Archives de catégorie : Arrêt / Cessation

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

Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes

 

  • Little is known about the addictiveness of electronic cigarettes (e-cigarettes).
  • We assessed dependence in daily users of e-cigarettes.
  • We found that e-cigarettes users were less addicted to e-cigarettes than smokers were addicted to tobacco cigarettes and nicotine gum users to the nicotine gum.

Published: 18 December 2014

Positive: Yes

Link to publication: http://www.drugandalcoholdependence.com/article/S0376-8716%2814%2901986-3/abstract#.VND5EhP-1Qw.twitter

DOI: http://dx.doi.org/10.1016/j.drugalcdep.2014.12.007

Authors

Jean-François Etter
Thomas Eissenberg


Summary

Objective

To assess dependence levels in users of e-cigarettes, and compare them with dependence levels in users of nicotine gums and tobacco cigarettes.

Design

Self-reports from cross-sectional Internet and mail surveys. Comparisons of: (a) 766 daily users of nicotine-containing e-cigarettes with 30 daily users of nicotine-free e-cigarettes; (b) 911 former smokers who used the e-cigarette daily with 451 former smokers who used the nicotine gum daily (but no e-cigarette); (c) 125 daily e-cigarette users who smoked daily (dual users) with two samples of daily smokers who did not use e-cigarettes (2206 enrolled on the Internet and 292 enrolled by mail from the general population of Geneva). We used the Fagerström test for nicotine dependence, the nicotine dependence syndrome scale, the cigarette dependence scale and versions of these scales adapted for e-cigarettes and nicotine gums.

Results

Dependence ratings were slightly higher in users of nicotine-containing e-cigarettes than in users of nicotine-free e-cigarettes. In former smokers, long-term (>3 months) users of e-cigarettes were less dependent on e-cigarettes than long-term users of the nicotine gum were dependent on the gum. There were few differences in dependence ratings between short-term (≤3 months) users of gums or e-cigarettes. Dependence on e-cigarettes was generally lower in dual users than dependence on tobacco cigarettes in the two other samples of daily smokers.


Conclusions

Some e-cigarette users were dependent on nicotine-containing e-cigarettes, but these products were less addictive than tobacco cigarettes. E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive.

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Factors associated with dual use of tobacco and electronic cigarettes: a case control study

The most important factor for dual use is risk perception. Thus, the fear-mongering about vaping pushes users to dual use, and ultimately kills.

Published: 19 January 2015

Positive: Neutral

Link to publication: http://www.ijdp.org/article/S0955-3959%2815%2900009-2/abstract

Press Release: http://www.ecigarette-research.com/web/index.php/research/2015/194-dual

Authors

Konstantinos E. Farsalinos
Giorgio Romagna
Vassilis Voudris


Summary

Highlights

  • A case control study of 7060 electronic cigarette users was performed.
  • Factors associated with dual use of electronic and tobacco cigarettes were assessed.
  • Risk perception was the strongest independent predictor of dual use.
  • Occasional use and use of old-generation devices were also associated with dual use.
  • Proper information about electronic cigarette risks is important to avoid dual use.

Abstract

Background

Many electronic cigarette (EC) users reduce cigarette consumption without completely quitting. It is important to assess the characteristics and experiences of these users, commonly called “dual users”, in comparison with EC users who have completely substituted smoking (non-smoking vapers)

Methods

A questionnaire was uploaded in an online survey tool. EC users were invited to participate irrespective of their current smoking status. Dual users were matched for age and gender with non-smoking vapers

Results

From 19,441 participants, 3682 were dual users. After random 1:1 matching with non-smoking vapers (all of whom were former smokers), 3530 participants in each group were compared. Dual users had longer smoking history, lower daily cigarette consumption and similar cigarette dependence compared to non-smoking vapers. Their daily consumption was reduced after initiation of EC use from 20 to 4 cigarettes per day. Most of them were using ECs daily, however, more were occasional EC users compared to non-smoking vapers. Use of advanced (third generation) devices and daily liquid consumption was lower in dual users compared to non-smoking vapers. The most important reason for initiating EC use was to reduce smoking and exposure of family members to smoke for both groups, but higher scores were given to “avoid smoking ban in public places” by dual users compared to non-smoking vapers. The strongest predictors of being dual user from multivariate analysis were: higher risk perception for ECs (OR = 2.27, 95%CI = 1.40-3.68), use of first-generation EC devices (OR = 1.98, 95%CI = 1.47-2.66), use of prefilled cartomizers (OR = 1.94, 95%CI = 1.23-3.06) and occasional use of ECs (OR = 1.62, 95%CI = 1.21-2.17)


