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== Disposable Vapes ==
=== 2024: [https://www.sciencedirect.com/science/article/pii/S0033350623005036 Who would be affected by a ban on disposable vapes? A population study in Great Britain] ===
* We used a nationally representative survey of ~70,000 adults in the general population in Great Britain (the Smoking Toolkit Study) to describe trends in disposable e-cigarette use since 2021, establish the number who would currently be affected by a ban on disposables, and assess their sociodemographic and smoking profile.
* Our data show that while disposable vapes are particularly popular among young adults, they are also used by a large number of current smokers and ex-smokers and by people from disadvantaged groups – including those with a history of mental health conditions and working in lower paid jobs.
* These findings suggest banning disposable vapes isn’t a straightforward solution to stop young people from vaping. It could also have unintended consequences for smokers, including discouraging people from using e-cigarettes to try to quit smoking or triggering relapse among those who have already used disposables to quit. It may also worsen health inequalities. We suggest these trade-offs should be carefully considered when making decisions around banning disposables.
* Sarah E. Jackson, Harry Tattan-Birch, Lion Shahab, Melissa Oldham, Dimitra Kale, Leonie Brose, Jamie Brown
* Public Health https://doi.org/10.1016/j.puhe.2023.12.024 Received 26 October 2023, Revised 19 December 2023, Accepted 20 December 2023, Available online 24 January 2024.<br />


=Dual Use=
=Dual Use=
===2023: [https://pubmed.ncbi.nlm.nih.gov/38192585/ Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial]===
*Our findings indicate that inclusion of varenicline in a cessation programme for adults who smoke and use e-cigarettes with an intention to quit smoking could result in smoking abstinence without serious adverse events. In the absence of evidence from other smoking cessation methods, it could be useful to suggest the use of varenicline in cessation programmes specifically designed to help dual users stop smoking.
*Caponnetto P, Spicuzza L, Campagna D, Ahluwalia JS, Russell C, Maglia M, Riela PM, Longo CF, Caci G, Quattropani MC, Signorelli MS, Polosa R. Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial. EClinicalMedicine. 2023 Nov 21;66:102316. doi: 10.1016/j.eclinm.2023.102316. PMID: 38192585; PMCID: PMC10772233.


===2021: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===
*Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
*Signed by 24 experts from around the world
*Covers 12 key points
**Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
**Adopts false and misleading claims about the risks of e-cigarettes.
**Draws on irrelevant information about an outbreak of lung injuries in North America.
**Misunderstands “dual-use”.
**Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
**Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
**Ignores perverse consequences of prohibition, even though these are foreseeable.
**Fails to show benefits for adolescents or address concerns it may cause harm to young people.
**Ignores the harmful effects of a vaping flavour ban on adults.
**Creates regulatory protection for the cigarette trade.
**Violates important regulatory principles, including those underpinning the European Union internal market.
**Proposes an illiberal policy and fails to recognise a major global public health opportunity.
*Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.


===2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===
===2020 [https://pubmed.ncbi.nlm.nih.gov/33086157/ A comparison of product dependence among cigarette only, ENDS only, and dual users: Findings from Wave 3 (2015-2016) of the PATH study]===
*Signed by 24 experts from around the world
*
*Covers 12 key points including dual use




===2019 [https://pubmed.ncbi.nlm.nih.gov/31278802/ 2019 Perceived relative harm of using e-cigarettes predicts future product switching among US adult cigarette and e-cigarette dual users]===
===2019: [https://pubmed.ncbi.nlm.nih.gov/31278802/ 2019 Perceived relative harm of using e-cigarettes predicts future product switching among US adult cigarette and e-cigarette dual users]===
*Compared with those with other perceptions of e‐cigarette harm, dual users who perceived e‐cigarettes as less harmful than cigarettes were more likely to become exclusive e‐cigarette users 1 year later.
*Compared with those with other perceptions of e‐cigarette harm, dual users who perceived e‐cigarettes as less harmful than cigarettes were more likely to become exclusive e‐cigarette users 1 year later.
*[https://sci-hub.se/10.1111/add.14730 PDF Version]
*[https://sci-hub.se/10.1111/add.14730 PDF Version]
   
   


===2019 [https://pubmed.ncbi.nlm.nih.gov/31477072/ Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes]===
===2019: [https://pubmed.ncbi.nlm.nih.gov/31477072/ Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes]===
*The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
*The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
*The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
*The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
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*Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.
*Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.
*Acknowledgement: Grants from the National Cancer Institute of the National Institutes of Health (P20CA202921 to University of Oklahoma, and 5P20CA202923 to Cherokee Nation) supported this study.
*Acknowledgement: Grants from the National Cancer Institute of the National Institutes of Health (P20CA202921 to University of Oklahoma, and 5P20CA202923 to Cherokee Nation) supported this study.
===2019: [https://www.tandfonline.com/doi/abs/10.1080/10826084.2019.1626435?journalCode=isum20 Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions]===
*Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
*This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
*[https://sci-hub.se/10.1080/10826084.2019.1626435 PDF Version]
*Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435
*Acklnowledgement: This work was supported by the National Institutes of Health (K01DA043413, K23DA039294, and K23DA042898). The funding source had no other role other than financial support.
===2018 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324349/ Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes]===
*In this population-based cohort study of 5105 participants, current exclusive e-cigarette users had greater concentrations of biomarkers of nicotine, tobacco-specific nitrosamines, volatile organic compounds, and metals compared with never tobacco users. However, these concentrations were lower than those observed in current exclusive cigarette smokers and dual users of both products.
*[https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3A0923e7cd-7d55-45fc-923e-4ad06343a73e#pageNum=1 PDF Version]
*Citation: Goniewicz ML, Smith DM, Edwards KC, Blount BC, Caldwell KL, Feng J, Wang L, Christensen C, Ambrose B, Borek N, van Bemmel D, Konkel K, Erives G, Stanton CA, Lambert E, Kimmel HL, Hatsukami D, Hecht SS, Niaura RS, Travers M, Lawrence C, Hyland AJ. Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes. JAMA Netw Open. 2018 Dec 7;1(8):e185937. doi: 10.1001/jamanetworkopen.2018.5937. PMID: 30646298; PMCID: PMC6324349.
===2018: [https://bmjopen.bmj.com/content/8/3/e018329.full Motivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional study ]===
*The most prevalent motivation for using e-cigarettes was to reduce tobacco smoking 48%, followed by quitting smoking 39.2%, and to use e-cigarettes in places where tobacco smoking was prohibited 10.2%.
*Citation: Bunch K, Fu M, Ballbè M, et alMotivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional studyBMJ Open 2018;8:e018329. doi: 10.1136/bmjopen-2017-018329
*Acknowledgement: The project was cofunded by the Instituto de Salud Carlos III, Subdirección General de Evaluación, Government of Spain (PI15/00291). The project was also cofunded by ISCIII-Subdirección General de Evaluación and by FEDER funds/European Regional Development Fund (ERDF)—a way to build Europe—in 2015 and Ministry of Universities and Research, Government of Catalonia (grant 2017SGR608).




===2017 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/ Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes]===
===2017: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/ Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes]===
*To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
*To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
*Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
*Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
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*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/pdf/ijerph-15-00012.pdf PDF Version]
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/pdf/ijerph-15-00012.pdf PDF Version]
*Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.
*Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.
===2016 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940751/ Reductions in biomarkers of exposure, impacts on smoking urge and assessment of product use and tolerability in adult smokers following partial or complete substitution of cigarettes with electronic cigarettes]===
*Subjects switching to e-cigarettes had significantly lower levels (29 %–95 %) of urinary [[Special:MyLanguage/Abbreviations|BoE]]s after 5 days. Nicotine equivalents declined by 25 %–40 %.
*Dual users who substituted half of their self-reported daily cigarette consumption with e-cigarettes experienced 7 %–38 % reductions, but had increases (1 %–20 %) in nicotine equivalents.
*Blood nicotine biomarker levels were lower in the cessation (75 %–96 %) and e-cigarette use groups (11 %–83 %); dual users had no significant reductions.
*All groups experienced significant decreases in exhaled CO (27 %–89 %). Exhaled NO increases (46 %–63 %) were observed in the cessation and e-cigarette use groups; dual users had minimal changes.
*By Day 5, all groups had greater reductions in smoking urge compared to cessation. However, reductions were larger in the dual use group.
*No serious adverse events were observed.
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940751/pdf/12889_2016_Article_3236.pdf PDF Version]
*Citation: D'Ruiz CD, Graff DW, Robinson E. Reductions in biomarkers of exposure, impacts on smoking urge and assessment of product use and tolerability in adult smokers following partial or complete substitution of cigarettes with electronic cigarettes. BMC Public Health. 2016 Jul 11;16:543. doi: 10.1186/s12889-016-3236-1. PMID: 27401980; PMCID: PMC4940751.
*Acknowledgement: This study was funded by Fontem Ventures B.V., a fully owned subsidiary of Imperial Brands plc, and the manufacturer of the e-cigarette products used in this study.
<br>


=Economic Impact=
=Economic Impact=




===2019 [https://progressivepolicy.org/issues/health-care/the-impact-of-electronic-cigarettes-on-cigarette-smoking-by-americans-and-its-health-and-economic-implications/ The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications]===
===2019: [https://progressivepolicy.org/issues/health-care/the-impact-of-electronic-cigarettes-on-cigarette-smoking-by-americans-and-its-health-and-economic-implications/ The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications]===
*In this study, we examined the growing use of electronic cigarettes and its implications. The wide use of e-cigarettes is a very recent development, and issues regarding their long-term effects and significance cannot be fully analyzed at this time. Using CDC and other data covering the last decade, however, we examined the relationship between the recent sharp increase in e-cigarette use among Americans and the contemporaneous acceleration in the declining rate of cigarette smoking.  
*In this study, we examined the growing use of electronic cigarettes and its implications. The wide use of e-cigarettes is a very recent development, and issues regarding their long-term effects and significance cannot be fully analyzed at this time. Using CDC and other data covering the last decade, however, we examined the relationship between the recent sharp increase in e-cigarette use among Americans and the contemporaneous acceleration in the declining rate of cigarette smoking.  
*We found that the sharp increase in e-cigarette use across many groups can explain as much as 70 percent of the accelerating decline in smoking rates. We also found no reasonable evidential basis for concerns that e-cigarettes are a gateway to cigarette smoking.  
*We found that the sharp increase in e-cigarette use across many groups can explain as much as 70 percent of the accelerating decline in smoking rates. We also found no reasonable evidential basis for concerns that e-cigarettes are a gateway to cigarette smoking.  
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===2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===
===2021: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===
*Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
*Signed by 24 experts from around the world
*Signed by 24 experts from around the world
*Covers 12 key points
*Covers 12 key points
**Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
**Adopts false and misleading claims about the risks of e-cigarettes.
**Draws on irrelevant information about an outbreak of lung injuries in North America.
**Misunderstands “dual-use”.
**Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
**Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
**Ignores perverse consequences of prohibition, even though these are foreseeable.
**Fails to show benefits for adolescents or address concerns it may cause harm to young people.
**Ignores the harmful effects of a vaping flavour (flavor) ban on adults.
**Creates regulatory protection for the cigarette trade.
**Violates important regulatory principles, including those underpinning the European Union internal market.
**Proposes an illiberal policy and fails to recognise a major global public health opportunity.
*Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.




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*Citation: Yang, Y., Lindblom, E. N., Salloum, R. G., & Ward, K. D. (2020). The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addictive Behaviors Reports, 11, 100273. doi:10.1016/j.abrep.2020.100273  
*Citation: Yang, Y., Lindblom, E. N., Salloum, R. G., & Ward, K. D. (2020). The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addictive Behaviors Reports, 11, 100273. doi:10.1016/j.abrep.2020.100273  
*Acknowledgement: This research was supported by the National Institute of Drug Abuse of the National Institutes of Health (R03DA048460).
*Acknowledgement: This research was supported by the National Institute of Drug Abuse of the National Institutes of Health (R03DA048460).


===2019:  [https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201906-472OC Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users]===
===2019:  [https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201906-472OC Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users]===
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*Citation: Ann Am Thorac Soc Vol 17, No 5, pp 573–581, May 2020, Copyright © 2020 by the American Thoracic Society, DOI: 10.1513/AnnalsATS.201906-472OC
*Citation: Ann Am Thorac Soc Vol 17, No 5, pp 573–581, May 2020, Copyright © 2020 by the American Thoracic Society, DOI: 10.1513/AnnalsATS.201906-472OC
*Acknowledgement: Supported by the National Institute on Drug Abuse of the National Institutes of Health (NIH) and the Center for Tobacco Products of the U.S. Food and Drug Administration (FDA) (P50-DA-036107) for the Penn State Tobacco Center of Regulatory Science.
*Acknowledgement: Supported by the National Institute on Drug Abuse of the National Institutes of Health (NIH) and the Center for Tobacco Products of the U.S. Food and Drug Administration (FDA) (P50-DA-036107) for the Penn State Tobacco Center of Regulatory Science.


===2019: [https://www.sciencedirect.com/science/article/abs/pii/S0306460318311821 The role of flavors in vaping initiation and satisfaction among U.S. adults]===
===2019: [https://www.sciencedirect.com/science/article/abs/pii/S0306460318311821 The role of flavors in vaping initiation and satisfaction among U.S. adults]===
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===2018 [https://www.regulations.gov/document?D=FDA-2017-N-6565-22941 Patterns of flavored e-cigarette use among adults vapers in the United States: an internet survey]===  
===2018: [https://www.regulations.gov/document?D=FDA-2017-N-6565-22941 Patterns of flavored e-cigarette use among adults vapers in the United States: an internet survey]===  
*Survey results submitted to the FDA
*Survey results submitted to the FDA
*In conclusion, this cross-sectional study of a very large sample of adult US e-cigarette users, most of which were former smokers, identified the importance of non-tobacco flavors in e-cigarette use initiation and sustained use, and their contribution to smoking cessation and relapse prevention. *This information should be considered by regulators in order to avoid unintentional adverse effects of over-restrictive regulation on e-cigarette flavors.
*In conclusion, this cross-sectional study of a very large sample of adult US e-cigarette users, most of which were former smokers, identified the importance of non-tobacco flavors in e-cigarette use initiation and sustained use, and their contribution to smoking cessation and relapse prevention. *This information should be considered by regulators in order to avoid unintentional adverse effects of over-restrictive regulation on e-cigarette flavors.
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*Citation: Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018 Jun 28;15(1):33. doi: 10.1186/s12954-018-0238-6. PMID: 29954412; PMCID: PMC6022703.
*Citation: Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018 Jun 28;15(1):33. doi: 10.1186/s12954-018-0238-6. PMID: 29954412; PMCID: PMC6022703.
*Acknowledgements: The authors are grateful to Julie Woessner and Alex Clark (Consumer Advocates for Smoke-free Alternatives Association), Stefan Didak and Danielle Bloss (Not Blowing Smoke), Gregory Conley (American Vaping Association), Cynthia Cabrera (Cating Group), and the Board of the Smoke-Free Alternatives Trade Association, without whose assistance this study would not have been possible. Fontem Ventures, a company that makes e-cigarettes, and a wholly owned subsidiary of Imperial Brands PLC provided funding for this study.
*Acknowledgements: The authors are grateful to Julie Woessner and Alex Clark (Consumer Advocates for Smoke-free Alternatives Association), Stefan Didak and Danielle Bloss (Not Blowing Smoke), Gregory Conley (American Vaping Association), Cynthia Cabrera (Cating Group), and the Board of the Smoke-Free Alternatives Trade Association, without whose assistance this study would not have been possible. Fontem Ventures, a company that makes e-cigarettes, and a wholly owned subsidiary of Imperial Brands PLC provided funding for this study.


===2018: [https://tobaccocontrol.bmj.com/content/28/2/168 Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment]===
===2018: [https://tobaccocontrol.bmj.com/content/28/2/168 Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment]===
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*Acknowledgement: Research reported in this publication was supported by grant number P50DA036151 from the National Institute on Drug Abuse (NIDA) and FDA Center for Tobacco Products (CTP).
*Acknowledgement: Research reported in this publication was supported by grant number P50DA036151 from the National Institute on Drug Abuse (NIDA) and FDA Center for Tobacco Products (CTP).


 
===2017: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/ Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes]===
===2017 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/ Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes]===
*To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
*To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
*Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
*Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
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*Citation: Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings, Tobacco Control 2016;25:ii67-ii72.
*Citation: Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings, Tobacco Control 2016;25:ii67-ii72.
*Acknowledgement: Support for this project was provided by Grant 1 R01 DA036492 from the National Institute on Drug Abuse, and in part by General Clinical Research Center Grant M01-RR06192 from the National Institutes of Health.
*Acknowledgement: Support for this project was provided by Grant 1 R01 DA036492 from the National Institute on Drug Abuse, and in part by General Clinical Research Center Grant M01-RR06192 from the National Institutes of Health.


===2015: [https://academic.oup.com/ntr/article-abstract/17/10/1255/1028251?redirectedFrom=fulltext The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes]===  
===2015: [https://academic.oup.com/ntr/article-abstract/17/10/1255/1028251?redirectedFrom=fulltext The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes]===  
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*Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333
*Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333
*Acknowledgement: This work was supported by NJOY, a company that markets electronic cigarettes, but does not make or sell any combustible tobacco products. All authors work for Pinney Associates and provide consulting services to GlaxoSmithKline Consumer Healthcare on their stop-smoking medications and to NJOY, Inc. on electronic nicotine delivery systems (ENDS). SS and JGG also own an interest in a novel nicotine medication in development. The study sponsor was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the manuscript, nor did the sponsor review the manuscript prior to submission.
*Acknowledgement: This work was supported by NJOY, a company that markets electronic cigarettes, but does not make or sell any combustible tobacco products. All authors work for Pinney Associates and provide consulting services to GlaxoSmithKline Consumer Healthcare on their stop-smoking medications and to NJOY, Inc. on electronic nicotine delivery systems (ENDS). SS and JGG also own an interest in a novel nicotine medication in development. The study sponsor was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the manuscript, nor did the sponsor review the manuscript prior to submission.


