E-cigarettes Research Articles

Smoking cessation medicines and e-cigarettes in smokers with obesity

Abstract Purpose The interaction between obesity and smoking is complex. Aim of this study is to compare the abstinence rates of smoking cessation pharmacotherapies vs electronic cigarettes in obese smokers. Methods 57 obese smokers (aged 41±8 years, BMI: 33.8 ±2.4 Kg/m2) visiting our unit from January 2016 to November 2022 were randomized into three smoking cessation therapy groups: 1. NRT (nicotine patch), 2. NRT + bupropion (NRT+bupr) and 3. Electronic cigarette (EC). Results There were not significant differences in severity of nicotine dependence and cigarette consumption (pack-years) between the three treatment groups. Furthermore, the three groups had similar age and prevalence of traditional risk factors. At the end of treatment period (3 months), 5/19 (26 %) and 9/19 (47%) of subjects under therapy with NRT alone and NRT + bupropion combination respectively, were abstinent from smoking while 10/19 (53%) of individuals using EC did not smoke combustible cigarettes. Left plot shows the continuous abstinence rates at 6 months. Continuous abstinence rates were similar in the NRT and NRT+bupropion group at 6 months compared to 3 months (end of treatment), while 8/19 (42%) of individuals using EC did not smoke. Interestingly , at 6 months among users of EC 6 continued vaping nicotine alone, 7 continued to smoke tobacco cigarettes while vaping and 4 continued smoking cigarettes alone. Nevertheless only 2 out of 19 participants in that group stayed abstinent from both combustible cigarette smoking and vaping. Blood pressure remained unchanged in all groups while weight decreased in the group treated with the combination of bupropion and NRT compared to NRT alone and EC groups (right plot, P<0.01). Conclusions Our preliminary data indicate that continuous abstinence rates at 6 months were higher in obese smokers receiving NRT+bupropion combination therapy compared to those of individuals who used NRT alone. There is also a low abstinence rate of both cigarette smoking and vaping among individuals using EC as an aid for smoking cessation. The NRT+bupropion combination therapy was associated with a favorable effect on weight change in obese smokers.EC vs pharmacotherapy in obese smokers

Differential effects of heat-not-burn, electronic cigarettes and conventional cigarettes on endothelial glycocalyx

Abstract Background Heat-not-burn cigarette (HNBC) and electronic cigarette (Ecig) constitute non-combustible smoke products. Their effect on endothelial glycocalyx has not been investigated so far. Patients and Methods: Out of 100 subjects attending smoking cessation clinic: α) 50 smokers were randomized to usage of HNBC (n=25) or Ecig (n=25) and β) 50 smokers were used as control group. Participants randomized to the newer tobacco products had similar clinical and demographic characteristics to the control group. Smoking status was verified by measuring the concentration of exhaled carbon monoxide [(e CO) (ppm), Bedfont Scientific, Maidstone, Kent UK]. Perfused Boundary Region (PBR), which is inversely related to endothelial glycocalyx thickness in sublingual arterioles (range 5–25 μm) and blood levels of cotinine, a stable metabolite of nicotine, was assessed in all participants. Exhaled CO, endothelial glycocalyx, and blood cotinine were assessed at baseline and after 1 month. Results Conventional cigarette smokers were aged: 48 ± 5 years, 53% female and used 27 ± 9 cigarettes/day, 29 ± 9 pack-years. HNBC users were aged: 46 ± 14 years, 55% female and used 26 ± 8 cigarettes/day, 30 ± 8 pack-years. Ecig users were aged: 45 ± 8 years, 51% female and used 27 ± 10 cigarettes/day, 28 ± 10 pack-years. Compared to baseline, switching to HNBC for 1 month improved only PBR20-25 (2.55±0.49 vs 2.34±0.34 μm, p=0.002). Ecig use did not alter endothelial glycocalyx in any range of microvessels throughout the study (p>0.05). In contrast, Tcig smoking for one month further worsened endothelial glycocalyx in all microvessels ranges compared to baseline (p<0.05). Blood cotinine levels were similar at baseline and after 1 month using HNBC (p=0.432), Ecig (p=0.535) or conventional cigarette (p=0.489). Compared to baseline, exhaled CO decreased in HNBC or Ecig users (mean percent change: -55% and -58% respectively p<0.001), while remained unchanged in Tcig smokers (p=0.312) at 1 month. Thus, Tcig smokers had higher CO than those who switched to HNBC or E-cig after one month (p<0.01). Conclusion Conventional cigarette users further worsened endothelial glycocalyx after continuing to smoke for one month. In contrast, smokers who switched to Ecig maintained glycocalyx integrity, while those who switched to HNBC showed modest improvement in glycocalyx integrity in microvessels ranging from 20 to 25 μm. Cotinine levels, which reflect nicotine exposure, were similar between the Tcig, HNBC and Ecig groups. Thus, endothelial glycocalyx impairment in the conventional cigarette group was independent of nicotine consumption and possibly related to greater exposure to toxic emissions, such as CO, after Tcig use than after switching to HNBC or Ecig.

