E-cigarettes For Smoking Cessation Research Articles

E-Cigarettes in Smoking Cessation and Harm Reduction: A Comprehensive Review of Recent Evidence and Potential Risks

The global prevalence of tobacco use has significantly decreased over the years, with projections indicating further decline. However, the rise of new nicotine products suggests that nicotine addiction will remain a major public health issue. Electronic cigarettes (e-cigarettes) are increasingly recognized as potential tools for smoking cessation and harm reduction. This review evaluates the safety and effectiveness of e-cigarettes both as standalone treatments and in combination with other therapies, such as nicotine replacement therapy (NRT), varenicline, cytisine, and behavioral approaches. A comprehensive analysis of studies published over the past decade, including systematic reviews, meta-analyses, and randomized controlled trials, shows that e-cigarettes can enhance smoking cessation rates and reduce tobacco-related harm. They exhibit comparable short-term efficacy to traditional treatments, with promising results in alleviating withdrawal symptoms and lowering smoking rates. However, the long-term safety and effectiveness of combining e-cigarettes with other therapies remain uncertain and require further investigation. Despite their potential benefits, e-cigarettes pose significant safety concerns, underscoring the need for ongoing research to refine cessation strategies and ensure their safe, long-term use. Rigorous evaluation and regulatory oversight are essential to optimize e-cigarettes' role in reducing tobacco harm.

Choice of smoking cessation products among people with substance use problems in the US: Findings from the Population Assessment of Tobacco and Health (PATH) study Wave 6

ObjectiveThe aim of this study was to compare past 12-month use of cigarette smoking cessation aids (e.g., Food and Drug Administration (FDA)-approved cessation products or e-cigarettes for smoking cessation) among people with substance use problems (PWSUPs) who currently smoke to people without substance use problems (SUPs) who currently smoke cigarettes in a nationally representative US sample. MethodsWe used the Population Assessment of Tobacco and Health (PATH) Wave 6 Study [n = 30,516]. Our sample comprised adult (18+) established cigarette smokers (100+ lifetime-sticks with daily/non-daily use) [n = 5,895]. The independent variable was SUP status (no, moderate, and high). The dependent variables were past-year use of: nicotine replacement therapies (NRTs), cessation medications [i.e., varenicline or bupropion], or e-cigarettes [for cigarette cessation and reduction]. Weighted multivariable logistic regression models for each dependent variable examined the associations between SUP status and each cessation aid, adjusting for cigarette dependence, daily cigarette smoking, and demographic factors. ResultsAmong people who smoke, a higher proportion of respondents with high SUP severity used NRTs, cessation medications, and e-cigarettes for cigarette cessation, respectively (12.3%, 8.4%, 15.7%), compared to those with no/low SUP severity (9.8%, 6.0%, 8.9%). In the multivariable models, respondents with high SUPs had 63% (95% CI:1.16–2.29) higher odds of using e-cigarettes for cessation than those without SUPs. No significant differences were seen between high (vs. no/low SUPs) in the past-year use of NRTs and cessation medications. ConclusionOur findings indicate that cigarette smokers with high SUPs had higher odds of using e-cigarettes for cessation and reduction compared to smokers without SUPs.

A Person-Centered Approach to Moralization-The Case of Vaping.

Using e-cigarettes for smoking cessation is a controversial topic among health experts. Evidence suggests that vaping might have been moralized among the general public. Despite the detrimental consequences of moralizing health behaviors on social cohesion and health, some argue for using moralization strategically to prevent and combat vaping. We aim to add to the body of literature showing the dangers of moralization in health by proposing a person-centered approach to the moralization of anti-vaping attitudes. Our cross-sectional survey explores the moralization of anti-vaping attitudes and its predictors on a convenience sample of 348 Romanian never-vapers, before the final vote to severely restrict vaping. By fitting a hierarchical regression model on our data, we found support for a unique contribution of negative prototypes (β = 0.13) and opinions of vapers (β = 0.08) in predicting moralization, with significant contributions of piggybacking on moralized self-control, on moralized attitudes toward smoking and on sanctity/degradation, disgust, anger, harm to children, and gender. Together, these variables explained 56% of the variance of the moralization of anti-vaping attitudes. Our findings add to our knowledge of motivated moralization and advise against using moralization in health, suggesting that people may weaponize it to legitimize group dislike.

