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E-cigarettes are primarily used by teenagers and young adults. Flavors in e-cigarettes increase their attractiveness and encourage young people and adults to start using them. This exposes young people in particular to the risk of nicotine addiction and various toxic substances from the aerosol of e-cigarettes. There are indications that various flavors in e-cigarettes are harmful to health, although toxicological studies are still lacking for the majority of flavors. There is a need for independent scientific investigations in this area. The scientific societies involved are calling for a ban on flavors in e-cigarettes, a ban on disposable e-cigarettes, effective regulation of the sale of e-cigarettes and effective control and implementation of the provisions for the protection of minors., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background:  Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role., Method:  Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes., Results:  Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes., Conclusions:  The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force., Competing Interests: Klaas Franzen, Stefan Andreas, Wulf Pankow, Wilfried Kunstmann und Reiner Hanewinkel sind ehrenamtlich für das Aktionsbündnis Nichtrauchen tätig. Natascha Sommer erhielt für Ihre Forschung zu E-Zigaretten finanzielle Unterstützung der Balzan-Preis Forschungsgruppe des Deutschen Zentrums für Lungenforschung (DZL) – Erika von Mutius, Klaus F. Rabe, Werner Seeger und Tobias Welte., (Thieme. All rights reserved.)

After several years of declining tobacco consumption, the number of smokers in Germany is currently stagnating or rising again. The reasons seem to be manifold, e. g. stress caused by the pandemic with social isolation, rising cost of living and war in Europe.With tobacco use still widespread in the German population, evidence-based tobacco cessation is rarely implemented.According to recent studies, e-cigarettes are involved in the pathogenesis of lung disease, cardiac and vascular damage. In addition, their ingredients also have carcinogenic effects. However, clinical studies on long-term use are not yet available.E-cigarettes as a consumer product are not superior to nicotine replacement products and addiction-reducing medications recommended in guidelines. In the therapeutic setting, they are slightly more effective than nicotine replacement products. However, they are usually consumed continuously and thus perpetuate nicotine dependence. Their use increases the risk of relapse to tobacco smoking.Despite the various new approaches, such as Internet-based offerings, app, etc., talks and pharmacotherapy are the gold standard and more effective than any therapy on its own., Competing Interests: PD Dr. med. K. F. Franzen und Prof. Dr.med.W. Pankow sind im Pfizer Advisory Board zur Tabakentwöhnung tätig. Prof. Dr. med. S. Andreas hat keine Interessenkonflikte im Bezug auf diese Publikation., (Thieme. All rights reserved.)

After several years of declining tobacco consumption, the number of smokers in Germany is currently stagnating or rising again. The reasons seem to be manifold, e. g. stress caused by the pandemic with social isolation, rising cost of living and war in Europe.With tobacco use still widespread in the German population, evidence-based tobacco cessation is rarely implemented.According to recent studies, e-cigarettes are involved in the pathogenesis of lung disease, cardiac and vascular damage. In addition, their ingredients also have carcinogenic effects. However, clinical studies on long-term use are not yet available.E-cigarettes as a consumer product are not superior to nicotine replacement products and addiction-reducing medications recommended in guidelines. In the therapeutic setting, they are slightly more effective than nicotine replacement products. However, they are usually consumed continuously and thus perpetuate nicotine dependence. Their use increases the risk of relapse to tobacco smoking.Despite the various new approaches, such as Internet-based offerings, app, etc., talks and pharmacotherapy are the gold standard and more effective than any therapy on its own., Competing Interests: PD Dr. med. K. F. Franzen und Prof. Dr. med. W. Pankow sind im Pfizer Advisory Board zur Tabakentwöhnung tätig. Prof. Dr. med. S. Andreas hat keine Interessenkonflikte im Bezug auf diese Publikation., (Thieme. All rights reserved.)

Tobacco control, psychosocial and medical assistance regarding tobacco cessation is still a hidden potential within the German health care system. So far doctors rarely talk to their patients about their smoking status and physical and psychological benefits of quitting.This paper focusses on recommended current diagnostic and treatment standards, as well as evidence-based methods to address the topic on how to stop smoking and its association with certain diseases such as COPD, lung cancer and COVID-19 infection. The role of e-cigarettes as a cessation tool and its health related risks are critically examined. Consequences and advice how to implement smoking cessation procedures into daily practice are presented., Competing Interests: Erklärung zu finanziellen InteressenForschungsförderung erhalten: ja, von einer anderen Institution; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: ja, von einer anderen Institution; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: ja, von einer anderen Institution; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Nicht-Sponsor der Veranstaltung): nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Sponsor der Veranstaltung): nein.Erklärung zu nicht-finanziellen InteressenA. Batra: Wissenschaftlicher Aktionskreis Tabakentwöhnung (WAT) e. V. (Vorsitzender), Deutsche Gesellschaft für Suchtforschung und Suchttherapie (DG-Sucht, Vorstandsmitglied), Deutsche Gesellschaft für Suchtmedizin (DGS), Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) e. V. (stell. Referatsleiter Abhängigkeitserkrankungen).A. Rupp: Berater für Nichtraucherhelden.de., (Thieme. All rights reserved.)

