Myth: Alternative nicotine products don't help people stop smoking

Myth: Alternative nicotine products don't help people stop smoking

There are claims that e-cigarettes, snus, and heated tobacco products don't help people stop smoking. The data dispels that myth, as many studies have shown that people are using these products to successfully quit smoking.

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INNCO: Myth of the month: Ecigs and snus don’t help smokers quit

• Each statement on this doc complies with the character limits on twitter. Feel free to copy/paste them into tweets.

Studies

2021: “It is the One Thing that has Worked”: facilitators and barriers to switching to nicotine salt pod system e-cigarettes among African American and Latinx people who smoke: a content analysis

• The majority said they would continue using JUUL to replace cigarettes (83% African American; 94% Latinx) and that JUUL worked better than other methods to reduce cigarettes (72%).
• PDF Version
• Citation: Pulvers K, Rice M, Ahluwalia JS, Arnold MJ, Marez C, Nollen NL. "It is the One Thing that has Worked": facilitators and barriers to switching to nicotine salt pod system e-cigarettes among African American and Latinx people who smoke: a content analysis. Harm Reduct J. 2021;18(1):98. Published 2021 Sep 16. doi:10.1186/s12954-021-00543-y
• Acknowledgement: This work was supported by the National Institutes of Health [5SC3GM122628]. KP, MR, and NLN were supported in part by 5SC3GM122628. JSA was funded in part by P20GM130414, a NIH funded Center of Biomedical Research Excellence (COBRE).

2021: Electronic cigarettes for smoking cessation

• Cochrane review of 56 peer-reviewed studies, 12,804 participants (Cochrane is the global gold standard for evidence reviews). “There is moderate‐certainty evidence that e-cigarettes increase quit rates compared to [nicotine patches & gum].”
• Citation: Hartmann-Boyce J, McRobbie H, Butler AR, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2021, Issue 4. Art. No.: CD010216. DOI:10.1002/14651858.CD010216.pub5. Accessed 28 July 2021.

2021: A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes

• A high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking.
• PDF Version
• Citation: Pasquale Caponnetto, PhD, Jennifer DiPiazza, PhD, Jason Kim, MD, Marilena Maglia, Lyc Psych, Riccardo Polosa, MD, PhD, A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes, Nicotine & Tobacco Research, Volume 23, Issue 7, July 2021, Pages 1113–1122, doi:10.1093/ntr/ntab005
• Acknowledgement: The authors wish also to thank PAX Labs (on June 13, 2017 the company became known as JUUL Labs) for the free supplies of JUUL e-cigarette kits and pods. At the time the research was conducted JUUL Labs were not part owned by Altria, a tobacco company. PAX Labs agreed also to supply pods for a further 3 months after the end of the pilot to participants who expressed a wish to continue using as JUUL was not available in Italy when this study has been conducted and not currently available at the 5% nicotine strength.

2021: Electronic cigarettes for smoking cessation

• There is moderate‐certainty evidence that ECs with nicotine increase quit rates compared to ECs without nicotine and compared to NRT.
• Citation: Hartmann-Boyce J, McRobbie H, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Butler AR, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2021 Apr 29;4(4):CD010216. doi: 10.1002/14651858.CD010216.pub5. PMID: 33913154; PMCID: PMC8092424.

2021: E-cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult: Randomised controlled trial

• Participants previously unable to stop smoking with conventional treatments.
• Validated smoking reduction (including cessation) was achieved by 26.5% vs 6.0% of participants in the EC and NRT study arms, respectively. Sustained validated abstinence rates at 6 months were 19.1% vs 3.0%.
• PDF Version
• Citation: Myers Smith, K., Phillips-Waller, A., Pesola, F., McRobbie, H., Przulj, D., Orzol, M., and Hajek, P. (2021) E-cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult: Randomised controlled trial. Addiction, doi.org/10.1111/add.15628
• Acknowledgements: The study was funded by a Tobacco Advisory Group project grant, Cancer Research UK (C6815/A20503).

