Abstract
BackgroundE-cigarettes are currently being debated regarding their possible role in smoking cessation and as they are becoming increasingly popular, the research to date requires investigation.ObjectivesTo investigate whether the use of e-cigarettes is associated with smoking cessation or reduction, and whether there is any difference in efficacy of e-cigarettes with and without nicotine on smoking cessation.Data SourcesA systematic review of articles with no limit on publication date was conducted by searching PubMed, Web of Knowledge and Scopus databases.MethodsPublished studies, those reported smoking abstinence or reduction in cigarette consumption after the use of e-cigarettes, were included. Studies were systematically reviewed, and meta-analyses were conducted using Mantel-Haenszel fixed-effect and random-effects models. Degree of heterogeneity among studies and quality of the selected studies were evaluated.ResultsSix studies were included involving 7,551 participants. Meta-analyses included 1,242 participants who had complete data on smoking cessation. Nicotine filled e-cigarettes were more effective for cessation than those without nicotine (pooled Risk Ratio 2.29, 95%CI 1.05-4.97). Amongst 1,242 smokers, 224 (18%) reported smoking cessation after using nicotine-enriched e-cigarettes for a minimum period of six months. Use of such e-cigarettes was positively associated with smoking cessation with a pooled Effect Size of 0.20 (95%CI 0.11-0.28). Use of e-cigarettes was also associated with a reduction in the number of cigarettes used.LimitationsIncluded studies were heterogeneous, due to different study designs and gender variation. Whilst we were able to comment on the efficacy of nicotine vs. non-nicotine e-cigarettes for smoking cessation, we were unable to comment on the efficacy of e-cigarettes vs. other interventions for cessation, given the lack of comparator groups in the studies included in this meta-analysis.ConclusionsUse of e-cigarettes is associated with smoking cessation and reduction. More randomised controlled trials are needed to assess effectiveness against other cessation methods.
Highlights
Smoking accounts for more deaths and diseases worldwide than any other modifiable risk factors.[1, 2] Literature suggests that approximately three quarters of smokers want to quit; smoking is highly addictive and smoking cessation is difficult with frequent relapses common amongst those who try to quit.[1]
Amongst 1,242 smokers, 224 (18%) reported smoking cessation after using nicotine-enriched e-cigarettes for a minimum period of six months. Use of such e-cigarettes was positively associated with smoking cessation with a pooled Effect Size of 0.20 (95%confidence interval (CI) 0.11-0.28)
Use of e-cigarettes was associated with a reduction in the number of cigarettes used
Summary
Smoking accounts for more deaths and diseases worldwide than any other modifiable risk factors.[1, 2] Literature suggests that approximately three quarters of smokers want to quit; smoking is highly addictive and smoking cessation is difficult with frequent relapses common amongst those who try to quit.[1] There is ongoing research on the effectiveness of various smoking cessation interventions. Nicotine replacement therapy (NRT), bupropion, varenicline and cytisine medications have been shown to improve the likelihood of quitting, with varenicline showing the greatest benefit. E-cigarettes are currently being debated regarding their possible role in smoking cessation and as they are becoming increasingly popular, the research to date requires investigation
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