Discrete Choice Experiment on Financial Incentives for Engaging Young Adults in Vaping Cessation Programs

Introduction Contingency management involves rewarding individuals based on objective evidence of behavioral changes. This study explores preferences for financial incentives in vaping cessation programs. Methods A discrete choice experiment (DCE) was conducted among young adult current e-cigarette users aged 19-29. DCE attributes (and levels) included reward amount ($100, $300), reward schedule (consistent value, escalating value), reward procedure (gain-framed, loss-framed), vaping education modules (yes, no), text messaging support (yes, no), and cost ($30, $100). Participants were randomized into one of the four blocks, each containing four choice sets. Each choice set presented two hypothetical vaping cessation programs. Choice data (n × choice sets × alternative programs = 154 × 4 × 2 = 1,232 observations) were analyzed using generalized estimation equation models. Results Participants showed a preference for vaping cessation programs offering a higher reward amount (odds ratio [OR] = 11.5; 95% CI,7.0-19.2), gain-framed rewards for sustained abstinence (OR = 1.4; 95% CI,1.0-1.8), text messaging support (OR = 1.9; 95% CI,1.4-2.5), and a lower program cost (OR = 2.6; 95% CI,1.8-3.8). Interaction tests showed significant effects of the rewards procedure among daily e-cigarette users (adjusted OR [AOR] = 2.1; 95% CI,1.3-3.5), but not some-day users; and among those with no quit attempts in the past six months (AOR = 2.7; 95% CI,1.5-4.7), but not those with previous quit attempts. Female participants preferred text messaging support (AOR = 3.6; 95% CI,2.3-5.4), whereas male participants did not show this preference. Conclusion A multifaceted vaping cessation intervention augmented with financial incentives might improve participation and engagement among young adults. Future studies should investigate how these attributes can enhance program reach and vaping abstinence outcomes in real-world settings.

Depressive symptoms among medical students

Abstract Background Adolescence is a period of psychological development which is associated with an increased risk of developing mental health disorders. Medical students have a higher prevalence of depression compared to the general population, but they are given low priority in the healthcare system. The aim of this study was to examine the prevalence of clinically significant scores on the Patient Health Questionnaire 9 (PHQ-9), and factors associated with clinically significant scores. Methods The research was conducted through a cross-sectional study among fifth-year medical students, using a 95-item questionnaire anonymously filled out. The questionnaire examined: socio-demographic and socio-economic characteristics of the students; students’ lifestyles (including alcohol consumption, binge drinking, smoking cigarettes, electronic cigarettes, use any of other tobacco products); Patient Health Questionnaire (PHQ-9); International Physical Activity Questionnaire (IPAQ); Zung’s Anxiety Scale; and Problematic Internet Use Scale. Based on the score on PHQ-9, the participants were classified in two groups: with clinically significant scores (score ≥10) and without clinically significant scores (score <10). Results The study included 461 medical students who completed the PHQ-9. Average score on PHQ-9 scale was 5.25±4.53 and total of 66 students (14.3%) had the PHQ-9 indicative of clinically significant depressive symptoms (PHQ-9 ≥10). The clinically significant depression was associated with smoking of any tobacco product (OR:3.02, 95% CI: 1.37-6.63), score on social support scale (0.94, 95% CI: 0.90-0.98), age (OR: 1.42, 95% CI: 1.06-1.90) and score on Zung anxiety scale (OR: 1.15, 95% CI: 1.16-1.34). Conclusions Considering that medical students, are at higher risk of developing clinically significant symptoms of depression, it is crucial to form psychological and social support programs. Key messages • Monitoring the mental health of young individuals holds significant importance. • It is crucial to detect risk factors in time and develop prevention programs.