2021: A systematic review of randomized controlled trials and network meta-analysis of e-cigarettes for smoking cessation

• Smokers assigned to use nicotine e-cigarettes were more likely to remain abstinent from smoking than those assigned to use licensed NRT, and both were more effective than usual care or placebo conditions.
• Citation: Chan GCK, Stjepanović D, Lim C, Sun T, Shanmuga Anandan A, Connor JP, Gartner C, Hall WD, Leung J. A systematic review of randomized controlled trials and network meta-analysis of e-cigarettes for smoking cessation. Addict Behav. 2021 Aug;119:106912. doi: 10.1016/j.addbeh.2021.106912. Epub 2021 Mar 15. PMID: 33798919.

2021: Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids

• One third of the total sample was biochemically verified smoking abstinent 7 months after quit date, with e-cigarette users (40%) having significantly higher chances to be smoking abstinent than NRT users (23%).
• PDF Version
• Citation: Adriaens, K., Belmans, E., Van Gucht, D. et al. Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids. Harm Reduct J 18, 28 (2021). https://doi.org/10.1186/s12954-021-00475-7
• Acknowledgement: This research received no external funding. EB is supported by a PhD-fellowship of the Research Foundation – Flanders (FWO-Vlaanderen; 1177820N).

2021: Use of e-cigarettes (vapes) among adults in Great Britain

• Nearly two thirds of current vapers are ex-smokers (64.6%), and the proportion continues to grow, while the proportion who also smoke (known as dual users) has fallen to 30.5% in 2021.
• Fewer than 1% of never smokers are current vapers (amounting to 4.9% of vapers).
• As in previous years the main reason given by ex-smokers for vaping is to help them quit (36%) then to prevent relapse (20%).
• The main reason given by current smokers for vaping is to cut down (26%) then to help them quit (17%) and to prevent relapse (14%).
• Nearly a third of smokers incorrectly believe vaping is more or equally as harmful as smoking (32% compared to 34% in 2020).
• Citation: Action on Smoking and Health (ASH). Use of e-cigarettes (vapes) among adults in Great Britain. 2021

2021: Predictors of smoking reduction among african american and latinx smokers in a randomized controlled trial of JUUL e-cigarettes

• Minority smokers decreased cigarette consumption in a trial of e-cigarettes.
• Smoking reduction was associated with a higher number of JUUL pods used.
• Lower baseline cigarette dependence predicted greater smoking reduction.
• Lower baseline cotinine predicted greater smoking reduction.
• Citation: Dana Rubenstein, Alexander W. Sokolovsky, Elizabeth R. Aston, Nicole L. Nollen, Christopher H. Schmid, Myra Rice, Kim Pulvers, Jasjit S. Ahluwalia, Predictors of smoking reduction among african american and latinx smokers in a randomized controlled trial of JUUL e-cigarettes, Addictive Behaviors, 2021, 107037, ISSN 0306-4603, doi: 10.1016/j.addbeh.2021.107037

2021: Patterns of E-Cigarette Use Among Primary Care Patients at an Urban Community Center

• Among primary care patients at a community health center, e-cigarette use was reported by a sizeable portion of the sample. Overall, odds of use were higher in certain patient populations, and individuals who formally used cigarettes were more likely to report e-cigarette use than individuals who currently smoke, suggesting that e-cigarettes may be functioning as a cessation aid or a strategy to reduce conventional cigarette use.
• Citation: O'Cleirigh C, King D, Stanton AM, Goldin A, Kirakosian N, Crane HM, Grasso C. Patterns of E-Cigarette Use Among Primary Care Patients at an Urban Community Center. J Community Health. 2021 Jul 2. doi: 10.1007/s10900-021-01015-x. Epub ahead of print. PMID: 34215994.
• Acknowledgement: The data is owned by a third-party organization (Fenway Health), and the organization’s IRB restricts access to patient data, due to concerns over a risk of inadvertent disclosure of personal health information. Given that the data are abstracted from patients’ primary care medical visits, the preparation of deidentified data is not permitted. Researchers with a reasonable request for a deidentified data set can contact the Fenway Health IRB

2021: Targeted smoking cessation for dual users of combustible and electronic cigarettes: a randomised controlled trial

• A targeted self-help intervention with high potential for dissemination could be efficacious in promoting smoking cessation among dual users of combustible cigarettes and e-cigarettes.
• PDF Version
• Citation: doi: 10.1016/S2468-2667(20)30307-8
• Acknowledgement: This work was supported by the National Institute on Drug Abuse of the NIH (R01DA037961). his work has also been supported in part by the Biostatistics and Bioinformatics Shared Resource and the Participant Research, Interventions, and Measures Resource at the H Lee Moffitt Cancer Center and Research Institute, a National Cancer Institute designated Comprehensive Cancer Center (P30CA76292).

