scholarly journals E-Cigarette Use and Future Cigarette Initiation Among Never Smokers and Relapse Among Former Smokers in the PATH Study

2019 ◽  
Vol 134 (5) ◽  
pp. 528-536 ◽  
Author(s):  
Robert McMillen ◽  
Jonathan D. Klein ◽  
Karen Wilson ◽  
Jonathan P. Winickoff ◽  
Susanne Tanski
Keyword(s):  
Cigarette Smoking ◽  
Harm Reduction ◽  
Electronic Cigarettes ◽  
Computer Assisted ◽  
Cigarette Use ◽  
Cigarette Smokers ◽  
Potential Harm ◽  
Increased Risk ◽  
Never Smokers

Objectives: Any potential harm-reduction benefit of electronic cigarettes (e-cigarettes) could be offset by nonsmokers who initiate e-cigarette use and then smoke combustible cigarettes. We examined correlates of e-cigarette use at baseline with combustible cigarette smoking at 1-year follow-up among adult distant former combustible cigarette smokers (ie, quit smoking ≥5 years ago) and never smokers. Methods: The Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal study, surveyed 26 446 US adults during 2 waves: 2013-2014 (baseline) and 2014-2015 (1-year follow-up). Participants completed an audio computer-assisted interview in English or Spanish. We compared combustible cigarette smoking at 1-year follow-up by e-cigarette use at baseline among distant former combustible cigarette smokers and never smokers. Results: Distant former combustible cigarette smokers who reported e-cigarette past 30-day use (9.3%) and ever use (6.7%) were significantly more likely than those who had never used e-cigarettes (1.3%) to have relapsed to current combustible cigarette smoking at follow-up ( P < .001). Never smokers who reported e-cigarette past 30-day use (25.6%) and ever use (13.9%) were significantly more likely than those who had never used e-cigarettes (2.1%) to have initiated combustible cigarette smoking ( P < .001). Adults who reported past 30-day e-cigarette use (7.0%) and ever e-cigarette use (1.7%) were more likely than those who had never used e-cigarettes (0.3%) to have transitioned from never smokers to current combustible cigarette smokers ( P < .001). E-cigarette use predicted combustible cigarette smoking in multivariable analyses controlling for covariates. Conclusions: Policies and counseling should consider the increased risk for nonsmokers of future combustible cigarette smoking use as a result of using e-cigarettes and any potential harm-reduction benefits e-cigarettes might bring to current combustible cigarette smokers.

scholarly journals Prospective association between use of electronic cigarettes and use of conventional cigarettes - a systematic review and meta-analysis

2021 ◽  
pp. 00976-2020
Author(s):  
Louise Adermark ◽  
Maria Rosaria Galanti ◽  
Charlotta Ryk ◽  
Hans Gilljam ◽  
Linnea Hedman
Keyword(s):  
Systematic Review ◽  
Cigarette Smoking ◽  
Electronic Cigarettes ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Cigarette Use ◽  
Study Selection ◽  
Prospective Association ◽  
Never Smokers

ObjectiveThe aim of this systematic review and meta-analysis was to assess the association between e-cigarette use and subsequent initiation or recurrence of cigarette smoking.Data sourcesA systematic literature search was finalised November 11, 2019 using PubMed incl. Medline, EMBASE, Cochrane Library, Scopus, PubMed Health, NICE evidence search, PROSPERO, CRD, and PsycInfo.Study selectionStudies were included if meeting the following criteria: reporting empirical results; longitudinal observational design with a minimum of 3 months of follow-up; including general population samples; allowing for the comparison between users and non-users of e-cigarettes. Studies rated as having high risk of bias were excluded. Studies were independently assessed by at least two authors. The procedures described by PRISMA were followed, and the quality of evidence was rated using GRADE.Data synthesisThirty longitudinal studies from 22 different cohorts assessing e-cigarette use among non- or never-smokers at baseline, and subsequent use of cigarette smoking at follow-up, were included in this review. A random-effects meta-analysis based on 89 076 participants showed a pooled unadjusted odds ratio (OR) of cigarette smoking among baseline non-smokers e-cigarette users compared with non-users of 4.68 (CI 3.64–6.02), while the adjusted OR was 3.37 (CI 2.68–4.24). These results were consistent irrespective of whether the outcome was measured as ever smoking or as past 30-day smoking. The evidence was graded as moderate.ConclusionsUse of e-cigarettes may predict the initiation or recurrence of cigarette smoking.

