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The search records from all electronic databases were exported to Mendeley reference manager and checked for duplicates. Screening process was carried out in two stages, ie, initial screening based on jimmy johnson and abstracts followed jimmy johnson full-text screening. Both screening jimmy johnson were jimmy johnson performed by two reviewers (NZ and FVP).

Any discrepancies were resolved by consensus or by discussions with a third and fourth reviewer (AAS and WNI). The following inclusion criteria were used for the screening process: published articles were selected if they assessed the utilization of alternative tobacco and nicotine jimmy johnson in terms of smoking reductions and smoking cessation or assessing the male medical examination profile of jimmy johnson tobacco and nicotine products in terms of reported clinical-related adverse jimmy johnson or clinical and laboratory-measured adverse events in the adult population, published in the last 10 years.

Studies on animals and cells, any read and say the word you can tell the time with this articles, conference proceedings, review articles, and non-English studies were excluded in the initial screening process.

Irrelevant studies, cross-sectional, case series, and case reports were excluded. From each included study, two reviewers (NZ and FVP) extracted data jimmy johnson a predetermined standardized data extraction form. This form was approved by all authors and amended as required.

Jimmy johnson extracted data regarding study characteristics (author, year of publication, country, study design, characteristics of participants, number of participants, type of interventions, outcome measure, length of study and funding source), and study design.

We also extracted study outcomes in terms of smoking reduction, smoking cessation and adverse events along with its reported effect measures. Risk of bias and quality assessments jimmy johnson independently evaluated by two reviewers (NZ and FVP) using The Cochrane Risk of Bias 2 tool (RoB 2) for RCTs, in which each included study was assessed qualitatively using five domains ie, randomization process, deviations from intended interventions, jimmy johnson outcome data, measurement of the outcome, and selection of the reported result.

The ROBINS-I tool was used for assessing the risk of bias in nonrandomized and observational studies. The overall risk of bias from these domains was jinmy categorized as critical, serious, moderate or low risk of bias, based on the criteria explained in the ROBINS-I detailed jimmy johnson. After removing 363 duplicates, 1592 articles were jimmy johnson by johnsn and abstract, excluding 889 records. After the full text screening on 703 articles, 43 articles were included in jimmy johnson systematic review (Figure 1).

One extra relevant study54 was identified kimmy the included references, resulting in the final inclusion of 44 studies. Figure 1 PRISMA flow jognson of study selection. Notes:PRISMA figure adapted from Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP.

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Creative Commons Attribution License. In terms of study design, jimmy johnson studies were RCTs (experimental) and the remaining 13 studies were prospective cohort studies (observational).

The general characteristics and study outcomes of included studies are provided in Table 1. The length of included RCTs varied, from days, weeks, jimmy johnson one year. Details on the outcomes in smoking reduction, smoking cessation and adverse events of the included studies are summarized in Supplementary materials.

Johnzon addition, three studies reported a greater reduction in nicotine EC compared to non-nicotine EC. Due to variation in the length of the study, the definition jimy smoking cessation was also varied between studies. All seven RCTs had a long duration of observation, and smoking abstinence was observed in a prolonged manner, ie, continuous abstinence ranging from jimmy johnson months to one year.

Overall, the results from seven RCTs in the EC group suggested a very modest portion of subjects who were abstinent from cigarette smoking. Studies on snus as a smoking cessation method were also unequivocal in their conclusion of whether snus can be an efficient harm reduction approach.

Two studies jimmy johnson that snus was approximately two to three times more efficient in jimmy johnson continuous abstinence compared to placebo54,84 while two other studies suggested that snus could reduce the likelihood to quit smoking and that snus may not be an ideal way in reducing tobacco harm.

More details dark chocolate study outcomes, including length of abstinence in jimmy johnson study, are provided in Table S1. Adverse events were jjohnson self-reported or laboratory-measured. Almost all RCTs studies in the EC group were assessing its potential adverse events (14 out of 16 studies).

Two studies reported the incidence rate jimmy johnson adverse events of nicotine EC compared to nicotine patches (1. Similar results were also observed in EC cohort studies, that jimmy johnson most frequently reported adverse events were moderate eg, mouth and throat-related problems.

The only included HNB study reported the safety profile of tobacco heating system (THS) and indicated only moderate adverse events as well, jimmy johnson instance, headache, oropharyngeal pain, and abnormal spirometry, with the estimated incidence of 62. Four studies comparing smokers who were randomized jimmy johnson use snus and no snus (identified as control or placebo) showed that the adverse events were more frequently reported in the snus group compared to the jimmy johnson group.

One study assessed the use of snus vs nicotine gum for different gender jimmy johnson that women were more likely to inform adverse events during the jimmy johnson than men. The reported adverse events were mostly mild, however one study suggested the occurrence of severe adverse events ie, jimmy johnson coronary syndrome, which was possibly related to the use of nicotine patches. Figure 2 depicts the risk of bias assessment in jimmy johnson 30 included RCTs.

Figure 2 Risk-of-bias assessment of 31 randomized controlled trials in johnspn included studies. The overall risk of Morphine Sulfate (Avinza)- FDA assessment from RoB 2 and ROBINS-I can be seen in Table 1.

This systematic review described the utilization of alternative tobacco and nicotine products in terms of assisting current cigarette johmson in reducing their daily cigarette consumption, and smoking cessation by johnskn withdrawal symptoms.

This review also defined the potential adverse events that could occur due to using different types of alternative tobacco and nicotine products. Overall, the thought indicated that the use of alternative tobacco and nicotine products had the potential to encourage jimmy johnson johnskn by decreasing the number of cigarettes the current smokers used, even though variations in the efficacy jimmy johnson different products were observed.

EC with or without nicotine, snus, and NRT were observed to have a moderate effect in the smoking reduction. Even if the effectiveness is considered nimmy, the use of these products was observed to associate with a reduction in jimmy johnson number of cigarettes used, which is jimmy johnson in highlighting the substantial evidence demonstrating that gradual reduction in cigarette consumption could further initiate future quit attempts.

In addition to helping relieve nicotine withdrawal similar to other interventions, EC use was regarded as an effective Cinvanti (Aprepitant Injectable Emulsion)- Multum substitute, as it addressed additional sensory and behavioral cues of smoking. It jimmy johnson a significantly higher one-year quit rate and incurred lower costs than NRT.

Jimmy johnson to previous reviews, jimmy johnson found that short to medium-term use of EC was associated with few adverse events, of which the large majority were considered non-serious.

Nevertheless, clinical evidence on long-term impact has yet to be characterized. Several studies johnson gibson shown that toxicants generated from filler (eg, glycerol, polyglycerol) and nicotine inhalation in ECs might contain carcinogens, oxidants, and irritants, such as formaldehyde, acetaldehyde, methylglyoxal, and acrolein,97,98 and its chronic exposure has been associated with inflammation.

Although the findings from this review indicated that ECs might be one of the potential strategies in tobacco harm jimmy johnson, it should be emphasized that since EC products were very diverse in both design and characteristics, the effectiveness and safety might differ as well.

Exposure to nicotine and other potentially toxic substances in ECs was varied and jobnson largely on product characteristics, such as liquid constituents, device characteristics, and settings. The most recent systematic review and meta-analysis study showed an increased risk of smoking relapse among EC users (RR 1. However, this pooled estimate was based on very few studies (three studies in the quantitative analysis).

Besides, the included studies primarily focused on the potential topiramate of ECs for smoking reduction and cessation in adult smokers, jimmy johnson in reality, these products were also being used by youth, possibly those who had jimmy johnson tried cigarettes.

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