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Utilité de la vape pour l’arrêt du tabac
Utility of vaping for tobacco cessation

Electronic cigarettes: fact and faction

There are a number of public health advocates who appear to consider electronic cigarettes (e-cigarettes) primarily as a threat to public health, and bodies such as the British Medical Association (BMA) and the World Health Organization (WHO) are warning smokers about their potential dangers.1 This editorial takes a close look at the evidence.

Published: 01 September 2014

Positive: Yes

Link to publication: http://bjgp.org/content/64/626/442

Authors:


Full text

WHAT ARE E-CIGARETTES?

E-cigarettes are devices designed to give much of the experience of smoking and usually contain a certain amount of nicotine without exposing the user to the highly carcinogenic tar and harmful carbon monoxide gas that cigarettes deliver.2 Many of them look broadly similar to cigarettes but are often larger and sport different colours; some look very different from cigarettes. Some have a tip that glows red, blue, or green when the user sucks on them. They contain a battery-powered heating element that is activated either manually or automatically when the user sucks on the end. This element heats a liquid mostly made up of propylene glycol or glycerol, usually with some nicotine and flavourings. The resulting vapour is inhaled and delivers varying amounts of nicotine, typically less than from smoking, depending on the device and experience of the user. Some of the vapour is exhaled as a visible mist.

Given that smokers smoke primarily for the nicotine but die primarily from the tar,3 one might imagine that e-cigarettes would be welcomed as a means to prevent much of the death and suffering caused by cigarettes. For every million smokers who switched to an e-cigarette we could expect a reduction of more than 6000 premature deaths in the UK each year, even in the event that e-cigarette use carries a significant risk of fatal diseases, and users were to continue to use them indefinitely.

SAFETY OF E-CIGARETTES

This raises the question as to why some in the public health community are so vociferous in their opposition to them. One concern is over safety. Given how long it took to discover the link between smoking and lung cancer when the risks were so great, we have to accept that it will probably be more than 30 years before we would have a chance of being able to use epidemiology to quantify risks from e-cigarette use. In fact we may never be able to do so because we are chasing a moving target in terms of the products and their development.

This means that we must make judgements based on the toxicology of the vapour. Despite alarmist commentaries, studies on the toxicology of the vapour tell us that, while propylene glycol is an irritant and some toxins are present in measurable quantities, the concentrations are in fact very low.4 Some reviews have bizarrely concluded that we do not know whether e-cigarette use is safer than smoking,5 ignoring the fact that the vapour contains nothing like the concentrations of carcinogens and toxins as cigarette smoke.6,7 In fact, toxin concentrations are almost all well below 1/20th that of cigarette smoke.

EFFECT OF E-CIGARETTES ON SMOKING PREVALENCE

The second concern is that widespread use of e-cigarettes may ‘re-normalise’ smoking, leading to an increase in smoking prevalence, or at least a slowing down of the rate of decline. Yet, in England, where the ‘Smoking Toolkit Study’ surveys the adult population every month, the rise in prevalence of e-cigarette use has been accompanied by an increase in smoking cessation rates and a continued fall in smoking prevalence.8,9 The proportion of those aged 16–25 years who have ever smoked regularly has stayed constant at 30% over the period when e-cigarette use has increased.8

E-CIGARETTES AND SMOKING CESSATION

The third concern is that there is only limited scientific evidence that e-cigarettes can help smokers to stop smoking. Two randomised controlled trials (RCTs) of now obsolete products that delivered little nicotine found those products to yield success rates broadly similar to licensed nicotine products.10,11 More trials of newer products are needed but these will only give us part of the answer. The number and variety of products, the rate of development, the time taken to conduct these trials, and the difficulty in generalising to people who are not willing to be randomised mean that we will have to supplement randomised trials with other kinds of study.