scholarly journals Reducing the Smoking-Related Health Burden through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

2020 ◽  
Author(s):  
Arielle Selya
Keyword(s):  
Cigarette Smoking ◽  
Harm Reduction ◽  
Death Rate ◽  
Electronic Cigarettes ◽  
Dynamics Simulation ◽  
Cigarette Use ◽  
Ideal Case ◽  
Cigarette Smokers ◽  
Implementation Challenges ◽  
The Ideal

Abstract Background: Electronic cigarettes (“e-cigarettes”) have altered nicotine use trends, and their impacts are controversial. Given their reduced risk profile relative to conventional cigarettes, e-cigarettes have potential for harm reduction. The current study presents a simulation-based analysis of an e-cigarette harm reduction policy. Methods: A system dynamics simulation model was constructed, with separate aging chains for cigarette smokers and e-cigarette users. These structures work together with a policy module to close the gap between actual (simulated) and a goal number of cigarette smokers, chosen to reduce the nicotine-attributable death rate to the accidental death rate. The policy is two-fold, first removing existing regulations on e-cigarettes (e.g. flavor bans) and second providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on conventional smoking occurs through three mechanisms: 1) diversion from ever initiating conventional smoking; 2) reducing smoking behavior and thus progression to established smoking; and 3) increasing smoking cessation. An important unintended effect was included, which increases the nicotine-related mortality accordingly with an increase in nicotine users due to e-cigarettes.Results: The base-case model replicated the historical exponential decline in conventional cigarette smoking and the exponential increase in e-cigarette use since their introduction circa 2010. The ideal-case policy was able to reduce conventional smoking to the goal level approximately 40 years after implementation. Policy scenarios that included realistic, practical obstacles to implementation delayed and weakened the effect of the policy by up to 95% in the worst case, relative to the same time point in the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations. Conclusions: Current findings demonstrate that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current knowledge of e-cigarettes’ effects on conventional smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles is essential in policy design. Ongoing research is needed with forthcoming data on e-cigarette use prevalence and possible effects on cigarette smoking.

Heated tobacco product use and combustible cigarette smoking relapse/initiation among former/never smokers in Japan: the JASTIS 2019 study with 1-year follow-up

2021 ◽  
pp. tobaccocontrol-2020-056168
Author(s):  
Yusuke Matsuyama ◽  
Takahiro Tabuchi
Keyword(s):  
Cigarette Smoking ◽  
Tobacco Product ◽  
Internet Survey ◽  
Baseline Survey ◽  
Multivariable Logistic Regression Analysis ◽  
Cigarette Smokers ◽  
Smoking Relapse ◽  
Former Smokers ◽  
Never Smokers

BackgroundUse of heated tobacco products (HTPs), which were first launched in Japan, has been rapidly spreading worldwide. The present study aimed to investigate whether HTP use was associated with combustible cigarette smoking relapse/initiation among former/never combustible cigarette smokers.MethodsA prospective cohort study was conducted by analysing two waves of data from the Japan ‘Society and New Tobacco’ Internet Survey. Among the 7766 never/former combustible cigarette smokers who answered the baseline survey in 2019, 5947 (follow-up rate: 76.6%) responded to the follow-up survey in 2020 (age range 18–73 years old; 50.5% men). The association between HTP use and combustible smoking after 1 year was investigated by multivariable logistic regression analysis adjusting for potential confounders.ResultsOf the respondents, 308 (5.2%) used HTPs at baseline. One year later, 97 (1.7%) non-HTP users and 39 (12.7%) HTP users were smoking combustible cigarettes. Among former smokers who had quit for 1 year or more and among never smokers, HTP use was significantly associated with combustible cigarette smoking 1 year later (OR=2.80, 95% CI 1.42 to 5.52 and OR=9.95, 95% CI 3.39 to 29.16, respectively), while the association was not significant among former smokers who recently quit.ConclusionHTP use was associated with relapse/initiation of combustible cigarette smoking after 1 year. The risks of HTP use, including subsequent combustible smoking, should be carefully monitored.