Conclusions

The results of this case-control study indicate that higher risk perceptions about, and less frequent use of, ECs was associated with dual use of ECs and tobacco cigarettes. Since this is a cross-sectional survey, which explores association but not causation, longitudinal studies are warranted to further explore the reasons for dual use.

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

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.

Published: 2014

Positive: Yes

Link to publication: http://circ.ahajournals.org/content/130/Suppl_2/A14945.short

Authors:

Muhammad A Rahman
Nicholas R Hann
Andrew M Wilson
George Mnatzaganian
Linda Worrall-Carter


Summary

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, (I2=93%, p<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.

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Tobacco Use Among Middle and High School Students — United States, 2013

Tobacco use is the leading preventable cause of disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). Among U.S. youths, cigarette smoking has declined in recent years; however, the use of some other tobacco products has increased (3), and nearly half of tobacco users use two or more tobacco products (4)

Published: 14 November 2014

Positive: No

Link to publication: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6345a2.htm?s_cid=mm6345a2_w

Analysis by « The end of the story »: http://tobaccoanalysis.blogspot.com.es/2014/11/new-cdc-study-reveals-that-youth.html

Authors

René A. Arrazola, MPH
Linda J. Neff, PhD
Sara M. Kennedy, MPH
Enver Holder-Hayes, MPH
Christopher D. Jones, PhD


Summary

Tobacco use is the leading preventable cause of disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). Among U.S. youths, cigarette smoking has declined in recent years; however, the use of some other tobacco products has increased (3), and nearly half of tobacco users use two or more tobacco products (4). CDC analyzed data from the 2013 National Youth Tobacco Survey* to determine the prevalence of ever (at least once) and current (at least 1 day in the past 30 days) use of one or more of 10 tobacco products (cigarettes, cigars, hookahs, smokeless tobacco, electronic cigarettes [e-cigarettes], pipes, snus, bidis, kreteks, and dissolvable tobacco) among U.S. middle school (grades 6–8) and high school (grades 9–12) students. In 2013, 22.9% of high school students reported current use of any tobacco product, and 12.6% reported current use of two or more tobacco products; current use of combustible products (i.e., cigarettes, cigars, pipes, bidis, kreteks, and/or hookahs) was substantially greater (20.7%) than use of other types of tobacco. Also, 46.0% of high school students reported having ever tried a tobacco product, and 31.4% reported ever trying two or more tobacco products. Among middle school students, 3.1% reported current use of cigars, and 2.9% reported current use of cigarettes, with non-Hispanic black students more than twice as likely to report current use of cigars than cigarettes. Monitoring the prevalence of the use of all available tobacco products, including new and emerging products, is critical to support effective population-based interventions to prevent and reduce tobacco use among youths as part of comprehensive tobacco prevention and control programs.