A review of surveys suggested that e-cigarette use by smokers might hinder quitting. However, the studies reviewed could not address the question satisfactorily because they failed to address differences in important factors such as nicotine dependence among those using e-cigarettes versus other smokers, and/or did not address whether the e-cigarettes were used as part of a quit attempt.6 A recent study has addressed these deficiencies.9 It used a survey methodology that had previously confirmed RCT findings that behavioural support and licensed nicotine products and varenicline obtained on prescription all improve smokers’ chances of stopping, while confirming findings from other studies that licensed nicotine products when bought over the counter may not improve the chances of stopping.12,13 The latest study, involving almost 6000 respondents, found that use of an e-cigarette in the most recent quit attempt was associated with a 60% increase in the odds of still being abstinent compared with using no aid and with using a licensed nicotine product bought over the counter.14 This difference persisted after adjusting statistically for a wide range of potential confounding variables. This is just one correlational study but it is an important piece of the jigsaw.

E-CIGARETTES AS A GATEWAY TO SMOKING

The fourth concern is that e-cigarettes may act as a gateway into smoking. The gateway hypothesis has been widely debated in relation to ‘soft’ and’ hard’ drugs and it has been recognised that simply counting the numbers of people who try a ‘soft’ drug and go on to use a ‘hard’ drug does not address the question.14 The reason is obvious: the association could easily be due to a pre-existing disposition on the part of the people concerned. To date, studies that have been claimed as addressing the gateway issue in relation to e-cigarettes have not in fact done so.1 Moreover, warnings about a rapid rise in e-cigarette use among the young have been based on the proportion of young people who report ever having tried an e-cigarette, not the proportion of current users.15 In England, the proportion of current users in people who have not smoked regularly remains extremely small at 0.2%.8

THE NEED FOR OBJECTIVITY

This brings us back to the question as to why some individuals and bodies involved in public health are so opposed to e-cigarettes. It may be a concern over how things might turn out in the future given commercial incentives, puritanical ethics, distaste for any industry profiting from a psychoactive drug, inappropriate application of a medical rather than a public health model, or even just a gut feeling that e-cigarettes are bad. Whatever the reasons, it is important that interpretation of the evidence and communication with policy makers and the public is not distorted by a priori judgements.16

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Electronic cigarette use and harm reversal: emerging evidence in the lung

Direct confirmation that long-term EC use leads to reductions in smoking-related diseases is not available and it will take a few decades before the tobacco harm reduction potential of this products is firmly established. Nonetheless, it is feasible to detect early changes in airway function and respiratory symptoms in smokers switching to e-vapor.

Published: 18 March 2015

Positive: Yes

Link to publication: http://www.biomedcentral.com/1741-7015/13/54

Authors:

Riccardo Polosa


Summary

Abstract

Electronic cigarettes (ECs) have been rapidly gaining ground on conventional cigarettes due to their efficiency in ceasing or reducing tobacco consumption, competitive prices, and the perception of them being a much less harmful smoking alternative. Direct confirmation that long-term EC use leads to reductions in smoking-related diseases is not available and it will take a few decades before the tobacco harm reduction potential of this products is firmly established. Nonetheless, it is feasible to detect early changes in airway function and respiratory symptoms in smokers switching to e-vapor. Acute investigations do not appear to support negative respiratory health outcomes in EC users and initial findings from long-term studies are supportive of a beneficial effect of EC use in relation to respiratory outcomes. The emerging evidence that EC use can reverse harm from tobacco smoking should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the e-vapor category.

Keywords:

E-cigarette; E-vapor products; Harm reversal; Lung function; Respiratory system; Smoking cessation; Tobacco harm reduction

Background

The electronic cigarette (EC) has been rapidly gaining ground on conventional cigarettes and could surpass consumption of conventional cigarettes within the next decade, according to some prediction analyses [1]. The growing popularity of ECs proves that many adult smokers are keen on using an alternative technologic form of smoking to reduce cigarette consumption or quit smoking and to relieve tobacco withdrawal symptoms [2]. Data from internet surveys [2],[3] and clinical trials [4],[5] have shown that ECs may help smokers quit or reduce their tobacco consumption. Moreover, the popularity of ECs appears to be associated with the fact that they can be used in many smoke-free areas, their prices are competitive, and they are perceived as a much less harmful smoking alternative [3],[6].