scholarly journals Electronic Cigarettes and Fecundability: Results From a Prospective Preconception Cohort Study

2020 ◽  
Author(s):  
Alyssa F Harlow ◽  
Elizabeth E Hatch ◽  
Amelia K Wesselink ◽  
Kenneth J Rothman ◽  
Lauren A Wise
Keyword(s):  
Cohort Study ◽  
Cigarette Smoking ◽  
Confidence Interval ◽  
Electronic Cigarettes ◽  
Smoking History ◽  
Cigarette Use ◽  
Web Based ◽  
Joint Associations ◽  
In Pregnancy

Abstract Although electronic cigarette (e-cigarette) aerosol contains similar toxicants to combustible cigarettes, few studies have examined their influence on fecundability. We assessed the association between e-cigarette use and fecundability, overall and according to combustible cigarette smoking history, in a cohort of 4,586 North American women (aged 21–45 years) enrolled during 2017–2020 in Pregnancy Study Online, a Web-based prospective preconception study. Women reported current and former e-cigarette use on baseline and follow-up questionnaires, and they completed bimonthly follow-up questionnaires until self-reported pregnancy or censoring. Fecundability ratios and 95% confidence intervals were calculated using proportional probabilities models, controlling for potential confounders. Overall, 17% of women had ever used e-cigarettes and 4% were current users. Compared with never use of e-cigarettes, current e-cigarette use was associated with slightly lower fecundability (fecundability ratio = 0.84, 95% confidence interval (CI): 0.67, 1.06). Compared with current nonusers of e-cigarettes and combustible cigarettes, fecundability ratios were 0.83 (95% CI: 0.54, 1.29) for current dual users of e-cigarettes and combustible cigarettes, 0.91 (95% CI: 0.70, 1.18) for current e-cigarette users who were nonsmokers of combustible cigarettes, and 1.01 (95% CI: 0.85, 1.20) for nonusers of e-cigarettes who were current smokers of combustible cigarettes. Current e-cigarette use was associated with slightly reduced fecundability, but estimates of its independent and joint associations with combustible cigarette smoking were inconsistent and imprecise.

scholarly journals User-Perceived Negative Respiratory Symptoms Associated with Electronic Cigarette Use

2020 ◽  
Vol 22 (Supplement_1) ◽  
pp. S45-S53
Author(s):  
Eric K Soule ◽  
Kendall M Bode ◽  
Abigail C Desrosiers ◽  
Mignonne Guy ◽  
Alison Breland ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
Health Outcomes ◽  
Respiratory System ◽  
Respiratory Symptoms ◽  
Online Survey ◽  
Electronic Cigarettes ◽  
Future Research ◽  
Scaling Analysis ◽  
Cigarette Use ◽  
Cigarette Smokers

Abstract Introduction Electronic cigarettes (ECIGs) expose users to an aerosol containing chemicals, which could affect the respiratory system negatively. This study examined negative respiratory symptoms associated with ECIG use. Methods In 2019, adult current ECIG users from 24 US states who reported experiencing negative respiratory symptoms from ECIG use (n = 49; 44.9% women; mean age = 35.2, SD = 11.5) completed an online survey and brainstormed statements that completed the prompt: “A specific negative effect or symptom related to my breathing, nose, mouth, throat, or lungs that I have experienced from vaping/using my e-cigarette is...” Participants sorted the final list of 56 statements into groups of similar content and rated statements on how true they were for them. Multidimensional scaling analysis identified thematic clusters. Results Eight ECIG use respiratory symptom clusters identified in analysis included Mucus and Congestion, Fatigue, Throat Symptoms, Breathing Problems, Mouth Symptoms, Chest Symptoms, Illness Symptoms, and Nose and Sinus Symptoms. Highly rated (ie, most common) symptoms included dry throat or mouth, fatigue during physical activity, coughing, shortness of breath, excessive phlegm, and bad taste in mouth. Mean cluster ratings did not differ based on lifetime cigarette smoking status (100 lifetime cigarettes smoked), but current cigarette smokers (ie, dual users) rated the Fatigue, Breathing Problems, Mucus and Congestion, and Nose and Sinus Symptoms clusters higher than noncurrent cigarette smokers. Conclusions Participant-identified respiratory symptoms perceived to be ECIG related, many similar to cigarette smoking symptoms. Future research should assess if these symptoms are associated with other negative health outcomes. Implications ECIG use exposes users to chemicals that may have negative health impacts on the respiratory system. Limited research has examined the broad range of negative respiratory symptoms associated with e-cigarette use. This study identified that ECIG–cigarette users perceive their ECIG use to be associated with negative respiratory symptoms. Many e-cigarette user-reported negative respiratory symptoms are similar to those associated with cigarette smoking, though some appear unique to e-cigarette use. Future research should continue to monitor respiratory symptoms reported by ECIG users and whether these are associated with health outcomes over time.

