E-cigarettes For Smoking Cessation Research Articles

E-Cigarettes for Smoking Cessation: Why do Users Continue with E-Cigarettes?

The advent of e-cigarettes (vaping) well over a decade ago, was welcomed as a tool to aid cigarette smoking cessation. Whilst it has served its aims for many, there remains several who switched to vaping but did not cease cigarette smoking. They also continued with vaping behaviours. The aim of this study is to identify and gain a better understanding of why their vaping behaviours continue. With that in mind, a qualitative study with focus groups was undertaken. A purposive convenience sample of 17 participants who are patrons of 3 vaping centres in the city of Kuala Lumpur were recruited. Four focus groups were formed from the sample of 17 participants. Data derived from the focus groups identified seven themes which emerged as motivating factors for continued vaping behaviours. They comprised of social acceptance; attraction to flavours; a sense of accomplishment; financial savings; convenience compared to smoking; perceived low health risk; and behavioural substitution. Findings suggest that vaping behaviours could be conceptualised by Choice Theory based on psychosocial needs of survival, achievement, love and belonging, freedom and fun. They highlight the role of psychosocial factors that could be considered of importance in informing policy and practices for smoking cessation programmes and activities.

Current and Former Smokers' Use of Electronic Cigarettes for Quitting Smoking: An Exploratory Study of Adolescents and Young Adults.

Background This exploratory study examines the prevalence and predictors of current and former smokers' use of electronic (e-) cigarettes for smoking cessation among a sample of adolescent and young adult established smokers. Methods We conducted school-wide surveys in two middle (n = 1166) and four high schools (n = 3614) in fall 2013 and one public college (n = 625) in spring 2014. We analyzed data from 189 established smokers (reported smoking 100 cigarettes in their lifetime) who also reported ever-use of e-cigarettes (50.7% female, 89.4% White race, Mage 18.3 [SD = 2.8]). We further classified participants as current smokers (reported past-month cigarette smoking) and former smokers (no past-month smoking). Adjusted logistic regression assessed associations of using e-cigarettes to quit smoking with demographic, cigarette and e-cigarette use patterns, e-cigarette flavor preference, and risk perception variables. Results Overall, 41.8% of the sample reported that they "have used an e-cigarette to quit smoking." In adjusted models, older age, White race, higher e-cigarette frequency, and preference for using a combination of e-cigarette flavors predicted increased odds of having used e-cigarettes to quit smoking (p < .05). Using e-cigarettes to quit smoking was not associated with current or former cigarette smoking status or perceptions that "e-cigarettes help people quit smoking" or "e-cigarettes are safer than quit smoking medications." Conclusions Adolescents and young adults who report more frequent e-cigarette use and preference for using flavor combinations are more likely to use e-cigarettes for smoking cessation. Future studies are needed to determine whether e-cigarette use leads to tobacco abstinence in youth smokers. Implications Among young established smokers, more frequent e-cigarette use and preference for using flavors mixed together, but not perceptions of harmfulness of e-cigarettes or comparative safety of e-cigarettes compared with cigarettes or other smoking cessation medications or helpfulness of e-cigarettes in quitting smoking, are associated with using e-cigarettes for smoking cessation.

Developing E-cigarette friendly smoking cessation services in England: staff perspectives

