Use Of Nicotine Products Research Articles

Mental Health Modulates Associations Between Institutional Belonging and Substance Use Risk.

The present study aimed to characterize profiles of mental health, incorporating indicators of both psychopathology and well-being, among college students and determine whether institutional belonging differentially relates to past-month substance use by mental health profile. Students (N = 4,018; 59.5% female, 74.7% White) completed a survey regarding mental health (i.e., anxiety symptoms, depressive symptoms, stress, flourishing, academic confidence), institutional belonging, and whether they had engaged in any binge drinking of alcohol and use of cannabis and nicotine products, including nicotine vaping, over the past month. Latent profile analyses indicated five profiles of mental health with differing levels of psychopathology and well-being. Greater institutional belonging was only related to higher odds of binge drinking among students in profiles characterized by average or high well-being, irrespective of psychopathology. Among students with overall poor mental health, higher institutional belonging was related to higher odds of nicotine use. Results were generally invariant to campus and year in college. Our findings highlight that both positive and negative aspects of mental health should be considered when assessing college students' substance use. Greater institutional belonging may incur risk for substance use differentially by mental health, with respect to binge drinking for those with high levels of positive well-being and nonvaping nicotine use for those with overall poor mental health. Because associations emerged between belonging and substance use risk, institutions could consider implementing or raising awareness of alcohol-free, inclusive activities to ensure that students can feel a sense of belonging while abstaining from drinking.

Nicotine Pouch and E-Cigarette Use and Co-Use Among US Youths in 2023 and 2024

The market sector of flavored commercial nicotine products without tobacco leaves recently expanded to nicotine pouches. Comprehensive epidemiologic analyses of patterns and trends in youth use of commercial nontobacco nicotine products are lacking. To estimate US youth nicotine pouch and e-cigarette use prevalence and associated sociodemographic variables in 2023 and 2024. This cross-sectional study used data from annual surveys conducted in school with a nationally representative sample of 10th and 12th graders in 2023 and 2024 as part of the Monitoring the Future Study. Self-reported sex, race, ethnicity, and college plans; survey year; grade; and population density. The primary outcomes were lifetime, past-12-month, and past-30-day self-reported nicotine pouch (yes or no) and e-cigarette (yes or no) use and co-use patterns (exclusive pouch without e-cigarettes, exclusive e-cigarette without pouches, or dual use). Of the 10 146 study participants (4886 [48.2%] male and 4818 [47.3%] female; 5674 [51.6%] in 10th grade and 4472 [48.4%] in 12th grade), nicotine pouch use increased from 2023 vs 2024 for lifetime use (3.0% [95% CI, 2.3%-4.0%] vs 5.4% [95% CI, 4.2%-6.8%]; risk difference [RD], 2.3% [95% CI, 1.0%-3.6%]; risk ratio [RR], 1.76 [95% CI, 1.30-2.40]), use in the past 12 months (2.4% [95% CI, 1.7%-3.2%] vs 4.6% [95% CI, 3.5%-5.9%]; RD, 2.2% [95% CI, 1.0%-3.4%]; RR, 1.95 [95% CI, 1.39-2.74]), and use in the past 30 days (1.3% [95% CI, 0.8%-1.8%] vs 2.6% [95% CI, 1.9%-3.4%]; RD, 1.3% [95% CI, 0.5%-2.1%]; RR, 2.05 [95% CI, 1.33-3.16]). E-cigarette use did not significantly change from 2023 to 2024 for lifetime use (28.5% [95% CI, 26.3%-30.7%] vs 26.7% [95% CI, 24.3%-29.3%]) and past-30-day use (13.4% [95% CI, 11.8%-15.2%] vs 11.8% [95% CI, 10.2%-13.7%]) but decreased for past-12-month use (20.0% [95% CI, 18.1%-22.0%] vs 17.6% [95% CI, 15.7%-19.7%]). From 2023 to 2024, exclusive nicotine pouch and pouch plus e-cigarette dual use generally increased, whereas exclusive e-cigarette use decreased, collectively constituting no significant change in the prevalence of any nontobacco nicotine use (using 1 or both products) across years. Demographic comparisons collapsed across 2023 to 2024 found that (1) male individuals reported higher nicotine pouch use prevalence than female individuals, whereas female individuals reported higher e-cigarette use prevalence than male individuals; (2) rural vs urban and non-Hispanic White vs Hispanic youths were more likely to use each product, with larger differences for pouches than e-cigarettes; and (3) nicotine pouch and e-cigarette use prevalence was higher among 12th vs 10th graders and those without vs with 4-year college plans. In this cross-sectional study, commercial nontobacco nicotine use in US 10th and 12th graders shifted from 2023 to 2024, marked by a doubling in nicotine pouch past-30-day use, an increase in pouch plus e-cigarette dual use, and a decrease in exclusive e-cigarette use. Prioritizing surveillance, regulation, and prevention addressing pediatric nicotine pouch use warrants consideration.