scholarly journals Association of mixed use of electronic and conventional cigarettes and exposure to second-hand smoke with prediabetes

2021 ◽  
Author(s):  
Seung Hoon Kim ◽  
Minah Park ◽  
Gyu Ri Kim ◽  
Hye Jin Joo ◽  
Sung-In Jang
Keyword(s):  
Glucose Metabolism ◽  
Electronic Cigarettes ◽  
Fold Increase ◽  
Population Based ◽  
Second Hand Smoke ◽  
Cigarette Use ◽  
Mixed Use ◽  
Increased Risk ◽  
Smoking Behaviors ◽  
Never Smokers

Abstract Context Despite previous studies regarding the association between smoking and diabetes, the effects of electronic cigarettes and second-hand smoke (SHS) on glucose metabolism and insulin sensitivity have not been fully elucidated. Objective To examine the association of mixed electronic and conventional cigarette use and exposure to SHS with prediabetes. Design Data from the 2014–2018 Korean National Health and Nutrition Examination Survey were analyzed. Setting Nationwide population-based Participants Of 39,199 participants, 22,385 participants (9,490 men, 12,895 women) without diabetes were included. The main independent variables were smoking behaviors, including exposure to SHS. Interventions None Main Outcome Measure(s) Prediabetes (HbA1C of 5.7–6.4%). Results Of 22,385 participants without diabetes, 6,735 had prediabetes. Mixed cigarette use was associated with a 1.57-fold increase in the odds of prediabetes when compared with never-smoking (odds ratio [OR]=1.57, 95% confidence interval [CI]=1.29–1.92) and a 1.27-fold increase when compared with conventional cigarette use only (OR=1.27, 95% CI=1.07–1.52). Participants who were current non-smokers but mixed users in the past had an increased risk of prediabetes (OR=1.54, 95% CI=1.04–2.13). There was no significant association between prediabetes and current non-smoking in individuals with previous conventional cigarette use only. Among never-smokers, exposure to SHS significantly increased the risk of prediabetes (OR=1.16, 95% CI=1.04–1.30). Conclusions Mixed use of electronic and conventional cigarettes and exposure to SHS increased the risk of prediabetes. Further studies are required to comprehensively investigate the molecular biology underlying the effects of previous and current mixed use of electronic cigarettes and SHS on glucose metabolism.

scholarly journals Differences in Levels of Biomarkers of Potential Harm among Users of a Heat-not-burn Tobacco Product, Cigarette Smokers, and Never-Smokers in Japan: A Post-Marketing Observational Study

2021 ◽  
Author(s):  
Chikako Sakaguchi ◽  
Yasufumi Nagata ◽  
Akira Kikuchi ◽  
Yuki Takeshige ◽  
Naoki Minami
Keyword(s):  
Cigarette Smoking ◽  
Tobacco Smoke ◽  
Cigarette Smokers ◽  
Potential Harm ◽  
Actual Use ◽  
Post Marketing ◽  
Harmful Substances ◽  
Never Smokers ◽  
The Impact

