Nicotine pouches (NPs) are oral products designed for legal-age nicotine users (LANUs). Packaged in permeable material and placed under the lip, they deliver nicotine through the oral mucosa. Unlike snus and moist snuff, NPs contain no tobacco leaf, and the nicotine meets pharmaceutical-grade standards. This results in a product with substantially reduced levels of harmful and potentially harmful constituents (HPHCs), notably tobacco-specific nitrosamines (TSNAs) can be avoided.

Media coverage often conflates nicotine content with nicotine uptake, and comparisons are sometimes made using smoke-machine data from cigarettes—an approach that overlooks key differences in delivery mechanisms. On the proposed risk continuum for nicotine-containing products, cigarettes represent the highest risk, while NPs and other non-combustible products occupy the lower-risk end. Due to the distinct routes of administration, direct comparisons between these products are akin to comparing apples and pears.

Importantly, not all nicotine in a pouch is absorbed during use. This presentation will focus on factors influencing nicotine uptake from pouches and highlight why pharmacokinetic measures may offer a more meaningful assessment than simple milligram-to-milligram comparisons.

AUTHOR: Anna Masser

AFFILIATION: Swedish Match North Europe, Regulatory & Scientific Affairs, SE-104 62, Stockholm, Sweden

Background: The anti-smoking policy in Russia has reduced the proportion of smokers to 30.7%, however, about a third of smokers are not ready to quit. Underestimating the complexity of completely quitting smoking is a serious barrier to improving the health of the population. In recent years, sufficient data has accumulated supporting that heated tobacco products (HTPs) are less harmful to health and are quite an effective means of quitting smoking.

The objective of study was to model the potential effects of all smokers switching to the use of HTPs. The effect was considered a decrease in the number of deaths when using HTPs, compared to mortality associated with smoking.

Material and Methods: The modelling compared the “zero” scenario (the current situation with smoking prevalence) with the “alternative” one assumed that all smokers completely switch to HTPs, and the reduction in health harm corresponds to the level of reduction in biomarkers of potential harmful effects of tobacco combustion products by 16-49% for five of the 8 endpoints based on data from available studies.

Results: The switching from cigarette smoking to HTPs in men of 35-59 years of age will save 39,102 lives (19.1% of tobacco-associated mortality) and 1.3 million DALY years or 27.7% of the losses that accompany cigarette smoking; in women 35-59 years of age, 3,815 deaths (4.1%) are potentially prevented and 822 thousand DALY years are saved or a reduction in losses by 15.7%.

Conclusions: If we take into account the 49% reduction in toxicity from the use of HTPs and recalculate it for the entire population of smokers, the transition to HTPs can have a significant demographic effect in terms of reducing mortality, primarily in active working ages; the epidemiological gain in per capita GDP metrics could reach 1.5 trillion rubles in 2022.

AUTHOR: Alexsandr Rozanov

AFFILIATION: Therapeutic Endocrinology Department, State Budgetary Healthcare Institution MONIKI, Moskow, Russian Federation

Background: Vaping (e-cigarettes) is increasingly being normalized in higher education environments, often under the guise of harm reduction or trend conformity. While some students adopt e-cigarettes for perceived health benefits over smoking, social influence, particularly from peers and family emerges as a critical under-recognized driver of initiation and continued use. This study explores how social exposure normalize vaping and influences vaping habits among students at Lancaster University.

Material and Methods: A repeated cross-sectional survey was conducted among 277 undergraduate students (aged 18–51) at Lancaster university. A structured questionnaire captured demographic data, vaping status and extent of peer and family influence. Data were analysed using cross-tabulation and Z-tests by Qualtrics to determine statistically significant associations. Ethical approval was gained before conducting the study.

Results: Among students whose parents currently use e-cigarettes, 67.4% reported e-cigarette use themselves with a significant difference compared to non-users (p = 0.00084). Similarly, 71.1% of those with a sibling who vapes also used e-cigarettes. Data on peer influence was especially strong, reporting 67.1% of students with at least one close friend who smokes also used e-cigarettes (a highly significant association (p<0.00001).

Conclusions: Social exposure particularly from siblings and peers significantly increases the likelihood of e-cigarette use among Lancaster university students. These influences contribute to the normalization of vaping and appear to outweigh health education and risk messaging. Public health strategies must consider these social dynamics to effectively reduce vaping rates in university student populations.

AUTHORS: Jarod Luckhurst¹, Benedicta Quaye²

AFFILIATIONS: ¹Biomedical and Life Sciences, Lancaster University, UK

²Faculty of Health and Medicine, Lancaster University, UK

Background: Smoking is one of the leading preventable causes of death worldwide. A significant gap exists in the literature regarding the inclusion of biological gender as a variable. The purpose of this review is to identify biological gender-related differences in trends of smoking prevalence and broader smoking behaviors.

Materials and Methods: A review of the available literature was conducted using the PubMed database, as well as international/national organizations (WHO, Eurobarometer, UMHRI).