Participant Experiences of a Quit Smoking Attempt Through Either Nicotine Replacement Therapy (NRT) Methods or the Use of an E-cigarette.

There is a lack of evidence exploring experiences of using e-cigarettes for smoking cessation. The study's main aim was to explore participant experiences of e-cigarettes compared to nicotine replacement therapy (NRT) delivered through stop smoking services. Semi-structured, face-to-face, and telephone interviews at 3-month post-quit follow-up in a randomized controlled trial comparing nicotine-containing e-cigarettes, nicotine-free e-cigarettes, and NRT for smoking cessation. N = 17 participants, 9 were male, mean age 44 years, 5 using nicotine-containing e-cigarettes, 7 nicotine-free e-cigarettes, and 5 NRT. Interviews were transcribed and analyzed using thematic analysis. Two global themes and 5 organizing themes were identified. Global themes included: (1) experiences of e-cigarette and NRT quit aids (e-cigarette positive impact and dilemmas, NRT perceptions and experiences), and (2) key mechanisms to support quit attempt (physical aids, advice and support, feedback and structure). E-cigarettes were viewed with caution, however, generally evaluated positively alongside NRT methods, finding e-cigarettes useful during a quit attempt due to their versatility in application. Nicotinecontaining e-cigarettes were favored due to their support with nicotine cravings. Participants were, however, wary of replacing smoking addiction with vaping habit. Participant e-cigarette experience were generally positive; however, concerns over long-term application were noted. There was a noticeable preference for nicotine-containing e-cigarettes, but further research is required to better understand how nicotine is used in conjunction with e-cigarettes long-term as a quit aid alongside other NRT.

Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds.

Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds.

Feasibility of a primary care patient decision aid for smoking cessation with information about e-cigarettes

Decision aids can promote shared decision making and behavior change and may be effective in helping patients quit smoking. Patients are increasingly using e-cigarettes for smoking cessation; however, little is known about the impact of including e-cigarette information in smoking cessation decision aids. Our objective was to assess the feasibility and acceptability of a smoking cessation decision aid including e-cigarette information. This study was conducted at one family medicine clinic in the United States. We used a pre-post design. In Phase I, the decision aid presented information about approved cessation methods. In Phase II, current e-cigarette users and patients with no intention of quitting received additional information on switching to e-cigarettes. We assessed the impact of the decision aids on quit attempts and abstinence, confidence and readiness to quit, confidence and readiness to switch to e-cigarettes, and patient satisfaction. We enrolled 60 patients in each phase (N = 120). Patients reported higher confidence and readiness to quit after viewing the decision aids and consulting with their physician (p < 0.01). Patients reported the decision aid helped prepare them to make a decision about quitting smoking and expressed satisfaction with the decision aid and clinician consultation. We did not observe an impact of including e-cigarette information. Smoking cessation decision aids are acceptable to patients and may promote behavior change. Future studies should explore the impact of providing patients e-cigarette information using larger sample sizes and rigorous designs. Further research is needed to identify strategies to promote shared decision-making regarding e-cigarettes.

Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Study cohort, 2017–2019

ObjectiveTo assess the effectiveness of e-cigarettes in smoking cessation in the USA from 2017 to 2019, given the 2017 increase in high nicotine e-cigarette sales.MethodsIn 2017, the PATH Cohort Study...

