The impact of electronic cigarette and heated tobacco products on conventional smoking: Α prospective cohort study from Italy
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Mario Negri Institute for Pharmacological Research, Milan, Italy
London School of Hygiene and Tropical Medicine, London, United Kingdom
Institute for the Study and Prevention of Cancer, Florence, Italy
University of Pavia, Pavia, Italy
Maastricht University, Maastricht, Netherlands
Italian National Institute of Health, Rome, Italy
Publication date: 2022-07-05
Tob. Prev. Cessation 2022;8(Supplement):A16
Debate continues about whether electronic cigarettes (e-cigarette) and heated tobacco products (HTP) reduce or increase the probability of smoking, with many studies compromised by stated or unstated conflicts of interest.

Taking advantage of a large prospective Italian cohort study, we evaluated the impact of novel (tobacco) products on conventional smoking behavior.

A total of 3185 participants in a representative sample of the general Italian population 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 heated tobacco products (HTP). We tracked transitions over that period and report odds ratios (OR) and corresponding 95% confidence intervals (CI) for changes in smoking in relation to baseline use of e-cigarettes and HTPs.

Never cigarette smokers who used e-cigarettes at baseline were much more likely to start smoking compared with never users (OR=10.98; 95% CI: 6.62–18.23) and current HTP users (OR=6.92; 95% CI: 3.96–12.09). The 17.2% of ex-smokers who relapsed at follow-up were more likely to be e-cigarette users (OR=7.05; 95% CI: 3.30–15.05) and HTP users (OR=9.78; 95% CI: 3.62–26.49). Among current smokers at baseline, those who had quit smoking at follow-up were 14.6% overall, but only 6.7% among current e-cigarette users and none among current HTP users.

Both e-cigarette and HTP use predict starting smoking and relapse and did not increase – and may even have reduced – smoking cessation among current smokers. These findings do not support the use of e-cigarettes and HTPs in tobacco control, at least in Italy, and reinforce the importance of regulating novel (tobacco) products the same way as conventional cigarettes.