Abstract Introduction Cigarette smoking is associated with the risk of certain diseases, but non-combustible products may lower these risks. The potential long-term health effects of the next-generation non-combustible products (heat-not-burn tobacco products (HNBP) or electronic vapor products) have not been thoroughly studied. The present study aimed to investigate the impact of biomarkers of potential harm (BoPH) of one of HNBP (a novel vapor product: NTV), under the conditions of actual use. Methods This study was an observational, cross-sectional, three-group, multi-center study. Exclusive NTV users (NTV, n = 259), conventional cigarette smokers (CC, n = 100) and never-smokers (NS, n=100) were enrolled. Biomarkers of tobacco smoke exposure (cotinine and total NNAL) and BoPH including parameters of physical pulmonary functions relevant to smoking-related diseases were examined, and subjects answered a questionnaire on cough-related symptoms (J-LCQ) and health-related quality of life (SF-36v2®). Results Levels of cotinine, total NNAL and BoPH (HDL-cholesterol, triglyceride, sICAM-1, WBC count, 11-DHTXB2, 2,3-d-TXB2, 8-epi-PGF2α, FEV1, %FEV1 and FEF25-75) were significantly different in the NTV group as compared to levels in CC group (p&lt;0.05). Significantly higher levels of cotinine, total NNAL, and 2,3-d-TXB2, and lower levels of FEV1 and %FEV1, were observed among NVT users compared to the NS group. Conclusion In a post-marketing study under actual use conditions, BoPH associated with smoking-related disease examined in exclusive NTV users were found to be favorably different from those of CC smokers, a finding attributable to a reduction in exposure to harmful substances of tobacco smoke. Implications Cigarette smoking is associated with increased risk of pulmonary diseases like COPD, cardiovascular diseases, and certain cancers. There is a growing body of evidence that HNBP reduces the exposure associated with smoking and that there is a favorable change in BoPH. However, long-term effects regarding the relative health risks to HNBP users compared to CC smokers have not been examined. This study provides post-marketing data under actual use conditions of the effects on biomarkers of potential harm in NTV, one of HNBP, exclusive users compared to CC smokers and never-smokers. The evidence suggests that exclusive NTV users have favorable levels of BoPH compared to CC smokers, and that is result from a sustained reduction in exposure to harmful substances of tobacco smoke.

scholarly journals Do electronic cigarettes increase cigarette smoking in UK adolescents? Evidence from a 12-month prospective study

2017 ◽  
Vol 27 (4) ◽  
pp. 365-372 ◽  
Author(s):  
Mark Conner ◽  
Sarah Grogan ◽  
Ruth Simms-Ellis ◽  
Keira Flett ◽  
Bianca Sykes-Muskett ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Carbon Monoxide ◽  
Cigarette Smoking ◽  
Prospective Study ◽  
Electronic Cigarettes ◽  
Cigarette Use ◽  
School Meals ◽  
Cross Sectional ◽  
Age Range

BackgroundIn cross-sectional surveys, increasing numbers of adolescents report using both electronic cigarettes (e-cigarettes) and cigarettes. This study assessed whether adolescent e-cigarette use was associated prospectively with initiation or escalation of cigarette use.MethodsData were from 2836 adolescents (aged 13–14 years at baseline) in 20 schools in England. At baseline, breath carbon monoxide levels, self-reported e-cigarette and cigarette use, sex, age, friends and family smoking, beliefs about cigarette use and percentage receiving free school meals (measure of socioeconomic status) were assessed. At 12-month follow-up, self-reported cigarette use was assessed and validated by breath carbon monoxide levels.ResultsAt baseline, 34.2% of adolescents reported ever using e-cigarettes (16.0% used only e-cigarettes). Baseline ever use of e-cigarettes was strongly associated with subsequent initiation (n=1726; OR 5.38, 95% CI 4.02 to 7.22; controlling for covariates, OR 4.06, 95% CI 2.94 to 5.60) and escalation (n=318; OR 1.91, 95% CI 1.14 to 3.21; controlling for covariates, this effect became non-significant, OR 1.39, 95% CI 0.97 to 1.82) of cigarette use.ConclusionsThis is the first study to report prospective relationships between ever use of e-cigarettes and initiation and escalation of cigarette use among UK adolescents. Ever use of e-cigarettes was robustly associated with initiation but more modestly related to escalation of cigarette use. Further research with longer follow-up in a broader age range of adolescents is required.

