Impact of electronic cigarette and heated tobacco product on conventional smoking: an Italian prospective cohort study conducted during the COVID-19 pandemic.

OBJECTIVE: Debate continues about whether electronic cigarettes (e-cigarettes) and heated tobacco products (HTP) reduce or increase the probability of smoking, with many studies compromised by stated or unstated conflicts of interest. We undertook a longitudinal study in Italy. METHODS: 3185 Italian participants aged 18-74 years provided baseline (April-May) and follow-up (November-December) responses in 2020, reporting smoking status and use of e-cigarettes and HTP. We tracked transitions over that period and reported risk ratios (RR) and corresponding 95% CIs for changes in smoking in relation to baseline use of e-cigarettes and HTPs. RESULTS: Never cigarette smokers who used e-cigarettes at baseline were much more likely to start smoking (compared with never users, RR 8.78; 95% CI: 5.65 to 13.65) and current HTP users (RR 5.80; 95% CI: 3.65 to 9.20). Among ex-smokers, relapse (17.2%) at follow-up was more likely among e-cigarette (RR 4.25; 95% CI: 2.40 to 7.52) and HTP users (RR 3.32; 95% CI: 2.05 to 5.37). Among current smokers at baseline, those who had continued smoking at follow-up were 85.4% overall. These were more frequently current novel product users (compared with non-users, RR 1.10; 95% CI: 1.02 to 1.19 for e-cigarette users; RR 1.17; 95% CI: 1.10 to 1.23 for HTP users). CONCLUSIONS: Both e-cigarette and HTP use predict starting smoking and relapse, and appear to reduce smoking cessation. Due to the limited sample size within specific strata, the association with quitting smoking should be confirmed by larger prospective studies. These findings do not support the use of e-cigarettes and HTPs in tobacco control as a consumer product, at least in Italy.

Use of electronic cigarettes and heated tobacco products during the Covid-19 pandemic.

Only a few studies investigated changes in electronic cigarette (e-cigarette) and heated tobacco product (HTP) use during pandemic restrictions. We conducted a web-based cross-sectional study of a representative sample of 6,003 Italian adults during the strictest phase of the Covid-19 lockdown (April-May 2020). Participants were asked to report changes in e-cigarette and HTP use compared to before the pandemic. E-cigarette users increased from 8.1% to 9.1% and HTP users from 4.0% to 4.5%. Among e-cigarette non-users before lockdown, 1.8% started using e-cigarettes during lockdown. New users were more frequently younger (p for trend 0.001), men (odds ratio, OR 1.56; 95% confidence interval, CI: 1.03-2.34), cannabis users (OR 2.35; 95% CI: 1.33-4.13), gamblers (OR 3.34; 95% CI: 2.18-5.11) and individuals with anxiety symptoms (OR 1.58; 95% CI: 1.00-2.52). 1.0% of HTP non-users started using it during lockdown. New users were less frequently current than never cigarette smokers (OR 0.19; 95% CI: 0.06-0.61) and more frequently gamblers (OR 2.23; 95% CI: 1.22-4.07). E-cigarettes and HTPs played little role as smoking cessation tools for hardcore smokers but rather provided opportunities for young never smokers to engage in socially acceptable activities, perhaps reflecting the obstacles they faced in obtaining other addictive substances during confinement.

COVID-19 confinement impact on weight gain and physical activity in the older adult population: Data from the LOST in Lombardia study.

BACKGROUND & AIMS: COVID-19 containment measures significantly impacted lifestyle of the general population, including physical activity. Although the older adults are particularly susceptible to the potential consequences of sedentary lifestyle and inactivity, few studies investigated pandemic effects in this segment of the population. We aimed to evaluate COVID-19 pandemic effects on weight gain and physical activity in the Italian older adults, and assess the impact of possible changes in physical activity on mental health wellbeing. METHODS: In November 2020, a cross-sectional survey was conducted on a representative sample of 4400 older adults (aged 65 or more) from the Lombardy region, Northern Italy. Changes in body mass index (BMI) and physical activity were assessed, compared to the previous year. Using unconditional multiple logistic models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) of a decrease in physical activity during COVID-19 pandemic and we evaluated if decreased physical activity was a determinant of a worsening in psychological wellbeing. RESULTS: Neither weight gain nor increase in obesity prevalence occurred during the pandemic. Mean time spent in physical activity significantly decreased, with 43.8% of participants reporting a decrease of 1 h/week or more during COVID-19 pandemic. A decreased physical activity was determinant of a worsening of selected mental health outcomes, such as: sleep quality (OR = 2.45; 95% CI: 1.91-3.15) and quantity (OR = 1.54; 95% CI: 1.18-2.02), anxiety (OR = 1.31; 95% CI: 1.14-1.52) and depressive symptoms (OR = 1.61; 95% CI: 1.38-1.88). CONCLUSION: During the COVID-19 pandemic, while no major changes in BMI were observed, physical activity significantly declined in the older adults. In this population, the lack of physical activity might have contributed to the observed worsening in mental health. During emergency periods, encouraging physical activity might be effective also to preserve psychological wellbeing.