Search

Introduction Screening for smoking when people interact with healthcare services and referral of those who smoke to stop smoking services (SSSs) is a key component of efforts to tackle tobacco use. However, little is known about what happens after someone is referred or signposted to SSSs. Methods As part of the Cessation of Smoking Trial in the Emergency Department (NCT04854616), those randomized to intervention (n  = 505) were referred to local SSSs (along with receiving brief advice and an e-cigarette starter kit) and those randomized to control (n  = 502) were given contact details for the same services (signposted). SSS engagement data were collected: (1) directly from participants and (2) from SSS, additional qualitative data came from 33 participant interviews. Results Engagement with SSSs was very low. 3.2% (n  = 16) of those in the intervention group and 2.4% (n  = 12) in the control group reported attending a one-to-one support session. From SSS data, engagement was also low with 8.9% (n  = 43) of those referred engaging and 3.1% (n  = 15) going on to quit with SSS support. The majority of the 24 intervention participants interviewed did not recall being contacted by an SSS. Conclusions Referral or signposting to SSSs within an Emergency Department-based trial resulted in very low levels of engagement. Barriers to engagement identified included participants not being contacted by SSSs and the support offered not meeting their needs. Implications Referral or signposting of those who smoke to SSSs from the Emergency Department resulted in low rates of engagement in this large multicenter randomized controlled trial. To better support those who smoke, it may be more effective for smoking cessation advice to be offered "in the moment" within clinical settings, and follow-up to be proactively offered rather than relying on people being motivated to contact the services themselves or engaging when contacted. [ABSTRACT FROM AUTHOR]

Background and Aims: Pathways of transitioning from tobacco smoking to vaping after receiving an e‐cigarette‐based smoking cessation intervention have been minimally explored. Study aims: 1) identify pathways between intervention delivery and final follow‐up; 2) describe baseline and post‐intervention statistical data in relation to smoking/vaping behaviour of the different pathway groups; 3) explore qualitative participant perspectives contextualising pathway groups. Design: Embedded mixed‐methods analysis of data collected for the Cessation of Smoking Trial in the Emergency Department (COSTED) randomised controlled trial. Setting: Recruitment from 6 Emergency Departments (5 in England and 1 in Scotland) between January and August 2022. Participants: 366 adult smokers who were randomised to receive the COSTED intervention and provided data at 6‐month follow‐up. Qualitative subsample of 24 participants interviewed after follow‐up. Interventions: Brief smoking cessation advice, provision of an e‐cigarette starter kit and referral to the local Stop Smoking Service. Measurements: Descriptive statistical reporting of identified pathways and smoking/vaping behaviour at baseline and 6‐month follow‐up. Semi‐structured phone/video interviews analysed thematically. Findings 13.4% (n = 49) of participants quit smoking within 1 month of receiving the intervention, 19.1% (n = 70) quit between 1 and 6 months, 24.9% (n = 91) reduced cigarettes per day (CPD) by at least 50%, and 42.6% did not experience a significant smoking reduction. Approximately a third of participants who quit reported not vaping at follow‐up. Reporting dual use was associated with a reduction in CPD. Appoximately a third reported experimenting with a different device to the one provided as part of the intervention. Quitters reported themes of satisfaction with vaping, changes in environment facilitating quitting and motivation to quit. Conclusions: Dual use of cigarettes and e‐cigarettes can result in a reduction of smoking and may prelude quitting smoking. Sustained e‐cigarette use is not always necessary for quitting success. Success depends on personal context as well satisfaction with vaping. [ABSTRACT FROM AUTHOR]

Introduction: E-cigarettes have been shown to be effective for tobacco smoking cessation. Predicting those who are most likely to achieve smoking abstinence after receiving an e-cigarette based smoking cessation intervention could help to target interventions more efficiently. Methods: A secondary analysis of baseline characteristics of 505 people who received an emergency department based smoking cessation intervention incorporating brief advice, provision of an e-cigarette starter kit and referral to stop smoking services. Gender, ethnicity, age, employment status, deprivation, partner smoking status, cigarettes per day, motivation to quit, cigarette dependence and previous e-cigarette use were assessed as predictors of abstinence. Self-reported smoking status was collected 6 months after intervention delivery. Results: At 6 months 169/505 (33%) of those who received the intervention self-reported abstinence. The groups that were more likely to report having quit were females (37.4% of females vs 31.0% of males), older people (41.1% of over 50s vs 33.3% of under 35s), lighter smokers (36.4% of those who smoked less than 10 cigarettes per day vs 30.7% for those who smoked over 20) and more motivated quitters (35.6% for those with high motivation vs 29.2% for those with low motivation). However, in multiple logistic regression, when adjusting for the other factors, no factors significantly predicted smoking abstinence. Degree of nicotine dependence was very similar between those who quit and those who did not. Conclusion: The study found no baseline factors that could predict successful smoking cessation with e-cigarettes. Consequently, this study does not support the use of a targeted e-cigarette-based smoking cessation intervention, suggesting the adoption of a more universal approach. [ABSTRACT FROM AUTHOR]

