Other methods of cigarette consumption include a variety of electronic products, as well as heated tobacco, snus and shisha. The questions in this chapter are: what other methods of consumption are used during pregnancy (either electronic or containing tobacco) and what is their prevalence? What is their benefit/risk balance? Can their use during pregnancy be proposed? Although the fetus is not exposed to the combustible toxins of tobacco, e-cigarette products may contain nicotine, which maintains the exposure of the fetus. Further research is needed on the other components of the electronic cigarette, such as flavorings and propylene glycol and/or glycerol, in order to assess the benefit/risk balance. In addition, some solvents contain ethanol. In the current state of knowledge, the precautionary principle should be respected and not recommend the initiation or continuation of the electronic cigarette during pregnancy (professional agreement). For smoking cessation or electronic cigarette cessation, it is recommended to provide the same advice and to use methods that have already been evaluated (professional agreement). For the JUUL, there are currently no data on obstetrical outcome when used. The use of shisha during pregnancy is associated with decreased fetal growth. It is recommended not to use shisha during pregnancy (GradeC). There are currently no data on the use of heated tobacco and obstetrical outcome.

The development and validation of survey measures for electronic nicotine and non-nicotine delivery system (ENDS) use has not kept pace with the burgeoning research on them. This, along with the diverse and evolving nature of ENDS, presents several unique measurement challenges and hampers surveillance and tobacco regulatory research efforts. In this commentary, we identify four important areas related to ENDS use (describing ENDS products; defining current use; evaluating frequency and quantity of use; and characterizing devices and e-liquids) and summarize a selective review of the measurement and definitions of these constructs across prominent national tobacco use surveys and 30 projects within the 14 federally-funded Tobacco Centers of Regulatory Science. Across these national, regional, and local studies, there was considerable variability and relatively little consensus in ENDS use measures - thus highlighting the need for caution when comparing findings across studies or over time until more research is available to evaluate the sensitivity of findings to differing measures. Drawing from the nascent ENDS use measurement research literature and our experiences, we conclude with general considerations for measuring ENDS use for tobacco researchers as an initial step towards the development of consensus measures.

A group of 11 French medical experts has developed guidelines through a Delphi progressive consensus about smoking management at the e-cigarette era. The lack of scientific data about e-cigarettes led the experts to set out recommendations, mainly based on clinical practice while waiting for scientific validations. The validated smoking cessation treatments keep the first place in the prevention and the treatment of tobacco-induced damages. The e-cigarette, experimented by a large proportion of smokers, is a safer product than tobacco. The health professional must answer the patients about the e-cigarettes: (1) A smoker who questions about e-cigarettes should receive information. Even if there is a lack of data, e-cigarettes offer much lower risks than tobacco. (2) A dual user is at high risk of returning to exclusive tobacco use; he should also optimize other nicotine intakes by combining nicotine replacement therapy and/or optimizing the nicotine intake through the e-cigarette. (3) A smoker who wish to use the e-cigarette in order to quit with or without associated pharmacological treatment should be accompanied and not discouraged. (4) A vaper who is tired to continuing to vape should be accompanied to quit. Specific guidelines are also provided for adolescents, pregnant women, patients during perioperative periods and also for pulmonary, cardiac and schizophrenic patients.