Co-use of smokeless nicotine products and marijuana among youth in Denmark: a cross-sectional population-based study.

Previous research suggests a gateway effect between the use of nicotine products and other harmful drugs, such as marijuana. As the use of smokeless nicotine products among youth in Denmark has been increasing, we aimed to identify factors associated with marijuana use and examined the co-use of smokeless nicotine products and marijuana among Danish youth. We used data from a cross-sectional Danish nationwide questionnaire-based survey among 15- to 29-year-olds conducted in 2022. Overall, 6236 were included in the analyses. Multiple logistic regression analyses were carried out to assess associations between use of smokeless nicotine products and marijuana ever-use and frequent use (⩾10 times). A multiple multinomial logistic regression analysis tested whether the association varied across the frequency of marijuana use. A total of 41.9% had ever used marijuana, of which 38.6% reported frequent use. Factors associated with marijuana use were current use of other nicotine products, being male, having medium- or long-cycle higher education without a current occupation, excessive binge drinking, and living in the Capital Region. Youth who used smokeless nicotine products had markedly higher odds of ever using marijuana (aOR: 4.13, 95%CI[3.3, 5.05]). Among respondents who had ever used marijuana, use of smokeless nicotine products was associated with frequent marijuana use (aOR: 1.73, 95%CI[1.39, 2.15]). This study found a significant co-use of smokeless nicotine products and marijuana in terms of both marijuana ever-use and frequent marijuana use. This highlights the potential additive consequences of the increasing use of smokeless nicotine products, which calls for preventive actions targeting youth.

Attitudes towards the use of nicotine products among vocational school students in Finland

Abstract Background Young people’s use of nicotine products is a global challenge, and it is changing over time. Young people in Finnish vocational education smoke cigarettes more often and rate their health more poorly than other upper-secondary students. The data for this study was collected in November 2020. The study aimed to investigate behaviours, attitudes and opinions about nicotine products among 15–28-year-old Finnish vocational students. Methods An electronic questionnaire survey was distributed to and collected from 449 students. The survey data was analysed with SPSS which categorised the participants into nicotine product non-users and users. A factor analysis was done, and the result was a six-factor model with six themes. Results Non-users and users had similar attitudes and impressions towards nicotine product. However, non-users disagreed more with the theme “social norms and feelings of pleasure from nicotine products” than the users (p < 0.001). The non-users disagreed more often with the theme of the nicotine appearance of nicotine products than the users did (p < 0.001). As regards the theme “use of nicotine products impacts appearance” the users strongly disagreed more often with this theme than non-users (p < 0.001). Most participants in both groups considered non-smoking fashionable. Conclusion Our findings suggest that understanding young people’s behaviour and attitudes towards nicotine products is important for protecting young people’s health. The connections between young people’s attitudes, their use or non-use of nicotine products, and everyday life trends are complex and time-bound. More research using multiple methods is needed to clarify the phenomenon.

Use of nicotine products and withdrawal support among personnel of the Finnish Defence Forces

IntroductionWhile the health hazards of smoking are well known, the harmful effects of smokeless tobacco (snus) and other nicotine products remain less familiar. This study investigates the prevalence and habits...

Differences in Discrimination, Violence, Mental Health, and Substance Use Outcomes by Cancer History Among LGBTQ+ Individuals in North Carolina