===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808473/ Preferred Flavors and Reasons for E-cigarette Use and Discontinued Use Among Never, Current, and Former Smokers]===
===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808473/ Preferred Flavors and Reasons for E-cigarette Use and Discontinued Use Among Never, Current, and Former Smokers]===
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*Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8
*Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8
*Acknowledgement: This research was funded by Cancer Research UK (CRUK), Grant Number C54889/A22732.
*Acknowledgement: This research was funded by Cancer Research UK (CRUK), Grant Number C54889/A22732.


===2016: [https://onlinelibrary.wiley.com/doi/abs/10.1111/add.13299 Protocol proposal for, and evaluation of, consistency in nicotine delivery from the liquid to the aerosol of electronic cigarettes atomizers: regulatory implications]===
===2016: [https://onlinelibrary.wiley.com/doi/abs/10.1111/add.13299 Protocol proposal for, and evaluation of, consistency in nicotine delivery from the liquid to the aerosol of electronic cigarettes atomizers: regulatory implications]===
Line 241: Line 307:
*Perceived EC dependency was significantly lower compared to smoking.
*Perceived EC dependency was significantly lower compared to smoking.
*[https://journals.sagepub.com/doi/pdf/10.4137/SART.S12756 PDF Version]
*[https://journals.sagepub.com/doi/pdf/10.4137/SART.S12756 PDF Version]


===2013: [https://pubmed.ncbi.nlm.nih.gov/22529223/ Nicotine levels in electronic cigarettes]===  
===2013: [https://pubmed.ncbi.nlm.nih.gov/22529223/ Nicotine levels in electronic cigarettes]===  
Line 248: Line 313:




=Older Adults=


=Personal Testimonies from people who used to smoke=


===2021: Paper: [https://tobaccocontrol.bmj.com/content/early/2021/08/12/tobaccocontrol-2021-056945 Ignoring our elders: tobacco control’s forgotten health equity issue]===
*BMJ Tobacco Control


===All Years: Video Collection: [https://www.youtube.com/channel/UCY3vMuTdXfL7Z4PAsx7Q5nA/videos Golden Oldies Capitol Tours]===
*People who used to smoke share how long they smoked and what flavors helped them to quit smoking.


===2019: Article: [https://filtermag.org/older-smokers-vaping/amp/ Older Smokers Are the Forgotten Victims of Our Vaping Wars]===
*Filter Magazine


===All Years: Collection 13,000+ Testimonies: [https://casaa.org/_testimonials/ CASAA - REAL PEOPLE. REAL STORIES.]===
*Online submissions of personal testimonies by people who switched from smoking to harm reduction products.


===2018: Power Point: [https://archive.gfn.events/downloads/2018/AnnieKleykamp.pdf Rethinking nicotine across the lifespan:  What about the older smoker?]===
*GFN: Annie Kleykamp, PhD




=Quitting Smoking: E-cigarette vs. NRT OR E-cigarette with NRT=


===2017: Article: [https://www.nytimes.com/2017/12/08/health/smokers-vaping-ecigarettes-elderly.html Some Older Smokers Turn to Vaping. That May Not Be a Bad Idea.]===
*NY Times


===2021: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00475-7 Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids]===
*One third of the total sample was biochemically verified smoking abstinent 7 months after quit date, with e-cigarette users (40%) having significantly higher chances to be smoking abstinent than NRT users (23%).
*[https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-021-00475-7.pdf PDF Version]
*Citation: Adriaens, K., Belmans, E., Van Gucht, D. et al. Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids. Harm Reduct J 18, 28 (2021). https://doi.org/10.1186/s12954-021-00475-7
*Acknowledgement: This research received no external funding. EB is supported by a PhD-fellowship of the Research Foundation – Flanders (FWO-Vlaanderen; 1177820N).


===2017: Article: [https://www.aarp.org/health/conditions-treatments/info-2017/vaping-popularity-fd.html Vaping Becoming Popular Among Older Smokers]===
*AARP


===2020: [https://pubmed.ncbi.nlm.nih.gov/32770246/ QuitNic: A pilot randomised controlled trial comparing nicotine vaping products with nicotine replacement therapy for smoking cessation following residential detoxification]===
*This pilot study showed that smoking cessation support involving options for nicotine replacement and Quitline-delivered cognitive behavioural counselling is attractive to people after they have been discharged from SUD (Substance Use Disorder) treatment.
*Retention was 63% at 6-weeks and 50% at 12-weeks. At 12-weeks, 68% of the NRT group reported using combination NRT while 96% of the NVP group used the device. Acceptability ratings for the products were high in both groups. At 12-weeks, 14% of the NVP group and 18% of the NRT group reported not smoking at all in the last 7 days. Mean CPD (Cigarettes Per Day) among continued smokers decreased significantly between baseline to 12-weeks in both groups; from 19.91 to 4.72 for the NVP group (p<0.001) and from 20.88 to 5.52 in the NRT group (p<0.001). Cravings and withdrawal symptoms significantly decreased for both groups.
*[https://sci-hub.se/10.1093/ntr/ntaa143 PDF Version]


===2011: Paper: [https://jamanetwork.com/journals/jama/article-abstract/1104250 The Older Smoker]===
*JAMA


===2020: [https://academic.oup.com/ntr/article/23/4/625/5906696?login=true Effectiveness of Electronic Cigarettes in Smoking Cessation: a Systematic Review and Meta-Analysis]===
*Our results suggest that nicotine-ECs may be more effective in smoking cessation when compared to placebo ECs or NRT.
*[https://sci-hub.st/10.1093/ntr/ntaa181 PDF Version]


=Personal Testimonies from people who used to smoke=


===2019: [https://www.journalslibrary.nihr.ac.uk/hta/hta23430#/abstract E-cigarettes compared with nicotine replacement therapy within the UK Stop Smoking Services: the TEC RCT]===
*The primary outcome was CO-validated sustained abstinence rates at 52 weeks. Participants lost to follow-up or not providing biochemical validation were included as non-abstainers.
*The 1-year quit rate was 9.9% in the NRT arm and 18.0% in the e-cigarette arm.
*The e-cigarette arm had significantly higher validated quit rates at all time points. Participants in the e-cigarette arm showed significantly better adherence and experienced fewer urges to smoke throughout the initial 4 weeks of their quit attempt than those in the NRT arm, and gave their allocated product more favourable ratings. They were also more likely to be still using their allocated product at 1 year
*Participants assigned to e-cigarettes reported significantly less coughing and phlegm at 1 year than those assigned to NRT
*A detailed economic analysis confirmed that, because e-cigarettes incur lower NHS costs than NRT and generate a higher quit rate, e-cigarette use is more cost-effective.
*[https://njl-admin.nihr.ac.uk/document/download/2030301 PDF Version]


===All Years: Video Collection: [https://www.youtube.com/channel/UCY3vMuTdXfL7Z4PAsx7Q5nA/videos Golden Oldies Capitol Tours]===
*People who used to smoke share how long they smoked and what flavors helped them to quit smoking.


===2019: [https://onlinelibrary.wiley.com/doi/full/10.1111/add.14829 Cost‐effectiveness of e‐cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomized controlled trial]===
*Using e‐cigarettes as a smoking cessation aid with standard behavioural support in stop‐smoking services in England is likely to be more cost‐effective than using nicotine replacement therapy in the same setting.
*[https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.14829 PDF Version]


===All Years: Collection 13,000+ Testimonies: [https://casaa.org/_testimonials/ CASAA - REAL PEOPLE. REAL STORIES.]===
*Online submissions of personal testimonies by people who switched from smoking to harm reduction products.


===2019: [https://pubmed.ncbi.nlm.nih.gov/31300577/ Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study]===
* In our study, the effect of e-cigarettes on smoking cessation was similar compared with that of nicotine gum, a well-documented NRT. In addition, e-cigarettes were well tolerated by the study population. Therefore, the use of e-cigarettes as an NRT may be considered for smoking-cessation purposes.
*[https://sci-hub.se/10.3122/jabfm.2019.04.180384 PDF Version]
===2019: [https://www.nejm.org/doi/10.1056/NEJMoa1808779?fbclid=IwAR1598EmpCMPL9ORj38EoajDAdP1DfHk3spcWXvCa9UZPRI442YPvozZeWw A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy]===
*A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.
*Conclusion: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.
*[https://www.nejm.org/doi/pdf/10.1056/NEJMoa1808779 PDF Version]
===2019: [https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(19)30269-3/fulltext Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial]===
*In summary, when looking at continuous abstinence from smoking, provision of patches plus a nicotine e-cigarette resulted in three to seven more smokers per 100 quitting long-term (depending on the analyses done) than with patches plus a nicotine-free e-cigarette. The smaller than anticipated sample size meant the study was not sensitive enough to pick up a definitive finding for the second comparison, although analyses suggest combination nicotine therapy—ie, use of a slow release nicotine patch, together with a faster-acting oral nicotine product (in this case a nicotine e-cigarette)—could result in five to ten more smokers per 100 quitting long-term than with monotherapy (ie, nicotine patches alone). Our findings are consistent with the current findings of the Cochrane review of e-cigarettes for smoking cessation and contribute to the growing body of evidence from randomised trials on the efficacy, effectiveness and safety of e-cigarettes for smoking cessation.
*[https://www.nejm.org/doi/pdf/10.1056/NEJMoa1808779 PDF Version]
===2018: [https://www.casaa.org/wp-content/uploads/American-Cancer-Society-Position-Statement-on-Electronic-Cigarettes.pdf American Cancer Society Position Statement on Electronic Cigarettes]===
*Based on currently available evidence, using current generation e-cigarettes is less harmful than smoking cigarettes, but the health effects of long-term use are not known.
*The ACS has always supported any smoker who is considering quitting, no matter what approach they use; there is nothing more important that they can do for their health. Some smokers, despite firm clinician advice, will not attempt to quit smoking cigarettes and will not use FDA approved cessation medications.  These individuals should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e cigarettes is preferable to continuing to smoke combustible products.
<br>
<br>
===2018: [https://onlinelibrary.wiley.com/doi/10.1111/add.14527 Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey]===
*Despite the need for more evidence on their efficacy and long‐term safety, NVPs are now a more popular method for cessation than licensed NRT and prescription stop‐smoking medications in many countries.
*In light of this, HPs should be prepared to provide balanced information about NVPs, particularly to smokers who are unable to stop smoking with approved cessation therapies, and for those who are requesting guidance regarding NVPs as a smoking cessation aid
*Overall, the results from this study have shown that discussions between smokers and HPs about both quitting smoking, and the possible role NVPs could play as a cessation aid, were infrequent in the four countries in 2016. This may represent a lost opportunity for encouraging quitting smoking by providing a potentially attractive option to help smokers to quit.
*[https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.14527 PDF Version]
===2016: E-cigarettes: a developing public health consensus===
*From: Public Health England, Action on Smoking and Health, Association of Directors of Public Health, British Lung Foundation, Cancer Research UK, Faculty of Public Health, Fresh North East, Healthier Futures, Public Health Action, Royal College of Physicians, Royal Society for Public Health, UK Centre for Tobacco and Alcohol Studies, UK Health Forum
*We all agree that e-cigarettes are significantly less harmful than smoking. One in two lifelong smokers dies from their addiction. All the evidence suggests that the health risks posed by e-cigarettes are relatively small by comparison but we must continue to study the long-term effects.
*And yet, millions of smokers have the impression that e-cigarettes are at least as harmful as tobacco
*The public health opportunity is in helping smokers to quit, so we may encourage smokers to try vaping but we certainly encourage vapers to stop smoking tobacco completely.
*We know that e-cigarettes are the most popular quitting tool in the country with more than 10 times as many people using them than using local stop smoking services
*The current national evidence is that in the UK regular e-cigarette among youth use is almost exclusively confined to those young people who have already smoked, and youth smoking prevalence is continuing to fall
We should not forget what is important here. We know that smoking is the number one killer in England and we have a public health responsibility to provide smokers with the information and the tools to help them quit smoking completely and forever.
===2014: Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study===
Conclusion: “Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.”
===2014: E-cigarette versus nicotine inhaler: comparing the perceptions and experiences of inhaled nicotine devices=== 
Related Article: E-Cigarettes vs. Nicotine Inhalers
“In conclusion, during this brief trial, the e-cigarette was found to be more acceptable, provided more satisfaction and rewards, and had higher perceived benefit than the nicotine inhaler. These findings may explain why the e-cigarette has become popular among smokers while the inhaler has not achieved the same favorability. Based on this difference, e-cigarettes could have the potential to become “tobacco cigarette substitutes,” owing to their high acceptance and perceived effectiveness. While toxicants have been identified in e-cigarettes, they are present at orders of magnitude lower than tobacco cigarettes. As such, e-cigarettes may hold value as a harm reduction strategy among those unwilling or unable to quit. However, given the large variation in the market with respect to brands, more data are needed to demonstrate their efficacy and safety, and to allow physicians to more appropriately inform their patients about these products.”
===2013: Electronic cigarettes for smoking cessation: a randomised controlled trial===
657 people were randomised (289 to nicotine e-cigarettes, 295 to patches, and 73 to placebo e-cigarettes) and were included in the intention-to-treat analysis.
At 6 months, verified abstinence was 7·3% (21 of 289) with nicotine e-cigarettes, 5·8% (17 of 295) with patches, and 4·1% (three of 73) with placebo e-cigarettes
===2013: A fresh look at tobacco harm reduction: the case for the electronic cigarette===
Smokers of any age can reap substantial health benefits by quitting. In fact, no other single public health effort is likely to achieve a benefit comparable to large-scale smoking cessation.
E-cigs might be the most promising product for tobacco harm reduction to date, because, besides delivering nicotine vapour without the combustion products that are responsible for nearly all of smoking’s damaging effect, they also replace some of the rituals associated with smoking behaviour.
Nicotine’s beneficial effects include correcting problems with concentration, attention and memory, as well as improving symptoms of mood impairments. Keeping such disabilities at bay right now can be much stronger motivation to continue using nicotine than any threats of diseases that may strike years and years in the future.
Nicotine’s beneficial effects can be controlled, and the detrimental effects of the smoky delivery system can be attenuated, by providing the drug via less hazardous delivery systems. Although more research is needed, e-cigs appear to be effective cigarette substitutes for inveterate smokers, and the health improvements enjoyed by switchers do not differ from those enjoyed by tobacco/nicotine abstainers.
===2013: Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review===
When compared to the harmful effects of smoking, these studies suggest that vaping could be used as a possible “harm reduction” tool. There is evidence supporting e-cigarettes as an aide for smoking cessation, at least as successful as currently available FDA-approved NRTs.
===2011: Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series===
The most important message from this case series is that these smokers, with a documented history of recurring relapses, were able to quit smoking and to remain abstinent for at least six months after taking up an electronic cigarette.
=Quitting Smoking / Preventing Relapse (No comparison to other methods)=
===2020: Highlights of Studies in Cardiovascular Disease Prevention Presented at the 2020 American College of Cardiology Annual Scientific Session===
In E3, nicotine e-cigarettes plus counseling was superior to counseling alone for smoking cessation. Non-nicotine e-cigarettes plus counseling was also more effective compared with counseling alone though its effects on cessation were modest. This trial demonstrates the efficacy of e-cigarettes as a tool for smoking cessation compared with counseling alone.
===2020: A magic bullet? The potential impact of e-cigarettes on the toll of cigarette smoking===
The combination of assumptions produces 360 possible scenarios. 357 (99%) yield positive estimates of life-years saved (LYS) due to vaping by 2100, from 143,000 to 65 million.
The impact of vaping is greatest when it most helps smokers who otherwise have the greatest difficulty quitting smoking.
Vaping is highly likely to reduce smoking-produced mortality. Still, vaping is not “the” answer to the public health crisis created by smoking. Rather, it may well be a tool to add to the armamentarium of effective tobacco control measures.
Harm reduction can, and many would say should, be a part of the complex formula that will eventually bring about the demise of smoking.
===2020: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntaa182/5906689?redirectedFrom=fulltext Patterns of e-cigarette use and subsequent cigarette smoking cessation over two years (2013/2014 to 2015/2016) in the Population Assessment of Tobacco and Health (PATH) Study]===
*Smoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices.
*In this study, the proportion of US adults who incorrectly perceived e-cigarettes as equal to, or more, harmful than cigarettes increased steadily regardless of smoking or vaping status. Current adult smokers appear to be poorly informed about the relative risks of e-cigarettes yet have potentially the most to gain from transitioning to these products. The findings of this study emphasise the urgent need to accurately communicate the reduced relative risk of e-cigarettes compared to continued cigarette smoking and clearly differentiate absolute and relative harms.
*The lack of accurate and consistent messaging from both public health agencies and the media may be contributing to public, and more specifically adult smokers’, perceptions about the relative risk of nicotine when decoupled from combustion and tobacco smoke.
*Confusion may potentially be discouraging adult smokers from using alternative, less hazardous products which may ultimately result in a missed opportunity to positively impact health at both an individual and population level.
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501702/pdf/12954_2020_Article_410.pdf PDF Version]
*Citation: Allison M Glasser, MPH, Mahathi Vojjala, MPH, Jennifer Cantrell, DrPH, MPA, David T Levy, PhD, Daniel P Giovenco, PhD, MPH, David Abrams, PhD, Raymond Niaura, PhD, Patterns of E-cigarette Use and Subsequent Cigarette Smoking Cessation Over 2 Years (2013/2014–2015/2016) in the Population Assessment of Tobacco and Health Study, Nicotine & Tobacco Research, , ntaa182, doi: 10.1093/ntr/ntaa182
*Acknowledgement: The paper was funded by Imperial Brands Plc.
===2020: Using e-cigarettes for smoking cessation: evaluation of a pilot project in the North West of England===
Of the 1022 participants who engaged with the pilot 614 were still engaged at 4 weeks, of whom 62% had quit smoking. Of those who still smoked tobacco at week 4, smoking had reduced from a baseline of 19.1 cigarettes/day to 8.7. Overall, 37% of those initially enrolled were confirmed to be using an e-cigarette on its own at follow-up. Successful quit was associated with occupation (unemployed, 33% vs intermediate, 47%) and residing in the less deprived quintiles of deprivation (50% vs 34% in the most deprived quintile.
E-cigarettes appear to be an effective nicotine replacement therapy
===2020: Tobacco harm reduction in the 21st century===
In conclusion, to reduce smoking and to save millions of lives, tobacco harm reduction in the form of cigarette substitution with low-risk products appears to be a promising path. These products, although not completely risk-free, offer an alternative to quit or die. In consideration of the available evidence, advice to tobacco smokers should include trying substitute products. The obvious fact so often overlooked is that smoking is rewarding and people like to do it. Giving smokers an alternative with efficient nicotine delivery means that they might prefer one of these products over cigarettes.
===2019: Association Between Electronic Cigarette Use and Smoking Reduction in France===
Findings  This cohort study found that, among daily smokers in France, regular (daily) electronic cigarette use is associated with a significantly higher decrease in the number of cigarettes smoked per day as well as an increase in smoking cessation attempts. However, among former smokers, electronic cigarette use is associated with an increase in the rate of smoking relapse.
NOTE: Article that covers above study - Adults who vape are more likely to quit cigarettes, study finds
“The study did find that the heightened risk of relapse disappeared in those who quit smoking more recently, which the researchers said may be due to improved e-cigarette technology.”
“For example, the study as a whole considered anybody who quit smoking from 2010 onward and found that, in that sample, vaping increased the risk of relapse. But when researchers only considered people who quit cigarettes as of 2013, former smokers were not more likely to relapse if they vaped.”
“The researchers noted in their study that "measures of plasma nicotine levels have shown that, compared with older models of [e-cigarettes], the new generation delivers higher levels of nicotine to the bloodstream," which may make them more satisfying.”
“Other "technical improvements in [e-cigarettes] over time," they said, may also explain why people who recently quit smoking and switched to e-cigarettes were less likely to relapse than those who quit earlier.”
===2019: Association of prevalence of electronic cigarette use with smoking cessation and cigarette consumption in England: a time–series analysis between 2007 and 2017===
The increase in prevalence of e‐cigarette use by smokers in England has been positively associated with an increase in success rates of quit attempts and overall quit rates
===2019 Electronic Cigarette Use and Cigarette Abstinence Over 2 Years Among U.S. Smokers in the Population Assessment of Tobacco and Health Study===
In this nationally representative longitudinal cohort study of US adult cigarette smokers, daily e-cigarette use, compared to no e-cigarette use, was associated with a 77% increased odds of prolonged cigarette smoking abstinence over the subsequent 2 years. Regular use of e-cigarettes may help some smokers to stop smoking combustible cigarettes.
Article: Daily e-cigarette use may help smokers quit regular cigarettes
===2019 Article: Adults who vape are more likely to quit cigarettes, study finds===
“The study did find that the heightened risk of relapse disappeared in those who quit smoking more recently, which the researchers said may be due to improved e-cigarette technology.”
“For example, the study as a whole considered anybody who quit smoking from 2010 onward and found that, in that sample, vaping increased the risk of relapse. But when researchers only considered people who quit cigarettes as of 2013, former smokers were not more likely to relapse if they vaped.”
“The researchers noted in their study that "measures of plasma nicotine levels have shown that, compared with older models of [e-cigarettes], the new generation delivers higher levels of nicotine to the bloodstream," which may make them more satisfying.”
“Other "technical improvements in [e-cigarettes] over time," they said, may also explain why people who recently quit smoking and switched to e-cigarettes were less likely to relapse than those who quit earlier.”
===2018 [https://academic.oup.com/ntr/article-abstract/20/8/977/4061315?redirectedFrom=fulltext Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking]===
*This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. Vapers advised smokers to find the right combination of device, flavors and nicotine strength, continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
*[https://sci-hub.do/10.1093/ntr/ntx176# PDF Version]
*Citation: Christopher Russell, PhD, Tiffany Dickson, MSc, Neil McKeganey, PhD, Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking, Nicotine & Tobacco Research, Volume 20, Issue 8, August 2018, Pages 977–984, doi: 10.1093/ntr/ntx176
*Acknowledgement: Funding for this study was provided by Nicoventures.
===2017: Predicting Short-Term Uptake of Electronic Cigarettes: Effects of Nicotine, Subjective Effects, and Simulated Demand===
Mean cigarettes per day decreased by 37% when e-cigarettes were available relative to baseline. Nicotine-containing cartridges were associated with greater use and craving reduction than 0 mg. Alleviation of withdrawal symptoms and taste and enjoyment factors predicted e-cigarette use.
===2017: Cohort study of electronic cigarette use: effectiveness and safety at 24 months===
Of the e-cigarette users, 61.1% remained abstinent from tobacco (while 23.1% and 26.0% of tobacco-only smokers and dual users achieved tobacco abstinence).