The National Youth Tobacco Survey is a cross-sectional, school-based, self-administered, pencil-and-paper questionnaire administered to U.S. middle school (grades 6–8) and high school (grades 9–12) students. Information is collected on tobacco control outcome indicators to monitor the impact of comprehensive tobacco control policies and programs (5) and regulatory authorities of the Food and Drug Administration (FDA) (6). A three-stage cluster sampling procedure was used to generate a nationally representative sample of students in grades 6–12. Of 250 schools selected for the 2013 National Youth Tobacco Survey, 187 (74.8%) participated, with a sample of 18,406 (90.7%) among 20,301 eligible students; the overall response rate was 67.8%. Participants were asked about ever and current use of cigarettes, cigars (defined as cigars, cigarillos, or little cigars), smokeless tobacco (defined as chewing tobacco, snuff, or dip), pipes, bidis, kreteks, hookah, snus, dissolvable tobacco, and e-cigarettes. Ever use was defined as ever trying a product, and current use was defined as using a product on 1 or more days during the past 30 days. For both ever use and current use, any tobacco use was defined as reporting the use of one or more tobacco products; use of two or more tobacco products was defined as reporting the use of two or more tobacco products in the specified time, current (in the past 30 days) or ever. Combustible tobacco was defined as cigarettes, cigars, pipes, bidis, kreteks, and/or hookahs. Noncombustible tobacco was defined as smokeless tobacco, snus, and/or dissolvable tobacco. A separate category was created for e-cigarette use. Data were adjusted for nonresponse and weighted to provide national prevalence estimates with 95% confidence intervals; statistically significant (p<0.05) differences between population subgroups were assessed using a t-test. Estimates for ever and current use are presented for each type of product, for any tobacco use, and for the use of two or more tobacco products by selected demographics for each school level (middle and high).

In 2013, 22.9% of high school students reported current use of a tobacco product, including 12.6% who reported current use of two or more tobacco products. Among all high school students, cigarettes (12.7%) and cigars (11.9%) were the most commonly reported tobacco products currently used, followed by smokeless tobacco (5.7%), hookahs (5.2%), e-cigarettes (4.5%), pipes (4.1%), snus (1.8%), kreteks (0.8%), bidis (0.6%), and dissolvable tobacco (0.4%) (Table 1). Among high school students who identified as non-Hispanic white or Hispanic, cigarettes were the product most commonly used, whereas cigar use was more common for all other race/ethnicities. Cigar use among non-Hispanic black students was nearly 50% higher than cigarette use. Younger children are less likely to try tobacco than older children with the proportions of current any tobacco users and current users of two or more tobacco products being lower among middle school students (6.5% and 2.9%, respectively) than high school students (22.9% and 12.6%, respectively). Cigars (3.1%) and cigarettes (2.9%) were the most commonly reported tobacco products currently used by middle school students, followed by pipes (1.9%); smokeless tobacco (1.4%); e-cigarettes and hookahs (1.1%); and bidis, kreteks, and snus (0.4%). The proportions of ever users of any tobacco product and ever users of two or more tobacco products were higher among high school (46.0% and 31.4%, respectively) than middle school (17.7% and 9.4%, respectively) students (Table 2).

Combustible tobacco products were the most commonly used form of tobacco among both current and ever tobacco users (Figure). Among high school students, 20.7% currently used combustible products (13.5% combustible only; 3.4% combustible and noncombustible only; 2.7% combustible and e-cigarettes only; and 1.1% combustible, noncombustible, and e-cigarettes). Of all middle school students, 5.4% currently used combustible products (4.0% combustible only; 0.8% combustible and noncombustible only; 0.4% combustible and e-cigarettes only; and 0.2% combustible, noncombustible, and e-cigarettes). Current use of only e-cigarettes was 0.6% among high school students and 0.4% among middle school students.


Discussion

In 2013, more than one in five high school students (22.9%) and more than one in 20 middle school students (6.5%) reported using a tobacco product on 1 or more days during the past 30 days. In addition, nearly half of high school students (46.0%) and almost one in five of middle school students (17.7%) had ever used tobacco. These findings indicate that continued efforts are needed to monitor and prevent the use of all forms of tobacco use among youths.

Combustible tobacco use remains the most common type of tobacco use and causes most tobacco-related disease and death in the United States (1). Nine out of 10 high school current and ever tobacco users used a combustible tobacco product (Figure). There was lower use of only noncombustible tobacco products or only e-cigarettes among both current and ever tobacco users. However, noncombustible products also pose health risks (7). Smokeless tobacco is not a safe alternative to combustible tobacco because it causes cancer and nicotine addiction (7). In addition, although the long-term impact of e-cigarette use on public health overall remains uncertain, the 2014 Surgeon General’s report found that nicotine use can have adverse effects on adolescent brain development; therefore, nicotine use by youths in any form (whether combustible, smokeless, or electronic) is unsafe (1).

