Use Of E-cigarettes For Smoking Cessation Research Articles

Evaluating the impact of varying expired carbon monoxide thresholds on smoking relapse identification: insights from the E3 trial on e-cigarette efficacy for smoking cessation

ObjectivesExpired carbon monoxide (ECO) is often used in smoking cessation trials to biochemically validate self-reported smoking status. The optimal ECO threshold to distinguish individuals who smoke from those who do...

Medicalisation of vaping in the UK? E-cigarette users' perspectives on the merging of commercial and medical routes to vaping.

In the UK, most smokers choosing e-cigarettes to quit smoking will access vaping via commercial routes. In recent years, however, a shift towards medicalisation of vaping has become apparent, with public health guidance supporting e-cigarettes for smoking cessation and increased partnership working between healthcare professionals and the vaping industry. To achieve the UK's Smokefree 2030 target, the UK Government has set out measures to use e-cigarettes in National Health Service (NHS) settings and to move towards streamlining processes to make e-cigarettes available to a million smokers. This article aims to understand acceptability of different approaches by seeking perspectives of people with lived experience of e-cigarette use for smoking cessation. Mixed methods data collected between March 2018 and March 2019 as part of a broader study of e-cigarette use trajectories (ECtra study). Data here relate to the views of partnership working and medicalisation of vaping extracted from 136 interviews/extended surveys of people who had used e-cigarettes to try to stop smoking. Qualitative data were thematically analysed. Participant ratings of interventions were presented descriptively, and differences in participant characteristics and ratings were reported. Three qualitative themes were identified: pro-partnership, anti-partnership and medicalisation dissonance. Medicalisation was discussed for its potential to reassure smokers about e-cigarette harms and its potential to reach smokers from disadvantaged backgrounds. Concerns were raised about cost-effectiveness, quality of support, conflicts of interest and limiting product choice. Most participants rated interventions involving partnership working as potentially helpful in switching from smoking to vaping. There were no statistically significant associations between age, gender and socioeconomic status, and helpfulness ratings. Both commercial and medical routes to vaping offer perceived benefits to vapers and may complement and reinforce each other to support smoking cessation.

Efficacy and Safety of E-Cigarette Use for Smoking Cessation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundPeople who smoke conventional cigarettes are increasingly turning to electronic cigarettes (e-cigarettes) as a pathway to quitting. However, the efficacy and safety of e-cigarettes for smoking cessation remains controversial. MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), identified through a systematic search of the MEDLINE, EMBASE, and Cochrane CENTRAL databases. Inclusion was restricted to RCTs with a follow-up duration ≥6 months. The primary endpoint was the most rigorous criterion of biochemically validated abstinence at maximum follow-up, and the primary comparison was nicotine e-cigarettes versus any conventional (ie, non-e-cigarette) smoking cessation therapy. The Cochrane Risk of Bias Tool was used to assess bias. Count data were pooled across trials using random-effects models with inverse variance weighting to estimate relative risks (RRs) and corresponding 95% confidence intervals (CIs). We registered the study protocol with the Open Science Framework Registries (osf.io/26fkq). ResultsA total of 5 RCTs (n = 3253) were included. Compared with conventional smoking cessation therapies, the use of nicotine e-cigarettes was associated with an increase in abstinence, defined by the most rigorous criterion of abstinence reported (RR 1.77; 95% CI, 1.29-2.44). Nicotine e-cigarettes also increased abstinence (defined by the most rigorous criterion) compared with non-nicotine e-cigarettes (RR 1.56; 95% CI, 1.13-2.15). The incidence of death or serious adverse events was low across all trials at maximum follow-up. ConclusionsAmong individuals attempting to quit smoking, nicotine e-cigarettes are more efficacious than conventional nicotine replacement or behavioral smoking cessation therapies, and may prove beneficial in reducing smoking-related health risks.