=Quitting Smoking / Preventing Relapse=


===2016: Patterns of Electronic Cigarette Use Among Adults in the United States===
Results: Current e-cigarette use is extremely low among never cigarette smokers (0.4%) and former smokers who quit cigarettes 4 or more years ago (0.8%). Although e-cigarette experimentation is most common among current cigarette smokers and young adults, daily use is highest among former smokers who quit in the past year (13.0%) and older adults. Compared to daily cigarette smokers, recently quit smokers were more than four times as likely to be daily users of e-cigarettes ( AOR : 4.33 [95% CI: 3.08–6.09]).
Conclusion: Extremely low e-cigarette use among never-smokers and longer term former smokers suggest that e-cigarettes neither promote widespread initiation nor relapse among adults. Recognition of the heterogeneity of smokers, including the time since quitting, is critical to draw accurate conclusions about patterns of e-cigarette use at the population level and its potential for public health benefit or harm.


===2016: Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries===
===See our [https://safernicotine.wiki/mediawiki/index.php/Myth:_Alternative_nicotine_products_don%27t_help_people_stop_smoking '''page''' with a collection of studies showing that many people successfully quit smoking with the use of these products.]===
E‐cigarette use in the European Union appears to be largely confined to current or former smokers, while current use and nicotine use by people who have never smoked is rare. More than one‐third of current e‐cigarette users polled reported smoking cessation and reduction.




===2015: E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis===
=Race / Ethnic / Socioeconomic / Education / Genetic=
Conclusions: “This systematic review and meta-analyses assessed the findings of six studies which reported smoking cessation after using e-cigarettes. We found an association between nicotine-enriched e-cigarette use and smoking cessation, suggesting that the devices may be an effective alternative smoking cessation method. We also found that use of e-cigarettes was also associated with a reduction in the number of cigarettes used, suggesting they may also have a role in tobacco harm reduction programs. To our knowledge, this is the most comprehensive evidence to date on this issue, and while there are a number of important implications for further research, these findings provide timely information to inform regulatory strategies.”


===2015: A Longitudinal Study of Electronic Cigarette Use Among a Population-Based Sample of Adult Smokers: Association With Smoking Cessation and Motivation to Quit===
Results: At follow-up, 23% were intensive users, 29% intermittent users, 18% had used once or twice, and 30% had not tried e-cigarettes. Logistic regression controlling for demographics and tobacco dependence indicated that intensive users of e-cigarettes were 6 times more likely than non-users/triers to report that they quit smoking (OR: 6.07, 95% CI = 1.11, 33.2). No such relationship was seen for intermittent users. There was a negative association between intermittent e-cigarette use and 1 of 2 indicators of motivation to quit at follow-up.
Conclusion: Daily use of electronic cigarettes for at least 1 month is strongly associated with quitting smoking at follow-up. Further investigation of the underlying reasons for intensive versus intermittent use will help shed light on the mechanisms underlying the associations between e-cigarette use, motivation to quit, and smoking cessation.


===2015: Associations Between E-Cigarette Type, Frequency of Use, and Quitting Smoking: Findings From a Longitudinal Online Panel Survey in Great Britain===  
===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296947/ Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence]===
Conclusion: Whether e-cigarette use is associated with quitting depends on type and frequency of use. Compared with respondents not using e-cigarettes, daily tank users were more likely, and non-daily cigalike users were less likely, to have quit. Tanks were more likely to be used by older respondents and respondents with lower education.  
*The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP (non-combustible nicotine products) for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups).
*Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to:
**wider circumstances of socioeconomic disadvantage;
**lack of a perceived advantage of alternative products over smoking;
**and a perceived lack of information about relative harms of NCNP compared to smoking.  
*Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage.
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296947/pdf/12889_2020_Article_9083.pdf PDF Version]
*Citation: Lucherini M, Hill S, Smith K. Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence. BMC Public Health. 2020;20(1):943. Published 2020 Jun 15. doi:10.1186/s12889-020-09083-9
*Acknowledgement: The review is part of a project funded by Cancer Research UK. The award number is: C55561/A21553.


===2015: Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study (PDF 14 pages)===
=== 2019: [https://bpspubs.onlinelibrary.wiley.com/doi/10.1002/prp2.468 Nicotine oxidation by genetic variants of CYP2B6 and in human brain microsomes] ===
Results: Follow-up data were available for 236 e-smokers, 491 tobacco smokers, and 232 dual smokers (overall response rate 70.8%). All e-smokers were tobacco ex-smokers. At 12 months, 61.9% of the e-smokers were still abstinent from tobacco smoking; 20.6% of the tobacco smokers and 22.0% of the dual smokers achieved tobacco abstinence. Adjusting for potential confounders, tobacco smoking abstinence or cessation remained significantly more likely among e-smokers...


* Tobacco consumption and liability to nicotine dependence are heritable traits. One clearly implicated pathway is the C-oxidation of nicotine to nicotine iminium ion and subsequently to cotinine by CYP2A6, one of three nicotine metabolism pathways.
* Common variation in the ''CYP2B6'' gene, encoding the cytochrome P450 2B6 enzyme, is associated with substrate-specific altered clearance of multiple drugs. CYP2B6 is a minor contributor to hepatic nicotine metabolism, but the enzyme has been proposed as relevant to nicotine-related behaviors because of reported ''CYP2B6'' mRNA expression in human brain tissue.
* Human cell study
* Adam Joseph Bloom, Pan-Fen Wang, Evan D. Kharasch First published: 11 March 2019
* This work was supported by the National Institutes of Health grants K01DA034035, R01DA14211 and R01DA25931.


===2014: Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints===
===2019: [https://academic.oup.com/ntr/article/21/10/1363/5039191?login=true Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking]===
When people, ready to switch to an e-cig, are severely restricted in terms of accessibility of nicotine-containing e-liquids, the success of e-cigs may be endangered. For the e-cig to be and remain successful, it is important that people have easy access to nicotine containing e-liquids.
*Furthermore, more educated smokers are more likely to switch to exclusive e-cigarette use than less educated smokers.  
Conclusion: “In a series of controlled lab sessions with e-cig-naïve tobacco smokers, second-generation e-cigs were shown to be immediately and highly effective in reducing abstinence-induced cigarette craving and withdrawal symptoms, while not resulting in increases in eCO. Ad libitum use of e-cigs—in between and until six months after the lab sessions—resulted in remarkable reductions in or (biologically confirmed) complete abstinence from tobacco smoking in almost half of the participants who had no intention to quit smoking. [highlighting added] Eight months after the start of the study 21% of all participants were completely abstinent from tobacco cigarettes. Similar reduction/cessation rates were obtained with guided versus non-guided switching to e-cigs. Part of the observed efficacy of e-cigs in this study may be related to the fact that they allowed to maintain relatively high blood nicotine levels and showed an excellent experienced benefits/complaints ratio, especially in comparison with continued tobacco smoking”...
*Such differential switching may exacerbate socioeconomic disparities in smoking-related morbidity and mortality, but lower the burden of tobacco-related disease.
E-cigarette is an attractive long-term alternative and safer source of nicotine to conventional cigarette. Since their invention in 2003, there has been constant innovation and development of more efficient and appealing products. Here we show for the first time that second generation PVs can substantially decrease cigarette consumption without causing significant side effects in smokers not intending to quit. Moreover, overall participants’ perception and acceptance of these products was very good, in particular for those who quit or reduced smoking. Compared to our earlier work with first generation “cig-alikes”, technical problems and difficulties in use familiarization with second generation PVs were negligible. Improved products reliability and attractiveness might have contributed to the very low number of study failures and lost to follow-up and high success rates thus confirming the notion that these products are attractive substitutes for conventional cigarettes. Although large and carefully conducted RCTs will be required to confirm these preliminary encouraging observations, the notion that second generation PVs can substantially decrease cigarette consumption in smokers not intending to quit should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the vapour category
*[https://sci-hub.st/10.1093/ntr/nty120 PDF Version]
*Citation: Friedman, A. S., & Horn, S. J. L. (2018). Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking. Nicotine & Tobacco Research. doi:10.1093/ntr/nty120
 
*Acknowledgement: This work was not supported by outside funding.
===2014: Success rates with nicotine personal vaporizers: a prospective 6-month pilot study of smokers not intending to quit===
Complete tobacco cessation is the best outcome for smokers, but the powerful addictive qualities of nicotine and of the ritualistic behavior of smoking create a huge hurdle, even for those with a strong desire to quit. Tobacco harm reduction (THR), the substitution of low-risk nicotine products for cigarette smoking, is a realistic strategy for smokers who have difficulty quitting. E-cigarettes are the newest and most promising products for THR. This approach has been recently exploited to reduce or reverse the burden of harm in smokers with mental health disorders and chronic airway disease.


===2014: Characteristics, Perceived Side Effects and Benefits of Electronic Cigarette Use: A Worldwide Survey of More than 19,000 Consumers===
The main results of this survey indicate that ECs may be an effective substitute for smoking even in highly dependent subjects who are heavy smokers. Significant benefits are experienced by these people in physiologic functions and in some disease conditions, with former smokers (those who completely substituted smoking with EC use) being more likely to report such beneficial effects.
Both former and current smokers initiated EC use with high nicotine-containing liquids. More than one-fifth of the population initiated use with more than 20 mg/mL nicotine concentration, with higher prevalence in former smokers, supporting the hypothesis that nicotine plays an important role in the success of ECs as smoking substitutes [4,16]. This can be attributed to the lower nicotine absorption from EC use compared to smoking [13,17,18]. Such repeated observations should be taken into consideration by the regulatory authorities.
The most important reasons for participants to initiate ECs were to reduce or completely quit smoking and to reduce exposure of family members to second-hand smoking. It seems that these subjects are well-informed about the adverse health effects of smoking and are willing to try an alternative product which they consider less harmful.
In conclusion, in this large sample of dedicated EC users, it seems that ECs are used as long-term substitutes to smoking. They can be effective even in subjects who are highly dependent on smoking and are heavy smokers. Mild temporary side-effects and significant benefits are reported by this population. Motivation for using ECs comes from their expected less harmful potential compared to smoking.


 
===2019: [https://pubmed.ncbi.nlm.nih.gov/31477072/ Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes]===
===2014: Reasons for quitting cigarette smoking and electronic cigarette use for cessation help===
Thus, this may be the first study to suggest that smokers who want to quit smoking for immediate, extrinsic rewards may be attracted to use e-cigarettes to stop smoking cigarettes than smokers who want to quit smoking for intrinsic reasons such as health concerns. In conclusion, e-cigarettes appear to provide a “smoking” alternative to a section of cigarette smokers who may not quit smoking for health reasons. Public health efforts may need to consider employing e-cigarettes to promote tobacco-related harm reduction.
 
===2014: Cigarette Users’ Interest in Using or Switching to Electronic Nicotine Delivery Systems (ENDS) for Smokeless Tobacco for Harm Reduction, Cessation, or Novelty: A Cross-Sectional Survey of US Adults===
This study highlights higher interest in ENDS versus smokeless tobacco and greater interest in both for harm reduction and cessation than due to novelty or smoking restrictions.
27.2% of current smokers had talked with a health care provider about ENDS, with 18.0% reporting that their provider endorsed ENDS use for cessation.
Developing educational campaigns and informing practitioners about ENDS as cessation or harm reduction aids is critical.
 
 
===2013: E-Cigarettes: Prevalence and Attitudes in Great Britain===
While we found evidence supporting the view that e-cigarette use may be a bridge to quitting, we found very little evidence of e-cigarette use among adults who had never smoked. British smokers would benefit from information about the effective use, risks, and benefits of e-cigarettes, as this might enable the use of e-cigarettes to improve public health.
 
 
===2013: EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study===
Conclusion: “In smokers not intending to quit, the use of e-cigarettes, with or without nicotine, decreased cigarette consumption and elicited enduring tobacco abstinence without causing significant side effects.”
 
 
===2013: 'Vaping' profiles and preferences: an online survey of electronic cigarette users===
Seventy-four percent of participants reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. Seventy-two percent of participants used a 'tank' system, most commonly. Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine containing liquid. E-cigarettes were generally considered to be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing; and be associated with low levels of craving. Among ex-smokers, 'time to first vape' was significantly longer than 'time to first cigarette' suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported significantly greater reduction in craving than current smokers.
E-cigarettes are used primarily for smoking cessation, but for a longer duration than nicotine replacement therapy, and users believe them to be safer than smoking
 
 
===2012: The electronic-cigarette: Effects on desire to smoke, withdrawal symptoms and cognition===
The e-cigarette can reduce desire to smoke and nicotine withdrawal symptoms 20 minutes after use.
The nicotine content in this respect may be more important for males.
The first study to demonstrate that the nicotine e-cigarette can improve working memory.
 
