Importance Cigarette smoking, maintained predominantly by nicotine dependence, is a long-term and relapsing behavior that continues to be a leading cause of preventable death and disease worldwide. E-cigarettes with nicotine are less harmful than cigarettes and have been shown to be more effective for smoking cessation than US Food and Drug Administration–approved nicotine replacement therapies. However, misperceptions of the harms of e-cigarettes are common, even among clinicians. This Special Communication is a position manuscript developed by a working group within the Treatment Research Network of the international Society for Research on Nicotine and Tobacco. The aims of the manuscript were to summarize the evidence on the use of e-cigarettes for smoking cessation and to provide recommendations for clinicians on how to engage in conversations with adult patients who currently smoke cigarettes. Specifically, advice is provided on (1) integration of e-cigarettes into patient-centered shared decision-making conversations on the risks and benefits of various pharmacologic smoking cessation treatments; and (2) practical guidance on the use of e-cigarettes for smoking cessation. Observations This Special Communication includes one overarching recommendation: integrate e-cigarettes into conversations on the risks and benefits of all evidence-based pharmacologic treatments for smoking cessation. In support of this recommendation, specific guidance is provided regarding how to discuss potential misperceptions and suggests questions to guide patient conversations. Finally, evidence-based best practices are provided for using e-cigarettes to quit smoking, which can be shared with patients. Conclusions and Relevance The significant burden of cigarette smoking, coupled with scientific evidence supporting e-cigarettes for smoking cessation, clearly indicates that it is appropriate to include e-cigarettes in discussions of evidence-based pharmacologic treatment for smoking cessation to reduce the harms of cigarette smoking. These recommendations are intended to provide evidence-informed guidance to clinicians regarding use of e-cigarettes for smoking cessation.

INTRODUCTION:Smoking cessation following a cancer diagnosis is critical for improving prognosis. For this reason, substantial efforts have been made to increase tobacco treatment in cancer care settings. The purpose of the present study is to provide an up-to-date estimate of tobacco/nicotine product use (inclusive of non-combustible products such as e-cigarettes and oral nicotine pouches) and cessation strategy uptake among individuals recently diagnosed with cancer. METHODS:Data were derived from the Population Assessment of Tobacco and Health study, a large, nationally representative survey. Weighted frequencies estimated tobacco/nicotine product use (e.g., cigarettes, cigars, e-cigarettes, oral pouches) and cessation strategy prevalence (e.g., nicotine replacement therapies, prescription medications, e-cigarettes, oral pouches). Logistic regressions evaluated associations between cancer diagnosis and cancer type (e.g., tobacco related vs. non-tobacco related cancers) on tobacco use and cessation strategy outcomes. RESULTS:Individuals with cancer used tobacco/nicotine products at similar rates as those without cancer. Individuals with cancer were more likely to use evidence-based cessation strategies (e.g., pharmacotherapy and counseling; AOR=2.36 [95% CI 1.30-4.27], p<.01), but appeared less likely to successfully quit (17.27% [5.42-29.13]) with cancer quit vs 31.16% [28.39-33.93] without cancer). Similarly, those with tobacco-related cancers appeared to have higher engagement with cessation strategies (11.90% [5.95 - 17.84]) than those with non-tobacco-related cancers (2.35% [0.74 - 3.95]). CONCLUSIONS:Efforts to increase reach and access to evidence-based cessation support in cancer settings have been fruitful; however, more work is needed to improve treatment effectiveness. Continued monitoring of the use of non-combustible products is warranted.

Objective: To examine lung cancer screening (LCS) outcomes in people living with HIV (PLWH). Further, we aimed to understand perspectives of providers regarding LCS in PLWH to contextualize current screening outcomes and referrals. Methods: Phase 1 involved electronic health record review to identify PLWH who had undergone a shared decision-making visit and LCS from 2015 to 2023 at Medical University of South Carolina (MUSC). Inclusion criteria were consistent with LCS eligibility criteria plus HIV diagnosis. Shared decision making visits were completed by 61 PLWH. Phase 2 included a survey of infectious disease providers' (N = 12) knowledge of and perceived barriers to LCS at MUSC. Results: In Phase 1, 97% (N = 59/61) completed baseline LCS. At baseline 58% had a normal lung RADS score. Two individuals were diagnosed with cancer (3%, N = 2/59). In Phase 2, twelve providers responded to the survey with 100% agreeing LCS is beneficial to PLWH. Majority of providers (83%) endorsed lack of knowledge on LCS guidelines. Conclusions: Among PLWH who completed a LCS, a clinically meaningful proportion had positive findings, including early-stage cancers. Findings from this study could be used to improve implementation of LCS programs in PLWH and programs to educate providers.