The Ethics of e-Cigarettes for Smoking Cessation: A Global Challenge

"Tobacco smoking is especially harmful for women because, in addition to its effects on mortality and morbidity, it negatively impacts pregnancy, reproductive, and health of the offspring. Data from our work in Romania revealed that pregnant tobacco smokers are seeking information and clinical advice related to e-cigarette use as a tobacco cessation approach. E-cigarette use increased rapidly in the recent years in the US and in other countries, including LMICs. The tobacco control field is deeply divided on how to respond to the increase in e-cigarette use. Additional evidence on the ethical issues related to e-cigarette use and tobacco cessation will inform our mHealth and other pregnancy tobacco cessation interventions and will guide future tobacco control policy direction. The objective of this study is to identify ethical concerns and associated attitudes and perceptions related to e-cigarette use for tobacco cessation during pregnancy among pregnant smokers, their life partners, medical professionals, and other stakeholders. We will interview (N=20) and conduct two focus groups with women who smoke (one focus group, N=10) and women who quit during pregnancy (one focus group, N=10); interview life partners (N=10) of such women; interview ObGyn physicians (N=10) and nurses (N=10); and interview (N=10) and conduct one focus group (N=10) with perinatal educators. Other relevant stakeholders will be also interviewed including the leadership of 2035 Tobacco Free Romania, the national Stop Smoking program, the Pure Air consortium, the Romanian Pneumology Society, the SAMAS NGO focused on maternal and child health and rights, and others. With respect to expected outcomes, the proposed application is anticipated to advance understanding of the smokers’ and other stakeholders’ ethical concerns and associated attitudes and perceptions related to e-cigarettes use for tobacco smoking cessation. The in-depth new knowledge will have a positive impact on the cessation of prenatal and postnatal tobacco smoking and will inform future tobacco control policy directions. Results will be available and will be presented at the time of the conference. This work is based on research partly funded through six NIH-funded projects (grant no. K01TW009654, R21TW010896, 5R21TW010896-02S1, 5R21TW010896-02S2, 1R21HD103039-0, 1R25TW010518-01A1). "

Otolaryngology Resident Education and Perceptions of e-cigarettes.

To date, there are no reports of otolaryngology residents' knowledge and confidence in discussing e-cigarette use. The purpose of this study was to evaluate otolaryngology resident e-cigarette knowledge and confidence in counseling patients on e-cigarette use. Cross-sectional national survey. Accreditation Council for Graduate Medical Education otolaryngology residents in the United States. US otolaryngology residents were distributed surveys electronically in September 2020. A total of 150 participants replied for a response rate of 8.88%. The majority, 93.10% have not received formal education on e-cigarettes during their residency training. The most common resource of e-cigarette information overall was social media (78.46%). Within academia, the most common resources of e-cigarette education were patient interactions (63.16%) and colleagues (54.74%). Patients commonly inquire residents about e-cigarettes for smoking cessation (85.07%) and their long-term health effects (83.58%). Almost 67% of residents rarely or never ask patients about e-cigarette use. Only 4.35% of residents are not confident discussing traditional cigarette use, while 58.70% are not confident discussing e-cigarettes. Otolaryngology residents have not received formal education in e-cigarettes and are not confident discussing e-cigarettes with their patients. This highlights the need for e-cigarette education during otolaryngology residency to improve patient e-cigarette counseling.

Evidence against e-cigarettes for smoking cessation

Electronic cigarettes (e-cigarettes) have been touted as a safer alternative to cigarettes and even as a smoking cessation aid. The health risks associated with smoking are well known, and smoking cessation has been studied extensively with options including behavioral therapy and pharmacotherapy (nicotine replacement therapy [NRT], varenicline, and bupropion). Several studies analyzed the effects of e-cigarettes as a smoking cessation aid. When used for smoking cessation, those who successfully abstain from cigarette smoking have a higher rate of continuation on e-cigarettes than NRT or pharmacotherapy. Other risks of e-cigarettes are highlighted including e-cigarette or vaping product use–associated lung injury. There is no approved pharmacotherapy for e-cigarette cessation. Two of the analyzed studies demonstrated the use of varenicline as a potential pharmacotherapy for e-cigarette cessation. The proposed benefits of e-cigarettes as a smoking cessation aid should be weighed against their probable detrimental effects. E-cigarette use should be discouraged as a whole and notably, as a smoking cessation aid.

Effect of Massachusetts House Bill No. 4196 on electronic cigarette use: a mixed-methods study