 
===2011: Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study===
Sustained 50% reduction in the number of cig/day at week-24 was shown in 13/40(32.5%) participants; their median of 25 cigs/day decreasing to 6 cigs/day (p < 0.001). Sustained 80% reduction was shown in 5/40(12.5%) participants; their median of 30 cigs/day decreasing to 3 cigs/day (p = 0.043). Sustained smoking abstinence at week-24 was observed in 9/40(22.5%) participants, with 6/9 still using the e-Cigarette by the end of the study. Combined sustained 50% reduction and smoking abstinence was shown in 22/40 (55%) participants, with an overall 88% fall in cigs/day.
The use of e-Cigarette substantially decreased cigarette consumption without causing significant side effects in smokers not intending to quit
 
 
===2011: Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy===
Almost all (97%) used e‐cigarettes containing nicotine.
Most (96%) said the e‐cigarette helped them to quit smoking or reduce their smoking (92%).
Reasons for using the e‐cigarette included the perception that it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%).
Most ex‐smokers (79%) feared they might relapse to smoking if they stopped using the e‐cigarette.
Users of nicotine‐containing e‐cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non‐nicotine e‐cigarettes.
 
 
===2011: Electronic cigarettes (e‐cigs): views of aficionados and clinical/public health Perspectives===
The health risks from smoking are large and are known with certainty. Comparatively, the health risks from e‐cig use are likely much smaller (if any) and temporarily switching to e‐cigs will likely yield a large health benefit.
If the patient perceives that the e‐cig is helping them to stay off cigarettes and is not reporting any health problems likely attributable to the e‐cig, then the focus should be on staying smoke‐free rather than e‐cig free.
 
 
===2011: Electronic Cigarettes As a Smoking-Cessation Tool: Results from an Online Survey===
A large percentage of respondents reported a reduction in the number of cigarettes they smoked (66.8%) and almost half reported abstinence from smoking for a period of time (48.8%). Those respondents using e-cigarettes more than 20 times per day had a quit rate of 70.0%. Of respondents who were not smoking at 6 months, 34.3% were not using e-cigarettes or any nicotine-containing products at the time.
 
 
===2011: Interviews With “Vapers”: Implications for Future Research With Electronic Cigarettes===
Experienced users report health gains typical for smoking cessation despite continued vaping.
There were pervasive themes including the language and culture of vaping; social and informational support among vapers, motives and perceived benefits of using e-cigs versus cigarettes including cigarette-like enjoyment, cost, restored sense of taste and smell, and improved breathing and exercise tolerance; rapidly reduced nicotine tolerance and dependence; and a strong interest in e-cig–related research and policy.
 
 
===2010: Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial===
Conclusions “The 16 mg Ruyan V8 ENDD alleviated desire to smoke after overnight abstinence, was well tolerated and had a pharmacokinetic profile more like the Nicorette inhalator than a tobacco cigarette. Evaluation of the ENDD for longer-term safety, potential for long-term use and efficacy as a cessation aid is needed.”
 
 
===2010: Electronic cigarettes: a survey of users===
Our results suggest that ecigarettes are used mainly to quit smoking, and may be useful for this purpose.
 
 
 
=Race / Ethnic / Socioeconomic / Education=
 
 
===2020: Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence===
The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP (non-combustible nicotine products) for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups).
Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to:
wider circumstances of socioeconomic disadvantage;
lack of a perceived advantage of alternative products over smoking;
and a perceived lack of information about relative harms of NCNP compared to smoking.
Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage.
 
 
===2019 Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking===
Furthermore, more educated smokers are more likely to switch to exclusive e-cigarette use than less educated smokers.
Such differential switching may exacerbate socioeconomic disparities in smoking-related morbidity and mortality, but lower the burden of tobacco-related disease.
 
 
===2019 [https://pubmed.ncbi.nlm.nih.gov/31477072/ Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes]===
*The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
*The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
*The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
*The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
Line 569: Line 396:




===2019: Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study===
===2019: [https://www.jabfm.org/content/32/4/567.long Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study]===
In our study, the effect of e-cigarettes on smoking cessation was similar compared with that of nicotine gum, a well-documented NRT. In addition, e-cigarettes were well tolerated by the study population. Therefore, the use of e-cigarettes as an NRT may be considered for smoking-cessation purposes.
*In our study, the effect of e-cigarettes on smoking cessation was similar compared with that of nicotine gum, a well-documented NRT. In addition, e-cigarettes were well tolerated by the study population. Therefore, the use of e-cigarettes as an NRT may be considered for smoking-cessation purposes.
*[https://www.jabfm.org/content/jabfp/32/4/567.full.pdf PDF Version]
*Citation: Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study; Seung-Hwa Lee, Sang-Hyun Ahn, Yoo-Seock Cheong; The Journal of the American Board of Family Medicine Jul 2019, 32 (4) 567-574; DOI: 10.3122/jabfm.2019.04.180384
*Acknowledgement: No outside funding




===2018 Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study===
===2018: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751515/ Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study]===
Compared with non-Hispanic Whites, non-Hispanic Black, and Hispanics were less likely to become exclusive e-cigarette users  
*Compared with non-Hispanic Whites, non-Hispanic Black, and Hispanics were less likely to become exclusive e-cigarette users  
Low-income smokers were less likely than higher-income smokers to become exclusive e-cigarette users
*Low-income smokers were less likely than higher-income smokers to become exclusive e-cigarette users
Black, Hispanic, and low-income smokers were more likely to believe e-cigarettes are more harmful than cigarettes and to have positive tobacco-related social norms.
*Black, Hispanic, and low-income smokers were more likely to believe e-cigarettes are more harmful than cigarettes and to have positive tobacco-related social norms.
Results of this study show that the exclusive use of e-cigarettes is more prevalent in higher-income and White smokers. Our data suggest that higher-income and White smokers may be more likely to use e-cigarettes as a means to quit combustible cigarettes compared with low-income and racial/ethnic minority smokers. These findings suggest that sociodemographic differences in e-cigarette uptake and use patterns may contribute to widening disparities in cigarette smoking.
*Results of this study show that the exclusive use of e-cigarettes is more prevalent in higher-income and White smokers. Our data suggest that higher-income and White smokers may be more likely to use e-cigarettes as a means to quit combustible cigarettes compared with low-income and racial/ethnic minority smokers. These findings suggest that sociodemographic differences in e-cigarette uptake and use patterns may contribute to widening disparities in cigarette smoking.
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751515/pdf/nty141.pdf PDF Version]
*Citation: Harlow AF, Stokes A, Brooks DR. Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res. 2019;21(10):1385-1393. doi:10.1093/ntr/nty141
*Acknowledgement: Research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health and the Center for Tobacco Products under Award Number P50HL120163.


===2016: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5086748/?report=classic Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample]===
*This study found more similarities than differences among Whites, African Americans/Blacks, and Hispanics with a history of tobacco smoking.
*African Americans/Blacks were significantly less likely to report ever-use compared to Whites and Hispanics (50% vs. 71% and 71%, respectively; p < 0.001).
*African American/Black ever users were more likely to report plans to continue using e-cigarettes compared to Whites and Hispanics (72% vs. 53% and 47%, respectively, p = 0.01).
*African American/Black participants were more likely to use e-cigarettes as a cessation aid compared to both Whites (p = 0.03) and Hispanics (p = 0.48)
*White participants were more likely to use e-cigarettes to save money compared to Hispanics (p = 0.02).
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5086748/pdf/ijerph-13-01009.pdf PDF Version]
*Citation: Webb Hooper M, Kolar SK. Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample. Int J Environ Res Public Health. 2016;13(10):1009. Published 2016 Oct 14. doi:10.3390/ijerph13101009
*Acknoledgement: We thank the Sylvester Comprehensive Cancer Center at the University of Miami for funding this study and Case Comprehensive Cancer Center for providing funds for open access publication.
<br>
<br>


===2016 Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample===
=Regulations (not including taxes)=
This study found more similarities than differences among Whites, African Americans/Blacks, and Hispanics with a history of tobacco smoking.
African Americans/Blacks were significantly less likely to report ever-use compared to Whites and Hispanics (50% vs. 71% and 71%, respectively; p < 0.001).
African American/Black ever users were more likely to report plans to continue using e-cigarettes compared to Whites and Hispanics (72% vs. 53% and 47%, respectively, p = 0.01).
African American/Black participants were more likely to use e-cigarettes as a cessation aid compared to both Whites (p = 0.03) and Hispanics (p = 0.48)
White participants were more likely to use e-cigarettes to save money compared to Hispanics (p = 0.02).


===2023: [https://pubmed.ncbi.nlm.nih.gov/37452656/ Impacts of EU Tobacco Products Directive regulations on use of e-cigarettes in adolescents in Great Britain: a natural experiment evaluation.]===


* Moore G, Hallingberg B, Brown R, McKell J, Van Godwin J, Bauld L, Gray L, Maynard O, Mackintosh AM, Munafò M, Blackwell A, Lowthian E, Page N. Public Health Res (Southampt). 2023 Jun;11(5):1-102. doi: 10.3310/WTMH3198. PMID: 37452656
* A report on the impacts of the EU Tobacco Products Directive (TPD) on youth e-cigarette use in Great Britain, with special focus on testing the renormalization hypothesis (a specific version of ‘gateway’ in which the effect is hypothesized to occur through the mechanism of social norms). This report examines national survey data of youth (aged 13-15) from England, Scotland, and Wales, using an interrupted time series analysis of TPD regulations.
** '''''Results:''''' ''Ever smoking continued to decline alongside the emergence of e-cigarettes, with a slight slowing in decline for regular use… Young people described e-cigarettes as a fad and indicated limited interaction with components of the [TPD] regulations. In primary statistical analyses in Wales, growth in ever use of e-cigarettes prior to [TPD] regulations did not continue after implementation… Data from England and Scotland exhibited a similar pattern. Smoking followed the opposite pattern, declining prior to the [TPD] regulations, but plateauing as growth in e-cigarette use stalled.''
* Once again, these data show an inverse relationship between e-cigarette use and cigarette smoking trends, suggesting substitution. Whether or not TPD regulations causally stopped the increase in e-cigarette use is still unresolved to me (i.e., it’s also possible that it was truly a social fad that to some extent burned out on its own). However, this report shows that if the decline in e-cigarette use can be attributed to TPD, then one must face the uncomfortable conclusion that it also stopped the decline in cigarette smoking.
* Regarding the renormalization hypothesis, this is not supported by the data: the proportion of youth who agree with the statements “trying smoking is OK” and “smoking regularly is OK” declined substantially over the time period when e-cigarette use was increasing, which is what the opposite of what the renormalization hypothesis would predict (much like the population-level smoking trends contradict what the gateway hypothesis would predict). This follows other informative work by Britt Hallingberg and colleagues (e.g. here) that also tests – and fails to support – the renormalization hypothesis (which is often assumed by its proponents without citing empirical evidence).


=Regulations and Taxes=
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37161460/ The impact of JUUL market entry on cigarette sales: evidence from a major chain retailer in Canada.] ===


* It turns out that despite the hysteria in some quarters, Juul was driving out smoking in Canada.
* Results: Our estimates suggested that JUUL market entry was, on average, significantly correlated with a 1.65% per-month decrease in cigarette sales during the initial months, and with a potentially larger impact on urban areas. Our results were robust across various specifications and tests. These findings implied that JUUL and combustible cigarettes act as economic substitutes during the study time period in Canada.
* Conclusions: These results suggested that local availability of ENDS products, such as JUUL, has the potential to reduce local cigarette consumption.
* Xu Y, Sen A, Chen T, Harris CM, Prakash S. Harm Reduct J. 2023 May 9;20(1):65. doi: 10.1186/s12954-023-00790-1. PMID: 37161460


===2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===
=== 2021: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response] ===
*Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
*Signed by 24 experts from around the world
*Signed by 24 experts from around the world
*Covers 12 key points
*Covers 12 key points
**Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
**Adopts false and misleading claims about the risks of e-cigarettes.
**Draws on irrelevant information about an outbreak of lung injuries in North America.
**Misunderstands “dual-use”.
**Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
**Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
**Ignores perverse consequences of prohibition, even though these are foreseeable.
**Fails to show benefits for adolescents or address concerns it may cause harm to young people.
**Ignores the harmful effects of a vaping flavour ban on adults.
**Creates regulatory protection for the cigarette trade.
**Violates important regulatory principles, including those underpinning the European Union internal market.
**Proposes an illiberal policy and fails to recognise a major global public health opportunity.
*Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.




===2020: Are E-Cigarette Regulations Jeopardizing the Public Health?===
===2020: [https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:fd12ee2e-fef6-4b30-84db-54680a86c685#pageNum=1 Are E-Cigarette Regulations Jeopardizing the Public Health?]===
The demonization of e-cigarettes in the U.S. is counterproductive. As part of a tobacco harm reduction strategy, the potential public health benefits from e-cigarettes are substantial. Opposition to e-cigarettes, often fueled by misleading information, curbs their use as a smoking cessation aid by millions of adults.
*The demonization of e-cigarettes in the U.S. is counterproductive. As part of a tobacco harm reduction strategy, the potential public health benefits from e-cigarettes are substantial. Opposition to e-cigarettes, often fueled by misleading information, curbs their use as a smoking cessation aid by millions of adults.
E-cigarettes are far less harmful than combustible cigarettes and constitute one of the most common -- and effective -- smoking cessation aids. Overzealous or poorly designed restrictions on vaping, combined with misleading information about e-cigarettes’ true health risks, are deterring smokers from pursuing a potentially life-saving alternative.
*E-cigarettes are far less harmful than combustible cigarettes and constitute one of the most common -- and effective -- smoking cessation aids. Overzealous or poorly designed restrictions on vaping, combined with misleading information about e-cigarettes’ true health risks, are deterring smokers from pursuing a potentially life-saving alternative.
If cigarette use were largely replaced by vaping over a 10-year period in the U.S., it would prevent as many as 6.6 million premature deaths.
*If cigarette use were largely replaced by vaping over a 10-year period in the U.S., it would prevent as many as 6.6 million premature deaths.
A report by a government agency, the Public Health of England, an agency of England’s Department of Health and Social Care, reported that most consumers who vape do so in order to stop smoking.
*A report by a government agency, the Public Health of England, an agency of England’s Department of Health and Social Care, reported that most consumers who vape do so in order to stop smoking.
The doses of toxins contained in e-cigarettes are typically hundreds or thousands of times lower than in regular cigarettes. While non-smokers would be ill-advised to take up vaping, smokers could reap significant health benefits from switching to e-cigarettes.
*The doses of toxins contained in e-cigarettes are typically hundreds or thousands of times lower than in regular cigarettes. While non-smokers would be ill-advised to take up vaping, smokers could reap significant health benefits from switching to e-cigarettes.
Underage vaping by nonsmokers is rare, which supports the correlation that the rise in vaping has led to a decline in smoking among teens.Not only does the hysteria surrounding e-cigarettes endanger smokers and jeopardize public health, it also undermines the credibility of health authorities on other important issues like the coronavirus and vaccines. The American public should be told the truth about e-cigarettes.
*Underage vaping by nonsmokers is rare, which supports the correlation that the rise in vaping has led to a decline in smoking among teens.  
*Not only does the hysteria surrounding e-cigarettes endanger smokers and jeopardize public health, it also undermines the credibility of health authorities on other important issues like the coronavirus and vaccines. The American public should be told the truth about e-cigarettes.
*Too often,  policymakers  have  acted  without  carefully  weighing  the  costs  and  benefits  of their  actions.  Knee-jerk opposition to  e-cigarettes,  often  fueled  by  misleading  information, curbs  their  use  as  a  smoking  cessation aid  by  millions  of adults.
*Acknowledgement: Liam  Sigaud, Dr.  Krisztina Pusok, Janson  Q.  Prieb  and  Steve  Pociask  are with the American  Consumer  Institute, Center  for  Citizen Research,  a nonprofit  educational  and research organization.  A  special  thanks  to  Guy  Bentley, Director  of  Consumer  Freedom Research at  the Reason Foundation,  for  his  helpful  comments.  For  more information about  the  Institute,  visit  www.TheAmericanConsumer.Org  or  follow  us  on Tweeter  @ConsumerPal. 




