Objectives This umbrella review aims to summarise the evidence about electronic nicotine delivery systems’ (ENDS) risk and safety health profile to inform ENDS health communication strategies. Data sources and study selection Six databases were searched for systematic reviews presenting evidence on ENDS-related health effects. Ninety reviews divided into five categories were included: toxicity=20, health effects=40, role in smoking cessation=24, role in transition to combustible cigarettes (CCs)=13 and industry marketing claims=4. Data extraction Findings were synthesised in narrative summaries. Meta-analyses were conducted by study type when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine’s Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limited-suggestive and limited-not-conclusive. Data synthesis We found high-level evidence that ENDS exposes users to toxic substances; increases the risk of respiratory disease; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CC initiation; and exposure to ENDS marketing increases its use/intention to use. Evidence was moderate for ENDS association with mental health and substance use, limited-suggestive for cardiovascular, and limited-not-conclusive for cancer, ear, ocular and oral diseases, and pregnancy outcomes. Conclusions As evidence is accumulating, ENDS communication can focus on high-level evidence on ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning) and anti-ENDS industry sentiment. Direct comparison between the harm of CCs and ENDS should be avoided. PROSPERO registration number CRD42021241630.

Aim: To identify the effects of strength and balance training on dynamic balance and patient reported outcomes in people with chronic ankle instability(CAI). Method: Five databases(CNKI, WanFang, Web of Science, EBSCO-SPORTD and PubMed were searched in September 2022. The search was conducted on randomized controlled trials(RCTs) that the effects of strength training, balance training and combination of strength and balance training in people with chronic ankle instability compared to a control group. Using Review Manager 5.3 and Stata-SE 15 to conduct Meta-analysis on the included literature. methodological quality and risk of bias were assessed by using the PEDro scale. Results: A total of 33 Chinese and English RCTs document were screened and 1154 patients with CAI were included in the study. Compared with control group, strength training, balance training and combination of strength and balance training demonstrated to be more effective in terms of improving patient reported outcomes(strength training: SMD = 0.80, 95%CI = 0.39–1.22; balance training: SMD = 0.79, 95%CI = 0.41–1.17; combination of strength and balance training: SMD = 1.28, 95%CI = 0.57, 1.99). Subgroup analysis: Intervention for 6 weeks, more than 3 times a week and more than 30 min each time were the best rehabilitation programs to improve CAI patientreported outcomes. Compared with control group, balance training demonstrated to be more effective in terms of improving Star Excursion Balance Test (SEBT)((anterior: SMD = 0.71, 95%CI = 0.03–1.40; posterolateral: SMD = 0.84, 95%CI = 0.22–1.46; posteromedial: SMD = 0.88, 95%CI = 0.45–1.32). However, strength training and combination of strength and balance training had no improvement effects on SEBT. Conclusions: Available evidence showed that, results of the comparison between balance training versus strength training suggest that the combination of strength and balance training achieves greater benefits for patient reported outcomes and balance training could bring greater benefits to dynamic balance. Strength training should be used cautiously in clinic to improve the dynamic balance in individuals with CAI. Trial registration: (http://www.crd.york.ac.uk/PROSPERO, Registration No. CRD42022371396).

Introduction: Waterpipe tobacco (WPT) smoking has increased among the young population in the United States. This study assessed the extent and predictors of WPT smoking initiation and progression among US adolescents (12–17 years) and young adults (18–24 years) longitudinally. Aims and Methods: We analyzed data from 4 waves (2013–2018) of the Population Assessment of Tobacco and Health (PATH) study comprising 10 692 respondents (adolescents = 5428 and young adults = 5264). Kaplan–Meier survival method estimated probabilities of WPT initiation and progression. Cox proportional hazards regression models delineated predictors of the outcomes. Results: Between 2013 and 2018, 4.8% of adolescents initiated and 10.6% progressed WPT smoking. Among young adults, 18.5% initiated and 14.1% progressed WPT smoking during the same time interval. Predictors among adolescents included, WPT initiation: Hispanic ethnicity (adjusted odds ratio (aHR) = 1.75, 95% confidence interval (CI) = 1.23–2.49), lower harm perception (aHR = 2.89, 95% CI = 2.10–3.98), and other tobacco products use (aHR = 3.97, 95% CI = 2.73–5.78); WPT progression: illicit drug use (aHR = 4.60, 95% CI = 1.99–10.67). Predictors among young adults included, WPT initiation: non-Hispanic Black (aHR = 2.31, 95% CI = 1.78–3.00), Hispanic (aHR = 1.77, 95% CI = 1.34–2.33), lower harm perception (aHR = 2.77, 95% CI = 2.19–3.50), and other tobacco products use (aHR = 3.14, 95% CI = 2.25–4.38); WPT progression: non-Hispanic Black (aHR = 1.51 95% CI = 1.09–2.10), lower harm perception (aHR = 1.80, 95% CI = 1.41–2.30), and alcohol use (aHR = 1.61, 95% CI = 1.13–2.30). Conclusions: Results indicate a high prevalence of WPT initiation and progression among adolescents and young adults over time, with minority racial/ethnic groups being at greater risk for both. WPT-specific risk communication interventions (eg, educational campaigns and health warning labels) are warranted to limit WPT smoking among young people.

Background: We aimed to examine the association between sleep duration and cognitive impairment among elderly Chinese people. Methods: generalized linear modeling was used to analyze the baseline data for adults aged 65 years and over (n = 4785) selected from the 2011 China Health and Retirement Longitudinal Study (CHARLS). The two aspects of cognitive impairment assessed in the study were mental status and memory. Sex-stratified logistic regression models were conducted to identify the effect of sleep duration in the different gender groups. Results: of all the participants, 49.8% were females and 32.5% aged 75 years and over. Of the participants, 59.7% had short sleep duration (8 h/day). Compared to normal sleep duration, long sleep duration was associated with lower mental status scores (β = −0.43, p = 0.001) and lower memory scores (β = −0.26, p = 0.006). Long sleep duration was associated with lower mental status in both men (β = −0.37, p = 0.033) and women (β = −0.46, p = 0.025), however, only in men was long sleep duration found to be associated with low memory scores (β = −0.26, p = 0.047). Conclusions: Our study showed that long sleep duration was significantly associated with poorer mental status and memory scores in elderly Chinese people. Paying greater attention to the effects of sleep patterns on the risk of cognitive decline may yield practical implications for dementia prevention and health promotion, especially among older women with lower educational attainment, living in rural areas, and those who have long sleep duration.