Impact of electronic cigarette and heated tobacco product on conventional smoking: an Italian prospective cohort study conducted during the COVID-19 pandemic.

Introduction:
This text is a summary of a longitudinal study investigating the impact of electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) on conventional smoking in Italy. The study was conducted during the COVID-19 pandemic, and the results highlight the relationship between the use of novel tobacco products and smoking behaviors. The study aims to provide insights into the regulatory implications of these products.

Key Points:

* The study is based on a large representative sample of Italian adults (N=3185) who provided baseline and follow-up responses in 2020.
* The researchers tracked transitions in smoking status, e-cigarette use, and HTP use over the study period.
* The study found that never cigarette smokers who used e-cigarettes at baseline were more likely to start smoking (RR 8.78; 95% CI: 5.65 to 13.65) and current HTP users (RR 5.80; 95% CI: 3.65 to 9.20).
* Among ex-smokers, relapse at follow-up was more likely among e-cigarette (RR 4.25; 95% CI: 2.40 to 7.52) and HTP users (RR 3.32; 95% CI: 2.05 to 5.37).
* Among current smokers at baseline, those who continued smoking at follow-up were more frequently current novel product users, with e-cigarette users having a higher risk (RR 1.10; 95% CI: 1.02 to 1.19) and HTP users having an even higher risk (RR 1.17; 95% CI: 1.10 to 1.23).
* The study emphasizes that e-cigarette and HTP use predict starting smoking and relapse, and may reduce smoking cessation.
* The study suggests that e-cigarettes and HTPs as consumer products may not be effective in tobacco control in Italy.

Main Message:
The study underlines the importance of regulating novel tobacco products, such as e-cigarettes and HTPs, in the same way as conventional cigarettes. The evidence from this Italian prospective cohort study indicates that the use of these novel products may lead to an increased likelihood of starting smoking and relapsing among ex-smokers. Furthermore, the use of these products does not seem to increase smoking cessation among current smokers. Therefore, the findings do not support the use of e-cigarettes and HTPs as a consumer product in tobacco control in Italy.

Gallus S, Stival C, McKee M, et al. Impact of electronic cigarette and heated tobacco product on conventional smoking: an Italian prospective cohort study conducted during the COVID-19 pandemic. Tobacco control. Published online October 7, 2022. doi:10.1136/tc-2022-057368