BackgroundElectronic cigarettes, or e-cigarettes, are devices that deliver nicotine-containing aerosol and were used by 2.8% of American adults in 2017. Many people who smoke cigarettes have used e-cigarettes for smoking cessation, and the general consensus among health providers is that while vaping is not harmless, it is less harmful than smoking. To try to reduce youth e-cigarette use, the Commonwealth of Massachusetts imposed a 75% excise tax on nicotine-containing vaping products and banned the sale of all flavored tobacco products, including combustible tobacco, effective June 1, 2020. This tax, like similar taxes in other states, aimed to reduce e-cigarette consumption. However, past research has found that e-cigarettes and cigarettes are economic substitutes, meaning that an increase in e-cigarettes prices may push more people who smoke e-cigarettes to smoke combustible cigarettes.MethodsTo determine the impacts of several events, such as the e-cigarette and vaping-associated lung injury (EVALI) outbreak and implementation of the Massachusetts e-cigarette tax, on e-cigarette and cigarette purchasing, we conducted an interrupted time-series analysis of year-on-year consumer purchasing data to impute changes in e-cigarette and cigarette purchasing in the Greater Boston area and the entire USA after several intervention points. We then surveyed a subset of people who used e-cigarettes to evaluate the plausibility that some e-cigarette consumers would travel out-of-state to purchase e-cigarettes.ResultsThe purchasing data indicated that there was no significant decrease in e-cigarette purchases in the Greater Boston convenience market after tax implementation. However, we found that e-cigarette purchases decreased significantly while cigarette purchases increased after several bans on e-cigarettes and numerous policy statements related to the EVALI outbreak. The survey results suggested that people who smoke e-cigarettes did not decrease their consumption after the implementation of the tax, but instead obtained e-cigarettes outside of Massachusetts.ConclusionThese results suggest that the Massachusetts flavor ban and tax did not reduce e-cigarette consumption in the Greater Boston area, and that messaging questioning the safety of e-cigarettes led to an increase in combustible cigarette use. This suggests the need for health authorities to reconsider how they communicate the relative risks of smoking and vaping.

A qualitative study of the views about smoking, licensed cessation aids and e-cigarettes in people with schizophrenia spectrum disorders

Smoking prevalence remains high among people with a mental health condition compared to those without. Understanding people’s motivation to quit and their views of smoking cessation support may help to develop future interventions. We conducted a qualitative study to explore the perceptions of 30 people with schizophrenia spectrum disorders who were current smokers, about smoking traditional cigarettes, the appeal of licensed medicines and e-cigarettes for smoking cessation or smoking reduction. The experiences of participants who were motivated to quit were compared with those who were not motivated to quit. Findings suggest traditional cigarettes were pleasurable and licensed cessation aids and e-cigarettes unappealing to participants who were unmotivated to quit. Whereas nicotine replacement products and e-cigarettes may be an appealing smoking cessation or reduction strategy for those motivated to quit. There is a need to find ways of making traditional cigarettes less appealing and alternative less harmful nicotine products (licensed and unlicensed) more appealing and accessible to this group of high risk smokers.

Awareness, knowledge and perception of electronic cigarettes among undergraduate students in Jazan Region, Saudi Arabia.

The use of electronic cigarettes (e-cigarettes) has steadily grown over the past few years, rising in popularity amongst young adults, especially. Owing to the perception that e-cigarettes are less harmful than conventional cigarettes, some people have resorted to using them as a means of quitting cigarette smoking. This study aimed to assess the awareness, knowledge, perception and use of e-cigarettes among Jazan University students in Saudi Arabia. An observational cross-sectional study was conducted with 775 students. Using stratified random sampling to recruit study participants, the dataset tabling the use of e-cigarettes, as well as knowledge, perception and awareness was collected using a translated and culturally adapted structured Arabic questionnaire. Our results showed that 21.0% of the participants used e-cigarettes and 35.1% of them used them to quit smoking. E-cigarette use was mostly reported by students from the College of Medical Applied Sciences (31.7%). The overall knowledge score was 3.9, with a standard deviation of 1.3 for the score range from zero to seven. About half of the participants correctly identified e-cigarettes as not less addictive' than cigarettes. However, 70.2% of students failed to identify e-cigarettes as a source of second-hand exposure to nicotine. About two-thirds of the sample believed that e-cigarettes could adversely affect health. The perception of using e-cigarettes for smoking cessation was not significantly associated with e-cigarette use. In conclusion, the prevalence of e-cigarette use was similar to that reported in the literature. However, Jazan University students failed to identify the health risks associated with e-cigarette use. Therefore, a strategy to enhance students' awareness of the benefits and harms of e-cigarettes is needed.