Prevalence of E-Cigarettes in Children and Adolescents: A Failure of Public Health Prevention

The rising prevalence of e-cigarette use among children and adolescents poses a significant challenge to public health prevention efforts. As these electronic nicotine delivery systems gain popularity among youth, concerns about the health impacts and long-term consequences have escalated. In this article, we delve into the concerning trends of e-cigarette use among the younger population, exploring the factors driving this phenomenon and evaluating the failures in current public health prevention strategies. By examining the regulatory gaps in e-cigarette marketing to the youth and proposing interventions to combat this growing issue, we aim to shed light on the urgent need for stronger policies and enforcement mechanisms to protect the health and well-being of our youth.

Effects of Maternal Electronic Cigarette Smoking vs Tobacco Cigarette Smoking on Fetal Lung Development: A Narrative Review

Effects of Maternal Electronic Cigarette Smoking vs Tobacco Cigarette Smoking on Fetal Lung Development: A Narrative Review

Rapid Untargeted Puff‐by‐Puff Analysis of (Electronic) Cigarette Emissions by Concentric Dielectric Barrier Discharge Ionisation Mass Spectrometry

Despite the soaring popularity of e‐cigarettes among teenagers and young adults, our understanding of the full extent of their health hazards have remained limited. This is due to the vast complexities of e‐cigarette aerosols and the difficulty in their full characterisation. Conventional mass spectrometry methods of e‐cigarette analysis, though pioneering in driving political and medical discourse, have been limited in their capabilities to uncover all compounds in its emissions due to prominent limitations in experimental setup. To overcome this major hurdle, we have developed a setup for puff‐by‐puff analysis of electronic and conventional cigarette emissions by concentric dielectric barrier discharge ionisation mass spectrometry. In this pilot study, the simple setup of in‐line dilution and high‐resolution mass spectrometry analysis allowed us to directly uncover 225 compounds in e‐cigarette puffs across a wide spectrum of chemical characteristics in two sequential 5‐minute runs. These include acids, carbonyls, aromatic cyclics, heterocyclics, unsaturated and saturated hydrocarbons, alcohols, esters, alkaloids, sulfur‐containing compounds, oxides, and nitriles. As a result, our setup provided a significant improvement in rapid compound identification, and demonstrated a much broader chemical landscape in e‐cigarette emissions than previously reported.

Association of Use of Menthol- Versus Tobacco-Flavored ENDS with Switching Completely Away from Cigarettes and Differences by Menthol Cigarette Smoking