BACKGROUND Health inequities among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority populations (LGBTQ+) are driven by anti-LGBTQ+ stigma and discrimination. However, there is limited research on the manifestations of stigma and discrimination among LGBTQ+ cancer survivors. METHODS Data were collected by the North Carolina Department of Health and Human Services via the 2023 North Carolina LGBTQ+ Health Needs Assessment. Differences in outcomes (i.e., discrimination, violence, homelessness, mental health, substance use, and overdose) between LGBTQ+ individuals by cancer history were assessed using Chi-squared tests. Further, multivariable logit models were used to generate predicted probabilities, average marginal effects (AME), and 95% confidence intervals (CI) of the association of cancer with each outcome. RESULTS A total of N = 3170 LGBTQ+ individuals (n = 200 cancer survivors) took part in the survey. In adjusted analyses, cancer history was associated with an 8.1 to 19.1 percentage point increase in the probability of all discrimination, violence, and homelessness outcomes. The largest AME of cancer was with accidental overdose (AME: 22.5; 95% CI, 15.2–29.8), followed by homelessness (AME: 19.1; 95% CI, 11.6–26.6), spouse or family violence (AME: 16.7; 95% CI, 9.3–24.1), LGBTQ+ violence (AME: 15.1; 95% CI, 7.8–22.5), sexual assault (AME: 14.1; 95% CI, 6.0–22.2), as well as nicotine product (AME: 9.0; 95%CI, 1.6–16.5) and cocaine use (AME: 8.9; 95% CI, 3.8–14.1). The most common barriers to mental health services were cost (36.0%) and health insurance (33.5%). LIMITATIONS The needs assessment was a convenience-based study, which limits the generalizability of our findings. CONCLUSIONS LGBTQ+ cancer survivors in North Carolina experience an elevated burden of discrimination, violence, suicide attempt, substance use, and accidental overdose in comparison to LGBTQ+ individuals without a cancer history.

The UK Tobacco and Vapes Bill (2023/4): framing strategies used by tobacco and nicotine industry actors faced with an endgame policy (a generational sales ban of tobacco products) and nicotine product restrictions

BackgroundIn 2023, the UK government proposed a Bill introducing a generational ban on the sale of tobacco products and measures targeting youth nicotine product (NP) use. Industries’ responses remain unexplored.MethodsWe...

Impact of nicotine product use on outcomes of patients receiving cervical disc arthroplasty: a propensity score analysis of the united States nationwide inpatient sample 2005–2020

BackgroundNicotine product use, including cigarette smoking and other nicotine products, is a known risk factor for various health complications. While previous studies have examined its impact on spinal procedures, its specific effects on cervical disc arthroplasty (CDA) remain unclear. This study aims to investigate the association between nicotine product use and inpatient outcomes in patients undergoing CDA.MethodsData from the 2005 to 2020 US Nationwide Inpatient Sample database of hospitalized adults ≥ 18 years old who underwent primary or revision CDA were extracted. Patients were divided into nicotine product users and non-users. Propensity score matching (PSM) was employed to balance the baseline characteristics between the groups. In-hospital mortality, unfavorable discharge, length of stay (LOS), and complications were compared between nicotine product users and non-users through logistic regression analyses.ResultsAfter 1:1 PSM, 5,562 patients were included in the analysis. After adjustment, nicotine product users had a significantly elevated risk of overall complications (adjusted odds ratio [aOR] = 1.37, 95% confidence interval [CI]: 1.13–1.66, p = 0.002) and infection (aOR = 1.74, 95% CI: 1.17–2.58, p = 0.006). No significant association was observed between nicotine product use and the risk of unfavorable discharge or prolonged LOS (both, p > 0.05). In stratified analyses, male, but not female nicotine product users, had a greater risk of infection (aOR = 2.12, 95% CI: 1.22–3.70, p = 0.008). Nicotine product use was significantly associated with higher infection risk among individuals without diabetes, obesity, and chronic pulmonary disease (p < 0.05).ConclusionsNicotine product use is associated with a higher risk of complications following CDA, particularly infections. The study highlights the importance of considering nicotine product use during preoperative assessments and postoperative care for patients undergoing CDA.

Use of nicotine products and tobacco cessation in Swiss primary care: Cross-sectional data from the Sentinella network.

Use of nicotine products and tobacco cessation in Swiss primary care: Cross-sectional data from the Sentinella network.

Analysis of Federal Legislation on Protection of Citizens from Exposure to Secondhand Tobacco Smoke and Consequences of Tobacco or Nicotine Product Use

Analysis of Federal Legislation on Protection of Citizens from Exposure to Secondhand Tobacco Smoke and Consequences of Tobacco or Nicotine Product Use

The rodent electronic nicotine delivery system: Apparatus for voluntary nose-only e-cigarette aerosol inhalation.