Effectiveness of e-cigarettes in smoking cessation: a systematic review and meta-analysis

Abstract Background Reports of the effectiveness of e-cigarettes (ECs) for smoking cessation vary across different studies making implementation recommendations hard to attain. We performed a systematic review and meta-analysis to synthesise the current evidence regarding the effectiveness of ECs for smoking cessation. Methods PubMed, PsycInfo and Embase databases were searched for randomized controlled trials comparing nicotine ECs with non-nicotine ECs or with established smoking cessation interventions (nicotine replacement therapy (NRT) and or counselling) published between 01/01/2014 and 01/05/2019. Data from eligible studies were extracted and used for random-effects meta-analyses. Results Our literature review yielded 13190 publications with 10 studies being identified as eligible for systematic review, covering 8362 participants, and 8 for meta-analyses (n = 30 - 6006). Using the last follow-up of eligible studies, the proportion of smokers achieving abstinence was 1.67 [95CI:0.99 - 2.81] times higher in nicotine EC users compared to non-nicotine EC users. The proportion of abstinent smokers was 1.69 [95CI:1.25 - 2.27] times higher in EC users compared to participants receiving NRT. EC users showed a 2.70 [95CI:1.15 - 6.30] times higher proportion of abstinent smokers in comparison to participants solely receiving counselling. Conclusions Our analysis showed modest effects of nicotine-ECs compared to non-nicotine ECs. When compared to NRT or counselling, results suggest that nicotine EC may be more effective for smoking cessation. As ECs also help maintaining routinized behaviour and social aspects of smoking, we hypothesise that this may explain their advantage as a tool for smoking cessation. However, given the small number of included studies, different populations, heterogeneous designs, and the overall moderate to low quality of evidence, it is not possible to offer clear recommendations. More comparable data is needed to strengthen confidence in the quality of evidence. Key messages The number of previous studies assessing the effectiveness of ECs for smoking cessation is limited. Further, comparability of these studies is restricted, weakening the quality of evidence. Although current evidence on the effectiveness of ECs for smoking cessation is inconclusive, our meta-analyses suggest that ECs could be a promising alternative tool in attempts to achieve abstinence.

Pulmonary Disease Related to E-Cigarettes

The potential role of E-cigarettes in smoking cessation is debatable, and whether they are harmful remains controversial worldwide. However, several cases of E-cigarette or vaping-associated lung injury (EVALI) have been reported in the United States. In this review, we discuss and summarize EVALI cases.

Health Professionals' Counseling about Electronic Cigarettes for Smokers and Vapers in a Country That Bans the Sales and Marketing of Electronic Cigarettes.

This study describes the prevalence and correlates of adult smokers’ discussions about electronic cigarettes (e-cigarettes) with health professionals (HPs), including whether these discussions may lead smokers and vapers to use e-cigarettes for smoking cessation. Methods: We analyzed data from an online survey of Mexican smokers recruited from a consumer panel for marketing research. Participants who had visited an HP in the prior four months (n = 1073) were asked about discussions of e-cigarettes during that visit and whether this led them to try to quit. Logistic models regressed these variables on socio-demographics and tobacco use-related variables. Results: Smokers who also used e-cigarettes (i.e., dual users) were more likely than exclusive smokers to have discussed e-cigarettes with their HP (adjusted odds ratio (AOR) = 3.96; 95% C.I. 2.73, 5.74), as were those who had recently attempted to quit smoking (AOR = 1.89; 95% C.I. 1.33, 2.7). Of smokers who had discussed e-cigarettes, 53.3% reported that the discussion led them to use e-cigarettes in their quit attempt. Also, dual users (AOR = 2.6; 95% C.I. 1.5, 4.5) and daily smokers (>5 cigarettes per day) (AOR = 3.62; 95% C.I. 1.9, 6.8) were more likely to report being led by their HP to use e-cigarettes in the quit attempt compared to exclusive smokers and non-daily smokers, respectively. Conclusions: Discussions between HP and smokers about e-cigarettes were relatively common in Mexico, where e-cigarettes are banned. These discussions appear driven by the use of e-cigarettes, as well as by greater smoking frequency and intentions to quit smoking.

Tobacco and electronic nicotine delivery systems regulation.