E-cigarette use for smoking cessation and its regulatory trends worldwide

E-cigarette use for smoking cessation and its regulatory trends worldwide

E-cigarette use for smoking cessation and its regulatory trends worldwide

E-cigarette use for smoking cessation and its regulatory trends worldwide

Efficacy and safety of e-cigarette use for smoking cessation: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Quitting smoking substantially reduces the risk of developing cardiovascular disease. Smokers are increasingly turning to electronic cigarettes (e-cigarettes) to help them quit smoking combustible cigarettes. However, the efficacy and safety of e-cigarettes for smoking cessation remain controversial. Purpose To examine the efficacy and safety of e-cigarette use for smoking cessation. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing nicotine and non-nicotine e-cigarettes (alone, or in combination with behavioural and/or pharmacological interventions) to conventional smoking cessation therapies (pharmacological, behavioural, or both). We systematically searched MEDLINE, Embase, and the Cochrane Libraries. Inclusion was restricted to RCTs that reported biochemically validated abstinence at six months or greater. The primary comparison was nicotine e-cigarettes versus any (non-e-cigarette) conventional smoking cessation therapy. Count data were pooled using DerSimonian and Laird random-effects models with inverse variance weighting to obtain relative risks (RRs) and 95% confidence intervals (CIs). Results A total of six RCTs (n=3,401) were included, with maximum follow-up durations ranging from six to 12 months. Compared with conventional smoking cessation therapies, point estimates favoured nicotine e-cigarettes for the most rigorous criterion of abstinence, continuous abstinence, and point prevalence abstinence, although findings were inconclusive due to wide 95% CIs (Table 1). Similar trends were observed when comparing non-nicotine e-cigarettes to traditional smoking cessation therapies. Compared with non-nicotine e-cigarettes, nicotine e-cigarettes increased abstinence as defined by the most rigorous criterion. Although there was a signal suggesting a potential increased risk of respiratory adverse events with nicotine e-cigarettes versus traditional therapies, the 95% CI is wide. Conclusion E-cigarettes appear to be more efficacious than conventional nicotine pharmacotherapies and behavioural smoking cessation therapies. Although currently available safety data are inconclusive, e-cigarettes may be considered for smoking cessation given the established long-term health consequences of continued smoking. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Mr. Levett is supported by an Ivan Racheff Scholarship, funded through the McGill University Faculty of Medicine and Health Sciences Research Bursary Program. Dr. Filion is supported by a Senior Research Scholar award from the Fonds de recherche du Québec – Santé and a William Dawson Scholar award from McGill University.

Knowledge and Attitudes Among Medical Students Toward the Clinical Usage of e-Cigarettes: A Cross-Sectional Study in a University Hospital in Saudi Arabia.

BackgroundTo assess knowledge and attitudes about e-smoking among undergraduate medical students, specifically focused on favorable view of therapeutic e-cigarette use for smoking cessation or harm reduction.MethodsThis cross-sectional study included medical students at King Abdulaziz University, Saudi Arabia. A six-item subscale was used to explore knowledge and attitudes about the therapeutic use of e-cigarettes, measuring participants’ likelihood of favoring such use. A four-item questionnaire measured confidence and importance of being educated about smoking and e-smoking, in addition to sources of knowledge about e-cigarettes.ResultsA total of 399 students participated. Smoking history included current smokers (19.8%) and ex-smokers (6.5%), while e-cigarettes were tried by 36.6% and are currently used by 11.5%. A minority (13.5%) believed that e-cigarettes are FDA-approved for smoking cessation, while approximately one-third believed e-smoking lowers cancer risks (31.1%) and could help with smoking cessation (31.1%). Further, 35.9% agreed or strongly agreed that e-cigarettes are better for patients than tobacco products, and 17.5% were likely to recommend e-smoking to their patients for smoking cessation. Reliability of the six-item scale showed Cronbach’s alpha = 0.676, which was enhanced to 0.746 after deletion of one item about addictiveness. Using the corrected five-item scale, 23.6% of the participants would favor therapeutic use of e-cigarettes.ConclusionWe observed several misconceptions about addictiveness and inadequate awareness about e-cigarettes’ harmful effects, leading to non-scientific opinions about its therapeutic use for harm reduction or in smoking cessation. Academic programs around this topic should be updated in accordance with majority expert recommendations.

Correlates of e-cigarette use for smoking cessation among clients in residential substance use disorder treatment

Little is known about e-cigarette use among persons in substance use disorder (SUD) treatment, or their use of e-cigarettes for smoking cessation. Prevalence of e-cigarette use and correlates of e-cigarette use for smoking cessation were examined among clients in SUD treatment. Participants (n = 332) were current cigarette smokers recruited from 20 residential SUD programs in California. We used multivariable logistic regression to identify correlates of using e-cigarettes for quitting smoking. Almost half (45.2%) of the sample had ever used e-cigarettes for smoking cessation, and 34% had used e-cigarettes in the past 30 days. Smokers who had used e-cigarettes for smoking cessation, compared to those who had not, were younger (adjusted odds ratio [AOR] = 0.94, 95% confidence interval [CI] = 0.91, 0.96), had more than a high school education (AOR = 1.69, 95% CI = 1.07, 2.68), sought treatment for both SUD and mental health disorder (AOR = 2.62, 95% CI = 1.38, 5.00), wanted help quitting smoking (AOR = 1.90, 95% CI = 1.03, 3.50) and perceived e-cigarettes as equally harmful (AOR = 3.03, 95% CI = 1.10, 8.33) or less harmful than tobacco cigarettes (AOR = 2.82, 95% CI = 1.02, 7.77). Black/African American and Hispanic/Latino participants were less likely to use e-cigarettes for smoking cessation than participants who identify as White. E-cigarettes were favorably perceived by clients in residential SUD treatment as a quit smoking aid. Treatment programs should consider how to advise clients with respect to the use of e-cigarettes for smoking cessation.