Introduction Menthol cigarettes and menthol-flavored electronic nicotine delivery systems (ENDS) are a current focus of US regulatory policy considerations. Informed policy requires understanding how ENDS flavor may influence smoking behavior, and whether this association varies by preferred cigarette flavor. Materials and methods The analytic sample included 8,428 US adults who smoked cigarettes (AWS) in the Adult JUUL Switching and Smoking Trajectories Study and used tobacco- or menthol-flavored JUUL products. Repeated-measures logistic regressions assessed the time-varying association between primary JUUL flavor (menthol vs. tobacco) and switching (no past-30-day smoking) across four follow-ups in year 2 of the study, adjusting for sociodemographics and baseline smoking history. Analyses also examined interactions with cigarette flavor preference (menthol vs. non-menthol). Results AWS smoking menthol cigarettes predominantly used menthol-flavored JUUL (∼70% of follow-ups) and had significantly higher switch rates (aOR[95%CI] = 1.30[1.09–1.55]). AWS primarily using menthol-flavored (vs. tobacco-flavored) JUUL had higher odds of switching (aOR = 1.24[1.08–1.43]). The association varied by preferred cigarette flavor: AWS who smoked non-menthol cigarettes had higher odds of switching when using menthol- (vs. tobacco-flavored) JUUL aOR = 1.21[1.05–1.40]). Among AWS who smoked menthol cigarettes, the difference in switching was not significant, but trended in the opposite direction (aOR = 0.94[0.79–1.11] for menthol- vs. tobacco-flavored JUUL). More generally, AWS who used cigarette-incongruent JUUL flavors (especially non-menthol cigarettes and Menthol-flavored JUUL) had higher odds of switching (aOR = 1.16[1.04–1.29]). Discussion Some menthol-flavored ENDS may promote complete switching beyond that facilitated by tobacco-flavored ENDS. Cigarette-incongruent ENDS flavors, especially menthol-flavored ENDS among people who smoke non-menthol cigarettes, may facilitate increased switching.

Association of food insecurity with the use of tobacco products and urine cotinine-measured smoking intensity: evidence from a population-based study in South Korea, 2019–2021

IntroductionThis study explored the association between food insecurity and tobacco product use and urine cotinine-measured smoking intensity.MethodsThis cross-sectional study included 13 705 adults representative of the Korean population. The 18-item...

Sex- and age-dependent impacts of nicotine and ethanol binge drinking on the brain: Insights from preclinical research.

Electronic cigarette use among adolescents is a growing concern, not only due to the high incidence of co-use with other substances, such as alcohol, but also due to the fact brain is still maturing during this period. Combined exposure to alcohol and nicotine leads to plastic adaptation of crucial circuits in the brain, which can contribute to the development of addiction. It is well established that nicotine exposure can facilitate alcohol binge drinking, and vice-versa, in a sex-, age- and exposure-dependent manner. Nonetheless, the central mechanisms underlying the synergistic relationship between these two substances and the emergence of differential behavioural traits dependent on these factors remain underexplored. Preclinical studies continue to provide valuable insights into such mechanisms. Here, we discuss recent preclinical findings that report behavioural changes characteristic of addiction following nicotine consumption, primarily in models of vaping and alcohol use; and insights into the neural mechanisms impacted by intake of these two substances, with a focus on the adolescent brain.

Use of E-Cigarette, Traditional Cigarettes, and C-Reactive Protein: The Cross Cohort Collaboration

This cross-sectional study included 18,797 participants from six longitudinal cohorts (CARDIA, FHS Gen III, HCHS/SOL, MESA, MiHeart, and REGARDS). 5,806 of them were with high-sensitivity C-reactive protein (hs-CRP) measurements. We found that among exclusive electronic cigarette (EC) use was associated with significantly lower high-sensitivity C-reactive protein (hs-CRP) levels compared to exclusive combustible cigarette use, suggesting a potentially lower inflammatory burden. hs-CRP levels in dual users and former smokers currently using EC were comparable to those observed in exclusive cigarette smokers. In contrast, individuals who exclusively used ECs showed no significant difference in hs-CRP levels compared to never smokers. These findings have important implications for tobacco regulation, public health, and clinical practice, highlighting the need for continued monitoring of EC-related health impacts.