Vapor toxicology under normal conditions of use is by far less problematic than that of conventional cigarettes [7], and exclusive EC users have significantly lower urine levels of tobacco smoke toxicants and carcinogens compared to cigarette smokers [8]. Thus, smokers completely switching to regular EC use are likely to gain significant health benefits.

Although a reduction in smoking-related diseases from long-term EC use can be inferred by the positive findings on Swedish snus (a tobacco harm reduction product consisting of refined oral tobacco which is low in nitrosamines) [9], direct confirmation is not available and it will take a few decades before a reduction in individual and population health outcomes due to the regular use of e-vapor products can be firmly established. Nonetheless, it is feasible to detect early changes in airway function and respiratory symptoms in smokers switching to e-vapor.

In this commentary, I discuss the emerging potential of ECs for harm reversal with a specific focus on the respiratory system.


Conclusion

Compared to combustible cigarettes, e-vapor products are at least 96% less harmful and may substantially reduce individual risk and population harm [22]. Future research will better define and further reduce residual risks from EC use to as low as possible by establishing appropriate quality control and standards. Although large longitudinal studies are warranted to elucidate whether ECs are a less harmful alternative to tobacco cigarettes and whether significant health benefits can be expected in smokers who switch from tobacco to ECs, the emerging evidence that EC use can reverse harm from tobacco smoking should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the e-vapor category [23].

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Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes

Given that continued smoking after a cancer diagnosis increases the risk of adverse health outcomes, patients with cancer are strongly advised to quit. Despite a current lack of evidence regarding their safety and effectiveness as a cessation tool, electronic cigarettes (E-cigarettes) are becoming increasingly popular. To guide oncologists’ communication with their patients about E-cigarette use, this article provides what to the authors’ knowledge is the first published clinical data regarding E-cigarette use and cessation outcomes among patients with cancer.

Published: 22 September 2014

Positive: No

Link to publication: http://onlinelibrary.wiley.com/enhanced/doi/10.1002/cncr.28811/

Debunked by Carl Philips: http://antithrlies.com/2015/03/12/what-is-peer-review-really-part-8-the-case-of-borderud-et-al/

Authors:

Sarah P. Borderud
Yuelin Li
Jack E. Burkhalter
Christine E. Sheffer
Jamie S. Ostroff


Summary

METHODS

A total of 1074 participants included smokers (patients with cancer) who recently enrolled in a tobacco treatment program at a comprehensive cancer center. Standard demographic, tobacco use history, and follow-up cessation outcomes were assessed.

RESULTS

A 3-fold increase in E-cigarette use was observed from 2012 to 2013 (10.6% vs 38.5%). E-cigarette users were more nicotine dependent than nonusers, had more prior quit attempts, and were more likely to be diagnosed with thoracic and head or neck cancers. Using a complete case analysis, E-cigarette users were as likely to be smoking at the time of follow-up as nonusers (odds ratio, 1.0; 95% confidence interval, 0.5-1.7). Using an intention-to-treat analysis, E-cigarette users were twice as likely to be smoking at the time of follow-up as nonusers (odds ratio, 2.0; 95% confidence interval, 1.2-3.3).


Conclusions

The high rate of E-cigarette use observed is consistent with recent articles highlighting increased E-cigarette use in the general population. The current longitudinal findings raise doubts concerning the usefulness of E-cigarettes for facilitating smoking cessation among patients with cancer. Further research is needed to evaluate the safety and efficacy of E-cigarettes as a cessation treatment for patients with cancer. Cancer 2014;120:3527–3535. © 2014 American Cancer Society.

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Does the magnitude of reduction in cigarettes per day predict smoking cessation? A qualitative review

Reduction in cigarettes per day (CPD) aided by nicotine replacement therapy (NRT) increases cessation in smokers; however, it is unclear whether this is due to use of NRT or reduction per se. If the latter, a greater magnitude of reduction in CPD should increase the odds of cessation.

