Myth: Alternative nicotine products don't help people stop smoking: Difference between revisions

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Myth: Alternative nicotine products don't help people stop smoking: Difference between revisions

Myth: Alternative nicotine products don't help people stop smoking (view source)

Revision as of 16:42, 28 April 2024

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-[[File:Can alternative nicotine products help people stop smoking.png|center|]]
+[[File:Can alternative nicotine products help people stop smoking.png|center]]
 <br>
-'''<big>Myth: Alternative nicotine products don't help people stop smoking</big>'''
+'''<big>Myth: Alternative nicotine products don't help people stop smoking or prevent returning to smoking</big>'''
-There are claims that e-cigarettes, snus, nicotine pouches, and heated tobacco products don't help people stop smoking. The data dispels that myth, as many studies have shown that people are using these products to quit smoking successfully.
+<span style="color:#ff0000">'''<big>There are claims that alternative nicotine products such as e-cigarettes, snus, nicotine pouches, and heated tobacco products don't help people stop smoking. The data dispels that myth, as many studies have shown that people are using these products to quit smoking successfully. The products are also helping people remain abstinent from smoking.</big>'''</span>
-='''Studies - No Intention of Quitting Smoking (Accidental Quitters)'''=
+='''No Intention of Quitting Smoking (Accidental Quitters)'''=
+===2024: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntae047/7623369 Using pod based e-cigarettes and nicotine pouches to reduce harm for adults with low socioeconomic status who smoke: A pilot randomized controlled trial]===
+*This study provides novel evidence that e-cigarettes and nicotine pouches can be a harm reduction tool for individuals with lower SES who smoke and are not willing to quit smoking, contributing to reducing tobacco-related disparities in this population.
+===2023: [https://link.springer.com/article/10.1007/s00213-023-06401-y Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches]===
+*A critically important design component of this study was that it was not a smoking cessation treatment study, and hence smoking abstinence was not the primary outcome. Accordingly, no smoking cessation counseling was provided and smokers who expressed a desire to receive treatment for nicotine dependence were excluded from the study. Thus, the study was not expected to lead to high smoking abstinence rates but was instead designed to differentiate the pharmacologic impact of nicotine vs. no nicotine (in ENDS or patch) on smoking behavior.
+*...there was a strong correlation between ENDS use and decrease in self-reported cigarette consumption in week 8 (end of treatment), but only in nicotine ENDS condition...
+*Smoking abstinence at week 8 was also related to ENDS use in the nicotine ENDS condition only; participants who were abstinent from smoking used more nicotine pods than non-abstinent participants
+*The main finding of this study was that the use of nicotine vs. no nicotine in ENDS was associated with a large and statistically significant reduction in expired air CO, an objective biomarker of smoking.
 ===2023: [https://pubmed.ncbi.nlm.nih.gov/36110040/ Associations between nicotine vaping uptake and cigarette smoking cessation vary by smokers' plans to quit: longitudinal findings from the International Tobacco Control Four Country Smoking and Vaping Surveys]===
@@ Line 30: / Line 39: @@
 *Article about the study: [https://www.revyuh.com/top-news/featured/e-cigarettes-may-help-you-quit-smoking-even-if-you-dont-want-to/ E-cigarettes may help you quit smoking, even if you don’t want to]
 *Press Release: [https://www.roswellpark.org/newsroom/202112-daily-vaping-dramatically-ups-quit-rate-heavy-smokers-not-aiming-quit Daily Vaping Dramatically Ups Quit Rate in Heavy Smokers Not Aiming to Quit]
+===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245610/ Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints]===
+*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.
+*“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. 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”...
+*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://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245610/pdf/ijerph-11-11220.pdf PDF Version]
+===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247211/ 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.
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247211/pdf/12889_2014_Article_7263.pdf PDF Version]
+=== 2013: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691171/ EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study] ===
+* ECLAT is a prospective 12-month randomized, controlled trial that evaluates smoking reduction/abstinence in 300 smokers not intending to quit experimenting two different nicotine strengths of a popular e-cigarette model compared to its non-nicotine choice.
+* The study consisted of nine visits during which cig/day use and exhaled carbon monoxide (eCO) levels were measured. Smoking reduction and abstinence rates were calculated. Adverse events and product preferences were also reviewed.
+* In smokers not intending to quit, the use of e-cigarettes<kbd>,</kbd> with or without nicotine, decreased cigarette consumption and elicited enduring tobacco abstinence without causing significant side effects.
+* Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R. PLoS One. 2013 Jun 24;8(6):e66317. doi: 10.1371/journal.pone.0066317
+===2011: [https://pubmed.ncbi.nlm.nih.gov/21989407/ 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
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203079/pdf/1471-2458-11-786.pdf PDF Version]
 <br>
-='''Studies - Combined Intending and Not Intending to Quit Smoking'''=
+='''Combined Intending and Not Intending to Quit Smoking'''=
+===2024: [https://www.tandfonline.com/eprint/88U4G6XY94SYYGDFVNGJ/full?target=10.1080/10826084.2024.2303990 Adult smokers’ Complete Switching Away from Cigarettes at 6, 9, and 12 Months after Initially Purchasing a JUUL e-Cigarette]===
+*"Approximately one-fifth of adult smokers reported 30-day point-prevalence abstinence at 6, 9, and 12 months after purchasing JUUL. Greater use of JUUL and stronger subjective reinforcing effects were associated with nonsmoking, validating the potential for ENDS to substitute for smoking, with potential for positive impacts on individual and population health."
 ===2023: [https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1 Electronic Cigarettes for Smoking Cessation: Cochrane Living Systematic Review]===
@@ Line 42: / Line 75: @@
 ===2021: [https://pubmed.ncbi.nlm.nih.gov/34002223/ Differences in Switching Away From Smoking Among Adult Smokers Using JUUL Products in Regions With Different Maximum Nicotine Concentrations: North America and the United Kingdom]===
 *In this longitudinal study of N.Am. and UK smokers who purchased JUUL, switch rates were higher in the N.Am. users, where smokers were using higher nicotine concentrations. The results were robust to multiple adjustments for differences between the two nicotine concentration policy regions across different statistical approaches, including PSM on relevant observable characteristics. These results have implications for regulatory policy, as the availability of ENDS with nicotine concentrations greater than 20 mg/mL may facilitate switching away from cigarette among adult smokers.
+===2021: [https://pubmed.ncbi.nlm.nih.gov/33894796/ Switching away from Cigarette Smoking with JUUL: Populations of Special Interest]===
+*Substantial rates of complete switching were consistently achieved across all medico-socio-demographic subgroups 12 months following the purchase of the JSK. The potential benefits of switching with JUUL on smokers are likely to be experienced by a wide range of adult smokers.
 ===2020: [https://pubmed.ncbi.nlm.nih.gov/32877429/ Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16]===
@@ Line 113: / Line 149: @@
 *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. 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.
 *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375383/pdf/ntu200.pdf PDF Version]
+===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464650/ Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study]===
+*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...
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464650/pdf/pone.0129443.pdf PDF Version]
+===2013: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850892/ 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
+*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.