===2020: A rational approach to e-cigarettes -challenging ERS policy on tobacco harm reduction===
===2020: [https://erj.ersjournals.com/content/55/5/2000166 A rational approach to e-cigarettes: challenging ERS policy on tobacco harm reduction]===
We  believe  that  blanket  opposition  to  e-cigarettes  is  misguided  and  will  lead  to  a  number  of important consequences that are adverse to health.  
*We  believe  that  blanket  opposition  to  e-cigarettes  is  misguided  and  will  lead  to  a  number  of important consequences that are adverse to health.  
First, smokers who would otherwise have quit smoking  by  switching  to  a  lower  risk  product  will  continue  to  smoke,  and  die  prematurely  from cancer,  cardiovascular  and  respiratory  disease.   
**First, smokers who would otherwise have quit smoking  by  switching  to  a  lower  risk  product  will  continue  to  smoke,  and  die  prematurely  from cancer,  cardiovascular  and  respiratory  disease.   
Second,  people  who  have  successfully  switched  to vaping may relapse to smoking if they come to believe that there is no health benefit from vaping, and  thus  increase  their  risk  of  avoidable  morbidity  and  premature death.
**Second,  people  who  have  successfully  switched  to vaping may relapse to smoking if they come to believe that there is no health benefit from vaping, and  thus  increase  their  risk  of  avoidable  morbidity  and  premature death.
Third,  the  pursuit  of arguments that vaping can’t help people to quit smoking, in the face of clear evidence that it does, risks undermining public trust in science.
**Third,  the  pursuit  of arguments that vaping can’t help people to quit smoking, in the face of clear evidence that it does, risks undermining public trust in science.
*[https://erj.ersjournals.com/content/erj/early/2020/02/20/13993003.00166-2020.full.pdf PDF Version]
*Citation: A rational approach to e-cigarettes: challenging ERS policy on tobacco harm reduction, John Britton, Jacob George, Linda Bauld, Sanjay Agrawal, John Moxham, Deborah Arnott, Ann McNeill, Nicholas S. Hopkinson - European Respiratory Journal May 2020, 55 (5) 2000166; DOI: 10.1183/13993003.00166-2020




===2020: The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data===
===2020: [https://academic.oup.com/ntr/article/23/3/535/5877479?login=true Vape shop owners/managers’ opinions about FDA regulation of e-cigarettes]===
We simulate that for every one standard e-cigarette pod (a device that contains liquid nicotine in e-cigarettes) of 0.7 ml no longer purchased as a result of an e-cigarette tax, the same tax increases traditional cigarettes purchased by 6.2 extra packs.  
*Vape shop owners/managers reported:
**1) entering the industry with positive intentions for their customers;
**2) training their personnel to adhere to regulations and provide good customer service; and
**3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors.
*[https://academic.oup.com/ntr/article-pdf/23/3/535/36276397/ntaa138.pdf PDF Version]
*Citation: Carla J Berg, PhD, MBA, Dianne C Barker, MHS, Steve Sussman, PhD, Betelihem Getachew, MPH, Kim Pulvers, PhD, MPH, Theodore L Wagener, PhD, Rashelle B Hayes, PhD, Lisa Henriksen, PhD, Vape Shop Owners/Managers’ Opinions About FDA Regulation of E-Cigarettes, Nicotine & Tobacco Research, Volume 23, Issue 3, March 2021, Pages 535–542, https://doi.org/10.1093/ntr/ntaa138
*Acknowledgement: This work was supported by the National Cancer Institute (R01CA215155-01A1; PI: Berg).  




===2020: Vape shop owners/managers’ opinions about FDA regulation of e-cigarettes===
===2019: [https://pubmed.ncbi.nlm.nih.gov/29617887/ E-cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation with the Potential Benefits of Increasing Smoking Cessation]===
Vape shop owners/managers reported:
*Potential life-years gained as a result of vaping-induced smoking cessation are projected to exceed potential life-years lost due to vaping-induced smoking initiation. These results hold over a wide range of plausible parameters
1) entering the industry with positive intentions for their customers;
*Our analysis strongly suggests that the upside health benefit associated with e-cigarettes, in terms of their potential to increase adult smoking cessation, exceeds their downside risk to health as a result of their possibly increasing the number of youthful smoking initiators. Public messaging and policy should continue to strive to reduce young people's exposure to all nicotine and tobacco products. But, they should not do so at the expense of limiting such products' potential to help adult smokers to quit.
2) training their personnel to adhere to regulations and provide good customer service; and
*[https://sci-hub.se/10.1093/ntr/nty062 PDF Version]
3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors.
*Citation: Warner, K. E., & Mendez, D. (2018). E-cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation with the Potential Benefits of Increasing Smoking Cessation. Nicotine & Tobacco Research. doi:10.1093/ntr/nty062
*Acknowledgements: This work was not supported by any external funding.




===2019: E-Cigarettes and Adult Smoking: Evidence from Minnesota===
===2019: [https://www.tandfonline.com/doi/abs/10.1080/10826084.2019.1626435?journalCode=isum20 Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions]===
We provide some of the first evidence on how e-cigarette taxes impact adult smokers, exploiting the large tax increase in Minnesota. That state was the first to impose a tax on e-cigarettes by extending the definition of tobacco products to include e-cigarettes. This tax, which is 95% of the wholesale price, provides a plausibly exogenous deterrent to e-cigarette use.
*Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
Our results suggest that in the sample period about 32,400 additional adult smokers would have quit smoking in Minnesota in the absence of the tax. If this tax were imposed on a national level about 1.8 million smokers would be deterred from quitting in a ten year period. The taxation of e-cigarettes at the same rate as cigarettes could deter more than 2.75 million smokers nationally from quitting in the same period.  
*This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
*[https://sci-hub.se/10.1080/10826084.2019.1626435 PDF Version]
*Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435
*Acklnowledgement: This work was supported by the National Institutes of Health (K01DA043413, K23DA039294, and K23DA042898). The funding source had no other role other than financial support.




===2019 [https://www.nber.org/papers/w26126 The Effect of E-Cigarette Taxes on Pre-pregnancy and Prenatal Smoking]===
*We show that e-cigarette taxes increase pre-pregnancy smoking, increase prenatal smoking, and lower smoking cessation during pregnancy. These findings imply that e-cigarettes and traditional cigarettes are substitutes among pregnant women.
* [https://www.nber.org/system/files/working_papers/w26126/revisions/w26126.rev0.pdf PDF Version]
*Citation: The Effect of E-Cigarette Taxes on Pre-Pregnancy and Prenatal Smoking, and Birth Outcomes - Rahi Abouk, Scott Adams, Bo Feng, Johanna Catherine Maclean, and Michael F. Pesko, NBER Working Paper No. 26126, July 2019, JEL No. I12
*Acknowledgements: Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA045016 (PI: Michael Pesko).


===2017: [https://academic.oup.com/ntr/article/19/11/1268/3061874 Does the Regulatory Environment for E-Cigarettes Influence the Effectiveness of E-Cigarettes for Smoking Cessation?]===
*This study shows that in a less restrictive EC (E-Cigarette) regulatory environment, use of ECs during a quit attempt facilitates, but in a more restrictive environment it inhibits, short-term sustained abstinence. The findings underscore the need for careful consideration on how best to regulate this emerging product so that EC benefits for smoking cessation are maximized and its risks to public health are minimized.
*[https://watermark.silverchair.com/ntx056.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAApowggKWBgkqhkiG9w0BBwagggKHMIICgwIBADCCAnwGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMXwB9-TJ7vlk7-kAOAgEQgIICTSAdHu4P0JkRyhh3rcZ-5MPXAOE-AKxfh7DVEp9gY8OxmSDo2jGuiPT1649CTOzTcBrsELY4ndWfagmJtzIIZi6yvCMXkTMbs19lls_Ep1rpfYNlH1ibKSH5oBSimq3X-2kueN3g1ccFloNS0PjhW3kCdpv6J5NhtPDLNuYMJv81ryIq-BVgx1PAyMBn1OKQo_5QiHPKryGY9UGO1tNhpeckS0ErlWlgE8sUs9jKQwyY1feQ4pDBeFCc2CFE2xF1QJQy6PpaHUJrEFnt78evuJvkkALtWsAer-nRIaC1agNg3aAyq-_9JUIUkVPtWGVsKJ2k3mQBH7w3jiMvOP4x-btObdaVqTntm7V-vU2SGtobOEArJa3M9Ml0cqGKme788rKsZEYgCD0vcE13-di-bGQyFHxMLJAQme4NYldPovuUb9ZvDtjBzf-OSfRgYel83Ik6rOr12IBsjHgBnyXD1chE0NNLHe1VlGtcZSfF-oyofGuC15ttmeegs8sEaduhXeFR5lkiBpjO8i74ENJe2N3ciEfRCh-ftaWoOEccBsFyuQ2_IAHwpcJzlW5T_TbropWPrzwecCzmlg9NW6ANdcGwXXa_K-tF3KpVZERIfl0NhoJwYNV-YYOcSzBTvCRncK3w7a_f0gfbu_qyTQiJEKjq7vKHb8kQIelfDTYGd5c6hjtG3eSMFCleNxy43Qi86Gx0xVFNldVTU7EJVGdXTszm3pyHA6vfLuBNzYhC6EjIRyyQSh6sAHoKweXTKT_QKlHpFgxjVjdLkXCRtLQ PDF Version]
*Citation: Hua-Hie Yong, PhD, Sara C Hitchman, PhD, K Michael Cummings, PhD, Ron Borland, PhD, Shannon M L Gravely, PhD, Ann McNeill, PhD, Geoffrey T Fong, PhD, Does the Regulatory Environment for E-Cigarettes Influence the Effectiveness of E-Cigarettes for Smoking Cessation?: Longitudinal Findings From the ITC Four Country Survey, Nicotine & Tobacco Research, Volume 19, Issue 11, November 2017, Pages 1268–1276, https://doi.org/10.1093/ntr/ntx056
*Acknowledgement: KMC has received grant funding from Pfizer, Inc. to study the impact of a hospital based tobacco cessation intervention and also has served as an expert witness in litigation filed against the tobacco industry. Ethical Approval: All waves of the study have received ethical approval from the relevant research ethics committee at the Cancer Council Victoria (Australia), Medical University of South Carolina (USA), University of Waterloo (Canada) and the University of Strathclyde (UK).


===2019 E-cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation with the Potential Benefits of Increasing Smoking Cessation===
Potential life-years gained as a result of vaping-induced smoking cessation are projected to exceed potential life-years lost due to vaping-induced smoking initiation. These results hold over a wide range of plausible parameters
Our analysis strongly suggests that the upside health benefit associated with e-cigarettes, in terms of their potential to increase adult smoking cessation, exceeds their downside risk to health as a result of their possibly increasing the number of youthful smoking initiators. Public messaging and policy should continue to strive to reduce young people's exposure to all nicotine and tobacco products. But, they should not do so at the expense of limiting such products' potential to help adult smokers to quit.


===2016: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079857/ A Framework for Evaluating the Public Health Impact of E-cigarettes and Other Vaporized Nicotine Products]===
*The primary aim of tobacco control policy should therefore be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to VNPs (vaporized nicotine products) rather than quitting all nicotine use. Countries whose policies discourage VNP use run the risk of neutralizing a potentially useful addition to methods of reducing tobacco use.
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079857/pdf/nihms770733.pdf PDF Version]
*Citation: Levy, D. T., Cummings, K. M., Villanti, A. C., Niaura, R., Abrams, D. B., Fong, G. T., & Borland, R. (2016). A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction, 112(1), 8–17. doi:10.1111/add.13394
*Acknowledgment: Funding was received from the Food and Drug Administration through the National Institute on Drug Abuse under grant 1R01DA036497-01.
*Article: [https://medicalxpress.com/news/2016-07-health-benefits-e-cigarette-tend-outweigh.html?fbclid=IwAR3ybNxlXyf-4rKoYsEEHpZELUKx6Us1TrkHvRN8JllyDYg8BuRjP2WbQ-s Public health benefits of e-cigarette use tend to outweigh the harms, new study says]
*Article: [https://medicalxpress.com/news/2016-04-tobacco-experts-fda-e-cigs-benefit.html Top tobacco control experts to FDA: Studies of e-cigs suggest more benefit than harm]


===2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions===
“Conclusion: This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.” (EC = E-cigarette, CC = Combustible Cigarette)




===2017 Does the Regulatory Environment for E-Cigarettes Influence the Effectiveness of E-Cigarettes for Smoking Cessation?===
===2015: [https://onlinelibrary.wiley.com/doi/abs/10.1111/add.12898 Ethical issues raised by a ban on the sale of electronic nicotine devices]===
This study shows that in a less restrictive EC regulatory environment, use of ECs during a quit attempt facilitates, but in a more restrictive environment, it inhibits, short-term sustained abstinence. The findings underscore the need for careful consideration on how best to regulate this emerging product so that EC benefits for smoking cessation are maximized and its risks to public health are minimized.
*Respect for autonomy: prohibiting ENDS infringes on smokers’ autonomy to use a less harmful nicotine product while inconsistently allowing individuals to begin and continue smoking cigarettes.
*Non‐maleficence: prohibition is supposed to prevent ENDS recruiting new smokers and discouraging smokers from quitting. It also perpetuates harm by preventing addicted smokers from using a less harmful nicotine product.
*Beneficence: ENDS could benefit addicted smokers by reducing their health risks if they use them to quit and do not engage in dual use.
*Distributive justice: lack of access to ENDS disadvantages smokers who want to reduce their health risks. Different national policies create inequalities in the availability of products to smokers internationally.
*[https://sci-hub.se/10.1111/add.12898 PDF Version]
*Citation: Hall, W., Gartner, C., & Forlini, C. (2015). Ethical issues raised by a ban on the sale of electronic nicotine devices. Addiction, 110(7), 1061–1067. doi:10.1111/add.12898
*Acknowledgement: C.G. is supported by an NHMRC Career Development Award. C.F. is supported by funding from the Australia Research Council for research on the use of stimulant drugs as cognitive enhancers. We would like to thank Sarah Yeates for her assistance in preparing this paper for publication.


=Taxes=


===2016: Study: A Framework for Evaluating the Public Health Impact of E-cigarettes and Other Vaporized Nicotine Products===
Article: Public health benefits of e-cigarette use tend to outweigh the harms, new study says -  Article: Top tobacco control experts to FDA: Studies of e-cigs suggest more benefit than harm
Comments: “...The primary aim of tobacco control policy should therefore be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to VNPs (vaporized nicotine products) rather than quitting all nicotine use. Countries whose policies discourage VNP use run the risk of neutralizing a potentially useful addition to methods of reducing tobacco use…”
===2015: Ethical issues raised by a ban on the sale of electronic nicotine devices===
Respect for autonomy: prohibiting ENDS infringes on smokers’ autonomy to use a less harmful nicotine product while inconsistently allowing individuals to begin and continue smoking cigarettes.
Non‐maleficence: prohibition is supposed to prevent ENDS recruiting new smokers and discouraging smokers from quitting. It also perpetuates harm by preventing addicted smokers from using a less harmful nicotine product.
Beneficence: ENDS could benefit addicted smokers by reducing their health risks if they use them to quit and do not engage in dual use.
Distributive justice: lack of access to ENDS disadvantages smokers who want to reduce their health risks. Different national policies create inequalities in the availability of products to smokers internationally.


===[https://safernicotine.wiki/mediawiki/index.php/ENDS_Taxes#Studies See this page: "ENDS Taxes" ]===
*Contains studies, articles, news, videos, etc. about taxing vapor products.
<br>
<br>


=Suggested studies to add to this page=
=Suggested studies to add to this page=
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**Other
**Other


=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37756034/ Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study.] ===


* smoking cessation using vaping. Also, an important aspect of this is the 'co-production' of messaging with the affected community.
* This study underscores the potential benefits of co production in health research, including the ability to target community needs, engage community stakeholders, and promote person-centered practices. The co developed mobile phone SMS text message program has the potential to support smokers to quit smoking using a vape. However, the rapidly changing e-cigarette landscape suggests that further research is needed to investigate the effectiveness of the co developed SMS text message program by considering disposable vapes. Despite the aforementioned limitations, the program was perceived as effective by participants in phase 3, highlighting the potential benefits of incorporating community perspectives and expertise in the development of smoking cessation interventions.
* Sideropoulos V, Vangeli E, Naughton F, Cox S, Frings D, Notley C, Brown J, Kimber C, Dawkins L. JMIR Form Res. 2023 Sep 27;7:e49668. doi: 10.2196/49668. PMID: 37756034
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37561572/ e-Cigarette Use and the Cessation of Tobacco Cigarette Smoking: Protocol for an Umbrella Review.] ===
* O'Leary R, Polosa R. JMIR Res Protoc. 2023 Aug 10;12:e47711. doi: 10.2196/47711. PMID: 37561572
* A protocol for an umbrella review: a systematic review of systematic reviews of ENDS for smoking cessation:
** Methods: The search will retrieve systematic reviews that include both clinical trials and experimental studies on the use of ENDS for smoking cessation. We will also include nonrandomized cohort studies that track ENDS use and the subsequent abstinence from smoking.
** Results: A second-order meta-analysis will calculate the range and average of quit rates for ENDS. A vote counting of the direction of effect, based on quit rates, will be used to present the relative effectiveness of ENDS for smoking cessation compared to other cessation treatments (including no treatment)… A sensitivity analysis will examine the impact of the intensity of cessation treatment on quit rates… Reporting bias will be presented with a tabulation of bias indicators. Publication bias will be assessed.
* Of course we have the excellent Cochrane systematic review [https://www.cochrane.org/CD010216/TOBACCO&#x20;can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used (here)], but there are also other systematic reviews on the topic that don’t necessarily align with the findings of the gold-standard Cochrane one. This umbrella review could be useful in adding another layer to the evidence base, especially since it will be assessing different types of bias.
* This umbrella review also has a novel angle compared to other systematic reviews, because it will include nonrandomized studies as well. Since most randomized studies are done in the context of a medical approach to cessation, they are often (though not always) limited to the minority who actively want to quit smoking soon. While nonrandomized studies have their own limitations, one advantage is that they more often include people who use ENDS as an alternative consumer product rather than as a medical cessation aid, making these studies more relevant to the majority of people who smoke.
* Definitely one to keep an eye on...
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37041075/ Vaping and socioeconomic inequalities in smoking cessation and relapse: a longitudinal analysis of the UK Household Longitudinal Study.] ===
* Vaping may help reduce inequalities and reduce stigma.
* Conclusions: Vaping may be especially helpful as a cessation aid for smokers without degree level education and therefore may help reduce inequalities in smoking. Nevertheless, other supports or aids may be needed to reach the most disadvantaged (ie, those with no qualifications) and to help people avoid relapse after cessation, though we did not find clear evidence suggesting that vaping would increase inequalities in relapse.
* Hardie I, Green MJ. Tob Control. 2023 Apr 11:tc-2022-057728. doi: 10.1136/tc-2022-057728. Online ahead of print. PMID: 37041075
* Human study
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37010872/ Assessment of Electronic Nicotine Delivery Systems With Cigarette Use and Self-reported Wheezing in the US Adult Population.] ===
* In this cohort study, exclusive ENDS use was not associated with an increase in the risk of self-reported wheezing. However, a small increase in risk between ENDS use and wheezing was reported by individuals who use cigarettes. This study adds to the literature about the potential health effects associated with ENDS use.
=== Add to dependance/addiction: 2022: [https://pubmed.ncbi.nlm.nih.gov/36480082/ A tale of flawed e-cigarette research undetected by defective peer review process] ===
* A plethora of poor-quality studies in the field of e-cigarette science is distorting scientific truth. This is due in part to defective editorial peer review process at scientific Journals of the highest reputation, which often gives voice to misinterpretation and misleading conclusions. This ignites division among tobacco control experts and promotes status quo in public health. The credibility of tobacco research is at stake!
===Add to Dual Use: 2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9223631/ Analyzing Trajectories of Acute Cigarette Reduction Post-Introduction of an E-Cigarette Using Ecological Momentary Assessment Data]===
===[https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-6-29 Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments]===
===[https://www.addiction-ssa.org/wp-content/uploads/2019/03/HuntK-Implementation-Of-Smokefree-Prisons-In-Scotland-Fri-8-Nov-19.pdf Implementation of  smokefree prisons in  Scotland: findings from  the Tobacco in Prisons  (TIPs) study]===


