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Our Publications (2025)
Our Publications (2025)
Here are our lab’s recent publications from 2025 onwards. Each entry includes a summary and a link to read the full manuscript. We invite you to browse through our work to learn more about our research and findings.
Heshmati J, Bates EL, Shahen S, Visintini S, Quiroouette E, Mullen K-A, Mir H. Nicotine pouch pharmacokinetics compared to smoked tobacco: A systematic review and meta-analysis. Drug and Alcohol Dependence Reports. 2025. https://doi.org/10.1016/j.dadr.2025.100389
Nicotine Pouches: Pharmacokinetics Compared to Cigarettes
Nicotine Pouches: Pharmacokinetics Compared to Cigarettes
Nicotine pouches deliver nicotine through the mouth rather than inhalation. Findings from our review and meta-analysis show that nicotine pouches can produce similar or even higher total nicotine exposure than cigarettes, depending on pouch strength and formulation. However, nicotine from pouches is absorbed more slowly, leading to lower peak levelsthan cigarettes at standard doses.
Key points
4 mg pouches deliver nicotine amounts close to cigarettes overall, but with lower and slower peaks
Higher-dose (≥8 mg) and flavored pouches can exceed cigarette nicotine delivery
Nicotine peaks faster with cigarettes (5–8 min) vs pouches (20–65 min)
Pouches can still lead to nicotine dependence
Youth-targeted flavors and marketing are a concern
Evidence on use for smoking cessation is limited and inconclusive
“Nicotine pouches are not currently recommended as a smoking-cessation aid. Evidence-based medications (e.g., NRT, varenicline, bupropion, cytisine) remain first-line treatments.”
Heshmati J, Shahen S, Bates EL, Visintini S, Quirouette E, Mullen K-A, et al. Nicotine pouches and clinical outcomes related to smoking cessation: A systematic review of randomized trials. Addiction. 2025. https://doi.org/10.1111/add.70193
Nicotine Pouches and Smoking Cessation
Nicotine Pouches and Smoking Cessation
Our review of randomized trials found that nicotine pouches are generally rated more satisfying than placebo and can reduce cigarette use, though they remain less satisfying than cigarettes. While some studies showed reductions in smoking, overall evidence for their role in smoking cessation is still limited. Reported side effects were mild, with no serious adverse events.
"Until more robust evidence is available, Nicotine Pouches (NPs) should not be considered a smoking cessation aid. Only evidence-based pharmacotherapies (i.e. NRTs, varenicline, bupropion and cytisine) should be recommended to people who smoke to help them reduce or quit."
Heshmati, J., Mullen, K., Walker, K. L., Mir, H. (2025). Vaping is associated with increased length of stay among cardiac inpatients. Tobacco Induced Diseases, 23(July), 112. https://doi.org/10.18332/tid/207800
Vaping is associated with increased length of stay among cardiac inpatients
Vaping is associated with increased length of stay among cardiac inpatients
This study looked at over 1,600 patients admitted to the University of Ottawa Heart Institute. Those who had used e-cigarettes in the past spent more time in the hospital compared to those who hadn’t. On average, current users stayed about 3 days longer. The findings highlight the potential impact of vaping on recovery in people with heart conditions.
Read more: https://doi.org/10.18332/tid/207800
Thode H, Heshmati J, Mir H. Association between e-cigarette use, physical activity and cardiorespiratory fitness: protocol for a systematic review. BMJ Open. 2025 Jul 28;15(7):e101489. doi: 10.1136/bmjopen-2025-101489. PMID: 40721252.
E-cigarette use and its link to physical activity and fitness: A systematic review protocol
E-cigarette use and its link to physical activity and fitness: A systematic review protocol
This protocol outlines a planned systematic review that will explore how e-cigarette use affects physical activity levels and cardiorespiratory fitness. The review will include studies comparing e-cigarette users and non-users on outcomes like VO2 max, exercise test results, or weekly physical activity. The goal is to better understand the health and fitness profile of people who vape, especially youth and young adults. The review will follow rigorous guidelines and include a forward citation strategy to capture the most relevant evidence.
Miller, V., Smith, E., Schulze, K. M., Desai, D., Ho, V., Dummer, T. J. B., Tardif, J.-C., Lear, S., Poirier, P., Mir, H., Teo, K. K., Zatonska, K., Szuba, A., Zimny, A., Szcześniak, D., Iype, T., Li, W., Joundi, R., Mente, A., … Anand, S. S. (2025). Association of dietary macronutrients with MRI-detected vascular brain injury and cognition in 9886 middle-aged participants from four countries: For the Canadian Alliance of Healthy Hearts and Minds (CAHHM) and the Prospective Urban Rural Epidemiological (PURE) Study Investigators. eClinicalMedicine, 86, 103333. https://doi.org/10.1016/j.eclinm.2025.103333
How can diet affect brain health?