Most youths who currently use tobacco believe that they will be able to stop using tobacco in the near future; unfortunately, however, many continue use well into adulthood (2). Youths who report use of multiple tobacco products are at higher risk for developing nicotine dependence; about two thirds (62.9%) of youths who use more than one tobacco product report tobacco dependence symptoms, compared with 36.0% of those who use one tobacco product (8). Thus, youths who use multiple tobacco products might be more likely to continue using tobacco into adulthood. Comprehensive youth tobacco prevention programs that prevent initiation of all types of tobacco products are critical to protect youths from tobacco use and nicotine dependence.

The findings in this report are subject to at least five limitations. First, data were only collected from youths who attended either public or private schools and might not be generalizable to all middle and high school-aged youths. Second, data were self-reported; thus, the findings are subject to recall and/or response bias. Third, current and ever tobacco use were estimated by including students who responded to using at least one of the 10 tobacco products included in the survey but might have had missing responses to any of the other nine tobacco products; missing responses were considered as nonuse, which might have resulted in conservative estimates. Fourth, nonresponse bias might have affected the results because the survey response rate was only 67.8%. Finally, estimates might differ from those derived from other nationally representative youth surveillance systems, in part because of differences in survey methods, survey type and topic, and age and setting of the target population. However, overall prevalence estimates are similar across the various youth surveys (2).

Although substantial progress has been made in decreasing cigarette use among youths (2), overall tobacco use is still high, with one in five high school students currently using tobacco and nearly half reporting they have ever used a tobacco product. Ever using a tobacco product is a concern because even one-time use of tobacco is associated with increased long-term risks for becoming a regular user (2). In April 2014, FDA issued a proposed rule to extend its jurisdiction over the manufacture, marketing, and distribution of tobacco products not currently regulated by FDA, which includes cigars, e-cigarettes, pipes, and hookahs (9). FDA is reviewing the comments received on this proposed rule. Full implementation of comprehensive tobacco control programs at CDC-recommended funding levels would be expected to result in further reductions in tobacco use and changes in social norms regarding the acceptability of tobacco use among U.S. youths (1,2,10). Additionally, considering how trends in tobacco product use and tobacco marketing changes, rigorous surveillance of all available forms of tobacco use by youths, particularly emerging products such as e-cigarettes, is essential. Rigorous surveillance of the use of all types of tobacco will inform enhanced prevention efforts that could protect the estimated 5.6 million youths in the United States currently projected to die prematurely from a smoking-related disease (1).

1Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Department of Biostatistics and Epidemiology, RTI International; 3Center for Tobacco Products, Food and Drug Administration (Corresponding contributor: René A. Arrazola, rarrazola@cdc.gov, 770-488-2414)

 

 

 

 

 

Trends in Electronic Cigarette Use Among U.S. Adults: Use is Increasing in Both Smokers and Nonsmokers

We assessed trends in use of electronic cigarettes among U.S. adults, demographic predictors of use, and smoking status of current electronic cigarette users.

Published: 22 September 2014

Positive: No

Link to publication: http://ntr.oxfordjournals.org/content/early/2014/11/06/ntr.ntu213.abstract

Authors

Robert C. McMillen, PhD
Mark A. Gottlieb, JD
Regina M. Whitmore Shaefer, MPH
Jonathan P. Winickoff, MD, MPH
Jonathan D. Klein, MD, MPH


Summary

Methods: Mixed-mode surveys were used to obtain representative, cross-sectional samples of U.S. adults in each of 4 years.

Results: Sample sizes for 2010, 2011, 2012, and 2013 were 3,240, 3,097, 3,101, and 3,245, respectively. Ever use of electronic cigarettes increased from 1.8% (2010) to 13.0% (2013), while current use increased from 0.3% to 6.8%, p < .001. Prevalence of use increased significantly across all demographic groups. In 2013, current use among young adults 18–24 (14.2%) was higher than adults 25–44 (8.6%), 45–64 (5.5%), and 65+ (1.2%). Daily smokers (30.3%) and nondaily smokers (34.1%) were the most likely to currently use e-cigarettes, compared to former smokers (5.4%) and never-smokers (1.4%), p < .001. However, 32.5% of current electronic cigarette users are never- or former smokers.