===[https://www.ahajournals.org/doi/10.1161/JAHA.120.019324 Expression of Key Inflammatory Proteins Is Increased in Immune Cells From Tobacco Cigarette Smokers But Not Electronic Cigarette Vapers: Implications for Atherosclerosis]===
===[https://www.ahajournals.org/doi/10.1161/JAHA.120.019324 Expression of Key Inflammatory Proteins Is Increased in Immune Cells From Tobacco Cigarette Smokers But Not Electronic Cigarette Vapers: Implications for Atherosclerosis]===
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===[https://academic.oup.com/aje/article/187/11/2397/5046037 Can E-Cigarettes and Pharmaceutical Aids Increase Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally Representative Cohort of American Smokers]===
===[https://academic.oup.com/aje/article/187/11/2397/5046037 Can E-Cigarettes and Pharmaceutical Aids Increase Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally Representative Cohort of American Smokers]===


===2016: [https://www.lungcancerjournal.info/article/S0169-5002(16)30323-3/fulltext Patients with lung cancer: Are electronic cigarettes harmful or useful?]===
*Based on current knowledge, for patients with lung or other forms of cancer who would otherwise continue to smoke, e-cigarettes offer an alternative way to quit smoking while they undergo medical treatment. The option to switch to e-cigarettes should be considered by healthcare practitioners with patients with cancer who would otherwise continue to smoke.
===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043356/ Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication]===
*Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation.


=More Information=
=More Information=
*Click on the category link below for more studies by topic on ENDS and Nicotine.
*Click on the category link below for more studies by topic on ENDS and Nicotine.
[[Category:Studies, Surveys, and Papers]]
[[index.php?title=Category:Studies, Surveys, and Papers]]

Latest revision as of 20:28, 14 February 2024


Studies, Surveys, Papers, and Case Studies

  • Sometimes it's necessary to view the PDF version to access the full study.
  • This page is for referencing the possible benefits of ENDS products vs. smoking cigarettes by adults. (Electronic Nicotine Delivery Systems are also known as vapor technology, ecigarettes, ecigs, EVP - electronic vapor product, etc.). They may also be referred to as ANDS - Alternative Nicotine Delivery System and SNP - safer nicotine product.


Disposable Vapes

2024: Who would be affected by a ban on disposable vapes? A population study in Great Britain

  • We used a nationally representative survey of ~70,000 adults in the general population in Great Britain (the Smoking Toolkit Study) to describe trends in disposable e-cigarette use since 2021, establish the number who would currently be affected by a ban on disposables, and assess their sociodemographic and smoking profile.
  • Our data show that while disposable vapes are particularly popular among young adults, they are also used by a large number of current smokers and ex-smokers and by people from disadvantaged groups – including those with a history of mental health conditions and working in lower paid jobs.
  • These findings suggest banning disposable vapes isn’t a straightforward solution to stop young people from vaping. It could also have unintended consequences for smokers, including discouraging people from using e-cigarettes to try to quit smoking or triggering relapse among those who have already used disposables to quit. It may also worsen health inequalities. We suggest these trade-offs should be carefully considered when making decisions around banning disposables.
  • Sarah E. Jackson, Harry Tattan-Birch, Lion Shahab, Melissa Oldham, Dimitra Kale, Leonie Brose, Jamie Brown
  • Public Health https://doi.org/10.1016/j.puhe.2023.12.024 Received 26 October 2023, Revised 19 December 2023, Accepted 20 December 2023, Available online 24 January 2024.

Dual Use

2023: Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial

  • Our findings indicate that inclusion of varenicline in a cessation programme for adults who smoke and use e-cigarettes with an intention to quit smoking could result in smoking abstinence without serious adverse events. In the absence of evidence from other smoking cessation methods, it could be useful to suggest the use of varenicline in cessation programmes specifically designed to help dual users stop smoking.
  • Caponnetto P, Spicuzza L, Campagna D, Ahluwalia JS, Russell C, Maglia M, Riela PM, Longo CF, Caci G, Quattropani MC, Signorelli MS, Polosa R. Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial. EClinicalMedicine. 2023 Nov 21;66:102316. doi: 10.1016/j.eclinm.2023.102316. PMID: 38192585; PMCID: PMC10772233.

2021: Regulation of e-cigarette flavours – a response

  • Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
  • Signed by 24 experts from around the world
  • Covers 12 key points
    • Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
    • Adopts false and misleading claims about the risks of e-cigarettes.
    • Draws on irrelevant information about an outbreak of lung injuries in North America.
    • Misunderstands “dual-use”.
    • Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
    • Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
    • Ignores perverse consequences of prohibition, even though these are foreseeable.
    • Fails to show benefits for adolescents or address concerns it may cause harm to young people.
    • Ignores the harmful effects of a vaping flavour ban on adults.
    • Creates regulatory protection for the cigarette trade.
    • Violates important regulatory principles, including those underpinning the European Union internal market.
    • Proposes an illiberal policy and fails to recognise a major global public health opportunity.
  • Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.

2020 A comparison of product dependence among cigarette only, ENDS only, and dual users: Findings from Wave 3 (2015-2016) of the PATH study


2019: 2019 Perceived relative harm of using e-cigarettes predicts future product switching among US adult cigarette and e-cigarette dual users

  • Compared with those with other perceptions of e‐cigarette harm, dual users who perceived e‐cigarettes as less harmful than cigarettes were more likely to become exclusive e‐cigarette users 1 year later.
  • PDF Version


2019: Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

  • The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
  • The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
  • PDF Version
  • Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.
  • Acknowledgement: Grants from the National Cancer Institute of the National Institutes of Health (P20CA202921 to University of Oklahoma, and 5P20CA202923 to Cherokee Nation) supported this study.

2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions

  • Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
  • This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
  • PDF Version
  • Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435
  • Acklnowledgement: This work was supported by the National Institutes of Health (K01DA043413, K23DA039294, and K23DA042898). The funding source had no other role other than financial support.

2018 Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes

  • In this population-based cohort study of 5105 participants, current exclusive e-cigarette users had greater concentrations of biomarkers of nicotine, tobacco-specific nitrosamines, volatile organic compounds, and metals compared with never tobacco users. However, these concentrations were lower than those observed in current exclusive cigarette smokers and dual users of both products.
  • PDF Version
  • Citation: Goniewicz ML, Smith DM, Edwards KC, Blount BC, Caldwell KL, Feng J, Wang L, Christensen C, Ambrose B, Borek N, van Bemmel D, Konkel K, Erives G, Stanton CA, Lambert E, Kimmel HL, Hatsukami D, Hecht SS, Niaura RS, Travers M, Lawrence C, Hyland AJ. Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes. JAMA Netw Open. 2018 Dec 7;1(8):e185937. doi: 10.1001/jamanetworkopen.2018.5937. PMID: 30646298; PMCID: PMC6324349.


2018: Motivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional study

  • The most prevalent motivation for using e-cigarettes was to reduce tobacco smoking 48%, followed by quitting smoking 39.2%, and to use e-cigarettes in places where tobacco smoking was prohibited 10.2%.
  • Citation: Bunch K, Fu M, Ballbè M, et alMotivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional studyBMJ Open 2018;8:e018329. doi: 10.1136/bmjopen-2017-018329
  • Acknowledgement: The project was cofunded by the Instituto de Salud Carlos III, Subdirección General de Evaluación, Government of Spain (PI15/00291). The project was also cofunded by ISCIII-Subdirección General de Evaluación and by FEDER funds/European Regional Development Fund (ERDF)—a way to build Europe—in 2015 and Ministry of Universities and Research, Government of Catalonia (grant 2017SGR608).


2017: Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes

  • To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
  • Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
  • After e-cig initiation, dual users decreased tobacco consumption by 82% and were low-to-moderately cigarette dependent.
  • The two groups (dual users and switchers) reported mostly using a flavor other than tobacco.
  • PDF Version
  • Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.


2016 Reductions in biomarkers of exposure, impacts on smoking urge and assessment of product use and tolerability in adult smokers following partial or complete substitution of cigarettes with electronic cigarettes

  • Subjects switching to e-cigarettes had significantly lower levels (29 %–95 %) of urinary BoEs after 5 days. Nicotine equivalents declined by 25 %–40 %.
  • Dual users who substituted half of their self-reported daily cigarette consumption with e-cigarettes experienced 7 %–38 % reductions, but had increases (1 %–20 %) in nicotine equivalents.
  • Blood nicotine biomarker levels were lower in the cessation (75 %–96 %) and e-cigarette use groups (11 %–83 %); dual users had no significant reductions.
  • All groups experienced significant decreases in exhaled CO (27 %–89 %). Exhaled NO increases (46 %–63 %) were observed in the cessation and e-cigarette use groups; dual users had minimal changes.
  • By Day 5, all groups had greater reductions in smoking urge compared to cessation. However, reductions were larger in the dual use group.
  • No serious adverse events were observed.
  • PDF Version
  • Citation: D'Ruiz CD, Graff DW, Robinson E. Reductions in biomarkers of exposure, impacts on smoking urge and assessment of product use and tolerability in adult smokers following partial or complete substitution of cigarettes with electronic cigarettes. BMC Public Health. 2016 Jul 11;16:543. doi: 10.1186/s12889-016-3236-1. PMID: 27401980; PMCID: PMC4940751.
  • Acknowledgement: This study was funded by Fontem Ventures B.V., a fully owned subsidiary of Imperial Brands plc, and the manufacturer of the e-cigarette products used in this study.


Economic Impact

2019: The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications

  • In this study, we examined the growing use of electronic cigarettes and its implications. The wide use of e-cigarettes is a very recent development, and issues regarding their long-term effects and significance cannot be fully analyzed at this time. Using CDC and other data covering the last decade, however, we examined the relationship between the recent sharp increase in e-cigarette use among Americans and the contemporaneous acceleration in the declining rate of cigarette smoking.
  • We found that the sharp increase in e-cigarette use across many groups can explain as much as 70 percent of the accelerating decline in smoking rates. We also found no reasonable evidential basis for concerns that e-cigarettes are a gateway to cigarette smoking.
  • We further found that e-cigarettes are highly effective in helping people stop smoking cigarettes.
  • Finally, we analyzed the impact of the sharp increase in e-cigarette use and the accelerating decline in cigarette smoking on healthcare costs and economic productivity. *We found that while e-cigarette users incur lower healthcare costs than cigarette smokers or ex-smokers, the longer lifespans of e-cigarette users and ex-smokers who used e-cigarettes to quit smoking result in higher lifetime healthcare costs. However, we also found that the value of the additional years of life associated with using e-cigarettes instead of smoking is much greater than the additional healthcare costs.
  • Lastly, we found that the increase in e-cigarette use and the associated reduction in smoking rates results in large productivity benefits, mainly from lower rates of illness.
  • PDF Version


2019: Cost‐effectiveness of e‐cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomized controlled trial

  • Using e‐cigarettes as a smoking cessation aid with standard behavioural (behavioral) support in stop‐smoking services in England is likely to be more cost‐effective than using nicotine replacement therapy in the same setting.
  • PDF Version


2019: Expenditure on smoking and alternative nicotine delivery products: a population survey in England

  • In England, expenditure among e‐cigarette and nicotine replacement therapy users is approximately one‐third of the expenditure of smokers. The average smoker may save an estimated £15.06 per week by switching completely to e‐cigarettes or £13.04 per week by switching to nicotine replacement therapy, although this is likely to differ according to individual usage patterns.
  • PDF Version


2018: Behavioral Economic Purchase Tasks to Estimate Demand for Novel Nicotine/tobacco Products and Prospectively Predict Future Use: Evidence From The Netherlands

  • Smokers valued FMCs [factory made cigarettes] more than ECs [electronic cigarettes] or VLNCs, [very low nicotine cigarettes] and FMCs were less sensitive to price increases. Demand indices predicted use of commercially available products over a 15 month period.
  • To serve as viable substitutes for FMCs, ECs and VLNCs will need to be priced lower than FMCs.
  • PDF Version


Flavors

2021: Regulation of e-cigarette flavours – a response

  • Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
  • Signed by 24 experts from around the world
  • Covers 12 key points
    • Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
    • Adopts false and misleading claims about the risks of e-cigarettes.
    • Draws on irrelevant information about an outbreak of lung injuries in North America.
    • Misunderstands “dual-use”.
    • Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
    • Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
    • Ignores perverse consequences of prohibition, even though these are foreseeable.
    • Fails to show benefits for adolescents or address concerns it may cause harm to young people.
    • Ignores the harmful effects of a vaping flavour (flavor) ban on adults.
    • Creates regulatory protection for the cigarette trade.
    • Violates important regulatory principles, including those underpinning the European Union internal market.
    • Proposes an illiberal policy and fails to recognise a major global public health opportunity.
  • Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.


2020: Paper: Intended and Unintended Effects of Banning Menthol Cigarettes

  • Menthol bans significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates.
  • Menthol bans shifted smokers’ cigarette purchases away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not bind).
  • PDF Full Paper


2020: Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation

  • Adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors.
  • Banning flavors altogether may be too blunt an instrument for the current problem (youth use of vapor products).
  • PDF Version
  • Citation: Friedman, A. S., & Xu, S. (2020). Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation. JAMA Network Open, 3(6), e203826. doi:10.1001/jamanetworkopen.2020.3826
  • Acknowledgment: : Ms Xu was supported by a T32 National Research Service Award from the Agency for Healthcare Research and Quality (HS017589).


2020: Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states

  • Policymakers should proceed with caution when considering bans on flavored nicotine e‐liquids: restricting legal sales may push some vapers towards illicit sources, user‐modified e‐liquids (e.g. to add flavoring) or even conventional cigarette use. Given EVALI’s potential lethality and a myriad of work suggesting that conventional cigarette use is probably far more dangerous than vaping nicotine, these outcomes could be disastrous for public health. There is no link between nicotine liquids and EVALI. It appears to have come from illicit cannabis products.
  • Link above is to the PDF version
  • Citation: Friedman, A. S. (2020). Association of Vaping‐related Lung Injuries with Rates of E‐cigarette and Cannabis Use across US States. Addiction. doi:10.1111/add.15235
  • Acknowledgement: Research reported in this publication was supported by grant number 3U54DA036151‐08S2 from the National Institute On Drug Abuse of the National Institutes of Health and FDA Center for Tobacco Products (CTP).


2020: Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers

  • Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.
  • According to a time-series analysis of data from the Smoking Toolkit study, in which repeated cross-sectional surveys are conducted with a representative sample of households in England, increasing prevalence of e-cigarette use in current smokers was predictive of higher success rates of quit attempts.
  • Most participants were self-reported long-term abstinent smokers (86.3%).
  • Those who start on a low self-reported nicotine e-liquid concentration (strength) will be more likely to relapse to tobacco smoking than those starting on a higher nicotine e-liquid, after controlling for cigarettes per day (CPD) before cessation.
  • Results suggest a change in flavor choices over the course of vaping initiation and uptake. There was a reduction in the proportion of people using a tobacco flavor, and increase in the proportion using a fruit/sweet/food flavor, from initial to current flavor choice
  • According to the 2017 ASH-A survey, among current users, fruit flavors were the most popular.
  • PDF Version
  • Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8
  • Acknowledgement: This research was funded by Cancer Research UK (CRUK), Grant Number C54889/A22732.


2020: The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults

  • Among the 18–24 age group, there was a significant increase in cigarette smoking.
  • Cigarette smoking increased among 25–34 years old.
  • Banning flavors in e-cigarettes can push some e-cigarette users to turn to cigarette smoking and could prompt some youth to initiate into smoking instead of e-cigarette use.
  • The proportions of e-cigarettes, cigarettes, and cigars obtained over the internet increased after the ban, and the proportions obtained from retailers outside of San Francisco also increased overall.
  • PDF Version
  • Citation: Yang, Y., Lindblom, E. N., Salloum, R. G., & Ward, K. D. (2020). The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addictive Behaviors Reports, 11, 100273. doi:10.1016/j.abrep.2020.100273
  • Acknowledgement: This research was supported by the National Institute of Drug Abuse of the National Institutes of Health (R03DA048460).