Background and aims: The use of e‐cigarettes may influence later smoking uptake in young people. Evidence and gap maps (EGMs) are interactive on‐line tools that display the evidence and gaps in a specific area of policy or research. The aim of this study was to map clusters and gaps in evidence exploring the relationship between e‐cigarette use or availability and subsequent combustible tobacco use in people aged < 30 years. Methods: We conducted an EGM of primary studies and systematic reviews. A framework and an interactive EGM was developed in consultation with an expert advisory group. A systematic search of five databases retrieved 9057 records, from which 134 studies were included. Systematic reviews were appraised using AMSTAR‐2, and all included studies were coded into the EGM framework resulting in the interactive web‐based EGM. A descriptive analysis of key characteristics of the identified evidence clusters and gaps resulted in this report. Results: Studies were completed between 2015 and 2023, with the first systematic reviews being published in 2017. Most studies were conducted in western high‐income countries, predominantly the United States. Cohort studies were the most frequently used study design. The evidence is clustered on e‐cigarette use as an exposure, with an absolute gap identified for evidence looking into the availability of e‐cigarettes and subsequent cessation of cigarette smoking. We also found little evidence analysing equity factors, and little exploring characteristics of e‐cigarette devices. Conclusions: This evidence and gap map (EGM) offers a tool to explore the available evidence regarding the e‐cigarette use/availability and later cigarette smoking in people under the age of 30 years at the time of the search. The majority of the 134 reports is from high‐income countries, with an uneven geographic distribution. Most of the systematic reviews are of lower quality, suggesting the need for higher‐quality reviews. The evidence is clustered around e‐cigarette use as an exposure and subsequent frequency/intensity of current combustible tobacco use. Gaps in evidence focusing on e‐cigarette availability, as well as on the influence of equity factors may warrant further research. This EGM can support funders and researchers in identifying future research priorities, while guiding practitioners and policymakers to the current evidence base. [ABSTRACT FROM AUTHOR]

Introduction Pod Vaping Devices (PVD) such as JUUL have become extremely popular in the United States although their uptake and use in the United Kingdom remain lower. A key difference between the United States and the United Kingdom is the nicotine strength legally permitted, typically 59 mg/mL in the United States but capped at 20 mg/mL in the United Kingdom and European Union. This may limit the ability of EU vaping devices to deliver satisfactory nicotine levels. The primary aim was to compare the EU- (18 mg/mL nicotine strength) with the U.S.-JUUL (59 mg/mL) on daily smokers' subjective experiences, craving relief, and blood nicotine levels. Aims and Methods Double-blind, counterbalanced within-participants design with two conditions: 18 mg/mL versus 59 mg/mL. On two separate occasions, UK smokers (N =19, 10 males, 9 females) vaped ad libitum for 60 mins and provided blood samples at baseline 5, 15, 30, and 60 min. Subjective effects (incl. satisfaction) were measured at 10 and 60 min and, craving and withdrawal symptoms (WS) at baseline, 10 and 60 min. Results Satisfaction did not differ between conditions. There was a significant interaction between Time and Nicotine concentration for Nicotine Hit (p =.045). Mean self-report of Nicotine Hit increased under the use of the 59 mg/mL from 10 to 60 min and decreased under the 18 mg/mL. Participants reported higher Throat Hits following use of the 59 mg/mL (p =.017). There were no differences in other subjective effects including craving, WS relief (p s >.05). Liquid consumption was doubled under the 18 versus the 59 mg/mL (p =.001) and nicotine boost was significantly higher in the 59 mg/mL at all time-points (p ≤.001). Conclusions The results did not support our hypotheses that satisfaction, craving, and withdrawal reduction would be higher with the 59 mg/mL JUUL. This could be because of the doubling of liquid consumption in the 18 mg/mL. Whether satisfaction and craving relief persist over the longer-term outside of the lab remains to be determined. Implications In a 60-min ad-lib vaping session, the EU-JUUL was found to produce comparable satisfaction, craving- and withdrawal relief as the U.S.-JUUL in this sample of UK smokers. These findings could suggest that the higher nicotine concentrations available in PVDs in the United States are not necessary for providing satisfaction and improving craving and WS. However, this was at the expense of a considerable increase in liquid consumption indicative of compensatory puffing. [ABSTRACT FROM AUTHOR]