Results show that dual use increases tobacco cessation.

Published: 05 March 2015

Positive: Yes

Link to publication: http://ntr.oxfordjournals.org/content/early/2015/03/04/ntr.ntv058.short?rss=1

A good analysis from Dr Siegel: http://tobaccoanalysis.blogspot.fr/2015/03/new-study-provides-evidence-that.html

Article en Français sur l’étude: http://www.ma-cigarette.fr/etude-la-cigarette-electronique-aide-au-sevrage-tabagique-meme-pour-les-vapofumeurs/

Authors:

Elias M. Klemperer, B.A.
John R. Hughes, M.D.


Summary

Methods: The authors searched PubMed, Cochrane, PsychINFO, clinicaltrials.gov and their personal libraries for studies on smoking reduction. Seven of the 76 (9%) identified intervention trials and four of 28 naturalistic studies (14%) reported on the magnitude of reduction in relation to the odds of cessation.

Results: Five of the seven intervention trials and three of the four naturalistic observational (cohort) studies found that increased reduction in CPD was associated with increased cessation. The intervention trials that reported effect sizes found that every one percent decrease in CPD or carbon monoxide (CO) was associated with a 3% to 4% increase in the odds of cessation. The naturalistic studies found that ordinal (e.g., quartile) increases in participants’ magnitude of reduction in CPD were associated with 50% to 290% increases in the odds of cessation. All of the naturalistic studies and four of the intervention trials included covariates; however, reduction’s association with cessation could still be due to its association with NRT use or motivation.


Conclusions

Although prospective prediction does not necessarily indicate causality, our findings suggest reduction in CPD is a mechanism of increased cessation in prior NRT-aided reduction studies.

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Understanding the evidence about the comparative success of smoking cessation methods: choice, second-order preferences, tobacco harm reduction, and other neglected considerations

Note that this is a working paper, not a study per se. The first version appeared on Nov 2014, this version is dated 22 February 2015

Published: Not yet

Positive: Yes

Link to publication: http://ep-ology.com/2014/11/24/working-paper-phillips-nissen-rodu-understanding-the-evidence-about-the-comparative-success-of-smoking-cessation-methods-choice-second-order-preferences-tobacco-harm-reduction-and-other-neglecte/

Authors:

Carl V Phillips

Catherine M Nissen

Brad Rodu


Summary

The extensive research on choices about smoking and the methods people use to quit is almost always interpreted in naïve and unhelpful ways. This is partially due to treating smoking cessation as if it were medical disease treatment, despite the fundamental differences, most notably that smoking is a choice that has benefits as well as costs]. The main problem, however, seems to be a failure to recognize what it means when someone indicates they want to quit smoking. An understanding of the preferences that motivate smoking and cessation allows us to categorize would – be quitters, par ticularly identifying the difference between first – and second – order preferences for quitting. This demonstrates the absurdity of attempts to determine what cessation method is “best” or even “better”, as well as explaining the frequent failure of medical interventions. This analysis offers advice for both readers of the research and those who wish to quit smoking.


Conclusions

There are an enormous number of studies of smoking cessation methods, and a new wave that includes e – cigarettes has begun. However, these seem to play the role of Rorschach test rather than aid to useful policy and education, or perhaps the “support, not enlightenment” role of the lamppost for the inebriated. They are interpreted as supporting the observer’s political bias about cessation methods, which may be based on other empirical observations or mere ideology. Even attempts at unbiased observations suffer from a failure to understand that the study of consumer preferences differs dramatically from medical treatment research, and must be interpreted with the eye of a social scientist.