2019: Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

  • Our results regarding anticipated reactions to FDA e-cigarette flavor regulation suggest complexities such that the benefits and risks of flavor ban need to be carefully evaluated.
  • A majority anticipated that they would personally attempt to circumvent potential FDA regulations of e-cigarettes by obtaining e-cigarette flavors from various illicit sources (e.g., Internet orders from foreign countries) or even self-making flavors.
  • The use of flavoring agents purchased from unregulated sources could lead to additional unanticipated toxicities.
  • It is also concerning that some established e-cigarette users believed that they would return to cigarette smoking if nontobacco e-cigarette flavors were banned. Thus, for adult e-cigarette users who use certain flavors to facilitate smoking cessation or reduction, banning all nontobacco flavors could precipitate relapse to smoking.
  • PDF Version
  • Citation: Ann Am Thorac Soc Vol 17, No 5, pp 573–581, May 2020, Copyright © 2020 by the American Thoracic Society, DOI: 10.1513/AnnalsATS.201906-472OC
  • Acknowledgement: Supported by the National Institute on Drug Abuse of the National Institutes of Health (NIH) and the Center for Tobacco Products of the U.S. Food and Drug Administration (FDA) (P50-DA-036107) for the Penn State Tobacco Center of Regulatory Science.

2019: The role of flavors in vaping initiation and satisfaction among U.S. adults

  • Most common reasons for vaping initiation were as an alternative to cigarettes (43.7%) and because respondents viewed e-cigarettes as less harmful than other tobacco products (31.2%). Flavor was the third most commonly reported reason.
  • Satisfaction among those who bought flavored e-liquid was higher than those who did not buy flavored e-liquid.
  • PDF Version
  • Citation: Landry, R. L., Groom, A. L., Vu, T.-H. T., Stokes, A. C., Berry, K. M., Kesh, A., … Payne, T. J. (2019). The role of flavors in vaping initiation and satisfaction among U.S. adults. Addictive Behaviors, 106077. doi:10.1016/j.addbeh.2019.106077
  • This research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) and the FDA Center for Tobacco Products (CTP) under Awards P50HL120163 and U54HL120163.


2018: Patterns of flavored e-cigarette use among adults vapers in the United States: an internet survey

  • Survey results submitted to the FDA
  • In conclusion, this cross-sectional study of a very large sample of adult US e-cigarette users, most of which were former smokers, identified the importance of non-tobacco flavors in e-cigarette use initiation and sustained use, and their contribution to smoking cessation and relapse prevention. *This information should be considered by regulators in order to avoid unintentional adverse effects of over-restrictive regulation on e-cigarette flavors.
  • PDF Version
  • Citation: Konstantinos Farsalinos, MD, MPH, Christopher Russell, PhD, George Lagoumintzis, PhD, Konstantinos Poulas, Submitted to: Docket No. FDA-2017 N-6565 for “Regulation of Flavors in Tobacco Products.”


2018: Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA

  • Adult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time. Restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes.
  • PDF Version
  • Citation: Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018 Jun 28;15(1):33. doi: 10.1186/s12954-018-0238-6. PMID: 29954412; PMCID: PMC6022703.
  • Acknowledgements: The authors are grateful to Julie Woessner and Alex Clark (Consumer Advocates for Smoke-free Alternatives Association), Stefan Didak and Danielle Bloss (Not Blowing Smoke), Gregory Conley (American Vaping Association), Cynthia Cabrera (Cating Group), and the Board of the Smoke-Free Alternatives Trade Association, without whose assistance this study would not have been possible. Fontem Ventures, a company that makes e-cigarettes, and a wholly owned subsidiary of Imperial Brands PLC provided funding for this study.

2018: Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment

  • A ban on flavoured e-cigarettes would likely increase the choice of cigarettes in smokers, the more harmful way of obtaining nicotine.
  • PDF Version
  • Citation:Buckell J, Marti J, Sindelar JLShould flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experimentTobacco Control 2019;28:168-175.
  • Acknowledgement: Research reported in this publication was supported by grant number P50DA036151 from the National Institute on Drug Abuse (NIDA) and FDA Center for Tobacco Products (CTP).

2017: Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes

  • To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
  • Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
  • After e-cig initiation, dual users decreased tobacco consumption by 82% and were low-to-moderately cigarette dependent.
  • The two groups (dual users and switchers) reported mostly using a flavor other than tobacco.
  • PDF Version
  • Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.


2016: Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings

  • The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates of people who smoke.
  • E-cigarette vaping rates are influenced by flavorings by people transistioning from smoking.
  • These findings have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of e-cigarettes for harm reduction.
  • PDF Version
  • Citation: Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings, Tobacco Control 2016;25:ii67-ii72.
  • Acknowledgement: Support for this project was provided by Grant 1 R01 DA036492 from the National Institute on Drug Abuse, and in part by General Clinical Research Center Grant M01-RR06192 from the National Institutes of Health.

2015: The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes

  • Nonsmoking teens’ interest in e-cigarettes was very low.
  • Adult smokers’ interest was significantly higher overall and for each flavor.
  • Teen interest did not vary by flavor, but adult interest did.
  • Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavor.
  • Nonsmoking teens who had never tried e-cigarettes had the lowest interest in flavors, followed by adults who had never tried e-cigarettes
  • PDF Version
  • Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333
  • Acknowledgement: This work was supported by NJOY, a company that markets electronic cigarettes, but does not make or sell any combustible tobacco products. All authors work for Pinney Associates and provide consulting services to GlaxoSmithKline Consumer Healthcare on their stop-smoking medications and to NJOY, Inc. on electronic nicotine delivery systems (ENDS). SS and JGG also own an interest in a novel nicotine medication in development. The study sponsor was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the manuscript, nor did the sponsor review the manuscript prior to submission.

2015: Preferred Flavors and Reasons for E-cigarette Use and Discontinued Use Among Never, Current, and Former Smokers

  • Never users had significantly lower prevalence of use of alcohol, marijuana, and other tobacco products (take less risks).
  • The most commonly reported reasons for e-cigarette use were “they might be less harmful than cigarettes” (77%); “they don’t smell” (77%); “they help people quit smoking” (66%); and “they cost less than other forms of tobacco” (62%); these reasons were more frequently endorsed by former smokers.
  • Among current e-cigarette users, the most commonly used flavor was fruit flavors (67%)
  • Over 90% of former cigarette smokers who were current e-cigarette users reported using e-cigarettes to quit smoking.
  • Over half of never smokers who are former e-cigarette users said they did not recently use e-cigarettes because they “just don’t think about it”, possibly indicating that addiction did not play a role in their use.
  • PDF Version
  • Citation: Berg CJ. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health. 2016 Mar;61(2):225-36. doi: 10.1007/s00038-015-0764-x. Epub 2015 Nov 18. PMID: 26582009; PMCID: PMC4808473.
  • Acknowledgement: This research was supported by the National Cancer Institute (1K07CA139114-01A1; PI: Berg) and the Georgia Cancer Coalition (PI: Berg).


2013: Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey

  • 4,618 participants were included in the analysis, with 4,515 reporting current smoking status (current vs. former smokers).
  • More than 90% were former smokers. The mean age was 40 years
  • At the time of participation, most commonly used flavors were fruits, followed by sweets.
  • Most participants (68.3%) were switching between flavours on a daily basis or within the day, with former smokers switching more frequently. More than half of the study sample mentioned that they like the variety of flavours and that the taste gets blunt from long-term use of the same flavour. The average score for importance of flavours variability in reducing or quitting smoking was 4 (“very important”). Finally, the majority of participants stated that restricting variability of flavours would make the EC experience less enjoyable while almost half of them answered that it would increase craving for tobacco cigarettes and would make reducing or completely substituting smoking less likely.
  • The results of this survey indicate that EC liquid flavourings play a major role in the overall experience of dedicated users and support the hypothesis that they are important contributors in reducing or eliminating smoking consumption.
  • PDF Version
  • Citation: Farsalinos, K., Romagna, G., Tsiapras, D., Kyrzopoulos, S., Spyrou, A., & Voudris, V. (2013). Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey. International Journal of Environmental Research and Public Health, 10(12), 7272–7282. doi:10.3390/ijerph10127272
  • Acknowledgement: No funding was received for this study.

Nicotine Levels

2020: Might limiting liquid nicotine concentration result in more toxic electronic cigarette aerosols?

  • Thus, if users seek a given nicotine yield, regulatory limits on nicotine concentration may have the unintended consequence of increasing exposure to aerosol and respiratory toxicants. This outcome demonstrates that attempting to control ECIG nicotine yield by regulating one factor at a time may have unintended health effects and highlights the need to consider multiple factors and outcomes simultaneously when designing regulations..
  • PDF Version


2020: Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers

  • Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.
  • According to a time-series analysis of data from the Smoking Toolkit study, in which repeated cross-sectional surveys are conducted with a representative sample of households in England, increasing prevalence of e-cigarette use in current smokers was predictive of higher success rates of quit attempts.
  • Most participants were self-reported long-term abstinent smokers (86.3%).
  • Those who start on a low self-reported nicotine e-liquid concentration (strength) will be more likely to relapse to tobacco smoking than those starting on a higher nicotine e-liquid, after controlling for cigarettes per day (CPD) before cessation.
  • Results suggest a change in flavor choices over the course of vaping initiation and uptake. There was a reduction in the proportion of people using a tobacco flavor, and increase in the proportion using a fruit/sweet/food flavor, from initial to current flavor choice
  • According to the 2017 ASH-A survey, among current users, fruit flavors were the most popular.
  • PDF Version
  • Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8
  • Acknowledgement: This research was funded by Cancer Research UK (CRUK), Grant Number C54889/A22732.

2016: Protocol proposal for, and evaluation of, consistency in nicotine delivery from the liquid to the aerosol of electronic cigarettes atomizers: regulatory implications

  • Electronic cigarettes that use tank‐type atomizers appear to deliver nicotine in more consistent quantities (within the acceptable limits for medicinal nebulizers and similar to the nicotine inhaler) than electronic cigarettes that use cartomizers.
  • The protocol for testing nicotine delivery consistency described in this paper could be used effectively for regulatory purposes.
  • PDF Version


2013: Evaluating Nicotine Levels Selection and Patterns of Electronic Cigarette use in a Group of “Vapers” Who Had Achieved Complete Substitution of Smoking

  • Nicotine levels appear to play an important role in achieving and maintaining smoking cessation in the group of motivated subjects studied. High nicotine-containing liquids were used while few mild and temporary side effects were reported. Proposals about regulation should consider the pragmatic use patterns of ECs, especially in consumers who have completely substituted smoking.
  • 42% of participants reported quitting smoking during the first month of EC use.
  • Liquids with nicotine concentration >15 mg/mL were used by 74% of users at initiation of EC use, while 16.2% had to increase the initial nicotine levels in order to achieve complete smoking abstinence.
  • 64.9% reported that from the time of smoking cessation to the time of the interview (8 months median duration of EC use) they reduced the nicotine concentration they were consuming.
  • The vast majority of participants reported better exercise capacity and improved olfactory and gustatory senses.
  • Perceived EC dependency was significantly lower compared to smoking.
  • PDF Version

2013: Nicotine levels in electronic cigarettes

  • E-cigarettes (ECs) generate vapor that contains nicotine, but EC brands and models differ in their efficacy and consistency of nicotine vaporization. In ECs, which vaporize nicotine effectively, the amount inhaled from 15 puffs is lower compared with smoking a conventional cigarette.
  • PDF Version


Older Adults

2021: Paper: Ignoring our elders: tobacco control’s forgotten health equity issue

  • BMJ Tobacco Control


2019: Article: Older Smokers Are the Forgotten Victims of Our Vaping Wars

  • Filter Magazine


2018: Power Point: Rethinking nicotine across the lifespan: What about the older smoker?

  • GFN: Annie Kleykamp, PhD


2017: Article: Some Older Smokers Turn to Vaping. That May Not Be a Bad Idea.

  • NY Times


2017: Article: Vaping Becoming Popular Among Older Smokers

  • AARP


2011: Paper: The Older Smoker

  • JAMA


Personal Testimonies from people who used to smoke

All Years: Video Collection: Golden Oldies Capitol Tours

  • People who used to smoke share how long they smoked and what flavors helped them to quit smoking.


All Years: Collection 13,000+ Testimonies: CASAA - REAL PEOPLE. REAL STORIES.

  • Online submissions of personal testimonies by people who switched from smoking to harm reduction products.


Quitting Smoking / Preventing Relapse

See our page with a collection of studies showing that many people successfully quit smoking with the use of these products.

Race / Ethnic / Socioeconomic / Education / Genetic

2020: Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence

  • The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP (non-combustible nicotine products) for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups).
  • Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to:
    • wider circumstances of socioeconomic disadvantage;
    • lack of a perceived advantage of alternative products over smoking;
    • and a perceived lack of information about relative harms of NCNP compared to smoking.
  • Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage.
  • PDF Version
  • Citation: Lucherini M, Hill S, Smith K. Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence. BMC Public Health. 2020;20(1):943. Published 2020 Jun 15. doi:10.1186/s12889-020-09083-9
  • Acknowledgement: The review is part of a project funded by Cancer Research UK. The award number is: C55561/A21553.

2019: Nicotine oxidation by genetic variants of CYP2B6 and in human brain microsomes

  • Tobacco consumption and liability to nicotine dependence are heritable traits. One clearly implicated pathway is the C-oxidation of nicotine to nicotine iminium ion and subsequently to cotinine by CYP2A6, one of three nicotine metabolism pathways.
  • Common variation in the CYP2B6 gene, encoding the cytochrome P450 2B6 enzyme, is associated with substrate-specific altered clearance of multiple drugs. CYP2B6 is a minor contributor to hepatic nicotine metabolism, but the enzyme has been proposed as relevant to nicotine-related behaviors because of reported CYP2B6 mRNA expression in human brain tissue.
  • Human cell study
  • Adam Joseph Bloom, Pan-Fen Wang, Evan D. Kharasch First published: 11 March 2019
  • This work was supported by the National Institutes of Health grants K01DA034035, R01DA14211 and R01DA25931.

2019: Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking

  • Furthermore, more educated smokers are more likely to switch to exclusive e-cigarette use than less educated smokers.
  • Such differential switching may exacerbate socioeconomic disparities in smoking-related morbidity and mortality, but lower the burden of tobacco-related disease.
  • PDF Version
  • Citation: Friedman, A. S., & Horn, S. J. L. (2018). Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking. Nicotine & Tobacco Research. doi:10.1093/ntr/nty120
  • Acknowledgement: This work was not supported by outside funding.


2019: Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

  • The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
  • The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
  • PDF Version
  • Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.
  • Acknowledgement: Grants from the National Cancer Institute of the National Institutes of Health (P20CA202921 to University of Oklahoma, and 5P20CA202923 to Cherokee Nation) supported this study.


2019: Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study

  • In our study, the effect of e-cigarettes on smoking cessation was similar compared with that of nicotine gum, a well-documented NRT. In addition, e-cigarettes were well tolerated by the study population. Therefore, the use of e-cigarettes as an NRT may be considered for smoking-cessation purposes.
  • PDF Version
  • Citation: Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study; Seung-Hwa Lee, Sang-Hyun Ahn, Yoo-Seock Cheong; The Journal of the American Board of Family Medicine Jul 2019, 32 (4) 567-574; DOI: 10.3122/jabfm.2019.04.180384
  • Acknowledgement: No outside funding


2018: Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study

  • Compared with non-Hispanic Whites, non-Hispanic Black, and Hispanics were less likely to become exclusive e-cigarette users
  • Low-income smokers were less likely than higher-income smokers to become exclusive e-cigarette users
  • Black, Hispanic, and low-income smokers were more likely to believe e-cigarettes are more harmful than cigarettes and to have positive tobacco-related social norms.
  • Results of this study show that the exclusive use of e-cigarettes is more prevalent in higher-income and White smokers. Our data suggest that higher-income and White smokers may be more likely to use e-cigarettes as a means to quit combustible cigarettes compared with low-income and racial/ethnic minority smokers. These findings suggest that sociodemographic differences in e-cigarette uptake and use patterns may contribute to widening disparities in cigarette smoking.
  • PDF Version
  • Citation: Harlow AF, Stokes A, Brooks DR. Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res. 2019;21(10):1385-1393. doi:10.1093/ntr/nty141
  • Acknowledgement: Research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health and the Center for Tobacco Products under Award Number P50HL120163.

2016: Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample

  • This study found more similarities than differences among Whites, African Americans/Blacks, and Hispanics with a history of tobacco smoking.
  • African Americans/Blacks were significantly less likely to report ever-use compared to Whites and Hispanics (50% vs. 71% and 71%, respectively; p < 0.001).
  • African American/Black ever users were more likely to report plans to continue using e-cigarettes compared to Whites and Hispanics (72% vs. 53% and 47%, respectively, p = 0.01).
  • African American/Black participants were more likely to use e-cigarettes as a cessation aid compared to both Whites (p = 0.03) and Hispanics (p = 0.48)
  • White participants were more likely to use e-cigarettes to save money compared to Hispanics (p = 0.02).
  • PDF Version
  • Citation: Webb Hooper M, Kolar SK. Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample. Int J Environ Res Public Health. 2016;13(10):1009. Published 2016 Oct 14. doi:10.3390/ijerph13101009
  • Acknoledgement: We thank the Sylvester Comprehensive Cancer Center at the University of Miami for funding this study and Case Comprehensive Cancer Center for providing funds for open access publication.



Regulations (not including taxes)

2023: Impacts of EU Tobacco Products Directive regulations on use of e-cigarettes in adolescents in Great Britain: a natural experiment evaluation.