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850892/pdf/1477-7517-10-19.pdf PDF Version]
+===2013: [https://academic.oup.com/ntr/article/15/10/1737/1183788 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.
+*[https://scholar.google.com/scholar_url?url=https://academic.oup.com/ntr/article-pdf/15/10/1737/4005852/ntt057.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=5-niYKGiHo6RywT0wZbgCg&scisig=AAGBfm1x30ekBGwfhPgkxdJKFW0eOfPFPw PDF Version]
 <br>
-='''Studies - Smoking Cessation'''=
+='''Intending to Quit Smoking'''=
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37455014/ E-cigarette support for smoking cessation: Identifying the effectiveness of intervention components in an on-line randomized optimization experiment.] ===
+* Kimber C, Sideropoulos V, Cox S, Frings D, Naughton F, Brown J, McRobbie H, Dawkins L. Addiction. 2023 Jul 16. doi: 10.1111/add.16294. Online ahead of print. PMID: 37455014
+* Measurements: The primary outcome was 4-week self-reported complete abstinence at 12 weeks post-randomization. Primary analyses were intention-to-treat (loss to follow-up recorded as smoking). Logistic regressions modelled the three- and two-way interactions and main effects, explored in that order.
+* Findings: In the adjusted model the only significant interaction was a two-way interaction, advice on flavour combined with text message support, which increased the odds of abstinence (odds ratio = 1.55, 95% confidence interval = 1.13–2.14, P = 0.007, Bayes factor = 7.25). There were no main effects of the intervention components.
+===2023 (News): [https://pubmed.ncbi.nlm.nih.gov/37041005/ Vaping: Government announces "swap to stop" scheme to cut smoking rates.] ===
+*One million smokers in England will be given a free vaping starter kit as part of a government package of measures to get smoking rates below 5% by 2030
 === 2023: [https://pubmed.ncbi.nlm.nih.gov/37148992/ Efficacy and Safety of E-Cigarette Use for Smoking Cessation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.] ===
-* Results: A total of 5 RCTs (n=3,253) were included. Compared with conventional smoking cessation therapies, the use of nicotine e-cigarettes was associated with an increase in abstinence, defined by the most rigorous criterion of abstinence reported (RR: 1.77; 95% CI: 1.29-2.44). Nicotine e-cigarettes also increased abstinence (defined by the most rigorous criterion) compared to non-nicotine e-cigarettes (RR: 1.56; 95% CI: 1.13-2.15). The incidence of death or SAEs was low across all trials at maximum follow-up.
+*Results: A total of 5 RCTs (n=3,253) were included. Compared with conventional smoking cessation therapies, the use of nicotine e-cigarettes was associated with an increase in abstinence, defined by the most rigorous criterion of abstinence reported (RR: 1.77; 95% CI: 1.29-2.44). Nicotine e-cigarettes also increased abstinence (defined by the most rigorous criterion) compared to non-nicotine e-cigarettes (RR: 1.56; 95% CI: 1.13-2.15). The incidence of death or SAEs was low across all trials at maximum follow-up.
-* Conclusions: Among individuals attempting to quit smoking, nicotine e-cigarettes are more efficacious than conventional nicotine replacement or behavioral smoking cessation therapies and may prove beneficial in reducing smoking-related health risks.
+*Conclusions: Among individuals attempting to quit smoking, nicotine e-cigarettes are more efficacious than conventional nicotine replacement or behavioral smoking cessation therapies and may prove beneficial in reducing smoking-related health risks.
 ===2023: [https://www.sciencedirect.com/science/article/pii/S221133552300092X An examination of quitting smoking as a reason for vaping by the type of nicotine vaping device used most often among adults who smoke and vape: Findings from the Canada, England and the United States 2020 ITC Smoking and Vaping Survey]===
@@ Line 183: / Line 243: @@
 *Long-term use of e-cigarettes was associated with a higher rate of quitting smoking.
 *[https://tobaccocontrol.bmj.com/content/tobaccocontrol/25/Suppl_1/i90.full.pdf PDF Version]
+===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511704/ 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.
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511704/pdf/nihms676311.pdf PDF Version]
+===2014: [https://academic.oup.com/ntr/article-abstract/17/2/245/1258995 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. Developing educational campaigns and informing practitioners about caveats around ENDS as cessation or harm reduction aids are critical.
+*[https://sci-hub.st/10.1093/ntr/ntu103 PDF Version]
+===2013: [https://pubmed.ncbi.nlm.nih.gov/23551515/ '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
+*[https://sci-hub.st/10.1111/add.12150 PDF Version]
+===2012: [https://www.sciencedirect.com/science/article/abs/pii/S0306460312000913 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.
+*[https://sci-hub.se/10.1016/j.addbeh.2012.03.004 PDF Version]
+===2011: [https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-5-585 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.
+*[https://jmedicalcasereports.biomedcentral.com/track/pdf/10.1186/1752-1947-5-585.pdf PDF Version]
+===2011: [https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2011.03505.x 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.
+*[https://sci-hub.se/10.1111/j.1360-0443.2011.03505.x PDF Version]
+===2011: [https://www.sciencedirect.com/science/article/abs/pii/S0749379710007920 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.
+*The distinct and unique advantage of e-cigarettes is that they allow individuals to utilize one device that can simultaneously address nicotine withdrawal, psychological factors, and behavioral cues that serve as barriers to smoking abstinence.
+*[https://sci-hub.se/10.1016/j.amepre.2010.12.006 PDF Version]
+===2011: [https://academic.oup.com/ntr/article/13/9/860/1134354 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.
+*[https://sci-hub.se/10.1093/ntr/ntr088 PDF Version]
+===2010: [https://tobaccocontrol.bmj.com/content/19/2/98 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.”
+*[https://sci-hub.se/10.1136/tc.2009.031567 PDF Version]
+===2010: [https://link.springer.com/article/10.1186/1471-2458-10-231 Electronic cigarettes: a survey of users]===
+*Our results suggest that ecigarettes are used mainly to quit smoking, and may be useful for this purpose.
+*[https://link.springer.com/content/pdf/10.1186%2F1471-2458-10-231.pdf PDF Version]
+===2006: [https://tobaccocontrol.bmj.com/content/15/3/210 Role of snus in initiation and cessation of tobacco smoking in Sweden]===
+*Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker, and increased likelihood of stopping smoking
+===2005: [https://tobaccocontrol.bmj.com/content/14/6/422 Is Swedish snus associated with smoking initiation or smoking cessation?]===
+*“Among males participating in a large population based twin study in Sweden, snus use was associated with smoking cessation but not initiation.”
+*[https://tobaccocontrol.bmj.com/content/tobaccocontrol/14/6/422.full.pdf PDF Version]
 <br>
-='''Consumer Products vs Medicinal Products for Smoking Cessation'''=
+='''Consumer Products vs Medicinal Products'''=
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37458789/ Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches.] ===
+* Rose JE, Frisbee S, Campbell D, Salley A, Claerhout S, Davis JM. Psychopharmacology (Berl). 2023 Jul 17. doi: 10.1007/s00213-023-06401-y. Online ahead of print. PMID: 37458789
+* Results: The use of nicotine in ENDS led to significant reductions in smoking (ENDS nicotine vs. placebo difference in CO change = -9.2 ppm; 90% CI (-1.5 ppm, -16.9 ppm)) and was highly correlated with reductions in self-reported cigarettes per day (r=0.6).