Aims: To estimate associations between e‐cigarette flavour and smoking cessation and study product use at 6 months or longer. Methods: Secondary analysis of data from a living systematic review, with meta‐analyses and narrative synthesis, incorporating data up to January 2022. Included studies provided people who smoked combustible cigarettes with nicotine e‐cigarettes for the purpose of smoking cessation compared with no treatment or other stop smoking interventions. Measurements included smoking cessation and study product use at 6 months or longer reported as risk ratios (RR) with 95% confidence intervals (CI); and flavour use at any time‐points. Results: We included 16 studies (n = 10 336); 14 contributed to subgroup analyses and 10 provided participants with a choice of e‐cigarette flavour. We judged nine, five and two studies at high, low and unclear risk of bias, respectively. Subgroup analyses showed no clear associations between flavour and cessation or product use. In all but one analysis, tests for subgroup differences resulted in I2 values between 0 and 35%. In the comparison between nicotine e‐cigarettes and nicotine replacement therapy (NRT) (I2 = 65.2% for subgroup differences), studies offering tobacco flavour e‐cigarettes showed evidence of a greater proportion of participants still using at 6 months or longer (RR = 3.81; 95% CI = 1.45–10.05; n = 1181; I2 = 84%), whereas there was little evidence for greater 6‐month use when studies offered a choice of flavours (RR = 1.44; 95% CI = 0.80–2.56; n = 454; I2 = 82%). However, substantial statistical heterogeneity within subgroups makes interpretation of this result unclear. In the 10 studies where participants had a choice of flavours, and this was tracked over time, some switching between flavours occurred, but there were no clear patterns in flavour preferences. Conclusions: There does not appear to be a clear association between e‐cigarette flavours and smoking cessation or longer‐term e‐cigarette use, possibly due to a paucity of data. There is evidence that people using e‐cigarettes to quit smoking switch between e‐cigarette flavours. [ABSTRACT FROM AUTHOR]

Background and aims: We aimed to create a basic set of definitions and relationships for identity‐related constructs, as part of the Addiction Ontology and E‐Cigarette Ontology projects, that could be used by researchers with diverse theoretical positions and so facilitate evidence synthesis and interoperability. Methods: We reviewed the use of identity‐related constructs in psychological and social sciences and how these have been applied to addiction with a focus on nicotine and tobacco research. We, then, used an iterative process of adaptation and review to arrive at a basic set of identity‐related classes with labels, definitions and relationships that could provide a common framework for research. Results: We propose that 'identity' be used to refer to 'a cognitive representation by a person or group of themselves', with 'self‐identity' referring to an individual's identity and 'group identity' referring to an identity held by a social group. Identities can then be classified at any level of granularity based on the content of the representations (e.g. 'tobacco smoker identity', 'cigarette smoker identity' and 'vaper identity'). We propose distinguishing identity from 'self‐appraisal' to capture the distinction between the representation of oneself (e.g. as an 'ex‐smoker') and (i) the importance and (ii) the positive or negative evaluation that we attach to what is represented. We label an identity that is appraised as enduring as a 'core identity', related to 'strong identity' because of the appraisal as important. Identities that are appraised positively or negatively involve 'positive self‐appraisal' and 'negative self‐appraisal' respectively. This allows us to create 'logically defined classes' of identity by combining them (e.g. 'positive core cigarette smoker identity' to refer to a cigarette smoker self‐identity that is both positive and important). We refer to the totality of self‐identities of a person as a 'composite self‐identity'. Conclusions: An ontology of identity constructs may assist in improving clarity when discussing theories and evidence relating to this construct in addiction research. [ABSTRACT FROM AUTHOR]

Introduction E-Cigarette voucher schemes have been piloted across the UK to support populations to quit smoking. This short report evaluates a scheme that targets vulnerable and disadvantaged smokers who had failed to quit smoking by other means. Methods Descriptive summary evaluation of service data on smoking outcomes and qualitative data from selected participants, as "key-informants" (n = 4) and key stakeholders (stop smoking staff, vape shop staff, and general practitioners [GPs]). Results In total, 668 participants were referred to the scheme, and 340 participants redeemed a voucher. By intention to treat analysis (ITT) 143/668 (21%) were recorded as quit smoking at 4 weeks. At 12 weeks, 7.5% of participants had quit, by ITT. Overall, the pilot project was well received by clients as it offered an affordable route into vaping for smoking cessation. GPs supported the scheme and appreciated being able to offer an alternative to entrenched smokers. Conclusions The scheme shows promise in supporting entrenched smokers to quit smoking. The offer of similar voucher schemes across the UK suggests the potential to reduce overall smoking prevalence and associated morbidity and mortality. Implications Working with GPs in a deprived area, it was possible to set-up a vape shop voucher scheme for smoking cessation. Patients with comorbidities who had tried and failed to quit smoking previously were referred to receive a vape shop voucher to be redeemed for an initial starter kit, alongside support from the stop smoking service. This innovative scheme enabled 42% of entrenched smokers who redeemed a voucher to successfully quit smoking within 4 weeks. [ABSTRACT FROM AUTHOR]