2021: A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes

• An estimated 60%–90% of people with schizophrenia smoke, compared with 15%–24% of the general population, exacerbating the already high morbidity and mortality rates observed in this population.
• Pilot Study - only 40 participants
• Sixteen (40%) participants quit by the end of 12 weeks. For the whole sample, we observed an overall, sustained 50% reduction in smoking or smoking abstinence in 37/40 (92.5%) of participants and an overall 75% reduction in median cigarettes per day from 25 to six was observed by the end of the 12 weeks.
• A high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking. Considering that most people with schizophrenia spectrum disorders continue smoking, alternative and efficient interventions to reduce or prevent morbidity and mortality are urgently needed.
• PDF Version
• Citation: Caponnetto P, DiPiazza J, Kim J, Maglia M, Polosa R. A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes. Nicotine Tob Res. 2021;23(7):1113-1122. doi:10.1093/ntr/ntab005
• Acknowledgement: The authors wish also to thank PAX Labs (on June 13, 2017 the company became known as JUUL Labs) for the free supplies of JUUL e-cigarette kits and pods. At the time the research was conducted JUUL Labs were not part owned by Altria, a tobacco company. PAX Labs agreed also to supply pods for a further 3 months after the end of the pilot to participants who expressed a wish to continue using as JUUL was not available in Italy when this study has been conducted and not currently available at the 5% nicotine strength.

2021: Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study

• The simulation suggests that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current evidence that e-cigarettes offset or divert from smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles can usefully inform policy design.
• PDF Version
• Citation: Selya AS. Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study. Harm Reduct J. 2021;18(1):36. Published 2021 Mar 20. doi:10.1186/s12954-021-00484-6
• Acknowledgement: This work was supported by the National Institute for General Medical Sciences (NIGMS) within the National Institutes of Health (NIH), grant number P20GM121341; by the Norwegian Agency for International Cooperation and Quality Enhancement in Higher Education (DIKU), grant number NNA-2016/10023. After the initial submission of this manuscript, AS became employed by Pinney Associates, Inc. which provides consulting services on tobacco harm minimization to JUUL Labs, Inc. The content presented here precedes this competing interest, and JUUL Labs, Inc. and PinneyAssociates, Inc. had any role in the conceptualization, design, analysis, interpretation, or presentation of data, nor in the decision to publish.

2021: Changes in dependence, withdrawal, and craving among adult smokers who switch to nicotine salt pod-based e-cigarettes

• Smokers who switch to nicotine salt pod system e-cigarettes maintain their nicotine levels and transfer their dependence, suggesting that nicotine salt pod system e-cigarettes have a similar reinforcement potential to cigarettes and facilitate switching.
• Must pay to view whole study / PDF
• Citation: Leavens, E. L. S., Nollen, N. L., Ahluwalia, J. S., Mayo, M. S., Rice, M., Brett, E. I., and Pulvers, K. (2021) Changes in dependence, withdrawal, and craving among adult smokers who switch to nicotine salt pod-based e-cigarettes. Addiction, doi: 10.1111/add.15597.

2021: Reappraising Choice in Addiction: Novel Conceptualizations and Treatments for Tobacco Use Disorder

• Given the advent of novel, alternative tobacco products, Tobacco Use Disorder must be conceptualized within a contemporary framework that includes harm reduction and alternative outcomes.
• PDF Version
• Citation: Amanda M Palmer, PhD, Benjamin A Toll, PhD, Matthew J Carpenter, PhD, Eric C Donny, PhD, Dorothy K Hatsukami, PhD, Alana M Rojewski, PhD, Tracy T Smith, PhD, Mehmet Sofuoglu, MD, PhD, Johannes Thrul, PhD, Neal L Benowitz, MD, On Behalf of the Society for Research on Nicotine & Tobacco Treatment Network, Reappraising Choice in Addiction: Novel Conceptualizations and Treatments for Tobacco Use Disorder, Nicotine & Tobacco Research, 2021;, ntab148, doi: 10.1093/ntr/ntab148
• Acknowledgement: This research was supported by by NIH Institutional Postdoctoral Training Grant NIHT32-HL144470, NIDA grant K01DA047433 (Smith), and NCI grant K07CA214839 (Rojewski), and the Hollings Cancer Center (P30 CA138313).