Smoking rates are high among patients in cancer care, and improving quit rates among these patients is critical for improving survival outcomes. Yet, many oncology outpatients do not receive tobacco treatment, and a sizeable portion even refuse available evidence-based resources. E-cigarettes deliver lower levels of known carcinogens compared to cigarettes, and several rigorous trials have shown higher quit rates among people who receive e-cigarettes compared to those who receive nicotine replacement therapy. Switching from cigarettes to e-cigarettes reduces exposure to carcinogens and may be an appealing harm reduction intervention for patients in cancer care who refuse traditional treatment. The present protocol describes an ongoing type 1 hybrid effectiveness-implementation trial among oncology outpatients at an NCI-designated cancer center to compare rates of switching to e-cigarettes to standard care, and advance understanding of key barriers and facilitators of implementation processes. Adults who smoke cigarettes and refuse all components of traditional tobacco treatment through an opt-out tobacco treatment service are randomized to receive either (1) a 13-week supply of e-cigarettes and a workbook for switching to e-cigarettes or (2) a workbook for quitting smoking. Participants assigned to e-cigarettes are instructed to set a switch date within two weeks of randomization, to use their e-cigarette ad libitum in advance of their switch date, and to stop smoking cigarettes and exclusively use their e-cigarette on their switch date. Participants complete biweekly assessments through the end of product provision and additional follow ups through 6 months. The primary outcome is complete switching (7-day point prevalence abstinence confirmed by expired breath carbon monoxide ≤ 5ppm) at 6 Months. Secondary outcomes include implementation processes, biomarkers of cancer risk, and health-related quality of life. This study examines a novel approach to harm reduction among oncology outpatients who refuse traditional tobacco treatment. Integrating effectiveness and implementation results helps to engage this population in harm reduction and provides critical evidence to refine delivery and planning for implementation. The proposed trial is highly significant, regardless of the results, and has the potential to influence harm-reduction approaches to tobacco use among patients in cancer care. The current study was registered on clinicaltrials.gov on June 26, 2025 (NCT07039292).

Importance:Cigarette smoking, maintained predominantly by nicotine dependence, is a long-term and relapsing behavior that continues to be a leading cause of preventable death and disease worldwide. E-cigarettes with nicotine are less harmful than cigarettes and have been shown to be more effective for smoking cessation than US Food and Drug Administration-approved nicotine replacement therapies. However, misperceptions of the harms of e-cigarettes are common, even among clinicians. This Special Communication is a position manuscript developed by a working group within the Treatment Research Network of the international Society for Research on Nicotine and Tobacco. The aims of the manuscript were to summarize the evidence on the use of e-cigarettes for smoking cessation and to provide recommendations for clinicians on how to engage in conversations with adult patients who currently smoke cigarettes. Specifically, advice is provided on (1) integration of e-cigarettes into patient-centered shared decision-making conversations on the risks and benefits of various pharmacologic smoking cessation treatments; and (2) practical guidance on the use of e-cigarettes for smoking cessation. Observations:This Special Communication includes one overarching recommendation: integrate e-cigarettes into conversations on the risks and benefits of all evidence-based pharmacologic treatments for smoking cessation. In support of this recommendation, specific guidance is provided regarding how to discuss potential misperceptions and suggests questions to guide patient conversations. Finally, evidence-based best practices are provided for using e-cigarettes to quit smoking, which can be shared with patients. Conclusions and Relevance:The significant burden of cigarette smoking, coupled with scientific evidence supporting e-cigarettes for smoking cessation, clearly indicates that it is appropriate to include e-cigarettes in discussions of evidence-based pharmacologic treatment for smoking cessation to reduce the harms of cigarette smoking. These recommendations are intended to provide evidence-informed guidance to clinicians regarding use of e-cigarettes for smoking cessation.