Text messages to support e-cigarette use for smoking cessation: a tool for researchers

E-cigarettes are now the most popular quit aid chosen by smokers in England. Mobile phone text messages have been shown to be a useful tool in facilitating smoking cessation attempts by providing behaviour change support. To date, no published examples of text messages exist specifically aimed at smokers attempting to quit with e-cigarettes (vaping). As part of a parent study, we led an online call to vapers asking what advice and information they would give, in the form of a text message, to smokers wishing to quit smoking by vaping. We received 102 initial suggestions. Alongside behaviour change and smoking cessation experts, we checked the messages for readability and scientific accuracy, removed inappropriate messages, refined and edited others, and added additional messages. Messages were also grouped by theme and relevance to the stage of quitting. 95 messages were taken forward for further evaluation by 376 smokers, ex-smokers and vapers. Here we present the full set of 95 messages along with a final set of 78 that were selected and ordered for our parent study by two members of the research team along with four vapers. We encourage engagement with this resource and further validation from researchers interested in smoking cessation with e-cigarettes.

Addressing and Overcoming Barriers to E-Cigarette Use for Smoking Cessation in Pregnancy: A Qualitative Study.

E-cigarettes may have a role in supporting pregnant women who would otherwise smoke to stop smoking. The study aimed to understand pregnant women’s vaping experiences, in particular how vaping to stop smoking is facilitated and how barriers to this are overcome. We conducted semi structured telephone interviews (n = 15) with pregnant or postpartum women who vaped during pregnancy, either exclusively (n = 10) or dual-used (n = 5) (smoked and vaped). Thematic analysis was used to analyse the interviews. Two themes emerged. First, ‘facilitating beliefs’: inherent beliefs that helped women overcome barriers to vaping. These included understanding the relative safety of vaping and economic gains compared with smoking and pregnancy being a motivator to stop smoking. Second, ‘becoming a confident vaper’: accumulating sufficient skill and confidence to comfortably vape. This included experimentation with e-cigarettes to ensure nicotine dependence and sensory needs were met. Seeking social support and employing strategies to address social stigma were also important. Positive beliefs about vaping and becoming proficient at vaping were viewed as ways to overcome barriers to vaping. The theoretical domain framework informed intervention recommendations to assist pregnant smokers who have tried but cannot stop smoking to switch to vaping.

A Randomized Controlled Trial Evaluating the Efficacy of E-Cigarette Use for Smoking Cessation in the General Population: E3 Trial Design

BackgroundSmoking cessation improves morbidity and mortality among smokers who achieve long-term abstinence. Many smokers are using electronic cigarettes (e-cigarettes) to attempt to quit, despite a lack of data concerning their efficacy and safety for smoking cessation. MethodsThe Evaluating the Efficacy of E-Cigarette use for Smoking Cessation (E3) trial is a multicentre randomized controlled trial (NCT02417467) with a treatment period of 12 weeks and follow-up of 52 weeks. A total of 376 participants motivated to quit smoking were enrolled at 17 Canadian centres (November 2016 to September 2019). Participants were randomized (1:1:1) to 1 of 3 treatment arms: nicotine e-cigarettes, non-nicotine e-cigarettes, or no e-cigarettes. All groups received individual counselling. Treatment allocation was double-blind for the e-cigarette groups. The trial includes follow-ups by telephone at weeks 1, 2, 8, and 18, and clinic visits at weeks 4, 12, 24, and 52. The primary endpoint is to compare nicotine e-cigarettes to counselling alone in terms of biochemically validated point-prevalence smoking abstinence at 12 weeks; the primary endpoint was changed from 52 weeks after early termination (77% of targeted enrollment) due to a prolonged delay in e-cigarette manufacturing. The secondary objectives are to examine the efficacy of nicotine and non-nicotine e-cigarettes in terms of point-prevalence and continuous smoking abstinence, and reduction in daily cigarette consumption at all follow-ups through week 52, and to describe the occurrence of adverse events. ConclusionThe E3 trial will provide regulators, health care professionals, and smokers with important information about the efficacy and safety of e-cigarettes for smoking cessation.

Nicotine addiction as a moral problem: Barriers to e-cigarette use for smoking cessation in two working-class areas in Northern England

Tobacco use in high-income countries correlates with socio-economic disadvantage, but although switching to electronic cigarettes could be a safer alternative, little is known about barriers to use. Drawing on eighteen months of data collection in two areas of Northern England in 2017/18 including ethnography and interviews with 59 smokers and e-cigarette users, I show that concern about continued nicotine addiction either deterred working-class smokers from switching to e-cigarettes or dictated the conditions of their use. Research participants were unhappy about addiction both as loss of control experienced as moral failure and as neglect of financial responsibilities i.e. role performance failure in relation to family responsibilities, or what I call ‘thrift as care’. They reduced the moral burden of addiction by lowering nicotine content, rejecting pleasure and minimising expenditure. They chose the cheapest possible tobacco, switched from combusted tobacco to cheaper e-cigarettes and bought cheap e-cigarettes and liquids. For working-class smokers, minimising spend on what they perceive negatively as addiction may be a greater moral concern than reducing health risk. I conclude that ensuring that vaping is significantly cheaper than smoking may be key to addressing health inequalities linked to tobacco use.