01 Vaping, mental and physical health in adolescents in a COMPASS-Quebec cohort

Abstract Background Better knowledge of the association between vaping and youth’s health would help raise awareness among adolescents, parents, professionals and decision-makers on the likely threat it represents. Objectives Our objective is to examine the association between vaping, its frequency, and adolescent health. Design/Methods This observational study is based on data from the 2022-23 survey round of COMPASS-Quebec school cohorts through self-reported measures. It includes 45,203 respondents aged from 12 to 18 years old from 99 schools of Eastern Quebec. A four-modality variable depicts the vaping frequency in the last twelve months (abstinence, < once/month, ≥ once/month, ≥ once/week, daily). The measurement of health states is based on 5 dichotomous indicators: (i) good vs poor physical health (excellent, very good, good, vs fair, poor), (ii) maximum oxygen consumption considered at risk for health vs not (estimated VO2max, calculated using Léger’s equation); (iii) good vs poor mental health (excellent, very good, good, vs fair, poor); (iv) the presence vs absence of moderate to severe anxiety (GAD7, score ≥10/30) and; (v) the presence vs absence of significant depressive symptoms (CESD-R, score ≥10/21). Sex, age and family material deprivation level are taken into account as confounding factors. Results The proportion of adolescents who have vaped in the last 12 months is 26.8%. After adjustment, daily vaping is associated with poor physical health, a VO2max considered at risk for health, poor mental health, moderate to severe anxiety and significant depressive symptoms, compared to abstinence (adjusted relative risk [aRR] 2,46 [95%CI: 2,05-2,88]; 1,66 [95%CI: 1,44-1,89]; 1,88 [95%CI: 1,66-2,11]; 1,75 [95%CI: 1,53-1,97]; 1,55 [95%CI: 1,40-1,70]). A gradient in the associations between vaping frequency and lower mental health indicators has been observed. Adolescents who have vaped <once/month, ≥once/month, ≥once/week and daily have more risk of presenting moderate to severe anxiety (aRR 1,21 [95%CI: 1,09-1,33]; 1,44 [95%CI: 1,27-1,61]; 1,54 [95%CI: 1,37-1,72]; 1,75 [95%CI: 1,53-1,97]). Regarding significant depressive symptoms, aRR are 1,23 [95%CI: 1,14-1,32], 1,39 [95%CI: 1,27-1,51], 1,49 [95%CI: 1,36-1,62], 1,55 [95%CI: 1,40-1,70]. Regarding poor mental health, aRR are 1,29 [95%CI: 1,17-1,42], 1,61 [95%CI : 1,43-1,79], 1,63 [95%CI : 1,45-1,81], 1,88 [95%CI: 1,66-2,11]. Conclusion This study suggests a consistent association between health, both physical and mental, and use of electronic cigarettes in adolescents. Longitudinal studies would help clarify possible causal influence of vaping on youth's health.

Assessing the reach and engagement of three anti-vaping messages on Facebook Targeting Australian Youth: a protocol for a randomised trial

BackgroundVaping among 18-24-year-old Australians has increased from 5.8% in 2019 to 21% in 2023. This protocol describes a trial to investigate the dissemination and engagement achieved by three anti-vaping messages on Facebook.MethodsThis research employs a 3-arm randomised experimental design. Three distinct anti-vaping messages will be disseminated via Facebook using Meta Ads Manager. Each arm has a message that focuses on either health risks, environmental impact, or anti-vape industry sentiment. The campaign will run for three months. The primary outcome is the engagement rate as a measure of the effectiveness of anti-vaping message, and the secondary outcomes include network indicators: size, density, centralisation, and centrality to evaluate the extent to which the messages are disseminated. Participants will be randomly exposed to one of the three messages. Data on reach and engagement will be compared across the groups.DiscussionThis study will provide insights into the dissemination of social media-based anti-vaping campaigns. By evaluating engagement rates and network indicators, the research aims to identify which message themes engage most with young Australians. The findings will contribute to the development of more effective public health strategies for vaping cessation and prevention among youth.Trial RegistrationThe study was registered on July 19th 2024 with the Australian New Zealand Clinical Trials Registry (ACTRN12624000885594).

Desires and Needs for Quitting Both e-Cigarettes and Cigarettes Among Young Adults: Formative Qualitative Study Informing the Development of a Smartphone Intervention for Dual Tobacco Cessation.