+* The effect of nicotine in nicotine patches was not statistically significant (patch nicotine vs. placebo difference in CO change = -0.1 ppm; 90% CI (-7.8 ppm, 7.6 ppm)).
 ===2023: [https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1 Electronic Cigarettes for Smoking Cessation: Cochrane Living Systematic Review]===
@@ Line 243: / Line 365: @@
 *“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.”
 *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238186/pdf/11606_2014_Article_2889.pdf PDF Version]
+===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171752/ 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.”
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171752/pdf/add0109-1531.pdf PDF Version]
+===2013: [https://pubmed.ncbi.nlm.nih.gov/24029165/ 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
+*[https://sci-hub.st/10.1016/S0140-6736(13)61842-5 PDF Version]
+===2013: [https://www.frontiersin.org/articles/10.3389/fpubh.2013.00056/full 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.
 <br>
-='''Importance of Nicotine Levels for Smoking Cessation'''=
+='''Importance of Nicotine Levels'''=
+===2022: [https://pubmed.ncbi.nlm.nih.gov/34850164/  Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers With No Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial]===
+*When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute.
 ===2021: [https://academic.oup.com/ntr/article/23/7/1113/6168972 A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes]===
@@ Line 261: / Line 398: @@
 *When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute.
 *The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.
+===2020: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00418-8 Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers]===
+*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.
+===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]
 ===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]
+===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025024/ 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. This can be attributed to the lower nicotine absorption from EC use compared to smoking. 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.
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025024/pdf/ijerph-11-04356.pdf PDF Version]
+===2013: [https://journals.sagepub.com/doi/full/10.4137/SART.S12756 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.
+*[https://journals.sagepub.com/doi/pdf/10.4137/SART.S12756 PDF Version]
 <br>
-='''Use of Flavors/Flavours for Smoking Cessation or to Maintain Abstinence'''=
+='''Flavors/Flavours'''=
-*See Also: [https://safernicotine.wiki/mediawiki/index.php/ENDS_Flavors ENDS - Flavors]
+===2023 (Article): [https://www.theguardian.com/society/2023/jul/16/smokers-who-get-e-cigarette-flavour-advice-more-likely-to-quit-report-finds Smokers who get e-cigarette flavour advice more likely to quit, report finds]===
+*Smokers who get help picking the flavour of e-cigarette they will use and receive supportive text messages are much more likely to quit, research has found.
+===See Also: [https://safernicotine.wiki/mediawiki/index.php/ENDS_Flavors ENDS - Flavors] and [https://safernicotine.wiki/mediawiki/index.php/Nicotine_-_Banning_Flavors_-_Opposition Nicotine - Banning Flavors - Opposition]===
+===2023: [https://pubmed.ncbi.nlm.nih.gov/38127516/ Randomized trial assessing the effect of the JUUL system on switching away from cigarettes and smoking reduction among U.S. adults who smoke cigarettes]===
+*Use of JUUL products may support complete switching away from cigarettes, including among those not ready to quit smoking. Results suggest a preference for nontobacco-flavored ENDS among adults who smoke, although smoking outcomes did not differ by flavor.
 ===2022: [https://pubmed.ncbi.nlm.nih.gov/36250607/ Associations between e-cigarette use and e-cigarette flavors with cigarette smoking quit attempts and quit success: Evidence from a US large, nationally representative 2018-2019 survey]===
@@ Line 305: / Line 471: @@
 *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]
+===2020: [https://www.sciencedirect.com/science/article/pii/S2352853220300134 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.
+*[https://sci-hub.st/10.1016/j.abrep.2020.100273 PDF Version]
 ===2019: [https://www.sciencedirect.com/science/article/abs/pii/S0306460318311821 The role of flavors in vaping initiation and satisfaction among U.S. adults]===
@@ Line 310: / Line 483: @@
 *'''Satisfaction among those who bought flavored e-liquid was higher than those who did not buy flavored e-liquid'''.
 *[https://sci-hub.st/10.1016/j.addbeh.2019.106077# 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]===
-*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.
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721166/pdf/12889_2019_Article_7523.pdf PDF Version]
 ===2019: [https://www.youtube.com/watch?v=WqTdqLZQUCo Video: Can Flavors Help People Who Smoke Quit Smoking?]===
@@ Line 325: / Line 493: @@
 *Flavors like cotton candy, bubble gum, and the many other examples opponents claim are obviously targeted to youth are in fact flavors someone trying to quit smoking wanted to vape and mixed themselves. These innovations in home-mixing resulted in the commercial market about to be banned today.
 *The preponderance of evidence indicates that non-tobacco flavors, including fruit, dessert, and candy, are essential to vaping as an effective way to quit smoking and avoid relapse.
+===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]
+===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]===
+*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.
+*[https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201906-472OC PDF Version]
 ===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]===
@@ Line 338: / Line 515: @@
 *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%.
-===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]===
+===2018: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022703/ Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA]===
-*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.
+*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.
-*[https://sci-hub.do/10.1093/ntr/ntx176# PDF Version]
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022703/pdf/12954_2018_Article_238.pdf PDF Version]
+===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]===
+*A ban on flavoured e-cigarettes would likely increase the choice of cigarettes in smokers, the more harmful way of obtaining nicotine.
+*[https://tobaccocontrol.bmj.com/content/tobaccocontrol/28/2/168.full.pdf PDF Version]
 ===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]===
@@ Line 348: / Line 529: @@
 *'''The two groups (dual users and switchers) reported mostly using a flavor other than tobacco'''.
 *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/pdf/ijerph-15-00012.pdf PDF Version]
+===2016: [https://tobaccocontrol.bmj.com/content/25/Suppl_2/ii67 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.
+*[https://tobaccocontrol.bmj.com/content/tobaccocontrol/25/Suppl_2/ii67.full.pdf PDF Version]
+===2015: [https://pubmed.ncbi.nlm.nih.gov/25675943/ Biochemically verified smoking cessation and vaping beliefs among vape store customers]===
+*Among vapor store customers in the USA who use ENDS to stop smoking, vaping longer, using newer-generation devices and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation.
+===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]===
+*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
+*[https://www.casaa.org/wp-content/uploads/Shiffman-on-flavors-1255-62.pdf PDF Version]
 ===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]===
@@ Line 356: / Line 554: @@
 *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.
 *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808473/pdf/nihms739529.pdf PDF Version]
+===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535370/ Counseling in Vape Shops: A Survey of Vape Shop Managers in Switzerland]===
+*Vape-shop managers explain how they successfully switched from smoking to vaping and help customers individually find the right combination of device, e-liquid flavor, and nicotine concentration.