Results: The smoking epidemic has followed different trajectories for men and women, with women adopting smoking later. The largest gender gap in smoking prevalence is observed in low- and middle-income countries. In Europe, and specifically in Greece, although smoking prevalence is higher among men, women also smoke at high rates (Greece 2023: 40% in men, 32% in women). Between 1990 and 2019, smoking decreased in both men and women globally, although in Greece the decrease was negligible among women (-0.6% versus -18.9% in men). Smoking prevalence is similar between sexes during adolescence, although preferences for tobacco products seem to diverge in Greece. Smoking habits change during pregnancy, with demographic and socioeconomic factors being linked to continued smoking. The influence of biological gender and hormonal balance is evident in the study of addiction, motivation to smoke, and perception of risk. Data suggests that women have less successful outcomes than men in quitting smoking.

Conclusions: Recognizing and further investigating the different smoking patterns between men and women may be the key to developing more effective targeted prevention and cessation methods.

AUTHORS: Maria Batagianni¹, Vana Sypsa²

AFFILIATIONS:¹National and Kapodistrian University of Athens, Greece

²Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece

WITHDRAWN

AUTHOR: Marewa Glover

AFFILIATION: Centre of Research Excellence: Indigenous Sovereignty & Smoking, New Zealand

Background: This study presents findings from a nationally representative survey conducted among 600 adult daily users of tobacco and/or nicotine products in Croatia. The objective was to explore consumption patterns, motivations, and perceptions related to smoking and cessation support.

Material and Methods: The conducted research included a nationally representative sample of smokers aged 18 to 75.

Results: The results of the study show that as many as 52% of respondents have been smoking for more than 10 years, with a quarter of them smoking for over 20 years. Traditional smoking products (cigarettes) remain the most common form of consumption, used by 82% of respondents, while 18% use smokeless products. As many as 44% of smokers admit they are not well informed about the negative health effects of smoking. 51% have attempted to quit smoking, with the average period of abstinence being just over three months. Only 14.9% of respondents reported health problems related to smoking, with 46.6% citing a shortness of breath and 37.5% reporting high blood pressure. More than 70% of smokers stated that they enjoy smoking, indicating that the approach to long-term smokers cannot be based solely on the demand for abstinence. 65% of smokers believe that personal determination and awareness of the harmful effects of smoking are the most effective aids in quitting, while 74% think that access to smoking cessation programs is poor.

Conclusions: These findings underscore the need for improved public health strategies to address persistent smoking rates as well as improved health communication in a way that motivates smokers and their families to reduce health risks.

AUTHORS: Ranko Stevanović, Stipe Drmić, Ivana Aras

AFFILIATION: Croatian Society for the Harm Reduction in Public Health (CSPHE), Zagreb, Croatia

Background: Endothelial dysfunction and systemic inflammation play key roles in COPD pathogenesis, with smoking being the main exogenous factor. The toxic components of cigarette smoke induce oxidative stress, driving inflammation and vascular damage.

This study aims at evaluating the impact of smoking risk management strategies on systemic inflammation and endothelial dysfunction in COPD patients, emphasizing tobacco harm reduction.

Material and Methods: A one-year observational study included 150 COPD patients (73% male, 27% female; mean age 63.94±6.42 and 60.66±7.82 years, respectively), with an average disease duration of 6.2±0.5 years and a smoking index of 24.05±2.97 pack-years. Patients were divided into three groups: Group 1 (50 patients) – smoking cessation, Group 2 (50 patients) – switched to electronic nicotine delivery systems (ENDS), and Group 3 (50 patients) – continued smoking. TNF-α and PDGF-AA levels were assessed using ELISA.

Results: Groups 1 and 2 showed a significant TNF-α reduction (from 14.75±4.52 to 6.35±2.97 pg/ml and 18.59±6.98 to 13.41±4.57 pg/ml, respectively) and PDGF-AA decrease (from 325.85±119.7 to 180.41±49.4 ng/ml and 407.18±123.09 to 282.36±33.19 ng/ml, respectively). The greatest improvement was observed in those who quit smoking, but switching to ENDS also led to notable benefits. Continued smoking worsened systemic inflammation and endothelial dysfunction.

Conclusions: Cigarette smoke and ENDS have different toxic effects on endothelial cells. Harm reduction strategies may mitigate systemic inflammation and vascular damage in COPD patients who are unwilling or unable to quit smoking completely.

AUTHOR: Tatyana Tayutina

AFFILIATION: Rostov State Medical University of the Ministry of Health, Russian Federation

Background: In Japan, heated tobacco products (HTPs) are used as a less hazardous alternative to conventional cigarettes. Our previous study demonstrated that cigarette smoking significantly alters the composition of skin gases which often influence human body odour. However, the effects of HTP use have not yet been investigated.

This study aimed to elucidate the impact of HTP use on dermal emission of skin gases, focusing on nicotine in the mainstream aerosol and ammonia as a stress marker indicative of autonomic nervous system activity.

Material and Methods: Skin gases were non-invasively collected from the forearm of current users using a passive flux sampler for one hour before and after the use of the same brand of HTP. Following sampling, the emission flux of ammonia was quantified via ion chromatography, and that of nicotine was determined via gas chromatography–mass spectrometry.