Cannabis and tobacco co-use has increased over time, but research evaluating co-use risks rarely considers different cannabis or tobacco use modalities (e.g., smoking, vaping). Data were analyzed from 4,071 participants from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey, a nationally representative survey of United States adults, who endorsed past 30-day cannabis use and current cigarette smoking and/or vaping. A weighted multinomial logistic regression was used to determine if current tobacco use (cigarettes, vaping, or dual use; independent variable) was associated with cannabis use modality (only smoking, only vaping, or smoking and vaping cannabis; dependent variable), controlling for race, sex, and education level. Compared to individuals who smoked cigarettes, those vaping (odds ratio [OR] = 7.12, 95

INTRODUCTION:Tobacco use can adversely affect cancer treatment outcomes, yet routine assessment has not been fully incorporated into oncology clinical trials. In 2012, rates of tobacco use assessment in actively accruing National Cancer Institute (NCI) trials were < 30% at enrollment and < 5% during follow-up, prompting efforts by the NCI and major oncology associations to promote and standardize tobacco assessment in oncology research and practice (including development of the Cancer Patient Tobacco Use Questionnaire [C-TUQ]). This study was conducted to re-examine assessment patterns in 2022 (including utilization of the C-TUQ) and evaluate progress. AIMS AND METHODS:Protocols and forms from 144 actively accruing (as of December 2022) NCI National Clinical Trials Network (NCTN) trials were evaluated using a standardized coding instrument. RESULTS:Of 144 trials, 49.3% assessed tobacco use at enrollment (43.8% measured cigarettes, 14.8% e-cigarettes, and ≤ 12.5% other tobacco products). Approximately 20.8% used at least one C-TUQ question, but only 3.5% used all four core items. Few measured second-hand smoke exposure (3.5%) or quit interest (2.8%). At follow-up, 8.3% assessed any form of tobacco use. Assessment rates were higher in smoking-related cancer trials. CONCLUSIONS:Almost half of the accruing trials did not measure any tobacco use and fewer used the C-TUQ. There was a ≥ 70% increase in tobacco use assessment at enrollment and follow-up compared to 2012, an improvement with room for further enhancement. Standardized tobacco use information enhances investigators' ability to estimate cancer treatment efficacy, offer equitable cessation support, and accurately understand the impact of tobacco use on treatment outcomes. IMPLICATIONS:In 2012, few (< 30%) cancer clinical trials evaluated tobacco use at enrollment and < 5% did so during follow-up, prompting efforts to promote and standardize tobacco assessment in oncology research and practice (including the development of the Cancer Patient Tobacco Use Questionnaire [C-TUQ]). The present study builds on this foundational paper and finds an overall increase in tobacco use assessment with room for improvement: 49.3% of trials in 2022 assessed tobacco use at enrollment and 8.3% did so during follow-up. About 20.8% used at least one C-TUQ question, highlighting that tobacco use assessment is not yet fully incorporated into oncology clinical trials.

INTRODUCTION:We conducted a pilot study to test the feasibility of a future randomized controlled trial comparing e-cigarettes to traditional pharmacotherapy among people who smoke daily, were motivated to quit, and failed to quit within the past 5 years using pharmacotherapy. AIMS AND METHODS:Eligible participants were assigned to either: (1) an e-cigarette (n = 20) or (2) combination nicotine replacement therapy (NRT; patches and lozenges; n = 10). Participants received 5 weeks of product and selected a quit date 1 week later. Assessments were completed weekly, and electronic diaries were completed each day. As a pilot randomized controlled trial, outcomes focus on effect sizes and not statistical significance. RESULTS:Participants in the e-cigarette and NRT groups had a mean age of 51 (SD = 13) and 50 (SD = 10) years old, were 55% and 60% female, and were 15% and 0% nonWhite, respectively. At least 90% of participants completed each weekly assessment and 77% of participants completed at least 80% of daily diaries. Mean cigarettes smoked per day reduced from 18 (SD = 6.2) to 2.4 (SD = 4.4) per day in the e-cigarette group and 16.5 (SD = 8.5) to 4.9 (SD = 5.9) per day in the NRT group. Rates of biochemically confirmed 7-day point-prevalence abstinence at the end of treatment were numerically, but not statistically, higher in the e-cigarette group than the NRT group (35% vs. 10%, OR = 4.8, 95% CI = 0.5 to 46.5). CONCLUSIONS:Among current daily cigarette smokers who have previously tried to quit and failed with standard pharmacotherapies, the provision of an e-cigarette is a feasible intervention. A larger adequately powered trial is warranted. IMPLICATIONS:This pilot study suggests that e-cigarettes may serve as an acceptable harm reduction intervention for people who smoke but cannot quit smoking with traditional pharmacotherapy, however, adequately powered randomized controlled trials are needed.