2021: How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys

• Use of fruit and other sweet flavored e-liquids is positively related to smokers’ transition away from cigarettes.
• Citation: Lin Li, PhD, Ron Borland, PhD, Kenneth Michael Cummings, PhD, Geoffrey T Fong, PhD, Shannon Gravely, PhD, Danielle M Smith, MPH, Maciej L Goniewicz, PhD, Richard J O’Connor, PhD, Mary E Thompson, PhD, Ann McNeill, PhD, How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys, Nicotine & Tobacco Research, Volume 23, Issue 9, September 2021, Pages 1490–1497, doi: 10.1093/ntr/ntab033

2020: QuitNic: A pilot randomised controlled trial comparing nicotine vaping products with nicotine replacement therapy for smoking cessation following residential detoxification

• This pilot study showed that smoking cessation support involving options for nicotine replacement and Quitline-delivered cognitive behavioural counselling is attractive to people after they have been discharged from SUD (Substance Use Disorder) treatment.
• Retention was 63% at 6-weeks and 50% at 12-weeks. At 12-weeks, 68% of the NRT group reported using combination NRT while 96% of the NVP group used the device. Acceptability ratings for the products were high in both groups. At 12-weeks, 14% of the NVP group and 18% of the NRT group reported not smoking at all in the last 7 days. Mean CPD (Cigarettes Per Day) among continued smokers decreased significantly between baseline to 12-weeks in both groups; from 19.91 to 4.72 for the NVP group (p<0.001) and from 20.88 to 5.52 in the NRT group (p<0.001). Cravings and withdrawal symptoms significantly decreased for both groups.
• PDF Version
• Citation: Bonevski, B., Manning, V., Wynne, O., Gartner, C., Borland, R., Baker, A. L., … Lubman, D. I. (2020). QuitNic: A pilot randomised controlled trial comparing nicotine vaping products with nicotine replacement therapy for smoking cessation following residential detoxification. Nicotine & Tobacco Research. doi:10.1093/ntr/ntaa143
• Acknowledgement: This study was supported by a VicHealth Innovation Research Grant (2016-0096).

2020: Effectiveness of Electronic Cigarettes in Smoking Cessation: a Systematic Review and Meta-Analysis

• Our results suggest that nicotine-ECs may be more effective in smoking cessation when compared to placebo ECs or NRT.
• PDF Version
• Citation: Igor Grabovac, MD, DSc, Moritz Oberndorfer, MSc, Jismy Fischer, Winfried Wiesinger, Sandra Haider, PhD, Thomas Ernst Dorner, MD, MPH, Effectiveness of Electronic Cigarettes in Smoking Cessation: A Systematic Review and Meta-analysis, Nicotine & Tobacco Research, Volume 23, Issue 4, April 2021, Pages 625–634, doi: 10.1093/ntr/ntaa181
• Acknowledgement: This study was funded by the Health Insurance Group of Styria (Steiermärkische Gebietskrankenkasse).

2020: Highlights of Studies in Cardiovascular Disease Prevention Presented at the 2020 American College of Cardiology Annual Scientific Session

• In E3, nicotine e-cigarettes plus counseling was superior to counseling alone for smoking cessation. Non-nicotine e-cigarettes plus counseling was also more effective compared with counseling alone though its effects on cessation were modest. This trial demonstrates the efficacy of e-cigarettes as a tool for smoking cessation compared with counseling alone.
• PDF Version
• Citation: Jia X, Al Rifai M, Liu J, Agarwala A, Gulati M, Virani SS. Highlights of Studies in Cardiovascular Disease Prevention Presented at the 2020 American College of Cardiology Annual Scientific Session. Curr Atheroscler Rep. 2020;22(8):32. Published 2020 Jun 18. doi:10.1007/s11883-020-00856-6

2020: A magic bullet? The potential impact of e-cigarettes on the toll of cigarette smoking

