Alternative nicotine delivery systems: current evidence

Alternative nicotine delivery products (ANDS) have gained popularity in recent years. Their potentially lower harm compared to traditional cigarettes and the possibility of using them as part of a harm-reduction strategy in tobacco addiction treatment have been discussed. Current epidemiological trends show a gradual increase in ANDS use by the general population, especially among adolescents and young adults, but also among non-smokers. The most comprehensive evidence regarding health effects is available for e-cigarettes, which suggests that their use does not increase cardiovascular risk, except for hypertension, compared to non-smokers, and reduces the risk of respiratory diseases compared to smoking traditional cigarettes; however, long-term data are lacking for older individuals. In the case of heated tobacco products, there is not enough reliable evidence on health risks compared to current smokers or non-smokers, while concerns remain about the potential toxicity of substances found in these products but absent in cigarette smoke. For nicotine pouches, there is a lack of reliable evidence on long-term effects. Electronic cigarettes are used as a smoking cessation tool in some countries, such as the UK. Existing evidence leans towards the potential use of e-cigarettes as a harm-reduction strategy, although there is currently no global consensus on their role in tobacco addiction treatment. Complete cessation of all tobacco and nicotine products remains the primary recommended approach.