Dual use of both e-cigarettes and cigarettes is popular among young adults and may lead to greater nicotine dependence and additive adverse health effects than single-product use. However, existing cessation programs target quitting either e-cigarettes or cigarettes, highlighting a need for interventions to help young adults quit both products (ie, dual tobacco cessation). This formative study is part of a larger project to develop a smartphone intervention for dual tobacco cessation among young adults. This study aimed to (1) explore desires for and experiences with quitting both e-cigarettes and cigarettes and (2) identify needs and preferences for dual tobacco cessation intervention programming. Semistructured interviews were conducted to elicit the need for and experience with dual tobacco cessation among 14 young adults (18-29 years old) recruited through Instagram (Meta) advertisements in 2023. We conducted a thematic analysis to identify common themes related to quitting experiences and cessation needs. Participants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly "cold turkey." The priority product for quitting first varied by the individual's perceived harm or level of consumption. Targets for dual tobacco cessation interventions included (1) highlighting the health effects of dual tobacco use compared with single product use, (2) providing cessation support to quit one prioritized product while cutting down the other product with the explicit goal to quit both, (3) emphasizing unique facilitators and barriers to quitting each product (eg, unpleasant smell of cigarettes facilitating smoking cessation and accessibility and flavors of e-cigarettes hindering vaping cessation), and (4) addressing co-use of tobacco with alcohol or cannabis. Participants wanted personalized interventions through smartphone apps that would tailor support to their tobacco use patterns and unique quitting goals and needs. They also suggested presenting intervention content in multimedia (eg, videos, graphic pictures, quizzes, and games) to increase engagement. This study provides important insights into young adults' experiences, needs, and preferences for dual tobacco product cessation. We highlight important targets for future smartphone apps to deliver personalized and tailored support to meet the heterogeneous needs and preferences of young people who want to quit using both e-cigarettes and cigarettes.

Co-existing ambient fine particulate matter exacerbated electronic cigarette toxicity on human respiratory cells.

Respiratory co-exposure to ambient PM2.5 and electronic cigarettes (e-cigarettes) frequently occurs in public. However, the combined effects on human respiratory health have not been well documented. To discuss potential co-effects and possible biological mechanisms, A549/THP-1 co-cultures and BEAS-2B cells were exposed to unvapedtobacco or mint-flavored e-liquids (0-7.2% v/v), e-cigarette aerosol extract (ECE, 0-50% v/v), PM2.5 (60 μg/mL), or PM2.5 + ECE for 24 h. Cell viability assessments on e-liquids, ECE, PM2.5 + ECE showed that the mint flavor exhibited higher cytotoxicity compared to the tobacco flavor in both A549/THP-1 and BEAS-2B. However, the influence of flavors on ROS levels and mRNA expression of inflammatory markers (IL-6, TNF-α, IL-8, IL-1β) after ECE exposure demonstrated inconsistency in the two cell models. PM2.5 + ECE treatment notably elevated ROS production and inflammation responses compared to ECE alone exposure. Only co-exposure induced a significant increase in nuclear transcription factor-κB p65 (NF-κB p65) and NOD-like receptor 3 (NLRP3) protein expression regardless of flavors. Our results indicate that PM2.5-treated cells exacerbate the adverse effects induced by ECE in both A549/THP-1 and BEAS-2B cells. Flavors in unvaped e-liquids affect cytotoxicity, oxidative stress and inflammation response, but these effects vary depending on the vaping process and the specific cell line.

Prognosis after switching to electronic cigarettes following percutaneous coronary intervention: a Korean nationwide study.