Tobacco use is the leading cause of death globally and in the United States. After decades of decline, driven by decreases in combusted tobacco use, nicotine product use has increased due to electronic nicotine delivery systems, also known as e-cigarettes or vapes. Preclinical models of nicotine self-administration can serve as important lodestars in the search for effective intervention and prevention tactics. Current variants of the preclinical models have substantial limitations, however. Therefore, we created the rodent electronic nicotine delivery system (RENDS), a novel low-cost nonproprietary nose-only preclinical model of nicotine aerosol self-administration. We confirmed that RENDS sequesters nicotine aerosol in the nose port by measuring fine particulate matter (PM <2.5 microns) generated by e-cigarettes. We also showed that rats robustly self-administer flavored nicotine aerosol, resulting in high blood levels of cotinine (the major nicotine metabolite) and spontaneous somatic withdrawal symptoms. Thus, we provide validation of the operation and function of the RENDS, opening the door to an open-source preclinical aerosol model of nicotine self-administration that is relatively low in cost. Four existing operant chambers can be retrofitted with the RENDS for less than $325/chamber. All RENDS diagrams and plans for custom-designed components are on Open Science Framework (https://osf.io/x2pqf/?view_only=775b55435b8e428f98e6da384ef7889d).

Observational studies of exposure to tobacco and nicotine products: Best practices for maximizing statistical precision and accuracy.

Observational studies of exposure to tobacco and nicotine products: Best practices for maximizing statistical precision and accuracy.

Trends in single and multiple non-combustible nicotine product use: a population study in England.

Non-combustible nicotine products are commonly used and are used alone or in combination. This study aimed to provide up-to-date estimates of the prevalence of single and multiple non-combustible nicotine product use among adults in England in 2023 and to estimate trends between 2013 and 2023. Data were drawn from repeated cross-sectional surveys of adults (≥18y) in England conducted between January 2013 and December 2023. Single non-combustible nicotine product use was defined as current use of one of: nicotine replacement therapy (NRT), e-cigarettes, nicotine pouches, or heated tobacco products. Multiple use was defined as current use of two or more of these products. We used logistic regression to estimate monthly time trends in the prevalence of single and multiple product use across the study period and provided descriptive data by smoking status and sociodemographic characteristics. The proportion of adults using any single non-combustible nicotine product increased non-linearly from 5.4% (95%CI=5.1-5.9) in January 2013 to 14.3% (13.6-15.0) in December 2023. The prevalence of multiple non-combustible nicotine product use was 0.7% (95% CI 0.6-0.9) in January 2013 and stable until 2020 before increasing to 1.4% by December 2023 (95% CI 1.2-1.7). Most single and multiple non-combustible nicotine product users were individuals who currently (44.7% [43.1-47.6] and 70.6% [64.2-76.1], respectively) or had formerly smoked (41.2% [39.1-43.4 and 25.5% [19.4-31.5). Use of non-combustible nicotine products has increased substantially among adults in England over the past decade. While most use only one product, a growing minority (predominantly individuals who currently smoke) use multiple non-combustible nicotine products. Over recent years, the proportion of adults in England reporting single and multiple non-combustible nicotine product use has risen, with the prevalence of single product use almost tripling and multiple product use doubling. It will be important to continue monitoring product use patterns as the market continues to evolve rapidly. There is also a need for further research to understand how different patterns of non-combustible nicotine use may affect people's motivation to stop smoking or success in quitting.

Differences in e-cigarette use behaviors and device and liquid characteristics of U.S. adults by sexual and gender identity.

E-cigarette use behaviors and device and liquid characteristics have addiction, cessation, and health implications. E-cigarettes may exacerbate or reduce existing tobacco and nicotine product disparities by sexual and gender identity. We examine e-cigarette device and liquid characteristics and tobacco and nicotine product use by sexual and gender identity. Data are from the VAPER study (wave 5: Feb-Apr 2023), an online cohort of U.S. adults (≥21 years) using e-cigarettes ≥5 days per week. Participants (n=1186) reported on tobacco and nicotine product use and submitted photos of their most used e-cigarette device and liquid. Rao-Scott Chi-square tests with Bonferroni corrections were used to cross-sectionally assess differences in tobacco and nicotine product use behaviors and e-cigarette device and liquid characteristics by sexual and gender identity. A greater percentage of bisexual women vs. heterosexual and gay men used disposable devices (54% vs. 31% and 19%) and nicotine concentrations ≥20mg/mL (77% vs 59% and 34%). A higher proportion of heterosexual women than men used disposable devices (42% vs 31%). A greater percentage of bisexual (20%) than heterosexual (9%) women never smoked cigarettes (p<0.05). A higher proportion of heterosexual (9.4%) and bisexual (16.4%) men vs. heterosexual women (3%) used nicotine pouches (p<0.05). E-cigarette characteristics, which have implications for addiction, health, and cessation, and tobacco and nicotine product use behaviors vary by sexual and gender identity. Targeted interventions may be needed to alleviate and prevent health disparities. Agencies must consider potential variation in regulatory impacts by sexual and gender identity. This study of adults frequently using e-cigarettes highlights differences in e-cigarette device and liquid characteristics and tobacco and nicotine product use by sexual and gender identity. For example, a greater percentage of bisexual and heterosexual women than heterosexual men used disposable e-cigarette devices. Given the variation in how e-cigarettes and other tobacco and nicotine products are used, researchers and regulators must consider how health outcomes, cessation behaviors, and responses to interventions or regulatory actions associated with e-cigarette use may vary by sexual and gender identity. .

