Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence.

TL;DR: In this paper, the authors identified potential disparities in exposure to e-cigarette and heated tobacco product (HTP) advertising and promotion across populations and identified causal relationships that underlie disparities.

TL;DR: Among young adult smokers in England, lower‐status occupational groups were more likely to use e‐cigarettes on a non‐daily basis than to have never used compared with higher status occupational groups.

TL;DR: This article identified and brought together systematic reviews with a focus on reducing risk behaviours in disadvantaged groups and highlighted where evidence is lacking, and identified gaps in the evidence for care leavers; Gypsies, Travellers, and Roma and limited evidence for refugees and unemployed people.

Abstract: Nicotine pouches (NP) are novel agents that deliver nicotine through buccal absorption as opposed to combustion. They are proposed as a harm reduction tool compared to smoking tobacco. However, there is limited evidence on their efficacy and safety. This review article summarizes the current evidence regarding NP pharmacokinetics compared to conventional tobacco products. We searched Medline, Embase, CENTRAL and Scopus for studies that assessed pharmacokinetic parameters of nicotine pouches. We identified studies involving tobacco-dependent adults and examined pharmacokinetic parameters such as total exposure, peak concentration, and time to peak. A meta-analysis was conducted using random-effects models to calculate pooled effect sizes. The Cochrane ROB 2.0 tool was used to evaluate the risk of bias in the included studies. A total of seven RCTs and crossover trials were included. Five compared NP pharmacokinetics with smoked tobacco, while two used moist snuff as comparators. Total nicotine exposure was significantly lower with 1.5 mg and 2 mg pouches, similar with 3.5 mg and 4 mg pouches, and significantly higher with pouches containing 8 mg or more when compared to cigarettes. A meta-analysis of three trials showed that 4 mg pouches delivered 91.73 % (95 % CI 85.03 %–98.42 %) of cigarette total nicotine exposure. Peak concentration was significantly lower with 1.5 mg, 2 mg, and 3.5 mg pouches while higher concentration pouches had greater peak when compared to cigarettes. A meta-analysis of three trials showed that 4 mg pouches showed a peak nicotine concentration of 69.15 % (95 % CI 58.55 %–79.76 %) compared with cigarettes. Peak nicotine concentration was consistently achieved earlier with cigarettes (5–8 min) than with pouches (20–65 min). Despite their buccal absorption, 4 mg pouches (most commonly used), deliver similar total nicotine exposure to cigarettes, though with lower peak concentrations and slower absorption. When combined with their flavours and aggressive marketing to youth, this raises concerns about the potential of nicotine pouches to cause nicotine dependence, especially among those using the product recreationally.

TL;DR: It is concluded that smokers from the most socio-economically deprived areas of Nottingham UK generally had low awareness of the services available to help them, and misconceptions about their availability and effectiveness.

TL;DR: Since 1990–1994, absolute inequalities in smoking-attributable mortality and the contribution of smoking to inequalities in total mortality have decreased in most countries among men, but increased among women, and in many European countries, smoking has become less important as a determinant of socioeconomic inequalities in mortality among men.

TL;DR: E-cigarettes did have some potential to overcome normative barriers to smoking cessation and therefore to reduce health inequalities, at least in relation to male smoking, and Kleinman's local moral worlds are drawn to make sense of these findings.

TL;DR: In England, expenditure among e-cigarette and nicotine replacement therapy (NRT) users is approximately one third of the expenditure of smokers, although this is likely to differ according to individual usage patterns.