Tobacco smoking is associated with severe health risks. In 2020, the WHO estimated that 8 million people have died due to smoking. Furthermore, smoking tobacco is a well-known risk factor for various infectious pulmonary diseases. The question raised, whether smoking is facilitating SARS-CoV-2-infections and increases adverse outcomes of COVID-19. To answer these questions a narrative review was conducted, finally including 7 systematic reviews with meta-analyses published in January and February 2021. Tobacco smoking was associated with an increased COVID-19 disease severity (odds ratio range of active vs. never smokers 1.55-2.19 and former vs. never smokers 1.20-2.48) and an increased COVID-19 in-hospital mortality (odds ratio range of active vs. never smokers 1.35-1.51 and former vs. never smokers 1.26-2.58). Beside immediate pulmonary toxic effects through active smoking, the cumulative livelong tobacco exposition and subsequent tobacco-associated diseases seem to predominantly predict adverse outcomes in patients with COVID-19. Data regarding an increased risk of infection among smokers is conflicting. However, a large observational study from England with 2.4 million persons reported an association between tobacco smoking and typical symptoms of COVID-19. For e-cigarettes and vaping less data exist, but experimental and first clinical investigations also suggest an increased risk for adverse outcomes for their use and SARS-CoV-2 infections. Especially during the current SARS-CoV-2 pandemic with limited therapeutic options it is particularly important to advise smokers of their increased risks for unfavourable COVID-19 outcomes. Evidence based support for smoking cessation should be offered. In Germany, the existing and well-established methods to support tobacco cessation need to be reimbursed by statutory health insurances., Competing Interests: R. Bals erhielt Forschungsunterstützung durch das BMBF, Wilhelm Sander Stiftung, Deutsche Krebshilfe, Mukoviszidose e. V., Schwiete Stiftung sowie Zuwendungen für Advisory Boards oder Vorträge von AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, CSL Behring.W. Pankow hatte Einkünfte aus Beratungstätigkeit für Pfizer Deutschland GmbH.C. Rustler: Geschäftsführung im Deutschen Netz Rauchfreier Krankenhäuser & Gesundheitseinrichtungen, Zuwendungen zur Implementierung des „rauchfrei tickets“ zur Vermittlung in die Rauchstoppberatung am Telefon der BZgA, Mitgliedschaft im Wissenschaftlichen Aktionskreis Tabakentwöhnung WAT e. V., Mitautorin der S3-Leitlinie „Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung“ (2021).Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Smoking cessation is one of the most powerful health promotion tools in the Western world. Behavioral group therapies are regarded as very promising interventions in this field. Quitting rates are usually evaluated after 6-12 months and lie between 30 and 45%. So far, there are no scientific data on potential protective indicators to remain successfully smoke free after this period. Therefore, the aim of this study was to detect the current smoking status of former participants of a cessation service in an urban German surrounding. We investigated reasons for relapses, quitting strategies, and psychosocial parameters., Methods: In 2019, 130 former patients (2011-2017; mean age 54 years; 37 pack/years; Fagerstroem = 5.75; 58.5% male, 41.5% female; 66% physical comorbidities; 35% psychiatric diagnoses) were invited to participate in a mailed survey (including WHO 5, SF 12, self-efficacy scale) and were asked about their current smoking status, personal history of smoking, and individual experiences with stopping after the 1‑year abstinence date., Results: A total of 53 persons replied (RR 41%), 29 (54%) of whom are currently smoke free; 24 relapsed intermittently or permanently, 9 experimented with e‑cigarettes, and 2 became dual users. Daily hassles as well as physical and mental challenges were the main reasons for relapsing., Conclusion: Due to the low response rate, conclusions are limited; however, the 1‑year abstinence rate might not be as reliable as thought so far; long-term "sober" nicotine addicts remain at risk of relapse., (© 2021. Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

The German Respiratory Society (DGP) turns against the e-cigarette as a means for harm reduction because of potential health risk and dangers to young people. The aerosol of e-cigarettes contains toxic ingredients that have been shown to be damaging to the lungs, the cardiovascular system and the immune system and are potentially carcinogenic. Studies on e-cigarettes as a means of smoking cessation are not very convincing, in order to favor e-cigarettes over nicotine replacement therapy, which have been tried and tested for many years, or other drugs that reduce the desire to smoke., Competing Interests: W. Pankow: Beratungshonorar von Pfizer. A. Rupp: Vortragshonorar von Pfizer.S. Andreas und M. Pfeifer geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)