Despite the increasing popularity of electronic cigarettes (E-cigarettes), the prognostic impact of switching to E-cigarettes in smokers with coronary artery disease who have undergone percutaneous coronary intervention (PCI) remains unclear. Using a nationwide cohort from the Korean National Health Insurance database, 17 973 adults (≥20 years) identified as smokers (based on a health screening examination within 3 years before PCI) who underwent health screening within 3 years after PCI were enrolled to determine changes in smoking habits. Patients were classified as continued combustible cigarette users, successful quitters, or switchers to E-cigarettes. The group switching to E-cigarettes was further divided into dual users (using both combustible and E-cigarettes) and those exclusively using E-cigarettes. Primary outcomes included major adverse cardiac events (MACEs), a composite of all-cause death, spontaneous myocardial infarction, and repeat revascularization. Among the total population, 8951 patients (49.8%) continued using combustible cigarettes, 1694 (9.4%) were switched to E-cigarettes, and 7328 (40.7%) successfully quit smoking after PCI. During a median follow-up of 2.4 years, the cumulative incidence of MACE was lower among E-cigarette switchers (10%) or quitters (13.4%) than among continued combustible cigarette users (17%). When continued combustible cigarette users were used as the reference, the multivariable-adjusted hazard ratios with 95% confidence intervals for MACE were 0.82 (0.69-0.98) for switchers to E-cigarettes and 0.87 (0.79-0.96) for successful quitters. Compared with dual users, entirely switching to E-cigarettes was associated with a significantly lower MACE risk (hazard ratio 0.71; 95% confidence interval 0.51-0.99). Among smokers who underwent PCI for coronary artery disease, switching to E-cigarette use (particularly complete transition) or quitting smoking was associated with reduced MACE risk than with continued combustible cigarette use. ClinicalTrials.gov NCT06338761.

A comprehensive content analysis of 104 Chinese electronic cigarette manufacturing enterprise official websites

ObjectiveThe goal was to analyse website content of Chinese electronic (e) cigarette manufacturing enterprises and understand the marketing strategies to provide evidence for decision-makers to regulate manufacturers.MethodsThrough QCC.com, one of...

Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies

ObjectiveTo systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation.Data source and study selectionFour databases...

Best practices for expansion of smoke-free and aerosol-free environments in Europe: Protocol for the consultation to experts.

Smoke-free legislation has been shown to positively impact reducing secondhand smoke (SHS) exposure, especially in countries that have implemented comprehensive legislation rather than partial bans. Also, secondhand aerosols (SHA) that come from the heating of tobacco or liquids, with or without nicotine, in electronic nicotine delivery systems (ENDS) have been proven to increase levels of harmful substances in the air. Therefore, protection against SHS and SHA exposure and expansion of smoke- and aerosol-free environments (SAFE) should be taken into account when creating or trying to expand or enforce clean air policies. This article aims to present the protocol for a consultation with experts on tobacco and nicotine control in order to identify best practices, barriers, and opportunities for the expansion of SAFE in Europe. We identified experts among policymakers, researchers, and tobacco regulators in European countries and invited them to participate in the consultation by completing an online survey designed, programmed, and pilot-tested using Survey Monkey. The responses to the questionnaire contained quantitative and qualitative information that was thematically analyzed. The experts' consultation allowed us to produce a report on barriers and opportunities for SAFE, a report and a position paper on SAFE best practices, a web-based repository of best practices, and a weight of evidence paper that assembles evidence supporting the expansion of SAFE on indoor and outdoor spaces.

E-Cigarettes in Smoking Cessation and Harm Reduction: A Comprehensive Review of Recent Evidence and Potential Risks

The global prevalence of tobacco use has significantly decreased over the years, with projections indicating further decline. However, the rise of new nicotine products suggests that nicotine addiction will remain a major public health issue. Electronic cigarettes (e-cigarettes) are increasingly recognized as potential tools for smoking cessation and harm reduction. This review evaluates the safety and effectiveness of e-cigarettes both as standalone treatments and in combination with other therapies, such as nicotine replacement therapy (NRT), varenicline, cytisine, and behavioral approaches. A comprehensive analysis of studies published over the past decade, including systematic reviews, meta-analyses, and randomized controlled trials, shows that e-cigarettes can enhance smoking cessation rates and reduce tobacco-related harm. They exhibit comparable short-term efficacy to traditional treatments, with promising results in alleviating withdrawal symptoms and lowering smoking rates. However, the long-term safety and effectiveness of combining e-cigarettes with other therapies remain uncertain and require further investigation. Despite their potential benefits, e-cigarettes pose significant safety concerns, underscoring the need for ongoing research to refine cessation strategies and ensure their safe, long-term use. Rigorous evaluation and regulatory oversight are essential to optimize e-cigarettes' role in reducing tobacco harm.