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E-cigarette use unlikely to help smoking cessation
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.
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.