Background and aims: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Methods: Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper‐level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. Results: Overlapping, but distinct classes were developed: 'tobacco‐containing product', 'nicotine‐containing product' and 'vaping device'. Subclasses of tobacco‐containing products are 'combustible tobacco‐containing product', 'heated tobacco product' and 'smokeless tobacco‐containing product'. Subclasses of combustible tobacco‐containing product include 'cigar', 'cigarillo', 'bidi' and 'cigarette' with further subclasses including 'manufactured cigarette'. Manufactured cigarettes have properties that include 'machine‐smoked nicotine yield' and 'machine‐smoked tar yield'. Subclasses of smokeless tobacco product include 'nasal snuff', 'chewing tobacco product', and 'oral snuff' with its subclass 'snus'. Subclasses of nicotine‐containing product include 'nicotine lozenge' and 'nicotine transdermal patch'. Subclasses of vaping device included 'electronic vaping device' with a further subclass, 'e‐cigarette'. E‐cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e‐liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. Conclusions: Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice. [ABSTRACT FROM AUTHOR]

Background and aims: Smoking is extremely common among adults experiencing homelessness, but there is lack of evidence for treatment efficacy. E‐cigarettes are an effective quitting aid, but they have not been widely tested in smokers with complex health and social needs. Here we build upon our cluster feasibility trial and evaluate the offer of an e‐cigarette or usual care to smokers accessing a homeless centre. Design, Setting and Participants: Multi‐centre two‐arm cluster‐randomized controlled trial with mixed‐method embedded process and economic evaluation in homeless centres in England, Scotland and Wales. Adult smokers (18+ years; n = 480) accessing homeless centres and who are known to centre staff and willing to consent. Intervention and Comparator: Clusters (n = 32) will be randomized to either an e‐cigarette starter pack with weekly allocations of nicotine containing e‐liquid for 4 weeks [choice of flavours (menthol, fruit and tobacco) and strengths 12 mg/ml and 18 mg/ml] or the usual care intervention, which comprises very brief advice and a leaflet signposting to the local stop smoking service. Measurements The primary outcome is 24‐week sustained carbon monoxide‐validated smoking cessation (Russell Standard defined, intention‐to‐treat analysis). Secondary outcomes: (i) 50% smoking reduction (cigarettes per day) from baseline to 24 weeks; (ii) 7‐day point prevalence quit rates at 4‐, 12‐ and 24‐week follow‐up; (iii) changes in risky smoking practices (e.g. sharing cigarettes, smoking discarded cigarettes) from baseline to 4, 12 and 24 weeks; (iv) cost‐effectiveness of the intervention; and (v) fidelity of intervention implementation; mechanisms of change; contextual influences and sustainability. Conclusions: This is the first study, to our knowledge, to randomly assign smokers experiencing homelessness to an e‐cigarette and usual care intervention to measure smoking abstinence with embedded process and economic evaluations. If effective, its results will be used to inform the larger‐scale implementation of offering e‐cigarettes throughout homeless centres to aid smoking cessation. [ABSTRACT FROM AUTHOR]

Background and Aims: There is concern that young people may be attracted to e‐liquid flavours, prompting long‐term vaping in naive users and potentially subsequent tobacco smoking. We aimed to review the use of e‐liquid flavours by young people and describe associations with uptake or cessation of both regular vaping and tobacco smoking, adverse effects and subjective experiences. Design Systematic review, including interventional, observational and qualitative studies reporting on the use of e‐cigarette flavours by young people (aged < 18 years). Setting: Studies published in English language from any country or cultural setting. Participants: Young people and their carers (aged < 18 years). Measurements A meta‐analysis was not possible due to substantial heterogeneity, inconsistency in reporting of flavour categorizations and non‐interventional study designs; thus, we narratively report findings. Findings In total, 58 studies were included. The quality of the evidence was extremely low. Most (n = 39) studies were cross‐sectional survey designs. In total, 11 longitudinal cohort studies assessed trajectories; eight qualitative studies reported on user experiences. Studies reported views and experiences of a total of 512 874 young people. Both cross‐sectional and longitudinal studies suggested that flavours are important for initiation and continuation of vaping. Qualitative evidence shows interest and enjoyment in flavours. There was judged to be insufficient evidence that use of e‐liquid flavours specifically is associated with uptake of smoking. No studies found clear associations between flavours and cessation in this population. We found no included reports of adverse effects of flavours. Conclusions: Flavours may be an important motivator for e‐cigarette uptake, but the role of flavours in tobacco smoking uptake or cessation is unclear. The quality of the evidence on use of e‐cigarette flavours by young people is low overall. [ABSTRACT FROM AUTHOR]