Results: Prior to HTP use, dermal emission of nicotine was detected in most participants, likely attributable to habitual use. A significant increase in dermal nicotine emission was observed in all participants immediately after HTP use, followed by a gradual decline. This indicates that inhaled nicotine is released through the skin surface via a systemic blood route. Meanwhile, a marked decrease in dermal ammonia emission was noted in several participants. The scatter diagram revealed a negative correlation between nicotine and ammonia emissions.

Conclusions: These findings suggest that HTP use may contribute to stress relief among tobacco users. Moreover, such non-invasive monitoring of skin gases may serve as a valuable method for assessing nicotine addiction in users.

AUTHORS: Yoshika Sekine, Masaki Kawaguchi

AFFILIATION: Graduate School of Science, Tokai University, Japan

Background: Swedish snus is a smokeless tobacco product (STP) associated with potentially reduced health risks compared with conventional cigarettes, due in large part to the absence of high toxicant levels generated by tobacco combustion. In 2019, the FDA granted a modified risk tobacco product (MRTP) claim for eight PMTA authorised General Snus products. This MRTP status and existing epidemiological data point to the viability of snus as a reduced risk alternative for adults who would otherwise continue to smoke. Oral nicotine pouches (ONPs), are similar in format to snus, but differ by being tobacco-free, offering potentially reduced risk of tobacco-related harm to consumers.

Material and Methods: This research presents an evaluation of ONPs through both chemical and in-vitro toxicological assessments. Thirteen products were studied, including nine VELO ONPs, two commercial competitor ONPs, and two snus comparators (General Snus and the 1S4 reference product). A total of 132 analytes (previously of interest in STPs and those examined in recent studies of ONPs) were measured in the toxicant assessment.

Results: The results showed that 70 analytes examined were not quantified in any samples tested. In most tests, the ONPs contained lower levels of analytes (>90%) than snus. Comparison of the analytes tested in this study, which are in the GOTHIATEK^® standard, showed that all the ONPs tested did not exceed the specific analytes’ maximum allowable limits established for snus.

An in-vitro toxicological assessment of the same products found that the studied ONPs have lower toxicological profiles compared to the snus products. Results suggest minimal contribution of flavour complexity and base formulations to cytotoxic or genotoxic effects.

Conclusions: Together, these findings support the hypothesis that ONPs may offer a potentially reduced risk profile alternative to smoking and provide a foundational step toward a comprehensive toxicological evaluation framework for ONPs.

AUTHORS: Simone Hadley¹, David Smart¹, Emma Bishop¹, Ioanna Vardakou¹, Belinda Zonnestein², Jana Jeffery¹, Yen Nguyen¹, Kevin McAdam³, Helena Digard¹, Stuart Meredith¹, Fabio Miazzi¹, Lydia Doherty¹, Olivia Chester¹

AFFILIATIONS: ¹B. A. T. (Investments) Limited

²Nicoventures Trading Limited

³McAdam Scientific Ltd.

Withdrawn

AUTHOR: Maria Alejandra Medina

AFFILIATION: Corporación Acción Técnica Social ATS, Colombia

Background: The use of electronic nicotine delivery systems (ENDS) among adolescents has risen globally, influenced by lack of regulation, limited knowledge, and socio-cultural factors. In Brazil, although ENDS are banned, their use among teens is growing.

Material and Methods: This report describes a 2025 health education initiative targeting electronic cigarettes devices (ENDS) in a public school in São Paulo.

Results: Educational sessions were conducted with 460 students aged 13 to 17 in southern São Paulo, Brazil. In this region, 59.3% rely on the public health system (SUS), 24.3% live in poor communities, and 12.6% identify as Black or Brown. Students, in a large number of these young people, reported ENDS experimentation and daily use. Health-related behaviors and lifestyles, though strongly influenced by economic and cultural factors, are understood as proximal social determinants. Accounts included peer sales, purchases in peripheral tobacco shops, and even “loyalty cards” for ENDS. Health complaints such as oral burns were mentioned, along with environmental concerns over improper disposal of devices. Despite prohibition to manufacture and sell (by the Brazilian regulatory agency ANVISA), ENDS remain easily accessible to teenagers. ENDS are currently banned in Brazil, despite their large-scale consumption.

Conclusions: Health education, communication, and promotion are essential strategies to reduce teenage access to and use of ENDS. Effective educational guidelines can enhance students’ understanding of health and environmental risks. Preventive actions should aim to raise awareness and promote healthier choices among youth. Urgent regulatory measures are needed for these products in Brazil.

AUTHORS: Osmar Clayton Person¹, Cintia Leci Rodrigues², Luciane Lucio Pereira³, Ingrid Dragan⁴, Marina Taricano⁵

AFFILIATIONS: ¹Federal University of São Paulo, Brazil

²São Camilo University Center, São Paulo, Brazil

³Beneficência Portuguesa of São Paulo, Brazil

⁴Independent Toxicologist, São Paulo, Brazil

⁵Morumbi Sul High School, São Paulo, Brazil