The smoking of tobacco cigarettes by millions of people over the past 100 or more years has had devastating public health consequences around the world. In some countries, this has been mitigated by the introduction of multiple regulatory strategies that have taken decades to implement. But even in the countries with most success at tobacco cigarette regulation, some smokers find it very hard to quit and need better treatment. Electronic cigarettes and other electronic nicotine delivery systems (ENDS) have emerged in the last decade or so. Initially designed to help smokers quit and produced by small independent entities, ENDS have become big business, with major transnational tobacco companies competing hard for market share where, for example, in the United States, a single device came to dominate the market within a couple of years and where soaring uptake by adolescents reached levels high enough to alarm the FDA. No doubts remain about the damaging health consequences of tobacco cigarettes. Controversies persist about e-cigarettes-their efficacy, health impacts, development of addiction and whether or not they provide a "gateway" to tobacco cigarette smoking. The regulation of tobacco cigarettes falls under a global WHO treaty, the Framework Convention on Tobacco Control (FCTC); over 180 countries are party to the FCTC. The regulation of ENDS has no such treaty, varies considerably around the world and in many countries remains completely untrammelled by specific directives. This paper will not discuss the evidence for or against the of e-cigarettes in smoking cessation (effectively discussed in this issue by Dr. Wallace) but aims to review the current state of tobacco regulation around the world, identify key differences in ENDS regulation, examine the impact of industry influence on public health policy and determine how the lessons of tobacco control should apply to ENDS.

E-cigarettes for smoking cessation.

E-cigarettes for smoking cessation.

"Cloud chasers" and "substitutes": e-cigarettes, vaping subcultures and vaper identities.

The use of e-cigarettes is increasing, a practice denoted as vaping. We explore user motives, self-identity as vapers and involvement in vaping subcultures, drawing on sociological theory of stigma, subcultures and symbolic boundaries. Based on analyses of semi-structured interviews with 30 Norwegian vapers, we find that there is a vaping subculture in Norway. We identify two dominant vaper identities. The first is labelled cloud chasers. These were dedicated vapers who identified with symbols and values in the subculture. Many were politically engaged in improving vaping regulation regimes and felt a sense of belonging to a vaping community. The second group is labelled substitutes. These were former daily smokers who used e-cigarettes for smoking cessation in a more pragmatic and defensive manner, to avoid health risks, to escape the stigma of smoking and to manage nicotine addiction. In this group, self-identity as a vaper was generally lacking. Vaping was often symbolically linked to the stigmatised smoker identity they wanted to escape, and was restricted to private contexts. The perceived symbolic meaning of e-cigarettes varies: for some, they are a symbol of pleasure and community. For others, they connote the stigmatised status of the addicted smoker seeking an alternative to cigarettes.

Perceptions about e-cigarette flavors: a qualitative investigation of young adult cigarette smokers who use e-cigarettes

Background: Although in recent years, an increased number of young adult smokers have used flavored e-cigarettes, little research has been conducted to explore young adult smokers’ perceptions about e-cigarette flavors.Methods: This study used qualitative methods to examine young adult smokers’ perceptions towards e-cigarette flavors, their intentions of using e-cigarettes given a flavor ban, and their perceived role of e-cigarette flavors in their smoking behaviors. We conducted in-depth, semi-structured interviews to explore these themes among a purposive sample of 25 young adult smokers in the U.S. (aged 18–34) who had used e-cigarettes to reduce cigarette smoking. Thematic content analysis was employed to assess the qualitative data.Results: Most participants reported enjoying e-cigarettes with fruit, candy, dessert or menthol/mint flavors and valued having a wide selection of flavors. Most participants reported that they would likely quit or significantly reduce e-cigarette use if e-cigarette flavors were banned. Participants had little knowledge of the nicotine concentration in their e-cigarettes or the harm associated with the use of e-cigarette flavorings. Additionally, participants perceived e-cigarette flavorings as helpful in cutting down smoking by allowing for increased e-cigarette use frequency and duration.Conclusion: Participants indicated positive perceptions towards e-cigarette flavors and considered the role of e-cigarette flavors to be important in cutting down on cigarettes. Banning or restricting flavored e-cigarettes may discourage participants from using e-cigarettes for smoking cessation. The lack of knowledge about flavored e-cigarettes’ harm and risks, together with the escalated consumption of flavored e-cigarettes, are causes for concern and warrant further attention.