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Beyond Cigarettes: The Risks of Non-Cigarette Nicotine Products and Implications for Tobacco Control BACKGROUND Whereas much is known about the effects of tobacco use, the current state of knowledge regarding non-cigarette nicotine products, such as electronic nicotine delivery systems (e-cigarettes and other vaping devices), water pipe/hookah, smokeless tobacco, pipes, cigars, little cigars, and cigarillos, that do not contain tobacco is not robust enough to yield a definitive consensus regarding their relative risks and benefits

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Where ELF testing is not immediately available, primary care pathways often use non-invasive scores such as FIB-4 or the NAFLD Fibrosis Score, with referral to secondary care for further assessment (including ELF or FibroScan) if scores suggest intermediate or high risk