 ===2013: [https://www.mdpi.com/1660-4601/10/12/7272/htm Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey]===
@@ Line 370: / Line 571: @@
 <br>
-='''Vaping Frequency or Duration - Effects on Smoking Cessation or Abstinence'''=
+='''Vaping Frequency or Duration'''=
+=== 2024: [https://pubmed.ncbi.nlm.nih.gov/38206633/ Concurrent E-cigarette Use While Enrolled in a Smoking Cessation Program: Associations between Frequency of use, Motives for Use and Smoking Cessation.] ===
+* More evidence suggesting the intuitively obvious idea that more frequent and regular use of e-cigarettes is more likely to assist with smoking cessation than occasional or never-use.  The figures below are for prevalence 7-day point abstinence at 6 months.
+* Adjusted quit probabilities were significantly higher (both p<0.001) for frequent baseline e-cigarette users (31.6%; 95% CI = 29.3%, 33.8%) than for non-users (25.8%; 25.3%, 26.3%) or occasional users (24.2%; 22.5%, 26.0%).
+* Prior observational studies investigating e-cigarettes use for smoking cessation have found that occasional users have poorer outcomes than either frequent or non-users. Consistent with these studies, occasional users in our data also had poorer outcomes. However, after adjustment for variables associated with cessation success we found that cessation probabilities did not differ between occasional and non-users.
+* turralde K, Veldhuizen S, Selby P, Zawertailo L. Nicotine Tob Res. 2024 Jan 11:ntae006. doi: 10.1093/ntr/ntae006. Online ahead of print. PMID: 38206633
 ===2022: [https://pubmed.ncbi.nlm.nih.gov/35913015/ Prospective Association between E-cigarette Use Frequency Patterns and Cigarette Smoking Abstinence among Adult Cigarette Smokers in the United States]===
@@ Line 430: / Line 638: @@
 *Long-term use of e-cigarettes was associated with a higher rate of quitting smoking.
 *[https://tobaccocontrol.bmj.com/content/tobaccocontrol/25/Suppl_1/i90.full.pdf PDF Version]
-<br>
+===2015: [https://pubmed.ncbi.nlm.nih.gov/25675943/ Biochemically verified smoking cessation and vaping beliefs among vape store customers]===
+*Among vapor store customers in the USA who use ENDS to stop smoking, vaping longer, using newer-generation devices and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation.
 ===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375383/ 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... 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. Daily use of electronic cigarettes for at least 1 month is strongly associated with quitting smoking at follow-up.
 *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375383/pdf/ntu200.pdf PDF Version]
+===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580313/ Associations Between E-Cigarette Type, Frequency of Use, and Quitting Smoking: Findings From a Longitudinal Online Panel Survey in Great Britain]===
+*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.
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580313/pdf/ntv078.pdf PDF Version]
+<br>
+='''Weight Concerns'''=
+===2018: [https://pubmed.ncbi.nlm.nih.gov/29570695/ Lack of Substantial Post-Cessation Weight Increase in Electronic Cigarettes Users]===
+*“Conclusion: Within the study limitations, EC use may help smokers attenuate cigarette consumption or remain abstinent, as well as reduce their post-cessation weight increase. The potential role of the e-vapour category for harm minimization in relation to tobacco and/or food abuse requires confirmation from larger prospective studies. Moreover, the observed lack of post-cessation weight gain in those who reduced substantially cigarette consumption by switching to ECs (i.e., dual users) is an interesting finding and calls for further research investigating the role of nicotine in weight control. Meanwhile, these preliminary findings should be communicated to smokers and particularly to weight-conscious smokers intending to quit.
+*By combining substantial reduction of smoking with prevention of post-cessation weight gain, EC-based interventions may promote an overall improvement in quality of life. Considering that the negative effects of weight increase could overshadow the health benefits of smoking abstinence, it is important to stimulate more research in this area.”
+===2018: [https://pubmed.ncbi.nlm.nih.gov/28525609/ E-cigarettes and Weight Loss—Product Design Innovation Insights From Industry Patents]===
+*E-cigarettes may be presented to cigarette users as a possible solution to support smoking cessation and address the fear of weight gain.
+===2017: [https://pubmed.ncbi.nlm.nih.gov/27798086/ Could Vaping be a New Weapon in the Battle of the Bulge?]===
+*Obesity is set to overtake tobacco smoking in many countries as the primary cause of several high-cost diseases. Tobacco smoking mitigates weight gain through nicotine’s effect on the brain and metabolism.
+*There have been some reports among vapers that vaping is helping to mitigate weight gain after stopping smoking and or vaping is helping them to control their weight. There are several potential mechanisms by which vaping, in addition to the direct effects of nicotine, could facilitate weight control, these include taste perception, physical mouthfeel, and sensation and behavioral replacement.
+===2011 [https://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-9-129 Anti-inflammatory effects of nicotine in obesity and ulcerative colitis]===
+*Nicotine, the principal addictive constituent of tobacco, has been shown to suppress appetite and attenuates obesity in many studies, but the underlying mechanism is not clear.
+*Low-grade inflammation is a key feature of obesity and links obesity to insulin resistance, impaired glucose tolerance and even diabetes.
+*Overall, these findings suggest that nicotine and specific α7nAChR agonists may be beneficial in the prevention and treatment of obesity-induced inflammation and insulin resistance. However, there is also evidence that heavy smoking affects body fat distribution that is associated with central obesity and insulin resistance. Moreover, smoking appears to aggravate insulin resistance in persons with type 2 diabetes and to impair glycemic control.
+*Much work remains in terms of understanding the anti-inflammatory effects of nicotine in obesity-related inflammation and ulcerative colitis. However, it is now known that the α7nAChR plays a major role in the anti-inflammatory effects of nicotine and nicotine attenuates inflammation in both obesity and ulcerative colitis. Since the inflammatory response is an integral process in both obesity and ulcerative colitis, controlling the inflammatory response could ameliorate tissue damage.
 <br>
-='''Using Alternative Nicotine Products by People Living With ''Physical Health Challenges'' to Aid Smoking Cessation'''=
+='''Physical Health Challenges'''=
 ===2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9908735/ Tobacco Harm Reduction with Vaporised Nicotine (THRiVe): A Feasibility Trial of Nicotine Vaping Products for Smoking Cessation Among People Living with HIV]===
 *This study found that the provision of NVPs for 12 weeks was associated with 7-day point prevalence tobacco smoking abstinence among 35% of a sample of PLHIV who smoked tobacco daily. These findings suggest that NVPs represent a potentially feasible and effective short-to-medium term tobacco smoking cessation aid and/or tobacco harm reduction strategy among PLHIV.
+===2021: [https://pubmed.ncbi.nlm.nih.gov/33894796/ Switching away from Cigarette Smoking with JUUL: Populations of Special Interest]===
+*Substantial rates of complete switching were consistently achieved across all medico-socio-demographic subgroups 12 months following the purchase of the JSK. The potential benefits of switching with JUUL on smokers are likely to be experienced by a wide range of adult smokers.
 ===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876707/ E-Cigarettes and Smoking Cessation in Smokers With Chronic Conditions]===
 *At a population level, e-cigarette use by smokers with chronic medical conditions is associated with more quitting activity and smoking abstinence.