Conclusions

There has been rapid growth in ever and current electronic cigarette use over the past 4 years. Use is highest among young adults and current cigarette smokers. Although smokers are most likely to use these products, almost a third of current users are nonsmokers, suggesting that e-cigarettes contribute to primary nicotine addiction and to renormalization of tobacco use. Regulatory action is needed at the federal, state, and local levels to ensure that these products do not contribute to preventable chronic disease.


 

Notes

The « nonsmokers » in the sentence « almost a third of current users are nonsmokers, suggesting that e-cigarettes contribute to primary nicotine addiction and to renormalization of tobacco use » considers ex-smokers, who stopped smoking by using vape, as non-smokers. Never smokers using vape is 1.4%. The rest thus is composed of ex-smokers.

This means that the conclusion is completely biased.

 

 

 

 

 

 

 

 

 

 

 

 

Success rates with nicotine personal vaporizers: a prospective 6-month pilot study of smokers not intending to quit

Success rates with nicotine personal vaporizers: a prospective 6-month pilot study of smokers not intending to quit

The objective is to examine e-cigarette use and conventional cigarette smoking.

Published: November 2014

Positive: Yes

Link to article:

http://www.biomedcentral.com/1471-2458/14/1159/abstract

Authors

Riccardo Polosa,

Pasquale Caponnetto,

Marilena Maglia,

Jaymin B Morjaria,

Cristina Russo

Background

Electronic cigarettes (e-Cigs) are an attractive long-term alternative nicotine source to conventional cigarettes. Although they may assist smokers to remain abstinent during their quit attempt, studies using first generation e-Cigs report low success rates. Second generation devices (personal vaporisers – PVs) may result in much higher quit rates, but their efficacy and safety in smoking cessation and/or reduction in clinical trials is unreported.

Method

We conducted a prospective proof-of-concept study monitoring modifications in smoking behaviour of 50 smokers (unwilling to quit) switched onto PVs. Participants attended five study visits: baseline, week-4, week-8, week-12 and week-24. Number of cigarettes/day (cigs/day) and exhaled carbon monoxide (eCO) levels were noted at each visit. Smoking reduction/abstinence rates, product usage, adverse events and subjective opinions of these products were also reviewed.

Results

Sustained 50% and 80% reduction in cigs/day at week-24 was reported in 15/50 (30%) and 7/50 (14%) participants with a reduction from 25cigs/day to 6cigs/day (p < 0.001) and 3cigs/day (p < 0.001), respectively. Smoking abstinence (self-reported abstinence from cigarette smoking verified by an eCO <=10 ppm) at week-24 was observed in 18/50 (36%) participants, with 15/18 (83.3%) still using their PVs at the end of the study. Combined 50% reduction and smoking abstinence was shown in 33/50 (66%) participants. Throat/mouth irritation (35.6%), dry throat/mouth (28.9%), headache (26.7%) and dry cough (22.2%) were frequently reported early in the study, but waned substantially by week-24. Participants’ perception and acceptance of the products was very good.


Conclusion

The use of second generation PVs substantially decreased cigarette consumption without causing significant adverse effects in smokers not intending to quit..

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Physicians’ Attitudes and Use of E-Cigarettes as Cessation Devices, North Carolina, 2013

Electronic cigarettes (e-cigarettes) are not currently approved or recommended by the Food and Drug Administration (FDA) or various medical organizations; yet, they appear to play a substantial role in tobacco users’ cessation attempts. This study reports on a physician survey that measured beliefs, attitudes, and behavior related to e-cigarettes and smoking cessation. To our knowledge this is the first study to measure attitudes toward e-cigarettes among physicians treating adult smokers.