BackgroundPublic health leadership in England has taken a distinctive international stance by identifying the potential public health benefit of e-cigarettes for smoking cessation. This includes the development of a ground-breaking set of national guidelines for developing e-cigarette friendly stop smoking services. However, little is known about the views of staff engaged within these services and whether or how such services are becoming e-cigarette friendly. This study aimed to investigate the uptake and usage of e-cigarette guidance, from the perspective of those enacting tobacco cessation interventions ‘on the ground’.MethodsQualitative semi-structured interviews were conducted with 25 cessation service staff, including advisors (n = 15), managers (n = 5) and commissioners (n = 5) from eight different services in the South-West of England, UK. A thematic analysis of the transcripts was conducted using NVivo software.ResultsAlthough some stop smoking services labelled themselves e-cigarette friendly, there was no consensus over what this should entail. For some, this meant active engagement, such as working with local vape shops, and in the case of one service, offering e-cigarettes through a voucher scheme to disadvantaged groups. For others, an e-cigarette friendly service was conceptualized in a passive sense, as one which welcomed service users using e-cigarettes. Many services did not use the ‘e-cigarette friendly’ claim in their branding or promotional material. Several discursive themes underlay differing staff attitudes. Those more reluctant to engage framed this in terms of their ‘duty of care’, with concerns focusing on the addictiveness of nicotine, lack of medically licensed product and ongoing scientific controversy. Those motivated to engage drew on a discourse of social justice goals and ‘doing things differently’ in relation to lower socio-economic status smokers, those with mental health issues and other vulnerable groups. Strong public health leadership was also identified as a key factor in changing staff attitudes towards e-cigarettes.ConclusionsOn-the-ground enactment of e-cigarette friendly services is varied as well as reflective of the wider policy and regulatory environment. Although the context of English stop smoking services is one of austerity and change, there are opportunities for active engagement with e-cigarettes to achieve overall cessation goals. For this to occur, training, policy consistency and sharing best practice are needed.

Uptake and Perceptions of E-cigarette use in Vascular Patients

Introduction: Smoking is one of the most important risk factors for cardiovascular disease (CVD). Electronic cigarettes (e-cigarettes) are becoming increasingly popular. However, little is known regarding their patterns of use in patients with established CVD.Aims: We aimed to assess the perceptions and patterns of use of e-cigarettes in patients presenting to a vascular clinic.Methods: We performed a qualitative study to identify perceptions and beliefs about e-cigarettes. Semi-structured interviews of consecutive patients consenting to participate were performed over five-months. Individuals were recruited from a vascular surgery outpatient clinic. Initial interviews were based on a questionnaire. Further structured interviews were conducted with patients currently using e-cigarettes, which were transcribed and analysed to assess perceptions and patterns of use.Results/Findings: Four overarching themes emerged: attraction to e-cigarettes as a harm reduction/smoking cessation strategy; uncertainty regarding the risks of e-cigarettes; use of various types of smoking cessation strategies; dual use and often complete relapse to tobacco products.Conclusions: Patients with established CVD view e-cigarettes as a means of smoking cessation; however, many relapse to tobacco products or use both simultaneously. Further research is necessary regarding the role of e-cigarettes in smoking cessation in this high-risk group.

National Academies Report Details Health Impact of E-Cigarettes

Back to table of contents Previous article Next article Professional NewsFull AccessNational Academies Report Details Health Impact of E-CigarettesNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:13 Mar 2018https://doi.org/10.1176/appi.pn.2018.3a12AbstractAmong the 47 conclusions reached by the expert committee are items related to smoking cessation and the harm reduction potential of e-cigarettes.A comprehensive new report from the National Academies of Sciences, Engineering, and Medicine (NASEM) provides some mixed signals in relation to a central question about the public health impact of electronic cigarettes: do they have a value in helping people quit smoking?The report cited strong evidence to suggest that electronic cigarettes, or e-cigarettes, contain fewer harmful compounds than traditional cigarettes and that smokers who completely switch to e-cigarettes can reduce their health risks in the short term. However, there is no substantive evidence that e-cigarettes can actually aid in smoking cessation. The role of e-cigarettes in smoking cessation has been a topic of much debate since these devices first came on the market. Some health professionals, for example, believe they can be a form of nicotine replacement therapy just like patches, while others worry that their resemblance to regular cigarettes reinforces negative smoking behaviors that make it harder to quit. As noted in the NASEM report—which included the results of over 800 peer-reviewed studies—there are some data from observational studies that suggest e-cigarettes can promote smoking cessation, but evidence from more controlled studies is lacking. The report identified just a handful of randomized clinical studies, and most of these showed only that e-cigarettes that contain nicotine are more effective at promoting smoking cessation than e-cigarettes without nicotine. There are insufficient data to know how these devices compare with current FDA-approved cessation products such as varenicline or nicotine patches.People who completely transition from traditional cigarettes to e-cigarettes appear to have improved health outcomes in the short term (one year or less), the report concluded. Douglas Ziedonis, M.D., M.P.H., a professor of psychiatry at the University of California, San Diego, was cautiously optimistic about this finding: “The short-term benefits are encouraging, but remember that addiction is a long-term issue,” he told Psychiatric News.Ziedonis said that while the concept of reducing harm in patients by encouraging switching to e-cigarettes is laudable, there are not enough data on the long-term behaviors of smokers who made the switch. “Many smokers, for example, will just flip-flop between tobacco products, and that is not helpful for their health,” he said. Until more evidence about cessation efficacy and long-term health outcomes becomes available, Ziedonis recommends that psychiatrists continue to focus on cessation strategies with their patients, though the use of e-cigarettes as part of the process can and should be a topic of conversation. Ziedonis said he believes the objective NASEM report will be a great resource for mental health professionals, even those who do not specialize in addiction psychiatry. “Smoking is associated with psychiatric disorders, and questions about e-cigarettes are only going to get more common in psychiatry offices,” he said. ■“Public Health Consequences of E-Cigarettes” can be accessed here. ISSUES NewArchived