 *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876707/pdf/nihms-1539531.pdf PDF Version]
+===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.
+===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.
 <br>
-='''Using Alternative Nicotine Products by People Living With ''Mental Health Challenges'' to Aid Smoking Cessation'''=
+='''Mental/Behavioral Health Conditions'''=
+===2023: [https://link.springer.com/article/10.1007/s11606-023-08137-z Electronic Cigarettes: an Overlooked Tool to Alleviate Disparities in Tobacco Use Disorder Among People with Mental Health and Substance Use Disorders]===
+*Although not a panacea, electronic cigarettes may represent a powerful harm reduction tool amongst subpopulations traditionally left behind in conventional smoking cessation movements. The argument in favor of studies of electronic cigarettes as a smoking cessation, harm reduction intervention in people with BHC [Behavioral Health Conditions] is multi-faceted. People with BHC have higher levels of smoking burdens and nicotine addiction compared to the general population, and they quit at lower rates. Unlike NRT, the nicotine delivery from an electronic cigarette mimics the nicotine pharmacokinetics of tobacco cigarettes unaccompanied by high levels of toxicants and carcinogens.
+===2022: [https://academic.oup.com/ntr/article-abstract/24/9/1405/6562456 E-Cigarette Provision to Promote Switching in Cigarette Smokers With Serious Mental Illness—A Randomized Trial]===
+*This was the first prospective study to compare e-cigarette provision with assessments only to evaluate the appeal and impact of e-cigarettes on smoking behavior, carbon monoxide exposure, and nicotine dependence among smokers with SMI who had tried but were unable to quit and were not currently interested in cessation treatment. The finding that e-cigarette provision led to significant reductions in smoking and carbon monoxide without increasing nicotine dependence has implications for reducing harm not only among the millions of smokers with SMI [serious mental illness] who struggle to quit, but also for other vulnerable smokers who cannot achieve cessation.
 ===2021: [https://academic.oup.com/ntr/article/23/7/1113/6168972 A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes]===
@@ Line 455: / Line 704: @@
 *A high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking.
 *[https://scholar.google.com/scholar_url?url=https://academic.oup.com/ntr/article-pdf/23/7/1113/38521536/ntab005.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=yBQBYYa-NZHsyQTPkaSoDg&scisig=AAGBfm3GpEvV3isL4-eiS-xFao9KegDu2Q PDF Version]
+===2021: [https://pubmed.ncbi.nlm.nih.gov/33894796/ Switching away from Cigarette Smoking with JUUL: Populations of Special Interest]===
+*Substantial rates of complete switching were consistently achieved across all medico-socio-demographic subgroups 12 months following the purchase of the JSK. The potential benefits of switching with JUUL on smokers are likely to be experienced by a wide range of adult smokers.
+===2019: [https://pubmed.ncbi.nlm.nih.gov/31169077/ Electronic Cigarette Use During a Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries with Mental Illness]===
+*Spontaneous e-cigarette use during cessation treatment was common among smokers with mental illness and was not associated with positive or negative treatment outcomes. The high rate of naturalistic e-cigarette use in this group suggests that e-cigarettes are an appealing strategy to obtain nicotine during cessation treatment that could be harnessed as a smoking cessation tool or for harm reduction.
 <br>
-='''Smoking Cessation and Abstinence for Expecting or Nursing Mothers'''=
+='''Pregnancy or Nursing'''=
+===See Also: [https://safernicotine.wiki/mediawiki/index.php?title=ENDS_Pregnancy ENDS Pregnancy]===
 ===2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9488528/ Can electronic cigarettes help pregnant smokers quit, and are they as safe to use in pregnancy as nicotine replacement treatments?]===
@@ Line 492: / Line 749: @@
 <br>
-='''Taxing Alternative Nicotine Products Reduces Smoking Cessation or Abstinence'''=
+='''Taxes'''=
-*See also: [https://safernicotine.wiki/mediawiki/index.php?title=ENDS_Taxes ENDS Taxes] to learn more about taxing vapor products.
+===See also: [https://safernicotine.wiki/mediawiki/index.php?title=ENDS_Taxes ENDS Taxes] to learn more about taxing vapor products.===
 ===2023: [https://www.sciencedirect.com/science/article/abs/pii/S0167629622001345 Intended and unintended effects of e-cigarette taxes on youth tobacco use]===
@@ Line 507: / Line 765: @@
 *Currently, Congress is considering doubling the cigarette excise tax (to $2.01 per pack) and setting the ENDS tax to parity with the new cigarette tax (Durbin 2021). This tax, if adopted, would imply a roughly $2.01 tax per 0.7 fluid mL of nicotine, assuming a Juul pod is equivalent to a pack of cigarettes (Truth Initiative 2019), or $2.87 per fluid mL. Our MTF results suggest that this would reduce youth current ENDS use by 5.5 pp but raise current cigarette use by 3.7 pp, assuming that the cigarette tax portion of the bill has no effect as suggested by the small, statistically insignificant cigarette tax effects estimated in this paper, and other recent studies (Hansen, Sabia, and Rees 2017). The YRBSS results meanwhile suggest much larger reductions in youth current ENDS use, but a sizable increase in youth current cigarette use of 2.3 pp. If ENDS are substantially safer products as suggested by several major government-commissioned reviews (McNeill et al. 2018; National Academies of Sciences, Engineering, and Medicine 2018; UK Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment 2020), our results suggest that the proposed bill may harm youth health in the United States
 *[https://www.nber.org/system/files/working_papers/w29216/w29216.pdf PDF Version]
+===2021 (Op-Ed): [https://filtermag.org/vape-taxes-increase-smoking/ To Increase Smoking Rates Among Young Adults, Keep Hiking Vape Taxes]===
+*Of eight states that had e-cigarette taxes prior to 2019, seven saw an increase in proportions of young adult smokers after their state e-cigarette tax went into effect. California had a 34 percent increase in people aged 18-24 who smoked after the passage of an e-cigarette tax. Deleware's increase was 48.6 percent. Pennsylvania passed a 40% wholesale tax on vapor products, which closed 1/3 of the vape shops in that state and increased smoking in the 18-24 year old age group by 19 percent. Kansas, Louisiana, Minnesota and West Virginia also say increases in smoking in young adults after passing taxes on vapor products.
 ===2021 (Revision): [https://www.nber.org/system/files/working_papers/w26724/w26724.pdf The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data]===
@@ Line 514: / Line 775: @@
 *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.
 *[https://www.nber.org/system/files/working_papers/w26724/w26724.pdf PDF Version]
+*Article: [https://www.forbes.com/sites/kellyphillipserb/2020/02/10/new-study-suggests-raising-taxes-on-e-cigarettes-could-encourage-traditional-smoking/?sh=2b80c6ba57bf New Study Suggests Raising Taxes On E-Cigarettes Could Encourage Traditional Smoking]
 ===2020: [https://www.emerald.com/insight/content/doi/10.1108/DAT-02-2020-0007/full/pdf Tobacco harm reduction in the 21st century]===
@@ Line 539: / Line 801: @@
 ='''Combining Alternative Nicotine Products With Other Quit Smoking Strategies'''=
+===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.