Published: 29 July 2014

Positive:  Yes

Link to publication: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0103462

Authors

Kelly L. Kandra
Leah M. Ranney
Joseph G. L. Lee
Adam O. Goldstein


Summary

Methods

Using a direct marketing company, a random sample of 787 North Carolina physicians were contacted in 2013 through email, with 413 opening the email and 128 responding (response rate = 31%). Physicians’ attitudes towards e-cigarettes were measured through a series of close-ended questions. Recommending e-cigarettes to patients served as the outcome variable for a logistic regression analysis.

Results

Two thirds (67%) of the surveyed physicians indicated e-cigarettes are a helpful aid for smoking cessation, and 35% recommended them to their patients. Physicians were more likely to recommend e-cigarettes when their patients asked about them or when the physician believed e-cigarettes were safer than smoking standard cigarettes.


Conclusion

Many North Carolina physicians are having conversations about e-cigarettes with their patients, and some are recommending them. Future FDA regulation of e-cigarettes may help provide evidence-based guidance to physicians about e-cigarettes and will help ensure that patients receive evidence-based recommendations about the safety and efficacy of e-cigarettes in tobacco cessation.

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Reasons for Starting and Stopping Electronic Cigarette Use

The aim of our study was to explore reasons for starting and then stopping electronic cigarette (e-cigarette) use.

Published: 3 October 2014

Positive: N/A

Link to publication: http://www.mdpi.com/1660-4601/11/10/10345

Authors

Jessica K. Pepper
Kurt M. Ribisl
Sherry L. Emery
Noel T. Brewer


Summary

Among a national sample of 3878 U.S. adults who reported ever trying e-cigarettes, the most common reasons for trying were curiosity (53%); because a friend or family member used, gave, or offered e-cigarettes (34%); and quitting or reducing smoking (30%). Nearly two-thirds (65%) of people who started using e-cigarettes later stopped using them. Discontinuation was more common among those whose main reason for trying was not goal-oriented (e.g., curiosity) than goal-oriented (e.g., quitting smoking) (81% vs. 45%, p < 0.001). The most common reasons for stopping e-cigarette use were that respondents were just experimenting (49%), using e-cigarettes did not feel like smoking cigarettes (15%), and users did not like the taste (14%).

Conclusion

Our results suggest there are two categories of e-cigarette users: those who try for goal-oriented reasons and typically continue using and those who try for non-goal-oriented reasons and then typically stop using. Research should distinguish e-cigarette experimenters from motivated users whose decisions to discontinue relate to the utility or experience of use. Depending on whether e-cigarettes prove to be effective smoking cessation tools or whether they deter cessation, public health programs may need distinct strategies to reach and influence different types of users.

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Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices

A wide range of electronic cigarette (EC) devices, from small cigarette-like (first-generation) to new-generation high-capacity batteries with electronic circuits that provide high energy to a refillable atomizer, are available for smokers to substitute smoking. Nicotine delivery to the bloodstream is important in determining the addictiveness of ECs, but also their efficacy as smoking substitutes. In this study, plasma nicotine levels were measured in experienced users using a first- vs. new-generation EC device for 1 hour with an 18 mg/ml nicotine-containing liquid. Plasma nicotine levels were higher by 35–72% when using the new- compared to the first-generation device. Compared to smoking one tobacco cigarette, the EC devices and liquid used in this study delivered one-third to one-fourth the amount of nicotine after 5 minutes of use. New-generation EC devices were more efficient in nicotine delivery, but still delivered nicotine much slower compared to tobacco cigarettes. The use of 18 mg/ml nicotine-concentration liquid probably compromises ECs’ effectiveness as smoking substitutes; this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes.

Published: 26 February 2014

Positive: Yes

Link to publication:

Authors

  • Konstantinos E. Farsalinos,
  • Alketa Spyrou,
  • Kalliroi Tsimopoulou,
  • Christos Stefopoulos,
  • Giorgio Romagna
  • Vassilis Voudris

Summary

Electronic cigarettes (ECs) have been introduced to the market in recent years as alternatives to smoking. They are considered part of tobacco harm reduction, a strategy of reducing adverse health effects by providing low-risk nicotine products to substitute smoking1. They deal with both the psycho-behavioral (through motor simulation and sensory stimulation) and the chemical (through delivery of nicotine) aspects of smoking addiction2. ECs mainly consist of a lithium battery and a part called atomizer, where the liquid is stored and evaporated by applying electrical current to a resistance and wick setup. There is a substantial variability of devices; small devices, looking similar to tobacco cigarettes (commonly referred as first-generation), consist of a low-capacity batteries and polyfil-filled atomizers, while new-generation devices consist of larger-capacity batteries, larger atomizers and electronic circuits providing the ability to set the power delivery to the atomizer.