Role of E-Cigarettes in smoking cessation: A systematic review

Introduction: E-cigarettes (EC) are devices that heat liquid into an aerosol that user inhales. Youth are using EC at increasing and alarming rates. The tobacco industry aggressively markets EC to youth, glamorizing EC use in advertisements, and offering EC in candy flavors such as bubble gum and gummy bears. The liquid usually in EC has nicotine and other additives which is addictive. Aim: The purpose of this study was to systematically review the role of e-cigarettes in smoking cessation. Materials and Methods: A literature review was performed; PubMed, PubMed Central and Cochrane Library, Embase, and Google Scholar were searched from 1970 to December 2017 to identify appropriate studies. Results: Out of the total 817 titles appeared, 17 articles fulfilled the criteria and were selected for the review. Two articles which were hand searched and one article which was through E-mail was also included in this review. EC have a direct impact on smokers and efficiency in quitting smoking was assessed very low. Majority of the study found that EC could increase the risk of smokers developing nicotine dependence and thus evidence on smoking reduction was found very low. Conclusions: There are relatively a few studies evaluating the role of EC in smoking cessation. EC products are marketed in a wide variety of channels that have broad reach among youth and young adults, including magazines, television, radio, and the Internet. More randomized controlled trials and longitudinal studies are needed to further clarify the role of EC in smoking cessation.

Electronic cigarette use, knowledge, and perceptions among health professional students

IntroductionOur study evaluated the electronic cigarette (e-cigarette) use, knowledge, and perceptions of health professional students enrolled in one of five colleges at a single academic health center. MethodsA 56-item survey was conducted to examine the use, knowledge, and perceptions of e-cigarettes among health professional students. An e-cigarette knowledge score was calculated according to correct responses to eight true-false survey items, with possible scores ranging from zero to eight points. Regressions were used to determine associations between students’ enrolled college/discipline and e-cigarette knowledge scores and to identify associations between three perception domains (smoking cessation, harm reduction, and enhanced regulation) and e-cigarette use. ResultsOf the 853 students responding, 24.2% reported e-cigarette ever-use. Of e-cigarette ever users, 85.5% had used within the past year, and 23.1% used e-cigarettes for smoking cessation. Participants from the colleges of public health, pharmacy, and nursing had significantly higher knowledge scores, compared to those in allied health. Knowledge scores from college of medicine participants did not differ significantly compared to scores from allied health. Perceptions of using e-cigarettes for smoking cessation, reduced harm compared to tobacco, and reduced e-cigarette regulation were significantly associated with using e-cigarettes. Discussion and conclusionsSelf-reported ever-use of e-cigarettes among health professional students in this sample was 3.5–6 times higher than previously reported among medical and nursing students. Substantial gaps in e-cigarette knowledge exist. Enhancing health professionals’ preparedness to effectively advise patients about the benefits and harms of e-cigarettes is crucial.

The Potential Influence of Regulatory Environment for E-Cigarettes on the Effectiveness of E-Cigarettes for Smoking Cessation: Different Reasons to Temper the Conclusions From Inadequate Data.

Author(s): Benmarhnia, Tarik; Leas, Eric; Hendrickson, Erik; Trinidad, Dennis R; Strong, David R; Pierce, John P

E-Cigarettes for Smoking Cessation: Harm or Benefit?