How can diet affect brain health?
In a study of almost 10,000 adults from four countries, researchers found that diets high in carbohydrates were linked to more hidden brain injuries seen on MRI and lower scores on memory and thinking tests. In contrast, people who ate more healthy fats such as monounsaturated and polyunsaturated fats showed fewer brain changes and better cognitive performance. These results highlight the importance of diet as a potential way to help protect the brain and lower the risk of dementia.
Cytisine Use Vs Nicotine Replacement Therapy in Relapsed Smokers with Heart Disease: Feasibility Results from a Pilot Randomized Trial—CJC Open. (n.d.). Retrieved July 3, 2025, from https://www.cjcopen.ca/article/S2589-790X(25)00321-X/fulltext
Testing a new option to help cardiovascular patients quit smoking after relapse
Testing a new option to help cardiovascular patients quit smoking after relapse
This pilot study looked at cytisine, a plant-based medicine, as a possible alternative to nicotine replacement therapy (NRT) for people with heart disease who had quit smoking but then relapsed. Thirteen participants were randomly assigned to use either cytisine or NRT for 25 days. Although only one person in the cytisine group quit completely and none did in the NRT group, both groups reduced the number of cigarettes smoked. The study showed that testing cytisine in this setting is feasible, but larger trials are needed to confirm its effectiveness.
Read more: https://doi.org/10.1016/j.cjco.2025.05.005
Heshmati J, Mullen KA, Quirouette E, Bernick J, Pipe A, et al. (2025) Patterns of e-cigarette use and interest in cessation among current users in Ontario: An online cross-sectional study. PLOS ONE 20(5): e0322736. https://doi.org/10.1371/journal.pone.0322736
Patterns of vaping and interest in quitting among Ontarian's
Patterns of vaping and interest in quitting among Ontarian's
This study surveyed 757 people in Ontario who currently use e-cigarettes to better understand their habits and interest in quitting. Most participants were young adults, and many reported daily use with high nicotine levels. Over 40% said they were interested in quitting, especially those who recognized vaping as harmful or addictive. In contrast, people who believed vaping was safer or less addictive than smoking were less likely to want to quit. These findings show the importance of education and tailored programs to help people who want to stop vaping.
Read more: https://doi.org/10.1371/journal.pone.0322736
Heshmati, J., Pandey, A., Benjamen, J., Furqan, M., Salman, M., Visintini, S., Mullen, K.-A., Guyatt, G., Pipe, A. L., & Mir, H. (2025). Vaping cessation interventions: A systematic review and meta-analysis. Tobacco Control. Advance online publication. https://doi.org/10.1136/tc-2024-058798
Interventions to support vaping cessation
Interventions to support vaping cessation
This study reviewed seven clinical trials testing different ways to help people quit vaping, including medications, counseling, and digital tools like text messaging. The results showed that people who received these interventions were more likely to stop vaping compared with those who did not. In fact, participants had higher short-term quit rates and were more likely to remain vape-free for weeks or months. The review highlights that while some strategies are promising, more research is needed to confirm which approaches work best and to guide doctors and policymakers in supporting people who want to quit vaping.
Read more: https://doi.org/10.1136/tc-2024-058798
Mir, H., Heshmati, J., Mullen, KA. et al. Cytisine compared to combination nicotine replacement therapy to reduce cigarette consumption in relapsed smokers: protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 11, 10 (2025). https://doi.org/10.1186/s40814-024-01591-4
Protocol: Testing cytisine for smoking relapse in cardiovascular patients
Protocol: Testing cytisine for smoking relapse in cardiovascular patients
This study describes the design of a clinical trial comparing cytisine, a plant-based medicine, with combination nicotine replacement therapy (NRT) for people with heart disease who relapsed to smoking after hospital discharge. The trial will enroll 60 participants at the University of Ottawa Heart Institute, randomly assigning them to cytisine or NRT for 25 days, along with counseling and follow-up support. The main goal is to test whether recruiting and treating these patients is feasible, while also tracking smoking reduction, quit rates, and side effects. Findings from this pilot will guide a larger trial aimed at improving care for patients who struggle with relapse.
Read more: https://doi.org/10.1186/s40814-024-01591-4
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