Consideration of the different categories of smokers presented here is crucial to both an informed interpretation of research and useful advice for smokers. Methods to aid smokers to understand their true preferences, and thus what might be a desirable quitting approach, follow naturally from these observations, particularly helping smokers to reflect on their motivations and desires. Standard methods for categorizing smokers or including covariates in studies can help discriminate among these categories of would – be quitters, but are likely to only be useful if explicitly interpreted in that context. For example, intensity – of – desire variables, like the standard “how soon after you wake up do you have your first cigarette”, might be used to identify subjects who are more likely to be in Category 1 rather than one of the other categories and thus allow better interpretation of the data. Blindly throwing those variables into statistical models without such structure, however, is unlikely to be particularly informative.

Unbiased and thoughtful interpretation of smoking cessation study results could provide much useful information about how to advise smokers who want to quit. But very little of that seems to be occurring. If helping people who want to quit, or want to want to quit – rather than just generating revenue or rhetoric – is the goal of the research, then some more serious attention to the nature of the phenomena being studied is in order, with smokers seen as consumers with first – and second – order preferences that drive their behavior, rather than as patients with an illness for whom assigning a cure would be appropriate.

Continuer la lecture de Understanding the evidence about the comparative success of smoking cessation methods: choice, second-order preferences, tobacco harm reduction, and other neglected considerations

Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments

Old (2009), but with interesting contents regarding THR

Published: 03 November 2009

Positive: Yes

Link to publication: http://www.harmreductionjournal.com/content/6/1/29

doi:10.1186/1477-7517-6-29

Authors:

Carl V Phillips


Summary

Nicotine is so desirable to many people that when they are given only the options of consuming nicotine by smoking, with its high health costs, and not consuming nicotine at all, many opt for the former. Few smokers realize that there is a third choice: non-combustion nicotine sources, such as smokeless tobacco, electronic cigarettes, or pharmaceutical nicotine, which eliminate almost all the risk while still allowing consumption of nicotine. Widespread dissemination of misleading health claims is used to prevent smokers from learning about this lifesaving option, and to discourage opinion leaders from telling smokers the truth. One common misleading claim is a risk-risk comparison that has not before been quantified: A smoker who would have eventually quit nicotine entirely, but learns the truth about low-risk alternatives, might switch to an alternative instead of quitting entirely, and thus might suffer a net increase in health risk. While this has mathematical face validity, a simple calculation of the tradeoff — switching to lifelong low-risk nicotine use versus continuing to smoke until quitting — shows that such net health costs are extremely unlikely and of trivial maximum magnitude. In particular, for the average smoker, smoking for just one more month before quitting causes greater health risk than switching to a low-risk nicotine source and never quitting it. Thus, discouraging a smoker, even one who would have quit entirely, from switching to a low-risk alternative is almost certainly more likely to kill him than it is to save him. Similarly, a strategy of waiting for better anti-smoking tools to be developed, rather than encouraging immediate tobacco harm reduction using current options, kills more smokers every month than it could possibly ever save.


Conclusion

While it is logically possible that lowering the risk from an exposure could increase population risk, the (1-x)/x calculation shows this is not plausible for THR. The suggestion that, despite the lower population risk, many individuals might still face greater risk is also logically possible, but the calculation presented here shows that this is not a substantial practical worry.

On average, someone who would die from smoking who is going to take more than a month to quit entirely (or will experience relapses that will have a similar health impact – probably roughly a total of one month worth of days) will have less total health risk by switching immediately, even if he never quits the alternative product. The typical pattern of even dedicated quitters, starting and stopping smoking for a year or two, will cause much more risk than switching to a low-risk alternative. Moreover, even an average smoker who was going to successfully quit after only a week or two more will suffer only a tiny net increase in physical health risk from switching now, a change so trivial compared to the net benefits of switching for smokers who will not quit for years or ever that it is clearly inconsequential.

The practical implications of this analysis do not change based on plausible variations in the input parameters, including the risk from using ST. Even if we use a completely implausible high risk from ST use, say that it causes 10% of the risk of smoking, then if an average smoker would have taken ten months to quit entirely, he would have had lower risk had he switched immediately. The break-even might be as low as about half a year – recall the conservative assumption built into the calculation. Thus, even discovering that ST use is an order of magnitude worse than the ample current evidence suggests would not fundamentally change the implications of the analysis.

