced study designs are needed to support epidemiological research that was more appropriate when the ways of consuming nicotine were limited and methods to assess causality in less than decades were unavailable. Given their different perspectives and scientific capabilities, progress in THR requires deeper and transparent engagement between industry scientists and those in academia that rigorously applies conflicts of interest norms.

Cross-sectional study on smoking types and stroke risk: development of a predictive model for identifying stroke risk.

Stroke, a major global health concern, is responsible for high mortality and long-term disabilities. With the aging population and increasing prevalence of risk factors, its incidence is on the rise. Existing risk assessment tools have limitations, and there is a pressing need for more accurate and personalized stroke risk prediction models. Smoking, a significant modifiable risk factor, has not been comprehensively examined in current models regarding different smoking types. Data were sourced from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) and the 2020-2021 Behavioral Risk Factor Surveillance System (BRFSS). Tobacco use (including combustible cigarettes and e-cigarettes) and stroke history were obtained through questionnaires. Participants were divided into four subgroups: non-smokers, exclusive combustible cigarette users, exclusive e-cigarette users, and dual users. Covariates such as age, sex, race, education, and health conditions were also collected. Multivariate logistic regression was used to analyze the relationship between smoking and stroke. Four machine-learning models (XGBoost, logistic regression, Random Forest, and Gaussian Naive Bayes) were evaluated using the area under the receiver-operating characteristic curve (AUC), and Shapley's additive interpretation method was applied for feature importance ranking and model interpretation. A total of 273,028 individuals were included in the study. Exclusive combustible cigarette users had an elevated stroke risk (β: 1.36, 95% CI: 1.26-1.47, P < 0.0001). Among the four machine-learning models, the XGBoost model showed the best discriminative ability with an AUC of 0.794 (95% CI = 0.787-0.802). This study reveals a significant association between smoking types and stroke risk. An XGBoost-based stroke prediction model was established, which has the potential to improve the accuracy of stroke risk assessment and contribute to personalized interventions for stroke prevention, thus alleviating the healthcare burden related to stroke.

Machine Learning of Smoking Relapse: the Role of Racial Differences and E-Cigarette Vaping Characteristics on Former Smokers.

Machine learning models can help identify multifaceted factors influencing tobacco use transitions. A random forest model is developed to predict smoking relapse, focusing on racial differences and vaping characteristics. Data are drawn from the Population Assessment of Tobacco and Health (PATH) study adult interview files. Former combustible cigarette smokers at baseline (Wave 5) were followed up 1year later (Wave 6). Predictors (n = 100) include a wide range of social demographics, psychosocial factors, health status, tobacco and substance use behaviors, and vaping characteristics. Among 4693 former smokers at baseline, 4.4% relapsed to smoking within 4years. Random forest models achieved high prediction accuracies across racial groups, with area under the curve (AUCs) of 0.77 for Whites, 0.88 for Blacks, and 0.70 for Hispanics. Quit history (i.e., recent vs. long-term quitters) was one of the top predictors across all racial and ethnic groups. Tobacco addiction was one of the top predictors among White and Hispanic former smokers but not among their Black and other race counterparts. Marijuana use was one of the top predictors for Blacks but not for other racial and ethnic individuals. Vaping status predicted relapse across all groups, but the importance of vaping characteristics differed. E-cigarette nicotine concentration levels and e-cigarette devices ranked higher for Whites and Hispanics than for Blacks and Others. The findings reveal notable racial differences in smoking relapse predictors, along with distinct roles of vaping characteristics across racial groups. Unique social, behavioral, and health factors are crucial for improving smoking cessation outcomes.

E-cigarette Use and Incident Cardiometabolic Conditions in the All of Us Research Program.

Although several potential respiratory and cardiovascular health effects of e-cigarettes have been reported, their association with incident cardiometabolic conditions remains unclear. We used longitudinal data from the All of Us research program to investigate the association between current exclusive e-cigarette use (EE), exclusive combustible cigarette use (ECC), and dual use (DU) with incident cardiometabolic conditions, including hypertension, type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), heart failure (HF), and atherosclerotic cardiovascular disease (ASCVD), using Cox regression analyses adjusted for age, sex, race and ethnicity, and body mass index (BMI). ECC use was used as a positive control to validate our methodology/findings. Among 249,190 individuals (67.2% female, 52.0% non-Hispanic White, 21.5% non-Hispanic Black) followed for 3.7-3.9 years, EE, compared with nonuse, was not significantly associated with hypertension (aHR 1.01[95%CI 0.83-1.23]), T2DM (0.88[0.66-1.16]), ASCVD (1.05[0.59-1.86]), or HF (0.82[0.47-1.41]), but was significantly associated with COPD (2.29[1.42-3.71]). Among individuals aged 30-70 years, EE was significantly associated with hypertension (1.39[1.09-1.77]). ECC and DU were strongly associated with all outcomes with DU having higher point estimates but overlapping confidence intervals for all outcomes except ASCVD (2.18[1.82-2.62]). We demonstrated significant longitudinal association between exclusive e-cigarette use and COPD, and hypertension only among individuals aged 30-70 years. ECC and DU were strongly associated with all conditions, with dual use potentially associated with higher ASCVD risk. These findings highlight some potential risks of e-cigarette use and provide context to inform advisories and regulatory policies on novel products on their health risks. These findings help to clarify the potential risks associated with e-cigarette use. Understanding these risks can aid the FDA in developing regulatory frameworks for tobacco products.