Purpose Cancer survivors in a state with no legal access to cannabis may be hesitant to discuss their cannabis use with providers, particularly in light of legal consequences which disproportionately affect certain racial groups. This study examined potential racial disparities in the relationship of cannabis use status with patient-provider discussions of and attitudes toward cannabis in a state where there is no legal cannabis marketplace. Methods Survivors of cancer ( N = 1003, M age = 62.36; 13% Black/African-American; 41% male) completed a cross-sectional survey. Weight-adjusted regressions examined racial differences in the relationship between cannabis use status with (a) comfort and discussion of cannabis with providers, and (b) beliefs about impact of legalization on patients’ and providers’ comfort discussing cannabis. Results No racial differences were observed in rates of cannabis use or discussion, and patients who used cannabis were more comfortable discussing cannabis. Black patients who had used cannabis reported the greatest comfort discussing cannabis with providers, but also the greatest perceived improvement in comfort in the event of legalization. Conclusions Results highlight comfort and willingness to discuss cannabis with cancer care providers, particularly among Black patients who already use cannabis, which was not the hypothesized direction of findings. Further work is needed to inform recommendations for provider-led communication about cannabis.

Background: While smoking rates have decreased in the United States (US), a high number of low socioeconomic status (SES) patients continue to smoke. Student-run clinics are one setting where reaching low SES patients for tobacco treatment may be feasible. However, these clinics have a unique set of challenges in tobacco treatment including limited resources and provider/patient inconsistency. The goal of this pilot study was to determine the feasibility of delivering a brief tobacco treatment intervention in a student-run medical clinic. Methods: Patients at a student-run clinic in the southeastern US were screened for tobacco use and interest in participation. A clinic member distributed nicotine replacement therapy (NRT) samples (patches and lozenges) and sent a fax referral to the South Carolina Quitline for patients who agreed to participate. In a subset of patients, follow up phone calls were completed at 1 and 4 weeks to assess smoking status and need for additional NRT supplies. Descriptive statistics for participant demographics and treatment acceptability were calculated. Results: Of 125 patients screened for tobacco use, 16% (n=20) reported smoking with 75% (n=15) accepting the treatment plan offered through the clinic. Ten patients participated in follow up calls, and 40% (n=4) reported using NRT (either patches, lozenges, or both) across the follow-up period. Conclusions: Delivery of a brief tobacco treatment intervention involving NRT sampling and Quitline referrals is both feasible and acceptable in the student-run free clinic space. This model may be reproducible in other clinics due to its simple protocol, which can be taught to providers and students regardless of experience level.

People who undergo lung cancer screening (LCS) and continue to smoke are at risk for negative clinical outcomes and lowered survival and need effective smoking cessation interventions. This pilot study tested an 8-week intervention for smoking cessation after LCS. The participants (N = 40) were randomized to the intervention group (combination nicotine replacement therapy [NRT] plus gain-framed text messaging for 8 weeks) or the control group (standard cessation counseling) after LCS. Assessments were completed at 8-week and 3-month follow-ups, including self-reported 7-day point prevalence abstinence. The mean age was 64.4 years old (SD = 6.2); 32.5% were Black or African American; and 55% were female. At Week 8, 14.3% (3/21) of the participants in the intervention group were abstinent versus 0% (0/19) in the control group (p > 0.05). At 3-month follow-up, 4.8% (1/21) of the participants in the intervention group were abstinent versus 0% (0/19) in the control group. Among the intervention group participants, up to 52.4% used the provided patches and up to 61.9% used the provided lozenges during the study period. This study demonstrated modest quit rates for LCS patients receiving gain-framed text messages and NRT. The results highlight the need for more effective smoking cessation interventions for this priority population.