Since this analysis is based entirely on mortality risk, it ignores other contributions to welfare. The reason that current smokers have not already quit, in spite of the health benefits of doing so, is that it would have resulted in substantial costs to them and, similarly, whenever a smoker chooses to switch it implies that there is a net welfare benefit (compared to either smoking or abstinence) to using the alternative product. This welfare gain from switching rather than quitting probably dwarfs the welfare implications of the mortality risk from low-risk products, though quantifying that is beyond the present scope.

Finally, it is worth noting that someone who switches from smoking to a low-risk alternative still has the option of quitting entirely, lowering his risk slightly more still. Indeed, there is reason to believe that eventually quitting alternative products is easier. This means that even the young smokers who might have been better off with several more months of smoking rather than a lifetime of THR product use stand a good chance of quitting entirely anyway (if they decide that the benefits of consumption are outweighed by the benefits of quitting), further favoring the option of switching now. Even those smokers who cannot afford another day of smoking but fortunately switch just in time (who are likely from older demographics that are the primary target for THR) could then survive long enough to quit nicotine entirely.

Many of the claims about health risk made to try to discourage the adoption of THR have been proven to be out-and-out false. This includes the « total social health risk will increase » claim. The present analysis does not relegate the « some people would be stopped from quitting entirely and thus have worse health outcomes » claim to universal falsehood – it will still inevitably be true for a very few individuals. But this is common in public health interventions, from automobile safety equipment to vaccines – the net social effects are overwhelmingly beneficial, though some people (who cannot be identified ex ante, and often not even ex post) suffer net harm rather than benefit. The analysis shows that only a tiny portion of all future quitters will be quitting soon enough that they would have higher expected risk by switching immediately. Moreover, the net increase in expected risk even for those individuals would be extremely small, and the net welfare effects would still be positive. Clearly, then, the claim does not represent a sufficient concern to override the huge net expected social benefit, to say nothing of the ethical requirement that smokers be informed about their options. The claim is thus relegated to being a distraction from rational and honest discourse on the subject, not a contribution to it.

This calculation emphasizes the cost of delaying the adoption of THR at the individual level also: Those of us who promote THR are familiar with smokers who, upon learning about THR, insist that they do not need to consider that option because they will eventually be exercising the « perfect » option of quitting anyway. But many such individuals never quit, and almost none quit in time for it to be a healthier choice. Similarly, each additional month that anti-THR activism keeps a potential switcher from learning about THR is more likely to kill him than is a lifetime of using ST or another low-risk nicotine product. To put it bluntly, anti-THR activism and disinformation do far more damage to public health than smokeless tobacco, electronic cigarettes, or other THR products ever could.

Since THR can be self-tailored and requires no clinical or government intervention, it does not matter that there may be smokers for whom no low risk product is an adequate substitute or that there is no political will to actively endorse it. THR can be adopted by individuals who do find an acceptable substitute, and likely will be widely adopted if smokers were simply given accurate information. The usual explanation for the lack of such information is that anti-tobacco extremists promulgate disinformation it and then even the opinion leaders who are genuinely concerned about public health repeat the inaccurate claims because they have been misled. But an alternative explanation is misplaced optimism on the part of the public health leaders: That is, many may not be misled by the disinformation about THR, but may genuinely believe that most smokers will successfully quit using nicotine very soon or that a perfect new anti-smoking method, policy, or product will be developed and cause everyone to quit soon, reducing their risks more than THR would. The present analysis shows just how overly-optimistic that belief needs to be in order to justify the failure to immediately promote THR using current technology.

Whatever the explanation for it, the present analysis shows that anti-THR activism is deadly. Hiding THR from smokers, waiting for them to decide to quit entirely or waiting for a new anti-smoking magic bullet, causes the deaths of more smokers every month than a lifetime using low-risk nicotine products ever could.