The growing popularity of ECs3, 4 has raised significant controversy in public health authorities. Organizations such as the World Health Organization and Food and Drug Administration have expressed concerns about the safety of e-cigarettes and the effects of nicotine intake. Recently, European Union has developed a new regulation which implements an upper limit of 20 mg/ml nicotine concentration in liquids that are used with ECs5. The decision was based on a study from our group, in which nicotine consumption and delivery to the user was evaluated6, 7. However, the route, speed and amount of nicotine absorption (and subsequent nicotine levels in plasma) are important determinants of the efficacy of ECs to serve as smoking substitutes and of any concerns about nicotine overdose or intoxication. Data on nicotine absorption are scarce. Initially, EC use (commonly called vaping) was found to deliver minimal amounts of nicotine to the user as measured by plasma nicotine levels8, 9. However, there has been a fast evolution of new, more efficient devices, and devices used at the time of those experiments are currently outdated and off the market. Surveys have shown that new-generation devices are more popular in dedicated EC users and a significant proportion of these users report complete smoking cessation10, 11. However, no study has evaluated nicotine absorption from such devices. Therefore, the purpose of this study was to compare the nicotine absorption from a first- vs. a new-generation device in experienced vapers.

Results

The use of 18 mg/ml nicotine-concentration liquid probably compromises ECs’ effectiveness as smoking substitutes; this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes.

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A Longitudinal Study of Electronic Cigarette Use in a Population-based Sample of Adult Smokers: Association with Smoking Cessation and Motivation to Quit

Increasingly popular electronic cigarettes (e-cigarettes) may be the most promising development yet to end cigarette smoking. However, there is sparse evidence that their use promotes cessation. We investigated whether e-cigarette use increases smoking cessation and/or has a deleterious effect on quitting smoking and motivation to quit.

Published: 3 June 2014

Positive: Yes

Link to publication: http://ntr.oxfordjournals.org/content/early/2014/10/07/ntr.ntu200.abstract.html

Authors

Lois Biener, Ph.D.
J. Lee Hargraves, Ph.D


Summary

Aims: Increasingly popular electronic cigarettes (e-cigarettes) may be the most promising development yet to end cigarette smoking. However, there is sparse evidence that their use promotes cessation. We investigated whether e-cigarette use increases smoking cessation and/or has a deleterious effect on quitting smoking and motivation to quit.

Methods: Representative samples of adults in two U.S. metropolitan areas were surveyed in 2011/2012 about their use of novel tobacco products. In 2014, follow-up interviews were conducted with 695 of the 1374 baseline cigarette smokers who had agreed to be re-contacted (retention rate: 51%). The follow-up interview assessed their smoking status and history of electronic cigarette usage. Respondents were categorized as intensive users (used e-cigarettes daily for at least one month), intermittent users (used regularly, but not daily for more than one month), and non-users/triers (used ecigarettes at most once or twice).


Conclusions

Results: At follow-up, 23% were intensive users, 29% intermittent users, 18% had used once or twice, and 30% hadn’t tried e-cigarettes. Logistic regression controlling for demographics and tobacco dependence indicated that intensive users of e-cigarettes were 6 times as likely as non-users/triers to report that they quit smoking (O.R. 6.07, 95% C.I. 1.11, 33.2). No such relationship was seen for intermittent users. There was a negative association between intermittent e-cigarette use and one of two indicators of motivation to quit at follow-up.

Conclusions: Daily use of electronic cigarettes for at least one month is strongly associated with quitting smoking at follow up. Further investigation of the underlying reasons for intensive versus intermittent use will help shed light on the mechanisms underlying the associations between e-cigarette use, motivation to quit and smoking cessation.

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