+===2023: [https://link.springer.com/article/10.1007/s00213-023-06401-y Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches]===
+*A critically important design component of this study was that it was not a smoking cessation treatment study, and hence smoking abstinence was not the primary outcome. Accordingly, no smoking cessation counseling was provided and smokers who expressed a desire to receive treatment for nicotine dependence were excluded from the study. Thus, the study was not expected to lead to high smoking abstinence rates but was instead designed to differentiate the pharmacologic impact of nicotine vs. no nicotine (in ENDS or patch) on smoking behavior.
+*...there was a strong correlation between ENDS use and decrease in self-reported cigarette consumption in week 8 (end of treatment), but only in nicotine ENDS condition...
+*Smoking abstinence at week 8 was also related to ENDS use in the nicotine ENDS condition only; participants who were abstinent from smoking used more nicotine pods than non-abstinent participants
+*The main finding of this study was that the use of nicotine vs. no nicotine in ENDS was associated with a large and statistically significant reduction in expired air CO, an objective biomarker of smoking.
+===2023: [https://onlinelibrary.wiley.com/doi/10.1111/add.16294 E-cigarette support for smoking cessation: Identifying the effectiveness of intervention components in an on-line randomized optimization experiment]===
+*Text-message support with tailored advice on flavour is a promising intervention combination for smokers using an e-cigarette in a quit attempt.
+*Article: [https://www.theguardian.com/society/2023/jul/16/smokers-who-get-e-cigarette-flavour-advice-more-likely-to-quit-report-finds Smokers who get e-cigarette flavour advice more likely to quit, report finds]
+**Smokers who get help picking the flavour of e-cigarette they will use and receive supportive text messages are much more likely to quit, research has found.
 ===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]===
@@ Line 556: / Line 833: @@
 <br>
-='''Vape Shop Support For Smoking Cessation'''=
+='''Vape Shop/Peer Support'''=
+===2021: [https://academic.oup.com/ntr/article-abstract/23/4/756/5936121 Vape Shop Employees: Do They Act as Smoking Cessation Counselors? ]===
+*Most vape shop employees provide advice to customers who desire to quit cigarette smoking and initiate electronic cigarette use. Approximately 85% of employees had quit cigarettes by switching to e-cigarettes.
+===2019: [https://www.mdpi.com/1660-4601/16/5/724/htm A Comparison of E-Cigarette Use Patterns and Smoking Cessation Behavior among Vapers by Primary Place of Purchase]===
+*Among those smoking 12 months prior to the survey, smoking cessation rates were higher for vape shop and internet customers than for retail customers, even though retail customers were more likely to use FDA-approved smoking cessation aids.
+===2018 (Report): [https://www.ncsct.co.uk/usr/pub/Working%20with%20vape%20shops%2002.10.18%20update.pdf Working with vape shops]===
+*UK National Centre for Smoking Cessation and Training (NCSCT)
+*This guide covers:
+**How can vape shops support stop smoking services?
+**How can stop smoking services work with vape shops?
+**What does ‘reputable vape shop’ mean?
+**Can vape shops be trusted?
+**Are vape shops owned by or associated with the tobacco industry?
 ===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]
+===2018: [https://www.mdpi.com/1660-4601/15/2/297 A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence]===
+*At an individual level, shops can provide a supportive environment. Shops also provided ongoing support to reduce risk of smoking lapse.
+*At an interpersonal level, shops can offer friendly personable service. For some vapers, shops also provided an opportunity for social interaction, acting as a community group.
+*At a structural level, shops provide a competitive environment, responding to legislative changes.
+*Furthermore, vape shops provide opportunity to those who do not wish to stop smoking to try vaping and perhaps eventually stop smoking.
+*Vape shops can provide effective behavioural support to quitters to maintain smoking abstinence. Health professionals could capitalise on this through partnership working with shops, to ensure best outcomes for clients wanting to use e-cigarettes to quit smoking.
+===2018: [https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-018-0307-z A qualitative assessment of business perspectives and tactics of tobacco and vape shop retailers in three communities in Orange County, CA, 2015–2016]===
+*Tobacco shops’ reasons for carrying e-cigarettes were business oriented... In comparison, vape shops opened because of the owner’s positive experiences with e-cigarettes and belief in the potential of e-cigarettes to help people quit or reduce smoking.
+===2018: [https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5467-9#Sec20 Vape shops: who uses them and what do they do?]===
+*The majority of vape shop customers are vapers who have quit smoking. Shop staff play a central role in providing customers with product information, and many provide smoking cessation advice.
+===2016: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877178/ A Qualitative Study of Vape Shop Operators' Perceptions of Risks and Benefits of E-Cigarette Use and Attitude Toward Their Potential Regulation by the US Food and Drug Administration, Florida, Georgia, South Carolina, or North Carolina, 2015]===
+*Most owners were former smokers and used ENDS to quit. Vape shop owners are in a unique position to serve as frontline consumer educators.
+*Vape shop owners perceived ENDS to be less harmful and more economical than conventional cigarettes and indicated that most of their customers used ENDS as a smoking cessation tool
+===2016: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382868/ A Pilot Study of Retail ‘Vape Shops’ in the San Francisco Bay Area]===
+*The intensive engagement with customers over time provides social support for quitting and practical advice, both of which are elements of recommended smoking cessation counseling.
+===2016: [http://www.tobaccopreventioncessation.com/A-Dollars-and-Sense-Exploration-of-r-nVape-Shop-Spending-and-E-cigarette-Use,67435,0,2.html A Dollars and “Sense” Exploration of Vape Shop Spending and E-cigarette Use]===
+*Across the US, vape shops have emerged to provide e-cigarette users access to products not usually available at gas stations or retail stores.
+*Mod use and intention to use e-cigs as a cessation device were significantly associated with vape shop spending.
+*Customers who spent more than $50/month used lower levels of nicotine (mg/ml) (p=0.003) but a greater quantity of e-liquid (ml/month).
+===2015: [https://pubmed.ncbi.nlm.nih.gov/25675943/ Biochemically verified smoking cessation and vaping beliefs among vape store customers]===
+*Among vapor store customers in the USA who use ENDS to stop smoking, vaping longer, using newer-generation devices and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation.
 ===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410194/ Quit and Smoking Reduction Rates in Vape Shop Consumers: A Prospective 12-Month Survey]===
 *Here we have shown for the first time that combining availability of appealing e-vapour products for smoking substitution with professional advice from vape shops staff it is possible to achieve high and stable success rates. By promoting healthier life-style changes in smokers, vape shops may become valuable allies in the fight against smoking.
+===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535370/ Counseling in Vape Shops: A Survey of Vape Shop Managers in Switzerland]===
+*Vape-shop managers explain how they successfully switched from smoking to vaping and help customers individually find the right combination of device, e-liquid flavor, and nicotine concentration.