• The combination of assumptions produces 360 possible scenarios. 357 (99%) yield positive estimates of life-years saved (LYS) due to vaping by 2100, from 143,000 to 65 million.
• The impact of vaping is greatest when it most helps smokers who otherwise have the greatest difficulty quitting smoking.
• Vaping is highly likely to reduce smoking-produced mortality. Still, vaping is not “the” answer to the public health crisis created by smoking. Rather, it may well be a tool to add to the armamentarium of effective tobacco control measures.
• Harm reduction can, and many would say should, be a part of the complex formula that will eventually bring about the demise of smoking.
• PDF Version
• Citation: Mendez, D., & Warner, K. E. (2020). A magic bullet? The potential impact of e-cigarettes on the toll of cigarette smoking. Nicotine & Tobacco Research. doi:10.1093/ntr/ntaa160
• Acknowledgement: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health (NIH) and FDA Center for Tobacco Products (CTP) (Award Number U54CA229974).

2020: Patterns of e-cigarette use and subsequent cigarette smoking cessation over two years (2013/2014 to 2015/2016) in the Population Assessment of Tobacco and Health (PATH) Study

• Smoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices.
• In this study, the proportion of US adults who incorrectly perceived e-cigarettes as equal to, or more, harmful than cigarettes increased steadily regardless of smoking or vaping status. Current adult smokers appear to be poorly informed about the relative risks of e-cigarettes yet have potentially the most to gain from transitioning to these products. The findings of this study emphasise the urgent need to accurately communicate the reduced relative risk of e-cigarettes compared to continued cigarette smoking and clearly differentiate absolute and relative harms.
• The lack of accurate and consistent messaging from both public health agencies and the media may be contributing to public, and more specifically adult smokers’, perceptions about the relative risk of nicotine when decoupled from combustion and tobacco smoke.
• Confusion may potentially be discouraging adult smokers from using alternative, less hazardous products which may ultimately result in a missed opportunity to positively impact health at both an individual and population level.
• PDF Version
• Citation: Allison M Glasser, MPH, Mahathi Vojjala, MPH, Jennifer Cantrell, DrPH, MPA, David T Levy, PhD, Daniel P Giovenco, PhD, MPH, David Abrams, PhD, Raymond Niaura, PhD, Patterns of E-cigarette Use and Subsequent Cigarette Smoking Cessation Over 2 Years (2013/2014–2015/2016) in the Population Assessment of Tobacco and Health Study, Nicotine & Tobacco Research, , ntaa182, doi: 10.1093/ntr/ntaa182
• Acknowledgement: The paper was funded by Imperial Brands Plc.

2020: Using e-cigarettes for smoking cessation: evaluation of a pilot project in the North West of England

• Of the 1022 participants who engaged with the pilot 614 were still engaged at 4 weeks, of whom 62% had quit smoking. Of those who still smoked tobacco at week 4, smoking had reduced from a baseline of 19.1 cigarettes/day to 8.7. Overall, 37% of those initially enrolled were confirmed to be using an e-cigarette on its own at follow-up. Successful quit was associated with occupation (unemployed, 33% vs intermediate, 47%) and residing in the less deprived quintiles of deprivation (50% vs 34% in the most deprived quintile.
• E-cigarettes appear to be an effective nicotine replacement therapy
• PDF Version
• Citation: OUP accepted manuscript. (2020). Nicotine & Tobacco Research. doi:10.1093/ntr/ntaa182
• Acknowledgement: This work was funded internally by NYU School of Global Public Health. DTL was also funded in part by the National Cancer Institute (P01CA200512).

2020: Tobacco harm reduction in the 21st century

• Covers Snus and smokeless tobacco, Heat not burn, and e-cigarettes
• In conclusion, to reduce smoking and to save millions of lives, tobacco harm reduction in the form of cigarette substitution with low-risk products appears to be a promising path. These products, although not completely risk-free, offer an alternative to quit or die. In consideration of the available evidence, advice to tobacco smokers should include trying substitute products. The obvious fact so often overlooked is that smoking is rewarding and people like to do it. Giving smokers an alternative with efficient nicotine delivery means that they might prefer one of these products over cigarettes.
• PDF Version and PDF2
• Citation: O'Leary, R. and Polosa, R. (2020), "Tobacco harm reduction in the 21st century", Drugs and Alcohol Today, Vol. 20 No. 3, pp. 219-234. doi: 10.1108/DAT-02-2020-0007

