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Impact of electronic cigarette and heated tobacco product on conventional smoking: an Italian prospective cohort study conducted during the COVID-19 pandemic
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  • Published on:
    No uncertainty exists around the failure of novel products as harm reduction strategies in Italy
    • Silvano Gallus, Head, Laboratory of Lifestyle Epidemiology Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
    • Other Contributors:
      • Alessandra Lugo, Senior Researcher
      • Giuseppe Gorini, Senior Epidemiologist
      • Roberta Pacifici, Head, National Centre on Addiction and Doping
      • Martin McKee, Professor of European Public Health

    We welcome discussion of our research even when it comes from those whose view on accepting tobacco industry funding is very different from ours. Tomaselli and Caponnetto, from the Center of Excellence for the acceleration of HArm Reduction (CoEHAR),[1] a group funded by the Foundation for a Smoke-Free World (FSFW), an organisation established by Philip Morris International (PMI) with funding of US$1 billion that promotes electronic cigarettes (e-cigarette) and heated tobacco products (HTP),[2] take issue with our finding [3] that these products increase smoking initiation and relapse and reduce quitting. [4]
    First, we are puzzled by their main criticism. Of course we agree that smokers who have failed to quit, ex-smokers prone to relapse, and never smokers prone to engage in addictive behaviours could be overrepresented among the baseline e-cigarette or HTP users in our study.[4] But this does not undermine our main conclusions. Even if we were to assume that either none or all novel product users in our cohort were more prone to addiction, our results would still be incompatible with the argument, which underpins the work of FSFW, that these products can reduce smoking conventional cigarettes when used as consumer products.
    Second, we hope that they agree with us that we should consider the totality of evidence on a topic as it is rare for a single study to provide a definitive answer, and especially given the record of the tobacco ind...

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    Conflict of Interest:
    None declared.
  • Published on:
    Inappropriate study design cannot predict smoking initiation and relapse with e-cigarette and heated tobacco product use
    • Venera Tomaselli, Associated Professor 1Department of Political and Social Sciences, University of Catania, Italy 2Center of Excellence for the Acceleration of Harm Re
    • Other Contributors:
      • Pasquale Caponnetto, Researcher

    The study by Gallus et al. [1] sought to establish whether electronic cigarettes (ECs) and heated
    tobacco products (HTPs) reduce or increase the probability of smoking in a cohort of Italian
    participants and concluded that both EC and HTP use predict smoking initiation and relapse
    among respondents. We would like to raise some concerns about the interpretation of the study
    findings. The study suffers from a potentially crucial bias of the outcome being present at baseline, as
    compared non-users with people who were already using products at baseline. Specifically,
    smokers who were using ECs or HTPs at baseline may already represent failed attempts to quit at
    baseline. Additionally, ex-smokers using these products may have already been in a trajectory to
    relapse to smoking at, or even long before, baseline, and may in fact have initiated such product
    use in order to avoid relapse. Still, this group may represent ex-smokers who were at higher risk
    for relapsing at baseline compared to ex-smokers who did not use these products. Similarly,
    never smokers who use novel nicotine products may represent individuals prone to the
    engagement of an inhalational habit. Therefore, they would be more likely to initiate smoking.
    The situation is very similar to assessing if people who drink beer at baseline are more likely to
    drink whiskey at follow up compared to non-drinkers of bee...

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    Conflict of Interest:
    VT and PC has been affiliated to the CoEHAR since December 2019 in a
    pro bono role. PC is coauthor of a protocol paper supported by an Investigator-Initiated Study
    award program established by Philip Morris International in