Continuer la lecture de Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments

Counseling Patients on the Use of Electronic Cigarettes

Published: January 2015

Positive: No

Link to publication: http://www.mayoclinicproceedings.org/article/S0025-6196%2814%2900989-6/fulltext#sec7

DOI: http://dx.doi.org/10.1016/j.mayocp.2014.11.004

Authors:

Jon O. Ebbert, MD, MS
Amenah A. Agunwamba, ScD, MPH
Lila J. Rutten, PhD, MPH


Summary

Electronic cigarettes (e-cigarettes) have substantially increased in popularity. Clear evidence about the safety of e-cigarettes is lacking, and laboratory experiments and case reports suggest these products may be associated with potential adverse health consequences. The effectiveness of e-cigarettes for smoking cessation is modest and appears to be comparable to the nicotine patch combined with minimal behavioral support. Although a role for e-cigarettes in the treatment of tobacco dependence may emerge in the future, the potential risk of e-cigarettes outweighs their known benefit as a recommended tobacco treatment strategy by clinicians. Patients should be counseled on the known efficacy and potential risks of e-cigarettes.


Conclusions

Clinicians are ethically obligated to promote smoking cessation using evidence-based treatment strategies. Smokers will ask about e-cigarettes, and we must be prepared to offer appropriate counseling. With the evidence available to date, clinicians must be circumspect in recommending e-cigarettes for use by cigarette smokers interested in quitting smoking for the following reasons:

1. They are not demonstrably superior to FDA-approved medications for smoking cessation.

2. They may not be effective for smoking cessation and dual use (ie, using e-cigarettes and continuing to smoke) will prolong exposure to tobacco.

3. They are not FDA-approved for the treatment of tobacco dependence.

4. Short-term safety data suggest they may cause airway reactivity.

5. The long-term health risk of exposure to e-cigarette constituent chemicals is unknown.

6. No regulatory oversight, such as requirements for good manufacturing practices, is currently in place for e-cigarette devices or e-juice.

More clinical safety data and increased product reliability and regulation are needed before e-cigarettes can assume a place in the standard clinical approaches to the treatment of tobacco dependence.

Continuer la lecture de Counseling Patients on the Use of Electronic Cigarettes

Use of e-Cigarettes among Current Smokers: Associations among Reasons for Use, Quit Intentions, and Current Tobacco Use.

Research has documented growing availability and use of e-cigarettes in the U.S. over the last decade.

We conducted a national panel survey of current adult cigarette smokers to assess attitudes, beliefs, and behaviors relating to e-cigarette use in the U.S. (N=2254).

Published: 14 January 2015

Positive: Yes

Link to publication: http://www.ncbi.nlm.nih.gov/pubmed/25589678

PMID:25589678

Authors:

Rutten LJ
Blake KD
Agunwamba AA
Grana RA
Wilson PM
Ebbert JO
Okamoto J
Leischow SJ


Summary

Among current cigarette smokers, 20.4% reported current use of e-cigarettes on some days and 3.7% reported daily use. Reported reasons for e-cigarette use included: quit smoking (58.4%), reduce smoking (57.9%), and reduce health risks (51.9%). No significant differences in sociodemographic characteristics between e-cigarette users and non-users were observed. Prior quit attempts were reported more frequently among e-cigarette users (82.8%) than non-users (74.0%). Intention to quit was reported more frequently among e-cigarette users (64.7%) than non-users (46.8%). Smokers intending to quit were more likely to be e-cigarette users than those not intending to quit (OR=1.90, CI=1.36-2.65). Those who used e-cigarettes to try to quit smoking (OR=2.25, CI=1.25-4.05), reduce stress (OR=3.66, CI=1.11-12.09), or because they cost less (OR=3.42, CI=1.64-7.13) were more likely to report decreases in cigarette smoking than those who did not indicate these reasons. Smokers who reported using e-cigarettes to quit smoking (OR=16.25, CI=8.32-31.74) or reduce stress (OR=4.30, CI=1.32-14.09) were significantly more likely to report an intention to quit than those who did not indicate those reasons for using e-cigarettes.