E-Cigarettes for Smoking Cessation: Harm or Benefit?

Current and Former Smokers' Use of Electronic Cigarettes for Quitting Smoking: An Exploratory Study of Adolescents and Young Adults.

This exploratory study examines the prevalence and predictors of current and former smokers' use of electronic (e-) cigarettes for smoking cessation among a sample of adolescent and young adult established smokers. We conducted school-wide surveys in two middle (n = 1166) and four high schools (n = 3614) in fall 2013 and one public college (n = 625) in spring 2014. We analyzed data from 189 established smokers (reported smoking 100 cigarettes in their lifetime) who also reported ever-use of e-cigarettes (50.7% female, 89.4% White race, Mage 18.3 [SD = 2.8]). We further classified participants as current smokers (reported past-month cigarette smoking) and former smokers (no past-month smoking). Adjusted logistic regression assessed associations of using e-cigarettes to quit smoking with demographic, cigarette and e-cigarette use patterns, e-cigarette flavor preference, and risk perception variables. Overall, 41.8% of the sample reported that they "have used an e-cigarette to quit smoking." In adjusted models, older age, White race, higher e-cigarette frequency, and preference for using a combination of e-cigarette flavors predicted increased odds of having used e-cigarettes to quit smoking (p < .05). Using e-cigarettes to quit smoking was not associated with current or former cigarette smoking status or perceptions that "e-cigarettes help people quit smoking" or "e-cigarettes are safer than quit smoking medications." Adolescents and young adults who report more frequent e-cigarette use and preference for using flavor combinations are more likely to use e-cigarettes for smoking cessation. Future studies are needed to determine whether e-cigarette use leads to tobacco abstinence in youth smokers. Among young established smokers, more frequent e-cigarette use and preference for using flavors mixed together, but not perceptions of harmfulness of e-cigarettes or comparative safety of e-cigarettes compared with cigarettes or other smoking cessation medications or helpfulness of e-cigarettes in quitting smoking, are associated with using e-cigarettes for smoking cessation.

Eurobarometer survey and e-cigarettes: unsubstantiated claims

Sir—We read with interest the paper written by Farsalinos and colleagues suggesting a role for e-cigarettes in smoking cessation and reduction among Europeans based on a cross-sectional survey 1. They claim: ‘Extrapolating to the whole European Union (EU) population, an estimated 6.1 million European have quit smoking with the use of e-cigarettes, while a further 9.1 million have reduced their smoking consumption’ 1. This could be interpreted easily as a causal statement, and indeed this is how it has been construed in news outlets 2. However, neither the cross-sectional nature of the study nor the way that survey questions were formulated support such statements. First of all, it is impossible to know how many of those who claim that they have stopped with the aid of e-cigarettes would have stopped anyway, and how many of those who used an e-cigarette but failed to stop would have stopped had they used another method. That is why researchers go to great lengths to compare quitting rates in randomized controlled trials (RCTs) and observational studies. Secondly, the study's key question (‘Did the use of electronic cigarettes or any similar device help you to stop or reduce your tobacco consumption?’) is overly crude and can lead to mislabeling of short cessation periods as cessation. Some of the heavier smokers may count short periods of non-smoking as total success, while the more occasional smokers may underestimate the difficulty of remaining quit longer term, both contributing potentially to higher reporting of quitting success. Moreover, given the charged atmosphere about e-cigarette regulations in the EU 3-5, such a leading question can persuade some e-cigarette users to report a positive effect on cessation/reduction in the hope of less strict regulations of e-cigarettes 6, 7. This question, furthermore, excludes those who use e-cigarettes for reasons other than quitting or reducing smoking (e.g. smoking where conventional cigarettes are not allowed), thus contributing to the selectiveness of certain responders/responses and subsequently biased conclusions based on these responses. Unsubstantiated claims based on weak evidence can lead only to more confusion about the potential role of e-cigarettes in tobacco control. None.

