E-cigarettes remain controversial because the scientific evidence of short term and long term effects on tolerance and the health value of a switch from tobacco to e-cigarettes is contested and controversial. Nevertheless the quality of e-cigarettes and e-liquids has improved. The main ingredients, propylene glycol, vegetable glycerine and nicotine are pharmaceutical-grade quality in most e-liquids. Flavors are almost all food grade. The high quality of ingredients has decreased the presence of impurities in e-liquids. The emissions of e-cigarettes do not contain solid particles or carbon monoxide. Nitrosamine content is at least one hundred times lower than in tobacco smoke. E-cigarette emissions in normal use do not contain any harmful constituents at significant levels except nicotine. UK public health authorities have stated that e-cigarette use is likely to be at least 95% less toxic than cigarette use. There are benefits from having a well-regulated legal market. In countries where e-liquid containing nicotine is not allowed, "do-it-yourself" liquids are common and have handling risks and may sometimes contain toxic impurities. Though e-cigarettes should never be assumed safe products for non-smokers, for smokers, the e-cigarette is at least 20 times less dangerous than the cigarette. Tobacco cessation specialists in countries where nicotine containing e-cigarettes are available increasingly provide counselling for e-cigarette use to stop smoking or to reduce smoking at the request of patients. Based on current knowledge, for patients with lung or other forms of cancer who would otherwise continue to smoke, e-cigarettes offer an alternative way to quit smoking while they undergo medical treatment.

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The diversity of HIV-infected smokers' profiles suggests that different types of anti-tobacco measures should be implemented in this population, such as information campaigns on specific risks incurred by HIV-infected smokers, non-specific and comprehensive measures for those for whom smoking is combined with other difficulties, and alternative therapeutic solutions for those who smoke to deal with lipodystrophy.

Tob. Prev. Cessation 2016;2(April):59 http://www.dx.doi.org/10.18332/tpc/62918 ABSTRACT BACKGROUND The aim of the study was to confirm or reject the hypothesis that variation in throat-hit depends on the nicotine concentration and the voltage applied to the resistance. A secondary aim was to assess the influence of throat-hit on the willingness of subjects to switch from tobacco to e-cigarette use."METhODS In this experimental blind test participants were 35 students (aged 22.0 + 7.7), current smokers, who tested five e-liquids with a nicotine concentration between 0 to 18mg/mL, at 3.5 or 4.5 volts (at 1.8Ω) powered by EGO type e-cigarettes . After describing their smoking habits (heaviness smoking index (HSI), and signing consent, participants smoked 1 puff every 5 minutes, inhaling for 3 seconds, for each of the 10 conditions and rated their subjective experience.RESULTS Analysis of the 350 puffs from the 35 smokers,indicated a learning process of 5 puffs. Within this population a nicotine concentration of 12.6mg/mL combined to 3.5volts and 10.9mg/ mL combined to 4.5volts was associated with OTH. Our results indicated a link between tobacco dependence and nicotine concentration of the e-liquid that provided an optimal throat-hit (OTH), with an +1.6mg/mL increase in nicotine content needed for the OTH for each one point increase in HSI. A link between the desire to switch from tobacco to e-cigarettes and the score of throat-hit was identified (r2=0.94). This desire is <1/10 when throat-hit is unpleasant (score 0-3) and exceeds 7/10 when throat-hit is optimal (score 7-10).CONCLUSIONS The present data justifies the need to further develop e-cigarettes so that an optimal OTH is identified quickly. Further research is needed to confirm the above results in other populations and to assess the specific influence of flavour on throat hit.

Background To assess the prevalence of and factors associated with tobacco smoking and dependence in HIV patients. Methods In a one-day cross-sectional national survey of a representative sample of 82 French units specialized in HIV-infected patient care, 727 consecutive outpatients were asked to complete a self-administered questionnaire, assessing smoking habits, dependence, cessation motivation, other substance abuse, sociocultural characteristics, life with HIV and its treatment. Smoking prevalence and dependence were assessed and compared with a representative sample of the general French population. Results The questionnaire was completed by 593 (82%) patients: 12% were active or ex-intravenous drug users, 37% were homosexual men, and 43% were active smokers (compared with 31% in the French population) of whom 56% were classified as moderately or highly dependent. Fourteen percent of smokers were highly motivated and free of other substance abuse and of depressive symptoms. Smoking was independently associated with male sex (odds ratio [OR]=2.38; 95% confidence interval [CI] 0.99–1.11), lower body mass index (OR 1.08; 95% CI 1.14–1.03), smoking environment (OR 4.75; 95% CI 3.02–7.49), excessive alcohol consumption (OR 2.50; 95% CI 1.20–5.23), illicit drug use (OR 2.43; 95% CI 1.41–4.19), HIV status disclosure to family (OR 1.81; 95% CI 1.16–2.85) and experience of rejection due to disclosure (OR 1.90; 95% CI 1.14–3.17). Disclosure and drug substitute usage were associated with high tobacco dependence. Conclusions Very few HIV smokers seem to be good candidates for a standard tobacco cessation program. Tobacco reduction or cessation strategies should be adapted to this population.