March 26, 2018
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E-cigarette use unlikely to help smoking cessation

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Abstinence from tobacco was less likely in cigarette smokers who used e-cigarettes after being discharged from the hospital, according to findings published in Annals of Internal Medicine.

“Many smokers report using e-cigarettes to help them quit smoking, but whether e-cigarettes aid cessation efforts is uncertain,” Nancy A. Rigotti, MD, from Massachusetts General Hospital and Harvard Medical School, and colleagues wrote.

Using secondary data from a randomized controlled trial, Rigotti and colleagues examined the effects of e-cigarette use after hospital discharge on tobacco use. The researchers enrolled 1,357 hospitalized adult cigarette smokers who planned to quit smoking and were advised to use evidence-based tobacco cessation treatments.

At discharge, participants were randomized to receive standard care (control) or sustained care (intervention). Those in the standard care group were encouraged to call a free telephone quitline and received a recommendation for an individualized cessation medication. Those in the sustained care group received a free 30-day supply of an FDA-approved cessation medication that they chose and five automated phone calls that urged participants to remain abstinent or attempt quitting again.

Abstinence from tobacco was less likely in cigarette smokers who used e-cigarettes after being discharged from the hospital.
Photo credit: Shutterstock

Participants reported their e-cigarette use at 1 and 3 months after discharge. The researchers assessed who quit smoking regular cigarettes via biochemically validated lab tests 6 months after discharge.

Data indicated that e-cigarettes were used by 28% of participants within 3 months after discharge. When the researchers analyzed 237 propensity score–matched pairs, they found that abstaining from tobacco use at 6 months was less likely among e-cigarette users than nonusers (10.1% vs. 26.6%; risk difference = –16.5%; 95% CI, –23.3 to –9.6).

There were variations in the association between e-cigarette use and quitting among participants in both the standard care group and the sustained care group.

Participants in the sustained care group who reported using e-cigarettes at any time during the 3 months after hospital discharge had a lower likelihood of achieving biochemically confirmed tobacco abstinence at 6 months (7.7% vs. 29.8%; risk difference = –22.1%; 95% CI, –32.3 to –11.9). Similarly, participants in the standard care group who reported using e-cigarettes at any time during the 3 months after hospital discharge also had a lower likelihood of achieving biochemically confirmed tobacco abstinence at 6 months (12% vs. 24.1%; risk difference = –12%; 95% CI, –21.2 to 2.9).

“Study participants who used e-cigarettes generally used them infrequently and not every day, a pattern that may not be an effective way to use them for quitting smoking,” Rigotti said in a press release. “It does not prove that e-cigarettes could not be of benefit if a smoker switches completely from tobacco cigarettes and uses them regularly, in the same way that FDA-approved nicotine replacement products are intended to be used.”

The findings suggest that randomized, controlled trials are imperative to determine whether e-cigarettes can aid in smoking cessation, but regulatory challenges in the United States make this difficult, according to Rigotti.

“In the meantime, I would tell smokers who want to quit or cut down to use one of the FDA-approved smoking cessation medications, which are known to be safe and effective, as a first choice,” she said. “If they do choose to try e-cigarettes, they should switch completely from tobacco cigarettes and use e-cigarettes daily, something the American Cancer Society has recently recommended.” – by Alaina Tedesco

Disclosure: Rigotti reports receiving a grant and nonfinancial support from Pfizer and personal fees from UpToDate.