What should dentists know and advise about electronic cigarettes to their patients

Electronic cigarettes (e-cigarettes) are battery-powered devices that convert nicotine into a vapor which can be inhaled. The vapors from e-cigarettes are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in e-cigarette vapors is safe. Worldwide use of electronic cigarettes has increased significantly over recent years but varies markedly between countries. The legal status of e-cigarettes is pending in most of the countries which are the need of the hour. The efficacy and effectiveness of e-cigarettes in smoking cessation or reducing the tobacco use are not established. The following review discusses the current data regarding e-cigarette, prevalence of e-cigarette, legislation of e-cigarettes, issues concerned with the use of the e-cigarette, and finally, the dentists being the health caregivers should be prepared to answer the patients' questions about the advisability of using e-cigarettes as a smoking cessation device.

E-cigarettes in smoking cessation: a harm reduction perspective

E-cigarettes in smoking cessation: a harm reduction perspective

E-cigarettes in smoking cessation: a harm reduction perspective

E-cigarettes in smoking cessation: a harm reduction perspective

Is there a role for e-cigarettes in smoking cessation?

The use of e-cigarettes has dramatically increased over the past few years and their role in smoking cessation remains controversial. Several clinical studies have evaluated their efficacy in smoking cessation but most of them are prospective cohort studies. Only two randomized, controlled trials have compared e-cigarettes versus placebo or patches. A meta-analysis of these two randomized, controlled trials has been performed. Nicotine-containing e-cigarettes appear to help smokers unable to stop smoking altogether to reduce their cigarette consumption when compared with placebo. However, these results are rated 'low' by GRADE standards. Many cohort studies have been conducted, with contradictory results. For some, e-cigarettes could increase the risk of nonsmokers developing nicotine dependence and of current smokers maintaining their dependence. The debate remains open and more randomized trials are needed with long-term data about the efficacy and safety of e-cigarettes.

Young adult e-cigarette users’ reasons for liking and not liking e-cigarettes: A qualitative study

Objective: To gain an in-depth understanding of what young adult electronic- or e-cigarette users like or dislike about e-cigarettes. We aimed to determine the reasons that may encourage young adults to use e-cigarettes or discourage them from using e-cigarettes.Design: Twelve focus group discussions were conducted with 62 current daily e-cigarette users (63% men) of mean age = 25.1 years (standard deviation = 5.5). Data were analysed following principles of inductive content analysis.Results: Results indicated 12 categories of reasons for liking e-cigarettes (e.g. recreation, smoking cessation) and 6 categories of reasons for not liking e-cigarettes (e.g. poor product quality, poor smoking experience).Conclusions: Young adults’ motives for using or not using e-cigarettes appear to be varied and their relative importance in terms of predicting e-cigarette use initiation, dependence, and cigarette/e-cigarette dual use needs to be carefully studied in population-based, empirical studies. The current findings suggest that e-cigarettes may serve social, recreational, and sensory expectancies that are unique relative to cigarettes and not dependent on nicotine. Further, successful use of e-cigarettes in smoking cessation will likely need higher standards of product quality control, better nicotine delivery efficiency and a counselling component that would teach smokers how to manage e-cigarette devices while trying to quit smoking cigarettes.

Quitting Attempts and Utilisation of Smoking Cessation Aids among Smokers in Germany: Results from the 2012 Epidemiological Survey of Substance Abuse

Aim: This study presents current data on smoking cessation and usage of smoking cessation aids among smokers in a representative sample of German smokers. Data of 2012 will be compared with data of the year 2000. Methods: The sample of the 2012 Epidemiological Survey of Substance Abuse (ESA) was randomly drawn from population registers and consisted of 9 084 individuals aged 18-64 years. A mixed-mode design including questionnaires, telephone and Internet interviews was applied. The response rate was 53,6%. Number of smoking cessation attempts and usage of smoking cessation aids were assessed among actual and former smokers. Results: Of the 4 261 persons who had smoked in their lifetime 54,1% are actual and 45,9% former smokers. Among actual smokers 64,5% have tried to quit smoking at least once; 24,3% within the last 12 months. Quit attempts were mostly undertaken without formal help (53,7%). Users of smoking cessation aids report that they used social support (22,6%), self-help material (13,3%), nicotine replacement products (11,3%) and E-cigarettes (8,4%). Conclusions: Compared to the year 2000 the number of former smokers has increased. While the number of smoking cessation attempts among smokers is unchanged, more smokers use smoking cessation aids. Using E-cigarettes for smoking cessation is becoming more important.