The Impact of Vaping on Primary Spontaneous Pneumothorax Outcomes

2021 ◽  
pp. 000313482110488
Author(s):  
Mohsin Shah ◽  
Mary K. Bryant ◽  
Gita N. Mody ◽  
Rebecca G. Maine ◽  
Judson B. Williams ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Electronic Cigarettes ◽  
Tertiary Care ◽  
Primary Spontaneous Pneumothorax ◽  
Smoking History ◽  
Care Hospital ◽  
Cigarette Use ◽  
Cigarette Smokers ◽  
Never Smokers ◽  
The Impact

Introduction Cigarette smoking is associated with primary spontaneous pneumothorax (PSP). Electronic cigarettes (E-cigarettes) are touted as a healthier alternative to cigarettes; however, the impact E-cigarette use has on PSP management is not known. The goal of this study was to determine if E-cigarette use is associated with inferior outcomes after PSP, compared to never smokers and cigarette smokers. Methods We conducted a retrospective cohort study of patients in a large tertiary care hospital system in an urban area who presented with PSP from September 2015 through February 2019. Primary spontaneous pneumothorax patients were identified from the institutional Society of Thoracic Surgeon (STS) database. Patients with pneumothoraces from traumatic, iatrogenic, and secondary etiologies were excluded. Baseline clinical and demographic data and outcomes including intervention(s) required, length of stay, and recurrence were evaluated. Results Identified were 71 patients with PSP. Seventeen (24%) had unverifiable smoking history. Of the remaining, 7 (13%) currently vaped, 27(50%) currently smoked cigarettes, and 20(37%) were never smokers. Mean age was 33 years; 80% male. All vapers required tube thoracostomy vs 74% of current smokers and 75% of never smokers. Vaping was associated with increased odds of recurrence compared to never smokers (OR 2.00, 95% CI 0.35,11.44). Vapers had the shortest median time to recurrence after initial hospitalization (10 d[4,18] v 20 d[5,13] cigarette smokers v 27 d[13 275] never smokers, P < .001). Conclusion Vaping may complicate PSP outcomes. As vaping use increases, especially among adolescents, it is imperative that the manner of tobacco use is documented and considered when caring for patients, especially those with pulmonary problems.

scholarly journals International Randomized Controlled Trial Evaluating Changes in Oral Health in Smokers after Switching to Combustion-Free Nicotine Delivery Systems: SMILE Study protocol

2020 ◽  
Author(s):  
Gianluca Conte ◽  
Sebastiano Antonio Pacino ◽  
Salvatore Urso ◽  
Pasquale Caponnetto ◽  
Francesca Benfatto ◽  
...  
Keyword(s):  
Oral Health ◽  
Cigarette Smoking ◽  
Electronic Cigarettes ◽  
Periodontal Diseases ◽  
Delivery Systems ◽  
Randomized Controlled ◽  
Nicotine Delivery ◽  
Never Smokers ◽  
The Impact

ABSTRACTAlthough the well-known detrimental effects of conventional cigarette smoking on oral health, there are still lack of evidences about the impact of less harmful alternatives (such as electronic cigarettes or heat not burn products), especially in young smokers with clinical absence of signs of periodontitis.SMILE will be a prospective, multicenter, interventional, open label, randomized, controlled, three parallel-arms study assessing oral health parameters and teeth appearance of 18 months duration.This study aims to compare short- and long-term impact on oral health between smokers continuing with conventional cigarette smoking, those switching to combustion-free nicotine delivery systems (C-F NDS), and never-smokers by objectively evaluating changes in gingival response, as a proxy for periodontal/gingival.The total number of participants in the study planned of the trial is 606 (505 regular smokers and 101 never-smokers).Regular smokers not intending to quit will be randomized in the ratio 1:4 either in continuing to smoke commercially manufactured conventional cigarettes (n = 101; Study Arm A) or switching to C-F NDS (n = 404; Study Arm B), never-smokers will be assigned in Arm C (n= 101).The primary outcome will be to assess and compare the percentage mean change in Modified Gingival Index (MGI) score between Baseline and 18 months follow-up between the Study Arms A and B.Secondary outcomes include the assessment of within- and between-group (Arm A, Arm B and Arm C) variations from baseline to 18 months follow-up of several endpoints, such as MGI, Tooth Stains Assessment, Dental Discolorations, Plaque Score Imaging, Oral Health Quality of Life (OHQOL) assessment and EuroQoL Visual Analog Scale (EQ VAS – QoL) assessment.Patient recruitment will start in January 2021 and enrolment is expected to be completed by June 2021.This will be the first study determining overall oral health impact of using CF-NDS in smokers without sign of periodontitis. Data from this study will provide valuable insights into the overall potential of C-F NDS to reduce the risk of periodontal diseases.

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