Background and aims: E‐cigarettes are the most popular consumer choice for support with smoking cessation in the United Kingdom. However, there are concerns that long‐term e‐cigarette use may sustain concurrent tobacco smoking or lead to relapse to smoking in ex‐smokers. We aimed to explore vaping trajectories, establishing e‐cigarette users' perspectives on continued e‐cigarette use in relation to smoking relapse or abstinence. Design Qualitative longitudinal study collecting detailed subjective data at baseline and ~12 months later. Setting: United Kingdom. Participants: E‐cigarette users (n = 37) who self‐reported that they had used e‐cigarettes to stop smoking at baseline. Measurements Semi‐structured qualitative interviews (face‐to‐face or telephone) collected self‐reported patterns of e‐cigarette use. Thematic analysis of transcripts and a mapping approach of individual pathways enabled exploration of self‐reported experiences, motives, resources, and environmental and social influences on vaping and any concurrent tobacco smoking. Findings Three broad participant pathways were identified: 'maintainer' (e‐cigarette use and not smoking), 'abstainer' (neither smoking nor using e‐cigarettes), and 'relapser' (dual‐using, or relapsed back to tobacco smoking only). In each pathway, individual experiences with vaping nicotine appeared to play an important role and appeared to be related to psychological and social factors. A social context supportive of vaping was important for the maintainers, as was a belief in the need to overcome nicotine addiction for the abstainers, and dislike of the 'vaping culture' expressed by some in the relapser group. Dual‐users held beliefs such as a need for cigarettes at time of acute stress that affirmed dependence on tobacco. Conclusions: In a sample of UK e‐cigarette users who report having used e‐cigarettes to quit smoking, a social context that supports continued vaping was perceived to be helpful in preventing relapse to smoking. [ABSTRACT FROM AUTHOR]

Introduction: Finding effective ways to help pregnant women quit smoking and maintain long-term abstinence is a public health priority. Electronic cigarettes (ie, vaping) could be a suitable cessation tool in pregnancy for those who struggle to quit; however, healthcare professionals (HCP) must be informed about these devices to offer appropriate advice. This study used the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Theoretical Domains Framework (TDF) to explore HCP attitudes towards vaping in pregnancy and postpartum; beliefs about the health risks of vaping; perceived barriers and facilitators of vaping in pregnancy; knowledge of current guidelines and policies; and training needs.Methods: Interviews (n = 60) were conducted with midwives (n = 17), health visitors (n = 10), general practitioners (n = 15) and stop smoking specialists (n = 18) across the United Kingdom. Interview transcriptions were analyzed thematically using the framework approach and the COM-B.Results: Discussing vaping as a tool for quitting smoking in pregnancy was prevented by a lack of capability (limited knowledge of vaping, lack of training in smoking cessation); lack of opportunity (restricted by organizational policies and guidelines, lack of time and financial issues impacting on training), and negative social influences (sensationalist media and stigma associated with vaping in pregnancy); and lack of motivation (fear of future litigation and comebacks should adverse effects from vaping arise).Conclusions: Factors related to capability, opportunity, and motivation were identified that influence HCPs attitudes and behaviors towards vaping in pregnancy. Gaps in knowledge and training needs were identified, which could inform the development of targeted vaping training.Implications: Vaping could be suitable in pregnancy for those struggling to quit smoking. However, HCPs must be informed about these devices to offer appropriate advice. These data extend our knowledge of factors influencing HCP attitudes and behaviors towards vaping in pregnancy. Generally, vaping was perceived as safer than cigarettes, but a perceived lack of evidence, health and safety risks, dependency, and regulation issues were concerning. Considering our findings, greater efforts are needed to ensure HCPs are sufficiently informed about vaping and guidelines available. More importance should be placed on training for all HCPs who have contact with pregnant women. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarette regulations included in the Tobacco Products Directive (TPD), Article 20, implemented in Europe by May 2017, aimed to improve safety for e-cigarette consumers, and prevent uptake among non-smokers, particularly young people. Before implementation, there were significant concerns from consumers, industry, and some in the scientific community about the potential negative impact of the TPD on people using e-cigarettes to remain abstinent from smoking. To date, there is limited evidence on how the TPD has affected consumers. This study aimed to add insight into how consumers perceived and experienced the regulations. Methods: Qualitative data, collected between March 2018 and March 2019, relating to participant views of the TPD were extracted from 160 interviews/extended surveys of e-cigarette consumers as part of a wider study into e-cigarette use trajectories (ECtra study). Data were thematically analysed. Results: Awareness of the TPD among consumers was not universal. Participants' smoking behaviour did not appear to be influenced by the legislation. Participants were reassured by manufacturing regulations and requirements for ingredients labels. Participants responded negatively to changes perceived to cause inconvenience and extra plastic waste. The product restrictions prompted some participants to purchase non-compliant products illegally, potentially putting their safety at risk. Conclusions: E-cigarette regulation should focus on ensuring product safety. Raising awareness of the TPD among consumers and smokers could be beneficial. [ABSTRACT FROM AUTHOR]