Oral nicotine pouches for cessation or reduction of use of other tobacco or nicotine products.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objectives To evaluate the benefits and harms of oral nicotine pouches when used to help people transition away from combustible tobacco use (smoking) To evaluate the impact of oral nicotine products on the prevalence of combustible tobacco use Secondary objectives To evaluate the benefits and harms of oral nicotine pouches when used to help people transition away from other non-combustible tobacco/commercial nicotine product use To evaluate the impact of oral nicotine products on the prevalence of use of other non-combustible tobacco/commercial nicotine products.

The Rodent Electronic Nicotine Delivery System: Apparatus for Voluntary Nose-Only E-Cigarette Aerosol Inhalation.

Tobacco use is the leading cause of death globally and in the U.S. After decades of decline, driven by decreases in combusted tobacco use, nicotine product use has increased due to Electronic Nicotine Delivery Systems, also known as e-cigarettes or vapes. Preclinical models of nicotine self-administration can serve as important lodestars in the search for effective intervention and prevention tactics. Current variants of the task have substantial limitations, however. Therefore, we created the Rodent Electronic Nicotine Delivery System, a novel low-cost non-proprietary nose-only preclinical model of nicotine aerosol self-administration. We confirmed that RENDS sequesters nicotine aerosol in the nose port by measuring fine particulate matter (PM < 2.5 microns) generated by e-cigarettes. We also showed that rats robustly self-administer flavored nicotine aerosol, resulting in high blood levels of cotinine (the major nicotine metabolite) and spontaneous somatic withdrawal symptoms. Thus, we provide strong validation of the operation and function of the RENDS, opening the door to an open-source preclinical aerosol model of nicotine self-administration that is relatively low cost. Four existing operant chambers can be retrofitted with the RENDS for less than $325/chamber. All RENDS diagrams and plans for custom designed components are on Open Science Framework (https://osf.io/x2pqf/?view_only=775b55435b8e428f98e6da384ef7889d).

Recent Stressful Experiences and Electronic Nicotine Product Use Among Young Adults

Background and Objective: The goal of the current study was to examine how specific recent stressors are related to electronic nicotine product use among young adults. Despite increases in electronic nicotine product use among adults, stressors shaping the use of these products remain largely unknown. The current study examined the types and average severity of stressors endorsed between young adults with past 30-day electronic nicotine product use and young adults with no lifetime use, as well as the association between frequency of recent electronic nicotine product use and average severity of stressors. Methods: 175 current electronic nicotine product users and 333 lifetime abstainers of electronic nicotine products and cigarettes reported recent stressful experiences that occurred in the past six months, as well as lifetime and past 30-day substance use. Chi-square, independent samples t-test, and regression analyses were performed. Results: There were no significant group differences in the primary type of stressor experienced (p = 0.320) or average stress of the three recent stressful experiences reported (p = 0.246). There was no significant relationship between electronic nicotine product use and average stress of the three recent stressful experiences, controlling for demographic and substance use covariates (p = 0.150). Both current electronic nicotine product users and lifetime abstainers endorsed school, family, and romantic relationship stressors most frequently as their top stressors. Conclusion: To our knowledge, this is the first study to examine group differences in specific stressor categories and perceived stress between current electronic nicotine product users and lifetime abstainers of these products. Given the novel assessment of stressor types, the current study provides a critical starting point for research on this timely topic. In addition, due to the high overlap between stress and nicotine use, future studies should investigate different populations of electronic nicotine product users and other methods to assess stressful experiences.

Cigarette Smoking and Electronic Nicotine Product Use Among People With Stimulant Use Disorder – Estimates From the 2021 National Survey on Drug Use and Health.

Cigarette Smoking and Electronic Nicotine Product Use Among People With Stimulant Use Disorder – Estimates From the 2021 National Survey on Drug Use and Health.

