2025 Session 3 Seminars

This presentation will provide an overview of the latest research to assess the long-term health effects of vaping, both in terms of relative (compared with smoking) and absolute risks (compared with not using anything at all). It will also briefly cover other novel nicotine delivery devices that are becoming more popular, specifically nicotine pouches, and how these compare with e-cigarettes. The talk will examine examples of frequent misrepresentations of findings, either underplaying or overplaying the consequences of e-cigarette use, and summarise what we can reasonably claim about the risks of vaping at this point in time, given the existing evidence. It will conclude by highlighting important gaps in the literature and will provide suggestions for what future research should focus on in order to improve our understanding of the population impact of vaping

The sale of non-tobacco oral products, particularly oral nicotine pouches, has recently increased in the U.S. and around the world, particularly among young adults. Such pouches provide the pharmacological effects of relatively pure nicotine without the risks of combusted or non-combusted tobacco products. The more important potential benefit for public health would be if people who smoke switched to ONP. The effectiveness of ONP for smoking cessation is not yet established, but clinical trials are ongoing. Other benefits reported by users of ONP include pleasure, mood modulation, cognitive enhancement (use at work or when studying), sports (golf, baseball – to promote concentration and focus), and partying (along with alcohol in bars where smoking is not permitted). It is clear that many people like to use nicotine and would like to continue its use in an ongoing way. The primary established risk of ONP is addictive use. In Scandinavia, compulsive daily use of snus is common among adolescent males, and this pattern is also observed in some U.S. users. There will likely be some risk of nicotine pouch use during pregnancy. Other potential harms of nicotine, including cardiovascular disease, impairment of adolescent brain development, oral disease, infectious disease risk and cancer, will be discussed, based on what is known about the harms of nicotine in Swedish snus. The overall impact of ONP on public health in the short term will likely depend on the balance of benefit in the promotion of smoking cessation vs the risks of addictive use, particularly among youth. Whether there will be public acceptance of ONP use once smoking is eliminated, based on the perceived cognitive and other benefits, remains to be seen.

The use of e-cigarettes to quit smoking has been politicized since the get-go. Vaping cessation is now also becoming politicized, with potentially harmful consequences. In this talk, I’ll discuss the importance of generating and communicating reliable and accurate information on both. I’ll draw on evidence from a recent overview of systematic reviews as well as two recent Cochrane living systematic reviews, one on e-cigarettes for smoking cessation and the other on interventions for quitting vaping. I’ll conclude by proposing a set of evidence-based statements that, hopefully, most will agree with, regardless of their stance on vaping and smoking.

In the absence of clear guidance from most major societies, what is the role of a clinician in counseling someone who smokes cigarettes about switching to e-cigarettes? What about in counseling someone to stop using e-cigarettes? How do you even begin to have the discussion with someone when the majority of both the public and clinicians believe that e-cigarettes are as least as harmful as combustible cigarettes? While there is compelling evidence that e-cigarettes are more effective than nicotine replacement at helping people quit smoking, there is very little guidance about how to actually have the conversation. This presentation will focus on the key challenges in communication with people about vaping and smoking cessation. It will discuss what literature there is, as well as provide suggestions for what to do in lieu of clear scientific and policy recommendations.

During this talk, Dr. Piper will review the challenges to the scientific community that arose when e-cigarettes came on the market and what we have learned about addressing the critical scientific questions needed to inform public health, clinical care, and regulation. She will discuss the potential benefits of developing and implementing a paradigm for investigating novel nicotine products to address these questions in a timely way.

THR, Cessation & Health

• Does the focus on vaping cessation come at the expense of smoking cessation
• Dual use has been a perennial battleground. Is this a failure of the product, regulation or public health communication
• Will nicotine pouches assuage safety concerns, and could or will  this change the conversation on THR
• Has nicotine addiction become a greater public health crisis than smoking