Nicotine containing vapes (e-cigarettes) are an effective tool to support people who smoke to quit tobacco. Despite this clinicians are wary of promoting vaping to their patients due to concerns that there may not be 'enough' evidence and about youth uptake of vaping. In this opinion article we discuss clinicians' views of vaping and consider the implications that harm misperceptions may have for public health. [ABSTRACT FROM AUTHOR]

Introduction: Smoking prevalence remains high in some vulnerable groups, including those who misuse substances, have a mental illness, are homeless, or are involved with the criminal justice system. E-cigarette use is increasing and may support smoking cessation/reduction.Methods: Systematic review of quantitative and qualitative data on the effectiveness of e-cigarettes for smoking cessation/reduction among vulnerable groups. Databases searched were MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, ProQuest Dissertations and Theses, and Open Grey. Narrative synthesis of quantitative data and thematic synthesis of qualitative data.Results: 2628 records and 46 full texts were screened; 9 studies were identified for inclusion. Due to low quality of evidence, it is uncertain whether e-cigarettes are effective for smoking cessation in vulnerable populations. A moderate quality study suggested that e-cigarettes were as effective as nicotine replacement therapy. Four studies suggested significant smoking reduction; however, three were uncontrolled and had sample sizes below 30. A prospective cohort study found no differences between e-cigarette users and nonusers. No significant adverse events and minimal side effects were identified. Qualitative thematic synthesis revealed barriers and facilitators associated with each component of the COM-B (capability, opportunity, motivation, and behavior) model, including practical barriers; perceptions of effectiveness for cessation/reduction; design features contributing to automatic and reflective motivation; smoking bans facilitating practical opportunity; and social connectedness increasing social opportunity.Conclusion: Further research is needed to identify the most appropriate device types for practicality and safety, level of support required in e-cigarette interventions, and to compare e-cigarettes with current best practice smoking cessation support among vulnerable groups.Implications: Smoking prevalence among people with mental illness, substance misuse, homelessness, or criminal justice system involvement remains high. E-cigarettes could support cessation. This systematic review found limited quantitative evidence assessing effectiveness. No serious adverse events were identified. Qualitative thematic synthesis revealed barriers and facilitators mapping to each component of the COM-B (capability, opportunity, motivation, and behavior) model, including practical barriers; perceived effectiveness; design features contributing to automatic and reflective motivation; smoking bans facilitating practical opportunity; and social connectedness increasing social opportunity. Further research should consider appropriate devices for practicality and safety, concurrent support, and comparison with best practice smoking cessation support. [ABSTRACT FROM AUTHOR]

Background and Aims: E-cigarettes are the most popular aid to quitting smoking in the UK. Although many smokers quit, relapse is common. Historically, the literature has reported strong associations between tobacco smoking lapse and relapse following a quit attempt. This article aims to explore how smoking lapse is experienced by those who vape to quit smoking.Design and Methods: A purposive sample of 40 UK vapers were matched to a sampling frame from a representative sample of UK quitters. Semi-structured qualitative interviews were conducted. Data were thematically analysed iteratively situating reported experiences of smoking lapse within narrative descriptions of vaping. Iterative categorization was used as a technique to further explore a subset of data specifically focused on smoking lapse.Results: Analysis revealed that smoking lapse is perceived qualitatively differently when using e-cigarettes as compared to past quit attempts. Having the pleasurable alternative of vaping meant that full relapse to smoking was not inevitable. Instead, lapses were perceived as 'permissive' or 'purposive', intentional and contextualised, or for some as unintentional, with the resulting emotional response negatively reinforcing ongoing tobacco smoking abstinence.Discussion and Conclusions: Our novel findings suggest that the role of tobacco smoking lapse in relation to relapse status may be theoretically redefined, drawing on data from vapers. These findings question the utility of previous theories of the role of smoking lapse in the relapse process. For ex-smokers, vaping offers a pleasurable, viable pharmacological, but also social and psychological, substitution option for smoking and potentially powerfully alters the experience and threat of any lapse. [ABSTRACT FROM AUTHOR]

The article focuses on health effects from vaping and increase cancer risk. It mentions study thus does not provide concrete evidence of adverse health consequences associated with vaping and particular by trying to separate the effects of the vaping itself of the damage caused by the smoking. It also mentions extent of the changes transcriptomics was more pronounced in smokers than vapers and preferential targeting of mitochondrial genes.

