A qualitative study on the development of socially responsive nurses: a conceptual model based on faculty members and student perspectives.

Hypertension is the leading modifiable risk factor for cardiovascular morbidity and mortality worldwide, contributing to approximately 10.4 million deaths annually [, ]. In Scotland, an estimated one in three adults has been diagnosed with high blood pressure, imposing a substantial burden on the National Health Service and representing a major public health priority []. Identifying modifiable behavioural determinants of hypertension prevalence therefore remains an important objective for population health research. Cigarette smoking is an established risk factor for cardiovascular disease, though its relationship with measured blood pressure has long been characterised as paradoxical [–]. While acute nicotine exposure elevates blood pressure through multiple mechanisms including sympathetic activation and catecholamine release [, ], numerous cross-sectional epidemiological studies have reported that current smokers have similar or even lower blood pressure levels compared with non-smokers [, –]. This paradox has been attributed to several mechanisms, including the lower body weight of smokers, selection bias, survival effects, more intensive clinical management of cardiovascular risk factors in smokers, and the vasodilatory properties of chronic carbon monoxide exposure []. Despite these complexities, the overall cardiovascular harm of cigarette smoking is beyond dispute. Electronic cigarettes (e-cigarettes) have emerged as a rapidly growing alternative nicotine delivery system [, ]. In Great Britain, an estimated 5.4 million adults aged 16 years and over currently used an e-cigarette daily or occasionally in 2024, overtaking the number of current cigarette smokers for the first time []. E-cigarettes are frequently used as a smoking cessation aid, and the UK regulatory and public health environment has been broadly supportive of their harm-reduction potential as related to combustible cigarettes []. Nevertheless, the long-term cardiovascular safety of e-cigarettes remains unclear and currently represents an area of active investigation.