 <br>
-='''Studies - Expansion/Contraction of the Alternative Nicotine Products Market vs Smoking'''=
+='''Expansion/Contraction of the Alternative Nicotine Products Market vs Smoking'''=
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37540451/ Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model] ===
+* Using a version of the ''SimSmoke'' model calibrated to the Canadian population, this study compares actual smoking trends from 2012-2020 with the counterfactual (i.e. what would have been expected in a world without e-cigarettes, as estimated by projecting pre-2012 trends):
+** Results: Comparing 2012-2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15-24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18-24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012-2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060.
+* Levy DT, Cadham CJ, Yuan Z, Li Y, Gravely S, Cummings KM. Can J Public Health. 2023 Aug 4. doi: 10.17269/s41997-023-00792-3. Online ahead of print. PMID: 37540451
 ===2022: [https://www.qeios.com/read/GM2450 Higher Sales of Electronic Nicotine Delivery Systems (ENDS) in the US Are Associated with Cigarette Sales Declines, according to a Trend Break Analysis]===
@@ Line 630: / Line 958: @@
 <br>
-='''Dual/Poly Nicotine Product Use Leading to Reductions in Smoking or Smoking Cessation'''=
+='''Dual/Poly Nicotine Product Use - Smoking Reduction - Part of Switching Process'''=
 ===2021: [https://link.springer.com/article/10.1007/s10900-021-01015-x Patterns of E-Cigarette Use Among Primary Care Patients at an Urban Community Center]===
@@ Line 665: / Line 993: @@
 **“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: [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 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.
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721166/pdf/12889_2019_Article_7523.pdf PDF Version]
+===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.
+*[https://sci-hub.se/10.1111/add.14730 PDF Version]
 ===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]===
@@ Line 673: / Line 1,010: @@
 *Daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. However, less frequent e-cigarette use was not associated with cigarette cessation/reduction. These results suggest incorporating frequency of e-cigarette use is important for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation.
 *[https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2018/03/24/tobaccocontrol-2017-054108.full.pdf PDF Version]
+===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%.
 ===2017: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntx269/4768299?redirectedFrom=fulltext Predicting Short-Term Uptake of Electronic Cigarettes: Effects of Nicotine, Subjective Effects, and Simulated Demand]===
@@ Line 686: / Line 1,026: @@
 *Among current e-cigarette users, 84% reported using e-cigarettes to quit cigarettes, to cut down on cigarettes, or because they believe they are less harmful than cigarettes. The least common reason for use was cost (48%). Among former e-cigarette users, 78% reported using e-cigarettes to quit cigarettes, to cut down on cigarettes, or because they believe they are less harmful than cigarettes, and the least common reason was also cost (30%).
 *[https://link.springer.com/content/pdf/10.1007/s11606-017-4123-x.pdf PDF Version]
+===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;
+*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'''.
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/pdf/ijerph-15-00012.pdf PDF Version]
 ===2016: [https://tobaccocontrol.bmj.com/content/25/Suppl_1/i90 Long-term e-cigarette use and smoking cessation: a longitudinal study with US population ]===
@@ Line 701: / Line 1,048: @@
 *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.
 *[https://sci-hub.st/10.1111/add.13506 PDF Version]
+===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]
 ===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378973/ E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis]===
@@ Line 707: / Line 1,063: @@
 <br>
-='''Alternative Nicotine Products- Facilitators and Barriers to Quitting Smoking or Remaining Abstinent'''=
+='''Facilitators and Barriers to Quitting Smoking or Remaining Abstinent'''=
-*See Also: [https://safernicotine.wiki/mediawiki/index.php/Nicotine_-_Misperceptions,_Misinformation,_or_Disinformation Nicotine - Misperceptions, Misinformation, or Disinformation]
+===See Also: [https://safernicotine.wiki/mediawiki/index.php/Nicotine_-_Misperceptions,_Misinformation,_or_Disinformation Nicotine - Misperceptions, Misinformation, or Disinformation]===
 ===2021: [https://academic.oup.com/ntr/article-abstract/24/6/855/6440299 Associations Between Nicotine Knowledge and Smoking Cessation Behaviors Among US Adults Who Smoke]===
@@ Line 719: / Line 1,076: @@
 ===2021: [https://pubmed.ncbi.nlm.nih.gov/33952270/  Effect of Massachusetts House Bill No. 4196 on electronic cigarette use: a mixed-methods study]===
 *...messaging questioning the safety of e-cigarettes led to an increase in combustible cigarette use. This suggests the need for health authorities to reconsider how they communicate the relative risks of smoking and vaping.
-<br>
+===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
+*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.
+*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751515/pdf/nty141.pdf PDF Version]
+= '''Long Term usage''' =
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37866230/ An 8-year longitudinal study of long-term, continuous users of electronic cigarettes.] (2012-2016 to 2021 8 years is the average) ===
+* Etter JF. ''Addictive Behaviors,'' 149, February 2024, 107891
+* A rare look at long-term e-cigarette use (from 2012-2016 to 2021, averaging 8 years’ difference) and the shifts in use patterns:
+** Findings: Fewer people in 2021 (11%) than at baseline (33%) had smoked tobacco in the past 31 days. Participants switched from second-generation models at baseline (e.g. Ego) to box mods in 2021 (e.g. iStick), they used larger refill bottles, they used home-made e-liquids twice as often, they used tobacco flavours less often and the nicotine concentration in e-liquids decreased from 12 to 6 mg/L.
+* Given the concerns over the proliferation of products with high nicotine concentrations, it’s reassuring that people who use e-cigarettes long term tend to reduce their nicotine concentration over time. Likewise with indicators of dependence:
+** There was no change over time in the time to the first e-cigarette puff of the day, but an e-cigarette dependence score of 0-100 decreased from 75 to 60, the frequency and strength of urges to vape decreased (from 31% to 18% of the “strong” urges) and the proportion of people who said they would be likely to succeed if they tried to stop vaping increased.
+* Reasons for vaping also changed over time:
+** ''Compared to baseline, fewer people in 2021 reported vaping to cope with cravings or other smoking cessation symptoms, and fewer people reported vaping to quit smoking, to avoid relapse into smoking, or to reduce their tobacco consumption.''
+* It makes sense that some of these motivations would decrease as people moved away from other tobacco products, but it is surprising to see that the reason of “avoiding relapse” was lower. If these reasons decreased, did other reasons increase? Yes, and they had to do with perceived addiction to e-cigarettes (from 49% to 62%), although endorsement of this was substantially lower than “vaping is less toxic than smoking tobacco” and simply “because I enjoy it” which nearly all participants endorsed.
+* Also notable is that at follow-up, 63% of participants said the flavors they used helped them quit or reduce their smoking, and 59% were afraid that they would start smoking again if they stopped using e-cigarettes.
 ='''Smoking Harm Reduction vs Nicotine Abstinence'''=
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37061812/ Nicotine - friend or foe? The complex interplay between its role in dependence, harm reduction and risk communication.] ===
+* Clearly, no one wants to see a generation of nicotine-dependent youth, and more effective measures to limit access to nicotine, especially combustible nicotine, are needed. But when it comes to communicating research to the wider public, we must avoid conflating the relatively limited harm of nicotine dependence with its effects on maintaining tobacco addiction, and therefore well-established tobacco-related harm, not least because of the impact this has on risk perceptions of those most in need of nicotine-based treatment: Tobacco users.