Self-rated health differences between exclusive e-cigarette users and exclusive cigarette smokers: evidence from the 2017–2019 Scottish Health Survey

The comparative health implications of e-cigarette use versus traditional cigarette smoking remain a critical focus in public health research. This cross-sectional study examined differences in self-rated general health between exclusive e-cigarette users and exclusive cigarette smokers, using data from the 2017–2019 Scottish Health Survey. A total of 2484 adults (aged 16 and above) were included and categorized as exclusive e-cigarette users (n = 565) or exclusive cigarette smokers (n = 1919). Self-rated health was assessed using a single-item measure with five response categories: “very bad,” “bad,” “fair,” “good,” and “very good”. Generalized ordinal logistic regression models were used to estimate the association between nicotine product use and self-rated health, adjusting for age, sex, Scottish Index of Multiple Deprivation, marital status, ethnicity, alcohol consumption frequency, physical activity, presence of longstanding physical or mental health conditions, and age of smoking initiation. In the fully adjusted model, exclusive e-cigarette users had higher odds of reporting better self-rated health compared to exclusive cigarette smokers overall (OR = 1.26, 95% CI 1.05–1.51, p = 0.012). A graded relationship was also observed in the fully adjusted model, with progressively lower odds of reporting better self-rated health as smoking intensity increased, using exclusive e-cigarette users as the reference group. Heavy smokers (≥ 20 cigarettes/day) had the lowest odds of reporting better self-rated health (OR = 0.63, 95% CI 0.49–0.80, p < 0.001), followed by moderate smokers (10 to < 20 cigarettes/day) (OR = 0.81, 95% CI 0.66–0.99, p = 0.047). In contrast, light smokers (< 10 cigarettes/day) showed no significant difference in self-rated health compared to exclusive e-cigarette users (OR = 0.94, 95% CI 0.75–1.18, p = 0.614). These findings indicate that exclusive e-cigarette use is associated with better self-rated health compared to exclusive cigarette smoking, particularly among moderate and heavy smokers. Additional analyses revealed no significant differences in self-rated health among exclusive e-cigarette users based on prior smoking history (OR = 0.94, 95% CI 0.43–2.08, p = 0.882) or among exclusive cigarette smokers based on prior e-cigarette use (OR = 0.87, 95% CI 0.69–1.09, p = 0.219). These findings suggest that prior use is unlikely to explain the observed association between exclusive e-cigarette use and better self-rated health compared to exclusive cigarette smoking. Given the subjective nature of self-rated health, these findings should be interpreted with caution. Future longitudinal studies incorporating objective health measures are essential to assess the long-term impacts of e-cigarette use and inform evidence-based harm reduction policies.

Literacy among tobacco users and healthcare professionals about tobacco harm reduction strategies: a scoping review protocol.

The proposed review identifies and describes the extent of Tobacco Harm Reduction (THR) strategies in Pakistan. It also examines the awareness and understanding of these strategies among healthcare professionals and tobacco users in Pakistan. Tobacco consumption poses a significant threat to human health and is a leading cause of non-communicable diseases. Over the last two decades, the prevalence of tobacco use has increased in low-and middle-income countries (LMICs), which has considerably contributed to the increasing prevalence of Non-Communicable Diseases (NCDs). Tobacco is consumed in various forms, including manufactured cigarettes, hookah/shisha, chewing tobacco, and dipping tobacco. Tobacco use can be reduced and prevented through various strategies adopted by many countries worldwide. One prominent strategy is THR. THR involves the use of safer nicotine products in recommended doses to cope with the symptoms of withdrawal and increase tobacco users' chances of quitting smoking. In Pakistan, the concept of tobacco harm reduction (THR) is not widely recognized by healthcare professionals and tobacco users. Literature available on Pakistani adults and adolescents (aged 13 years and above) will be included. Literature available as free full text will be included regardless of the publication date. Furthermore, literature available in English or Urdu will be considered eligible. Also, literature available in any form of publication, such as research studies, reviews, organizational websites or blogs, will be considered eligible. Literature that includes Pakistani data mixed with data from any other country will be excluded. The literature search will use PubMed, CINAHL, ProQuest Theses & Dissertations, EBSCO Dentistry and Oral Sciences, and PsycInfo databases for online and gray literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram will record the included and excluded literature. Two independent reviewers will screen all the retrieved literature. After confirming the eligibility criteria, data from included records will be extracted on an Excel sheet that will record the important characteristics of the literature source and the main findings. Meta-synthesis of collated data will be performed, and the results will be presented as narrative summaries and frequency tables. https://osf.io/dashboard.