BACKGROUND-AIM:
Evidence on the long-term health effects of novel nicotine products (NNPs), including electronic cigarettes (EC) and heated tobacco products (HTP), remains limited. To our knowledge, to date, only one case-control study has been published on this issue, reporting a fourfold increase in lung cancer risk among dual users of EC and conventional cigarette (CC) compared with exclusive CC smokers. This study aims to investigate the association between the use of NNPs and the risk of selected noncommunicable diseases in a large sample of Italian adults.

METHODS:
Between October 2023 and March 2024, a cross-sectional sample of 22,380 Italian adults was recruited through an online panel within the IG 2021 AIRC project (ID: 25987). Participants completed a structured questionnaire on their use of CCs, ECs, and HTPs, and self-reported the diagnosis of selected neoplasms, cardiovascular diseases (CVD) or respiratory diseases, including the year of diagnosis. Using multivariable logistic regression, we estimated sex- and age-adjusted odds ratios (aORs) of self-reported incidence of selected conditions occurred in the last five years (2018–2024) for ever CC smokers and for ever exclusive NNP users, each compared with individuals reporting never use of any nicotine product.

RESULTS:
Among 22,380 participants, 12,818 (57.3%) were ever CC smokers and 484 (2.2%) were ever exclusive NNP users. Overall, 41 individuals (0.2%) reported a lung cancer diagnosis occurred in the last five years, 256 (1.1%) reported at least one smoking-related cancer, 490 (2.2%) at least one non-smoking-related cancer, 1,005 (4.5%) a CVD, and 522 (2.3%) a respiratory disease. The aOR for lung cancer was 4.11 (95% CI: 1.59–10.61) among ever CC smokers and 21.73 (95% CI: 5.74–82.3) among ever exclusive NNP users. Corresponding aORs for ever CC smokers and ever exclusive NNP users, respectively, were: 2.16 (95% CI: 1.60–2.93) and 7.13 (95% CI: 4.06–12.54) for smoking-related cancers; 1.21 (95% CI: 1.00–1.47) and 2.11 (95% CI: 1.24–3.59) for non-smoking-related cancers; 1.39 (95% CI: 1.22–1.60) and 1.82 (95% CI: 1.20–2.76) for CVDs; and 2.13 (95% CI: 1.74–2.61) and 3.21 (95% CI: 1.94–5.31) for respiratory tract diseases. Similar patterns of increased risk among NNP users compared with CC smokers were observed for several specific cancers, including those of the oral cavity and pharynx, esophagus, larynx, pancreas, bladder, kidney, liver, stomach, and brain, as well as leukemias.

CONCLUSIONS:
Although this study relies on self-reported use of products and diagnoses and it is limited by its cross-sectional design, our findings are far to support the claim that ECs and HTPs confer reduced health risks compared with CCs. Ever exclusive NNP users showed risks for tobacco-related cancers that were 2.3-10.9 times those of ever CC smokers.