Conclusions

Nearly a quarter of smokers in our study reported e-cigarettes use, primarily motivated by intentions to quit or reduce smoking. These findings identify a clinical and public health opportunity to re-engage smokers in cessation efforts.

Continuer la lecture de Use of e-Cigarettes among Current Smokers: Associations among Reasons for Use, Quit Intentions, and Current Tobacco Use.

Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies

To investigate the efficacy and the adverse effects (AEs) of the electronic cigarette, we performed a systematic review of published studies.

Published: 9 August 2014

Positive: Yes

Link to publication: http://jpubhealth.oxfordjournals.org/content/early/2014/08/09/pubmed.fdu055.short

doi: 10.1093/pubmed/fdu055

Authors:

Maria Rosaria Gualano
Stefano Passi
Fabrizio Bert
Giuseppe La Torre
Giacomo Scaioli
Roberta Siliquini


Summary

Methods We selected experimental and observational studies examining the efficacy (as reduction of desire to smoke and/or number of cigarettes smoked and/or quitting or as reduction of nicotine withdrawal symptoms) and the safety of EC (AEs self-reported or clinical/laboratory). The following search engines were used: PubMed, ISI Web of Knowledge and Cochrane Controlled Trials Register.

Results Finally, six experimental studies and six cohort studies were included. In the prospective 12-month, randomized controlled trial, smoking reduction was documented in 22.3 and 10.3% at Weeks 12 and 52, respectively (P < 0.001 versus baseline). Moreover, two cohort studies reported a reduction in the number of cigarette/day (from 50 to 80%) after the introduction of the EC. ‘Mouth and throat irritation’, ‘nausea’, ‘headache’ and ‘dry cough’ were the most frequently AEs reported.


Conclusions

The use of the EC can reduce the number of cigarettes smoked and withdrawal symptoms, but the AEs reported are mainly related to a short period of use. Long-term studies are needed to evaluate the effects of the EC usage after a chronic exposure.

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Biochemically verified smoking cessation and vaping beliefs among vape store customers

To evaluate biochemically verified smoking status, and electronic nicotine delivery systems (ENDS) use behaviors and beliefs among a sample of customers from vapor stores (stores specializing in ENDS).

Published: Not yet (as of 13 February 2015)

Positive: Yes

Publication link: http://onlinelibrary.wiley.com/doi/10.1111/add.12878/abstract

doi: 10.1111/add.12878

Authors:

Alayna P. Tackett
William V. Lechner
Ellen Meier
DeMond M. Grant
Leslie M. Driskill
Noor N. Tahirkheli2
Theodore L. Wagener


Summary

Design, Setting, Participants

A cross-sectional survey of 215 adult vapor store customers at four retail locations in the Midwestern United States; a subset of participants (n=181) also completed exhaled carbon monoxide (CO) testing to verify smoking status.

Measurements

Outcomes evaluated included ENDS preferences, harm beliefs, use behaviors, smoking history and current biochemically verified smoking status.

Findings

Most customers reported starting ENDS as a means of smoking cessation (86%), using newer generation devices (89%), vaping non-tobacco/non-menthol flavors (72%), and using e-liquid with nicotine strengths of ≤20 mg/ml (72%). There was a high rate of switching (91.4%) to newer generation ENDS among those who started with a first generation product. Exhaled CO readings confirmed that 66% of the tested sample had quit smoking. Among those who continued to smoke, mean cigarettes per day decreased from 22.1 to 7.5 (p <.001). People who reported vaping longer (OR=4.7, 95% CI = 2.0–10.8), using newer generation devices (OR=3.0, 95% CI = 1.0–8.4) and using non-tobacco and non-menthol flavors (OR=2.6, 95% CI = 1.1–6.1) were more likely to have quit smoking.


Conclusions

Among vapor store customers in the US who use electronic nicotine delivery devices to stop smoking, vaping longer, using newer generation devices, and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation. Continuer la lecture de Biochemically verified smoking cessation and vaping beliefs among vape store customers