 ===2021: [https://www.cdhowe.org/sites/default/files/attachments/research_papers/mixed/Commentary_600.pdf The Taxation of Nicotine in Canada: A Harm-Reduction Approach to the Profusion of New Products]===
@@ Line 736: / Line 1,116: @@
 *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.
 *[https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1742-1241.2011.02751.x PDF Version]
-<br>
-=Studies - Not Catagorized=
-===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580313/ Associations Between E-Cigarette Type, Frequency of Use, and Quitting Smoking: Findings From a Longitudinal Online Panel Survey in Great Britain]===
-*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.
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580313/pdf/ntv078.pdf PDF Version]
-===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464650/ Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study]===
-*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...
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464650/pdf/pone.0129443.pdf PDF Version]
-===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171752/ 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.”
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171752/pdf/add0109-1531.pdf PDF Version]
-===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245610/ Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints]===
-*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.
-*“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. 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”...
-*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://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245610/pdf/ijerph-11-11220.pdf PDF Version]
-===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247211/ 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.
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247211/pdf/12889_2014_Article_7263.pdf PDF Version]
-===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025024/ 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. This can be attributed to the lower nicotine absorption from EC use compared to smoking. 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.
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025024/pdf/ijerph-11-04356.pdf PDF Version]
-===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511704/ 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.
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511704/pdf/nihms676311.pdf PDF Version]
-===2014: [https://academic.oup.com/ntr/article-abstract/17/2/245/1258995 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. Developing educational campaigns and informing practitioners about caveats around ENDS as cessation or harm reduction aids are critical.
-*[https://sci-hub.st/10.1093/ntr/ntu103 PDF Version]
-===2013: [https://pubmed.ncbi.nlm.nih.gov/24029165/ 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
-*[https://sci-hub.st/10.1016/S0140-6736(13)61842-5 PDF Version]
-===2013: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850892/ 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
-*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.
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850892/pdf/1477-7517-10-19.pdf PDF Version]
-===2013: [https://www.frontiersin.org/articles/10.3389/fpubh.2013.00056/full 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.
-===2013: [https://academic.oup.com/ntr/article/15/10/1737/1183788 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.
-*[https://scholar.google.com/scholar_url?url=https://academic.oup.com/ntr/article-pdf/15/10/1737/4005852/ntt057.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=5-niYKGiHo6RywT0wZbgCg&scisig=AAGBfm1x30ekBGwfhPgkxdJKFW0eOfPFPw PDF Version]
-===2013: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691171/ EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study]===
-*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. In view of the fact that subjects in this study had no immediate intention of quitting, the reported overall abstinence rate of 8.7% at 52-week was remarkable.
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691171/pdf/pone.0066317.pdf PDF Version]
-===2013: [https://pubmed.ncbi.nlm.nih.gov/23551515/ '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
-*[https://sci-hub.st/10.1111/add.12150 PDF Version]
-===2012: [https://www.sciencedirect.com/science/article/abs/pii/S0306460312000913 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.
-*[https://sci-hub.se/10.1016/j.addbeh.2012.03.004 PDF Version]
-===2011: [https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-5-585 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.
-*[https://jmedicalcasereports.biomedcentral.com/track/pdf/10.1186/1752-1947-5-585.pdf PDF Version]
-===2011: [https://pubmed.ncbi.nlm.nih.gov/21989407/ 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
-*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203079/pdf/1471-2458-11-786.pdf PDF Version]
-===2011: [https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2011.03505.x 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.
-*[https://sci-hub.se/10.1111/j.1360-0443.2011.03505.x PDF Version]
-===2011: [https://www.sciencedirect.com/science/article/abs/pii/S0749379710007920 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.
-*The distinct and unique advantage of e-cigarettes is that they allow individuals to utilize one device that can simultaneously address nicotine withdrawal, psychological factors, and behavioral cues that serve as barriers to smoking abstinence.
-*[https://sci-hub.se/10.1016/j.amepre.2010.12.006 PDF Version]
-===2011: [https://academic.oup.com/ntr/article/13/9/860/1134354 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.
-*[https://sci-hub.se/10.1093/ntr/ntr088 PDF Version]
-===2010: [https://tobaccocontrol.bmj.com/content/19/2/98 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.”
-*[https://sci-hub.se/10.1136/tc.2009.031567 PDF Version]
+== Military/Veterans ==
-===2010: [https://link.springer.com/article/10.1186/1471-2458-10-231 Electronic cigarettes: a survey of users]===
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37712011/ Motives for using electronic nicotine delivery systems (ENDS) as a cessation tool are associated with tobacco abstinence at 1-year follow-up: A prospective investigation among young adults in the United States Air Force.] ===
-*Our results suggest that ecigarettes are used mainly to quit smoking, and may be useful for this purpose.
-*[https://link.springer.com/content/pdf/10.1186%2F1471-2458-10-231.pdf PDF Version]
+* Researchers who are willing to push back on the mantra of giving primacy to "FDA authorised smoking cessation treatments" and going with evidence of public health impact as the basis for their conclusions.
+* Results: Smokers reporting ENDS use for cigarette cessation were more likely to be abstinent at one-year follow-up (Odds Ratio[OR] = 1.62, 95% CI: 1.06-2.49, P =.03) as well as quit using non-cigarette tobacco products (OR = 2.11, 95% CI: 1.65-2.70, P <.001) than those reporting ENDS use for alternative reasons.
+* Conclusions: Current tobacco users are recommended to use FDA-approved products for smoking cessation, such as nicotine replacement therapy. However, given the high prevalence of cigarette use among military populations, ENDS may provide a useful alternative harm reduction strategy for this high-risk population.
+* Aycock CA, Wang XQ, Williams JB, Fahey MC, Talcott GW, Klesges RC, Little MA.Prev Med Rep. 2023 Sep 8;35:102399. doi: 10.1016/j.pmedr.2023.102399. eCollection 2023 Oct. PMID: 37712011
+* [https://www.sciencedirect.com/science/article/pii/S2211335523002905/pdfft?md5=867cf8f684964cf79bee181e1ee01a1e&pid=1-s2.0-S2211335523002905-main.pdf PDF Version]
-===2006: [https://tobaccocontrol.bmj.com/content/15/3/210 Role of snus in initiation and cessation of tobacco smoking in Sweden]===
+=Jails & Prisons=
-*Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker, and increased likelihood of stopping smoking
+=Drug or Alcohol Treatment Facilities=
-===2005: [https://tobaccocontrol.bmj.com/content/14/6/422 Is Swedish snus associated with smoking initiation or smoking cessation?]===
-*“Among males participating in a large population based twin study in Sweden, snus use was associated with smoking cessation but not initiation.”
-*[https://tobaccocontrol.bmj.com/content/tobaccocontrol/14/6/422.full.pdf PDF Version]
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+===2024: [https://pubmed.ncbi.nlm.nih.gov/38653554/ A qualitative study of using nicotine products for smoking cessation after discharge from residential drug and alcohol treatment in Australia]===
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