E-Cigarettes for Smoking Cessation

Nicotine cessation medication, combined with behavioral support, is considered the “gold standard” treatment for tobacco cessation, but it is only successful in 20% to 30% of patients. New and alternate tobacco cessation strategies are needed to address patients who fail or are unwilling to use current evidence-based options for cessation. Electronic cigarettes are one such product gaining popularity for use as a smoking cessation aid. Robust evidence-based support of e-cigarettes for smoking cessation is lacking, but their use is likely less harmful than that of conventional cigarettes. As such, it is reasonable to support a quit attempt with e-cigarettes following failure of evidence-based cessation treatments and behavioral support, stressing the fact that it is safest to do so without continuing to smoke tobacco.

Abstract 14945: Electronic Cigarettes Are Effective for Smoking Cessation: Evidence From a Systematic Review and Meta-analysis

Introduction: Smoking is the leading cause of preventable death worldwide. Finding effective interventions for smoking cessation has proven difficult and existing interventions have limited consumer appeal. Electronic cigarettes (e-cigarettes) are becoming increasingly popular and a possible role for them in smoking cessation is being debated. Our objective was therefore to analyse existing research to investigate whether use of e-cigarettes is an effective smoking cessation method. Hypothesis: We assessed the hypothesis that use of e-cigarettes is an effective smoking cessation method. Methods: A systematic review of articles in English of any publication date was conducted by searching PubMed, Web of Knowledge and Scopus databases. Published studies investigating the effectiveness of e-cigarettes for smoking cessation among current smokers were included. Studies were systematically reviewed, and meta-analyses were conducted using the Mantel-Haenszel fixed-effect and random-effects models. Heterogeneity and quality of the selected studies were also evaluated. Results: Six studies were selected, including two randomised controlled trials, two cohort studies and two cross-sectional studies, and included 7,551 participants. Meta-analyses included 1,242 participants on whom complete smoking cessation data was available. Of these, 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). Nicotine filled e-cigarettes were more effective in achieving cessation compared to those without nicotine (pooled Risk Ratio 2.29, 95%CI 1.05-4.97). Use of e-cigarettes was also effective in reducing smokers’ daily cigarette consumption. The studies included were heterogeneous, (I 2 =93%, p&lt;0.001). A meta-regression model showed that 98% of this heterogeneity was caused by study design and gender variation. Conclusions: In conclusion, available literature suggests that the use of e-cigarettes may be an effective alternate smoking cessation method. Further research is required to investigate this among both genders.

Efficacy of electronic cigarettes for smoking cessation.

To review data demonstrating effective smoking cessation with electronic cigarettes (e-cigarettes). A literature search of MEDLINE/PubMed (1946-March 2014) was performed using the search terms e-cigarettes, electronic cigarettes, and smoking cessation. Additional references were identified from a review of literature citations. All English-language clinical studies assessing efficacy of e-cigarettes compared with baseline, placebo, or other pharmacological methods to aid in withdrawal symptoms, smoking reduction, or cessation were evaluated. A total of 6 clinical studies were included in the review. In small studies, e-cigarettes significantly decreased desire to smoke, number of cigarettes smoked per day, and exhaled carbon monoxide levels. Symptoms of nicotine withdrawal and adverse effects were variable. The most common adverse effects were nausea, headache, cough, and mouth/throat irritation. Compared with nicotine patches, e-cigarettes were associated with fewer adverse effects and higher adherence. Most studies showed a significant decrease in cigarette use acutely; however, long-term cessation was not sustained at 6 months. There is limited evidence for the effectiveness of e-cigarettes in smoking cessation; however, there may be a place in therapy to help modify smoking habits or reduce the number of cigarettes smoked. Studies available provided different administration patterns such as use while smoking, instead of smoking, or as needed. Short-term studies reviewed were small and did not necessarily evaluate cessation with a focus on parameters associated with cessation withdrawal symptoms. Though long-term safety is unknown, concerns regarding increased poisoning exposures among adults in comparison with cigarettes are alarming.