Electronic Cigarettes as Smoking Cessation Tool: Are We There?
Bottom Line: When assessing available data regarding e-cigarettes and smoking cessation, it is evident that these devices are not clearly superior to approved nicotine replacement therapy or “usual care.” Importantly however, the current data also show that these devices are not clearly inferior to approved nicotine replacement therapy or “usual care.” In fact, regular use is associated with the reduction of combustible cigarette use.
Electronic cigarette (e-cigarette) use is rapidly increasing, with many users reporting trying e-cigarettes as a method to quit combustible cigarettes. A review of the current research informs several realities of e-cigarettes in the cessation landscape:
- E-cigarette use is rapidly increasing and most prevalent among current smokers.
- E-cigarettes are no more or less effective than nicotine replacement therapy for cessation.
- Incorporation of e-cigarettes with varenicline and other non-nicotine pharmacotherapies warrants further investigation.
- Reduction of combustible cigarette use is seen with regular e-cigarette users.
- When compared to combustible cigarettes, e-cigarettes have less acute toxic effects.
- Long term effects of e-cigarettes remain unknown.
When evaluating data from four randomized controlled trials and multiple cohort studies, differential association between e-cigarette use and cessation rates was seen.
Cessation rates are highest in UK cohort studies and in studies using a multi-faceted approach, such as with the addition of varenicline. The largest evidence base is derived from observational cohort studies.
For instance, two large longitudinal cohort studies have examined the association of intensive (i.e., daily) use of e-cigarettes with cessation of combustible cigarettes. Brose and colleagues surveyed 4,064 adult smokers in the UK at baseline and one-year later with a retention rate of 43% at follow up. The authors found an association between e-cigarette use and increased quit attempts but no association between e-cigarette use and cessation.
Biener and colleagues surveyed 1,374 US smokers at baseline and 2–3 years later. Self-reported one-month cessation rates were 12% for e-cigarette non-users, 9% for non-daily e-cigarette users and 20% for daily e-cigarette users. In adjusted analyses, compared to non-users, regular e-cigarette users were six times more likely to quit smoking.
These epidemiological data highlight that e-cigarette users are integrating these devices as a smoking cessation tool. What remains unclear is whether the current state of scientific evidence supports this social phenomenon. Overall, the current evidence remains too small for conclusive results regarding efficacy of e-cigarettes for combustible cessation. There does appear to be a consistent reduction in daily combustible cigarette use in regular e-cigarette users.
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