  • Moore G, Hallingberg B, Brown R, McKell J, Van Godwin J, Bauld L, Gray L, Maynard O, Mackintosh AM, Munafò M, Blackwell A, Lowthian E, Page N. Public Health Res (Southampt). 2023 Jun;11(5):1-102. doi: 10.3310/WTMH3198. PMID: 37452656
  • A report on the impacts of the EU Tobacco Products Directive (TPD) on youth e-cigarette use in Great Britain, with special focus on testing the renormalization hypothesis (a specific version of ‘gateway’ in which the effect is hypothesized to occur through the mechanism of social norms). This report examines national survey data of youth (aged 13-15) from England, Scotland, and Wales, using an interrupted time series analysis of TPD regulations.
    • Results: Ever smoking continued to decline alongside the emergence of e-cigarettes, with a slight slowing in decline for regular use… Young people described e-cigarettes as a fad and indicated limited interaction with components of the [TPD] regulations. In primary statistical analyses in Wales, growth in ever use of e-cigarettes prior to [TPD] regulations did not continue after implementation… Data from England and Scotland exhibited a similar pattern. Smoking followed the opposite pattern, declining prior to the [TPD] regulations, but plateauing as growth in e-cigarette use stalled.
  • Once again, these data show an inverse relationship between e-cigarette use and cigarette smoking trends, suggesting substitution. Whether or not TPD regulations causally stopped the increase in e-cigarette use is still unresolved to me (i.e., it’s also possible that it was truly a social fad that to some extent burned out on its own). However, this report shows that if the decline in e-cigarette use can be attributed to TPD, then one must face the uncomfortable conclusion that it also stopped the decline in cigarette smoking.
  • Regarding the renormalization hypothesis, this is not supported by the data: the proportion of youth who agree with the statements “trying smoking is OK” and “smoking regularly is OK” declined substantially over the time period when e-cigarette use was increasing, which is what the opposite of what the renormalization hypothesis would predict (much like the population-level smoking trends contradict what the gateway hypothesis would predict). This follows other informative work by Britt Hallingberg and colleagues (e.g. here) that also tests – and fails to support – the renormalization hypothesis (which is often assumed by its proponents without citing empirical evidence).

2023: The impact of JUUL market entry on cigarette sales: evidence from a major chain retailer in Canada.

  • It turns out that despite the hysteria in some quarters, Juul was driving out smoking in Canada.
  • Results: Our estimates suggested that JUUL market entry was, on average, significantly correlated with a 1.65% per-month decrease in cigarette sales during the initial months, and with a potentially larger impact on urban areas. Our results were robust across various specifications and tests. These findings implied that JUUL and combustible cigarettes act as economic substitutes during the study time period in Canada.
  • Conclusions: These results suggested that local availability of ENDS products, such as JUUL, has the potential to reduce local cigarette consumption.
  • Xu Y, Sen A, Chen T, Harris CM, Prakash S. Harm Reduct J. 2023 May 9;20(1):65. doi: 10.1186/s12954-023-00790-1. PMID: 37161460

2021: Regulation of e-cigarette flavours – a response

  • Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
  • Signed by 24 experts from around the world
  • Covers 12 key points
    • Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
    • Adopts false and misleading claims about the risks of e-cigarettes.
    • Draws on irrelevant information about an outbreak of lung injuries in North America.
    • Misunderstands “dual-use”.
    • Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
    • Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
    • Ignores perverse consequences of prohibition, even though these are foreseeable.
    • Fails to show benefits for adolescents or address concerns it may cause harm to young people.
    • Ignores the harmful effects of a vaping flavour ban on adults.
    • Creates regulatory protection for the cigarette trade.
    • Violates important regulatory principles, including those underpinning the European Union internal market.
    • Proposes an illiberal policy and fails to recognise a major global public health opportunity.
  • Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.


2020: Are E-Cigarette Regulations Jeopardizing the Public Health?

  • The demonization of e-cigarettes in the U.S. is counterproductive. As part of a tobacco harm reduction strategy, the potential public health benefits from e-cigarettes are substantial. Opposition to e-cigarettes, often fueled by misleading information, curbs their use as a smoking cessation aid by millions of adults.
  • E-cigarettes are far less harmful than combustible cigarettes and constitute one of the most common -- and effective -- smoking cessation aids. Overzealous or poorly designed restrictions on vaping, combined with misleading information about e-cigarettes’ true health risks, are deterring smokers from pursuing a potentially life-saving alternative.
  • If cigarette use were largely replaced by vaping over a 10-year period in the U.S., it would prevent as many as 6.6 million premature deaths.
  • A report by a government agency, the Public Health of England, an agency of England’s Department of Health and Social Care, reported that most consumers who vape do so in order to stop smoking.
  • The doses of toxins contained in e-cigarettes are typically hundreds or thousands of times lower than in regular cigarettes. While non-smokers would be ill-advised to take up vaping, smokers could reap significant health benefits from switching to e-cigarettes.
  • Underage vaping by nonsmokers is rare, which supports the correlation that the rise in vaping has led to a decline in smoking among teens.
  • Not only does the hysteria surrounding e-cigarettes endanger smokers and jeopardize public health, it also undermines the credibility of health authorities on other important issues like the coronavirus and vaccines. The American public should be told the truth about e-cigarettes.
  • Too often, policymakers have acted without carefully weighing the costs and benefits of their actions. Knee-jerk opposition to e-cigarettes, often fueled by misleading information, curbs their use as a smoking cessation aid by millions of adults.
  • Acknowledgement: Liam Sigaud, Dr. Krisztina Pusok, Janson Q. Prieb and Steve Pociask are with the American Consumer Institute, Center for Citizen Research, a nonprofit educational and research organization. A special thanks to Guy Bentley, Director of Consumer Freedom Research at the Reason Foundation, for his helpful comments. For more information about the Institute, visit www.TheAmericanConsumer.Org or follow us on Tweeter @ConsumerPal.


2020: A rational approach to e-cigarettes: challenging ERS policy on tobacco harm reduction

  • We believe that blanket opposition to e-cigarettes is misguided and will lead to a number of important consequences that are adverse to health.
    • First, smokers who would otherwise have quit smoking by switching to a lower risk product will continue to smoke, and die prematurely from cancer, cardiovascular and respiratory disease.
    • Second, people who have successfully switched to vaping may relapse to smoking if they come to believe that there is no health benefit from vaping, and thus increase their risk of avoidable morbidity and premature death.
    • Third, the pursuit of arguments that vaping can’t help people to quit smoking, in the face of clear evidence that it does, risks undermining public trust in science.
  • PDF Version
  • Citation: A rational approach to e-cigarettes: challenging ERS policy on tobacco harm reduction, John Britton, Jacob George, Linda Bauld, Sanjay Agrawal, John Moxham, Deborah Arnott, Ann McNeill, Nicholas S. Hopkinson - European Respiratory Journal May 2020, 55 (5) 2000166; DOI: 10.1183/13993003.00166-2020


2020: Vape shop owners/managers’ opinions about FDA regulation of e-cigarettes

  • Vape shop owners/managers reported:
    • 1) entering the industry with positive intentions for their customers;
    • 2) training their personnel to adhere to regulations and provide good customer service; and
    • 3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors.
  • PDF Version
  • Citation: Carla J Berg, PhD, MBA, Dianne C Barker, MHS, Steve Sussman, PhD, Betelihem Getachew, MPH, Kim Pulvers, PhD, MPH, Theodore L Wagener, PhD, Rashelle B Hayes, PhD, Lisa Henriksen, PhD, Vape Shop Owners/Managers’ Opinions About FDA Regulation of E-Cigarettes, Nicotine & Tobacco Research, Volume 23, Issue 3, March 2021, Pages 535–542, https://doi.org/10.1093/ntr/ntaa138
  • Acknowledgement: This work was supported by the National Cancer Institute (R01CA215155-01A1; PI: Berg).


2019: E-cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation with the Potential Benefits of Increasing Smoking Cessation

  • Potential life-years gained as a result of vaping-induced smoking cessation are projected to exceed potential life-years lost due to vaping-induced smoking initiation. These results hold over a wide range of plausible parameters
  • Our analysis strongly suggests that the upside health benefit associated with e-cigarettes, in terms of their potential to increase adult smoking cessation, exceeds their downside risk to health as a result of their possibly increasing the number of youthful smoking initiators. Public messaging and policy should continue to strive to reduce young people's exposure to all nicotine and tobacco products. But, they should not do so at the expense of limiting such products' potential to help adult smokers to quit.
  • PDF Version
  • Citation: Warner, K. E., & Mendez, D. (2018). E-cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation with the Potential Benefits of Increasing Smoking Cessation. Nicotine & Tobacco Research. doi:10.1093/ntr/nty062
  • Acknowledgements: This work was not supported by any external funding.


2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions

  • Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
  • This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
  • PDF Version
  • Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435
  • Acklnowledgement: This work was supported by the National Institutes of Health (K01DA043413, K23DA039294, and K23DA042898). The funding source had no other role other than financial support.


2017: Does the Regulatory Environment for E-Cigarettes Influence the Effectiveness of E-Cigarettes for Smoking Cessation?

  • This study shows that in a less restrictive EC (E-Cigarette) regulatory environment, use of ECs during a quit attempt facilitates, but in a more restrictive environment it inhibits, short-term sustained abstinence. The findings underscore the need for careful consideration on how best to regulate this emerging product so that EC benefits for smoking cessation are maximized and its risks to public health are minimized.
  • PDF Version
  • Citation: Hua-Hie Yong, PhD, Sara C Hitchman, PhD, K Michael Cummings, PhD, Ron Borland, PhD, Shannon M L Gravely, PhD, Ann McNeill, PhD, Geoffrey T Fong, PhD, Does the Regulatory Environment for E-Cigarettes Influence the Effectiveness of E-Cigarettes for Smoking Cessation?: Longitudinal Findings From the ITC Four Country Survey, Nicotine & Tobacco Research, Volume 19, Issue 11, November 2017, Pages 1268–1276, https://doi.org/10.1093/ntr/ntx056
  • Acknowledgement: KMC has received grant funding from Pfizer, Inc. to study the impact of a hospital based tobacco cessation intervention and also has served as an expert witness in litigation filed against the tobacco industry. Ethical Approval: All waves of the study have received ethical approval from the relevant research ethics committee at the Cancer Council Victoria (Australia), Medical University of South Carolina (USA), University of Waterloo (Canada) and the University of Strathclyde (UK).


2016: A Framework for Evaluating the Public Health Impact of E-cigarettes and Other Vaporized Nicotine Products

  • The primary aim of tobacco control policy should therefore be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to VNPs (vaporized nicotine products) rather than quitting all nicotine use. Countries whose policies discourage VNP use run the risk of neutralizing a potentially useful addition to methods of reducing tobacco use.
  • PDF Version
  • Citation: Levy, D. T., Cummings, K. M., Villanti, A. C., Niaura, R., Abrams, D. B., Fong, G. T., & Borland, R. (2016). A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction, 112(1), 8–17. doi:10.1111/add.13394
  • Acknowledgment: Funding was received from the Food and Drug Administration through the National Institute on Drug Abuse under grant 1R01DA036497-01.
  • Article: Public health benefits of e-cigarette use tend to outweigh the harms, new study says
  • Article: Top tobacco control experts to FDA: Studies of e-cigs suggest more benefit than harm


2015: Ethical issues raised by a ban on the sale of electronic nicotine devices

  • Respect for autonomy: prohibiting ENDS infringes on smokers’ autonomy to use a less harmful nicotine product while inconsistently allowing individuals to begin and continue smoking cigarettes.
  • Non‐maleficence: prohibition is supposed to prevent ENDS recruiting new smokers and discouraging smokers from quitting. It also perpetuates harm by preventing addicted smokers from using a less harmful nicotine product.
  • Beneficence: ENDS could benefit addicted smokers by reducing their health risks if they use them to quit and do not engage in dual use.
  • Distributive justice: lack of access to ENDS disadvantages smokers who want to reduce their health risks. Different national policies create inequalities in the availability of products to smokers internationally.
  • PDF Version
  • Citation: Hall, W., Gartner, C., & Forlini, C. (2015). Ethical issues raised by a ban on the sale of electronic nicotine devices. Addiction, 110(7), 1061–1067. doi:10.1111/add.12898
  • Acknowledgement: C.G. is supported by an NHMRC Career Development Award. C.F. is supported by funding from the Australia Research Council for research on the use of stimulant drugs as cognitive enhancers. We would like to thank Sarah Yeates for her assistance in preparing this paper for publication.

Taxes

See this page: "ENDS Taxes"

  • Contains studies, articles, news, videos, etc. about taxing vapor products.



Suggested studies to add to this page

  • If you'd prefer someone else to add a study to a topic, use this subject for one of the regular page editors to address.
  • PAGE EDITORS - Please add Studies, Surveys, Papers, etc. in this format to keep page consistent for all viewers.
    • Topic
    • Year (list new to old) Name of Study (In link format to the study)
    • Note here if animal study (leave blank if not)
    • Brief Summary
    • Link to PDF Version
    • Citation
    • Acknowledgements (funded by, helped by)
    • Keywords
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2023: Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study.

  • smoking cessation using vaping. Also, an important aspect of this is the 'co-production' of messaging with the affected community.
  • This study underscores the potential benefits of co production in health research, including the ability to target community needs, engage community stakeholders, and promote person-centered practices. The co developed mobile phone SMS text message program has the potential to support smokers to quit smoking using a vape. However, the rapidly changing e-cigarette landscape suggests that further research is needed to investigate the effectiveness of the co developed SMS text message program by considering disposable vapes. Despite the aforementioned limitations, the program was perceived as effective by participants in phase 3, highlighting the potential benefits of incorporating community perspectives and expertise in the development of smoking cessation interventions.
  • Sideropoulos V, Vangeli E, Naughton F, Cox S, Frings D, Notley C, Brown J, Kimber C, Dawkins L. JMIR Form Res. 2023 Sep 27;7:e49668. doi: 10.2196/49668. PMID: 37756034

2023: e-Cigarette Use and the Cessation of Tobacco Cigarette Smoking: Protocol for an Umbrella Review.

  • O'Leary R, Polosa R. JMIR Res Protoc. 2023 Aug 10;12:e47711. doi: 10.2196/47711. PMID: 37561572
  • A protocol for an umbrella review: a systematic review of systematic reviews of ENDS for smoking cessation:
    • Methods: The search will retrieve systematic reviews that include both clinical trials and experimental studies on the use of ENDS for smoking cessation. We will also include nonrandomized cohort studies that track ENDS use and the subsequent abstinence from smoking.
    • Results: A second-order meta-analysis will calculate the range and average of quit rates for ENDS. A vote counting of the direction of effect, based on quit rates, will be used to present the relative effectiveness of ENDS for smoking cessation compared to other cessation treatments (including no treatment)… A sensitivity analysis will examine the impact of the intensity of cessation treatment on quit rates… Reporting bias will be presented with a tabulation of bias indicators. Publication bias will be assessed.
  • Of course we have the excellent Cochrane systematic review (here), but there are also other systematic reviews on the topic that don’t necessarily align with the findings of the gold-standard Cochrane one. This umbrella review could be useful in adding another layer to the evidence base, especially since it will be assessing different types of bias.
  • This umbrella review also has a novel angle compared to other systematic reviews, because it will include nonrandomized studies as well. Since most randomized studies are done in the context of a medical approach to cessation, they are often (though not always) limited to the minority who actively want to quit smoking soon. While nonrandomized studies have their own limitations, one advantage is that they more often include people who use ENDS as an alternative consumer product rather than as a medical cessation aid, making these studies more relevant to the majority of people who smoke.
  • Definitely one to keep an eye on...

2023: Vaping and socioeconomic inequalities in smoking cessation and relapse: a longitudinal analysis of the UK Household Longitudinal Study.

  • Vaping may help reduce inequalities and reduce stigma.
  • Conclusions: Vaping may be especially helpful as a cessation aid for smokers without degree level education and therefore may help reduce inequalities in smoking. Nevertheless, other supports or aids may be needed to reach the most disadvantaged (ie, those with no qualifications) and to help people avoid relapse after cessation, though we did not find clear evidence suggesting that vaping would increase inequalities in relapse.
  • Hardie I, Green MJ. Tob Control. 2023 Apr 11:tc-2022-057728. doi: 10.1136/tc-2022-057728. Online ahead of print. PMID: 37041075
  • Human study

2023: Assessment of Electronic Nicotine Delivery Systems With Cigarette Use and Self-reported Wheezing in the US Adult Population.

  • In this cohort study, exclusive ENDS use was not associated with an increase in the risk of self-reported wheezing. However, a small increase in risk between ENDS use and wheezing was reported by individuals who use cigarettes. This study adds to the literature about the potential health effects associated with ENDS use.

Add to dependance/addiction: 2022: A tale of flawed e-cigarette research undetected by defective peer review process

  • A plethora of poor-quality studies in the field of e-cigarette science is distorting scientific truth. This is due in part to defective editorial peer review process at scientific Journals of the highest reputation, which often gives voice to misinterpretation and misleading conclusions. This ignites division among tobacco control experts and promotes status quo in public health. The credibility of tobacco research is at stake!

Add to Dual Use: 2022: Analyzing Trajectories of Acute Cigarette Reduction Post-Introduction of an E-Cigarette Using Ecological Momentary Assessment Data

Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments

Implementation of smokefree prisons in Scotland: findings from the Tobacco in Prisons (TIPs) study

Expression of Key Inflammatory Proteins Is Increased in Immune Cells From Tobacco Cigarette Smokers But Not Electronic Cigarette Vapers: Implications for Atherosclerosis

Can E-Cigarettes and Pharmaceutical Aids Increase Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally Representative Cohort of American Smokers

2016: Patients with lung cancer: Are electronic cigarettes harmful or useful?

  • Based on current knowledge, for patients with lung or other forms of cancer who would otherwise continue to smoke, e-cigarettes offer an alternative way to quit smoking while they undergo medical treatment. The option to switch to e-cigarettes should be considered by healthcare practitioners with patients with cancer who would otherwise continue to smoke.

2019: Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication

  • Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation.

More Information

  • Click on the category link below for more studies by topic on ENDS and Nicotine.

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