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There appeared to be no consistent pattern according to diagnosis for the sensitivities of the algorithms including a lookback period, while these algorithms identified current smoking with lower specificity among patients with mental and behavioural disorders, and ever smoked with lower specificity among patients with diseases of the circulatory system relative to patients with most other diagnoses

Furthermore, e-cigarettes are thought to increase dual smoking and downstream substance use through the gateway hypothesis, whereby exposure to nicotine products further puts individuals at risk of initiating other substances by stimulating neurotransmitters associated with the reward system 4,55,71,72,73

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3), and the highest burden in terms of disability-adjusted life years (DALYs) lost, followed by North America and Europe [50, 51]