Adult electronic cigarette (e-cigarette) use is increasing globally, and early studies have suggested that similar trends may be observed among the adolescent population, albeit at lower levels. The current literature review presents data collected since 2014 from 21 cross-sectional studies and one cohort study that were all published in English. In particular, it focuses on awareness, ever use, past 30-day use, and regular use of e-cigarettes. The article suggests that adolescents are nearing complete awareness of e-cigarettes. Furthermore, in relation to ever use and past 30-day use, higher prevalence rates continue to be reported across time, especially in the United States. Nonetheless, reported regular use of e-cigarettes remains much lower than past 30-day use, although conclusions are limited due to inconsistencies with measurement and consequent lack of cross-cultural applicability. The majority of studies do not report whether adolescents use non-nicotine e-cigarettes. There is a current absence of longitudinal studies that explore any association between e-cigarettes and tobacco use and little qualitative data that may illuminate how and why adolescents use e-cigarettes. Through addressing these methodological limitations, future research will be able to inform health care and policy more effectively. [ABSTRACT FROM AUTHOR]

The public health response to e-cigarette or vaping associated with lung injury (EVALI) has highlighted the widespread misunderstanding of vaping products. We urgently need to clean up the science of e-cigarette and other electronic vaping products to avoid regulatory actions based on erroneous beliefs. [ABSTRACT FROM PUBLISHER]

Background: E-cigarettes are the most popular aid to smoking cessation attempts in England and the USA. This research examined associations between e-cigarette device characteristics and patterns of use, tobacco-smoking relapse, and smoking abstinence. Methods: A convenience sample of 371 participants with experience of vaping, and tobacco-smoking abstinence and/or relapse completed an online cross-sectional survey about e-cigarettes. Factors associated with smoking relapse were examined using multiple linear and logistic regression models. Results: Most participants were self-reported long-term abstinent smokers (86.3%) intending to continue vaping. Most initiated e-cigarette use with a vape pen (45.8%) or cig-a-like (38.7%) before moving onto a tank device (89%). Due to missing data, managed through pairwise deletion, only around 70 participants were included in some of the main analyses. Those using a tank or vape pen appeared less likely to relapse than those using a cig-a-like (tank vs. cig-a-like OR = 0.06, 95% CI 0.01–0.64, p = 0.019). There was an inverse association between starting self-reported e-cigarette liquid nicotine concentration and relapse, interacting with device type (OR = 0.79, 95% CI 0.63–0.99, p = 0.047), suggesting that risk of relapse may have been greater if starting with a low e-cigarette liquid nicotine concentration and/or cig-a-like device. Participants reported moving from tobacco-flavored cig-a-likes to fruit/sweet/food flavors with tank devices. Conclusions: Knowledge of how people have successfully maintained tobacco-smoking abstinence using vaping could help other tobacco smokers wishing to quit tobacco smoking through vaping. [ABSTRACT FROM AUTHOR]

Background: Online information on electronic cigarettes (e-cigarettes) may influence people's perception and use of e-cigarettes. Websites with information on e-cigarettes in the Chinese language have not been systematically assessed.Objective: The aim of this study was to assess and compare the types and credibility of Web-based information on e-cigarettes identified from Google (in English) and Baidu (in Chinese) search engines.Methods: We used the keywords vaping or e-cigarettes to conduct a search on Google and the equivalent Chinese characters for Baidu. The first 50 unique and relevant websites from each of the two search engines were included in this analysis. The main characteristics of the websites, credibility of the websites, and claims made on the included websites were systematically assessed and compared.Results: Compared with websites on Google, more websites on Baidu were owned by manufacturers or retailers (15/50, 30% vs 33/50, 66%; P<.001). None of the Baidu websites, compared to 24% (12/50) of Google websites, were provided by public or health professional institutions. The Baidu websites were more likely to contain e-cigarette advertising (P<.001) and less likely to provide information on health education (P<.001). The overall credibility of the included Baidu websites was lower than that of the Google websites (P<.001). An age restriction warning was shown on all advertising websites from Google (15/15) but only on 10 of the 33 (30%) advertising websites from Baidu (P<.001). Conflicting or unclear health and social claims were common on the included websites.Conclusions: Although conflicting or unclear claims on e-cigarettes were common on websites from both Baidu and Google search engines, there was a lack of online information from public health authorities in China. Unbiased information and evidence-based recommendations on e-cigarettes should be provided by public health authorities to help the public make informed decisions regarding the use of e-cigarettes. [ABSTRACT FROM AUTHOR]

The article reports that e-cigarettes are considered a disruptive technology evidencing rapid growth in the financial market and attracting a distinct new customer base of would-be quitters. Where use is permitted, and regulation is favourable to users , e-cigarettes have become the most popular method of smoking cessation and for many are a long-term alternative to smoking.

