Objective Debate continues about whether electronic cigarettes (e-cigarettes) and heated tobacco products (HTP) reduce or increase the probability of smoking, with many studies compromised by stated or unstated conflicts of interest. We undertook a longitudinal study in Italy.
Methods 3185 Italian participants aged 18–74 years provided baseline (April–May) and follow-up (November–December) responses in 2020, reporting smoking status and use of e-cigarettes and HTP. We tracked transitions over that period and reported risk ratios (RR) and corresponding 95% CIs for changes in smoking in relation to baseline use of e-cigarettes and HTPs.
Results Never cigarette smokers who used e-cigarettes at baseline were much more likely to start smoking (compared with never users, 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 (17.2%) 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 had continued smoking at follow-up were 85.4% overall. These were more frequently current novel product users (compared with non-users, RR 1.10; 95% CI: 1.02 to 1.19 for e-cigarette users; RR 1.17; 95% CI: 1.10 to 1.23 for HTP users).
Conclusions Both e-cigarette and HTP use predict starting smoking and relapse, and appear to reduce smoking cessation. Due to the limited sample size within specific strata, the association with quitting smoking should be confirmed by larger prospective studies. These findings do not support the use of e-cigarettes and HTPs in tobacco control as a consumer product, at least in Italy.
- electronic nicotine delivery devices
- non-cigarette tobacco products
- global health
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Twitter @SilvanoGallus, @martinmckee, @GiuseppeGorini, @alessandra_lugo
Contributors SG had the original study idea; RP and AO obtained the funding. AL and CS did the statistical analysis; SG drafted the article in collaboration with CS and AL; all other authors made substantial contributions to conception, design and data interpretation; all the authors approved the final version of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding The survey was co-funded by the Italian National Institute of Health (ISS) and Fondazione Cariplo. The work of SG, AL, CS and AO is partially supported by a research grant of the DG-Welfare of Lombardy Region (Call: Progetti di ricerca in ambito sanitario connessi all’emergenza COVID 19; DGR n. XI/3017). The work of GC and GG is partially supported by the Tuscany Region within the Lost in Toscana Project. The research leading to these results has received funding from AIRC under IG 2021 - ID. 25987 project – P.I. Gallus Silvano.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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