Background Smoking after a cancer diagnosis has significant health consequences, and there are substantial benefits if cancer survivors cease smoking. However, there are few smoking cessation interventions for cancer survivors that have been effective, and they are highly resource intensive. Thus, novel low resource cessation interventions are needed. One such intervention modality that has not been tested among cancer survivors is using pre-recorded videos to deliver information about skills and resources to achieve smoking cessation. Objective This study aimed to assess barriers to smoking cessation, interest in a video-based smoking cessation intervention, and video content preferences (eg, topic, video length, age and gender of video presenter, presenter type [peer, medical professional]) among individuals with cancer who smoke cigarettes. Methods Participants were recruited from a cancer center in the southeast United States that houses an opt-out tobacco treatment program in which tobacco treatment specialists proactively call all patients who have a current smoking status in their medical record. Patients were informed about the study, and their contact information was sent to the study team. Verbal consent was obtained from individuals who were cancer survivors, who were currently smoking, and who agreed to participate; semi-structured qualitative interviews were conducted (n=10). Participants were asked questions about smoking history, previous quit attempts, barriers to quitting smoking, previous experience with and openness to watching videos about quitting smoking, and participant preferences related to video content and presentation. Interviews were transcribed and coded by two reviewers, and a codebook was developed. A thematic analysis was then conducted. Results Results indicated that all participants had previously tried to quit smoking, but other substance use (5/10; 50%), negative affect (eg, depression [4/10; 40%], anxiety [1/10; 10%], stress [2/10; 20%], and loneliness [1/10; 10%]), the social environment (eg, being around others who smoke [2/10; 20%] and risky social situations [2/10; 20%]), and habits surrounding smoking were significant barriers for cessation. All participants were open to watching smoking cessation videos and expressed a desire to see a peer with lived experience in the videos. Most (8/10; 80%) participants did not have preferences related to the age or gender of video presenters. Many participants had difficulty articulating content preferences for the videos. Conclusions Cancer survivors who smoke may not be aware of their knowledge gaps related to smoking cessation, and videos may be an acceptable way to provide evidence-based information to fill knowledge gaps.

Tobacco use, particularly smoking, remains the leading cause of preventable death in the United States. While Medicaid in all states provides some coverage of tobacco cessation treatments, rates of tobacco use remain much higher among Medicaid beneficiaries (30.0

This cross-sectional study describes nicotine pouch use among adolescents and adults who use other nicotine products.

INTRODUCTION:Dual use of combustible cigarettes and e-cigarettes is common and has harmful health effects. Many who dual use want to quit, but there are no empirically supported dual cessation interventions. High-dose nicotine replacement therapy is effective for treating heavy smoking and may be applied to treating dual use of combustible cigarettes and e-cigarettes. METHODS:In this pilot feasibility trial, individuals using both combustible cigarettes and e-cigarettes who wanted to quit were randomly assigned to a 28-day supply of nicotine replacement therapy in one of 3 doses: Standard (21mg patch, qd + 4mg lozenge prn [minimum of 5, up to 20/day]); Mid (21mg patch + 14mg patch + 4mg lozenge [5-30/day]), or High (2 × 21mg patches + 4mg lozenges [5-40/day]). Participants reported combustible cigarette and e-cigarette use daily throughout treatment and 1-month follow-up. RESULTS:Participants enrolled in the study (N=46 from 2023 to 2024, analyzed 2025) had high nicotine dependence and most completed study procedures. Participants in the Mid group reported using nicotine replacement therapy on more days relative to the other groups. Participants in Mid and High reported numerically higher 7-day point-prevalence dual abstinence at end of treatment (13% for both groups vs 6% Standard) and follow-up (33% for both groups vs 0% Standard). Generaelized estimating equation models showed a significantly higher likelihood of abstinence on a given day for the Mid and High groups relative to Standard (ps<0.05). CONCLUSIONS:Augmented doses of nicotine replacement therapy are a feasible, promising treatment for dual cessation of combustible cigarettes and e-cigarettes. Future research should evaluate this approach in a more rigorous, fully powered trial. TRIAL REGISTRATION:This study is registered at www. CLINICALTRIALS:gov NCT06087328.

Background The use of e-cigarettes has been increasing, especially since the introduction of ‘pod’ devices to the marketplace since 2018. Most adults who vape report interest in quitting. The present study examined level of interest in e-cigarette cessation between users with varying cigarette smoking histories and device types. Methods Data obtained from wave 5 (2018–2019) of the Population Assessment of Tobacco and Health study (n=34 309). Analyses were conducted on adult current established e-cigarette users, categorised on cigarette smoking history (current, former or never) and device type (disposable, cartridge/pod, tank or mod). Participants reported if they planned to ever quit e-cigarettes, attempted to quit in the past year and attempted to quit by cutting back in the past year. Results Of the 2922 established e-cigarette users, 68.21% reported plans to quit vaping; 17.27% reported attempting to quit e-cigarettes in the past year; and 29.28% reported attempting to quit by cutting back in the past year. Cartridge users had higher odds of interest in quitting than tank and mod users. Disposable and cartridge users had higher odds of reporting a past year quit attempt than tank and mod users. Individuals with no smoking history had higher odds of reporting a past year quit attempt or cutting back relative to those reporting dual use (of both e-cigarettes and cigarettes) and former smoking. Conclusions Tobacco control should consider the type of e-cigarette device that is being used, alongside users’ cigarette smoking history, when developing interventions and other resources for vaping cessation.