Background: We have little understanding of how vapers use e-cigarettes beyond cessation. E-cigarettes may have a role to play in reducing the health-related harms of tobacco smoking, through not only assisting smoking cessation attempts but also supporting long-term abstinence from smoking. However, there are fears that vaping may lead to the 'renormalisation' of smoking type behaviours. This study aimed to explore patterns of use and reported experiences of vapers quitting smoking using an e-cigarette in relation to long-term smoking status (abstinence or relapse). Methods: A purposive sample of 40 UK vapers was matched to a sampling frame of demographic characteristics from a representative sample of UK quitters. Following full informed consent, semi-structured qualitative interviews were conducted. Data were thematically analysed by two members of the research team. Final thematic analysis was verified and agreed by consensus. Results: The sample self-reported long histories of tobacco use and multiple previous quit attempts which had eventually resulted in relapse back to smoking, although a small but important group had never before attempted to quit. Initiating e-cigarette use was experienced as a revelation for some, who were quickly able to fully switch to using e-cigarettes as an alternative to tobacco smoking. For others, periods of dual use or smoking relapse combined with attempts at vaping that were not initially satisfactory. Many of these chose a cheaper 'cig-a-like' device which they found to be inadequate. Experimentation with different devices and different setups, over time, resulted in some 'sliding' rather than switching to vaping. This involved periods of 'dual use'. Some settled on patterns of vaping as a direct substitute of previous tobacco smoking, whereas others reported 'grazing' patterns of vaping throughout the day that were perceived to support tobacco smoking abstinence. Conclusions: Our data demonstrates that e-cigarettes may be a unique harm reduction innovation for smoking relapse prevention. E-cigarettes meet the needs of some ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction. Some vapers reported that they found vaping pleasurable and enjoyable—being more than a substitute but actually preferred, over time, to tobacco smoking. This clearly suggests that vaping is a viable long-term substitute for smoking, with substantial implications for tobacco harm reduction. [ABSTRACT FROM AUTHOR]

Moderate certainty evidence supports use of nicotine electronic cigarettes to quit smoking combustible cigarettes. However, there is less certainty regarding how long people continue to use e-cigarettes after smoking cessation attempts. We set out to synthesise data on the proportion of people still using e-cigarettes or other study products at 6 months or longer in studies of e-cigarettes for smoking cessation. We updated Cochrane searches (November 2021). For the first time, we meta-analysed prevalence of continued e-cigarette use among individuals allocated to e-cigarette conditions, and among those individuals who had successfully quit smoking. We updated meta-analyses comparing proportions continuing product use among individuals allocated to use nicotine e-cigarettes and other treatments. We included 19 studies (n = 7787). The pooled prevalence of continued e-cigarette use at 6 months or longer was 54% (95% CI: 46% to 61%, I2 86%, N = 1482) in participants assigned to e-cigarette conditions. Of participants who had quit combustible cigarettes overall 70% were still using e-cigarettes at six months or longer (95% CI: 53% to 82%, I2 73%, N = 215). Heterogeneity in direction of effect precluded meta-analysis comparing long-term use of nicotine e-cigarettes with NRT. More people were using nicotine e-cigarettes at longest follow-up compared to non-nicotine e-cigarettes, but CIs included no difference (risk ratio 1.15, 95% CI: 0.94 to 1.41, n = 601). The levels of continued e-cigarette use observed may reflect the success of e-cigarettes as a quitting tool. Further research is needed to establish drivers of variation in and implications of continued use of e-cigarettes. [ABSTRACT FROM AUTHOR]

Background: Concern about youth uptake of vaping is widespread. Regulation and education campaigns aim to protect children from initiating use, yet it is likely that children will be primarily influenced by the behaviour of people in their immediate environment. This is the first known study exploring e-cigarette users' views and reported experiences of vaping around children.Methods: Following informed consent, semi-structured qualitative interviews were conducted with 40 adults who had attempted to give up smoking by vaping. Participants were recruited from England as part of a wider study into e-cigarette use trajectories and smoking relapse (ECtra study). Data were extracted from 28 interviews where participants had spontaneously discussed vaping around children. Extracted data were analysed thematically and situated in previous analysis of vaping identity which distinguished between recreational and medicinal vapers.Results: Vaping behaviour around children was in part a habituated replication of smoking norms but also guided by broad vaping identity; recreational users were more permissive and medicinal users more secretive. Vaping in the home appeared to be determined by caregivers' need to reconcile vaping behaviour so that it was congruent with parental identity as a responsible caregiver. Participant perspectives reflected existing moral discourses applied to e-cigarettes around the use of "harm reduction for smokers" and "potential for youth harm".Conclusion: Vaping is likely to be role modelled within the community and home despite attempts by e-cigarette users to conceal the behaviour. The ambivalent contextualisation of e-cigarettes means that e-cigarette users may lack a clear narrative to draw on when discussing vaping with children. Public health guidance for vaping around children could be helpful, but to be most effective, should take into consideration users' vaping identity. [ABSTRACT FROM AUTHOR]