2019: E-cigarettes compared with nicotine replacement therapy within the UK Stop Smoking Services: the TEC RCT

• The primary outcome was CO-validated sustained abstinence rates at 52 weeks. Participants lost to follow-up or not providing biochemical validation were included as non-abstainers.
• The 1-year quit rate was 9.9% in the NRT arm and 18.0% in the e-cigarette arm.
• The e-cigarette arm had significantly higher validated quit rates at all time points. Participants in the e-cigarette arm showed significantly better adherence and experienced fewer urges to smoke throughout the initial 4 weeks of their quit attempt than those in the NRT arm, and gave their allocated product more favourable ratings. They were also more likely to be still using their allocated product at 1 year
• Participants assigned to e-cigarettes reported significantly less coughing and phlegm at 1 year than those assigned to NRT
• A detailed economic analysis confirmed that, because e-cigarettes incur lower NHS costs than NRT and generate a higher quit rate, e-cigarette use is more cost-effective.
• PDF Version
• Citation: Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, et al. E-cigarettes compared with nicotine replacement therapy within the UK Stop Smoking Services: the TEC RCT. Health Technol Assess 2019;23(43)
• Acknowledgement: This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health and Social Care.

2019: Cost‐effectiveness of e‐cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomized controlled trial

• Using e‐cigarettes as a smoking cessation aid with standard behavioural support in stop‐smoking services in England is likely to be more cost‐effective than using nicotine replacement therapy in the same setting.
• PDF Version
• Citation: Li, J., Hajek, P., Pesola, F., Wu, Q., Phillips-Waller, A., Przulj, D., Myers Smith, K., Bisal, N., Sasieni, P., Dawkins, L., Ross, L., Goniewicz, M. L., McRobbie, H., and Parrott, S. (2020) Cost-effectiveness of e-cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomized controlled trial. Addiction, 115: 507– 517. https://doi.org/10.1111/add.14829.
• Acknowledgement: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (12/167/135) and by a grant (A16893) from the Cancer Research UK Prevention Trials Unit.

2019: Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study

• In our study, the effect of e-cigarettes on smoking cessation was similar compared with that of nicotine gum, a well-documented NRT. In addition, e-cigarettes were well tolerated by the study population. Therefore, the use of e-cigarettes as an NRT may be considered for smoking-cessation purposes.
• PDF Version
• Citation: Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study; Seung-Hwa Lee, Sang-Hyun Ahn, Yoo-Seock Cheong; The Journal of the American Board of Family Medicine Jul 2019, 32 (4) 567-574; DOI: 10.3122/jabfm.2019.04.180384
• Acknowledgement: No outside funding

2019: A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy

• A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.
• Conclusion: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.
• PDF Version
• Citation: Hajek P, Phillips-Walker A, Przulj D, et al. (2019). A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019;380(7):629–37; doi: 10.1056/NEJMoa1808779.
• Acknowledgement: Supported by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number, 12/167/135) and by a grant (A16893) from the Cancer Research UK Prevention Trials Unit.

2019: Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial

• In summary, when looking at continuous abstinence from smoking, provision of patches plus a nicotine e-cigarette resulted in three to seven more smokers per 100 quitting long-term (depending on the analyses done) than with patches plus a nicotine-free e-cigarette. The smaller than anticipated sample size meant the study was not sensitive enough to pick up a definitive finding for the second comparison, although analyses suggest combination nicotine therapy—ie, use of a slow release nicotine patch, together with a faster-acting oral nicotine product (in this case a nicotine e-cigarette)—could result in five to ten more smokers per 100 quitting long-term than with monotherapy (ie, nicotine patches alone). Our findings are consistent with the current findings of the Cochrane review of e-cigarettes for smoking cessation and contribute to the growing body of evidence from randomised trials on the efficacy, effectiveness and safety of e-cigarettes for smoking cessation.
• PDF Version
• Citation: Walker, N., Parag, V., Verbiest, M., Laking, G., Laugesen, M., & Bullen, C. (2019). Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial. The Lancet Respiratory Medicine. doi:10.1016/s2213-2600(19)30269-3
• Acknowledgement: Funded by Health Research Council of New Zealand.

2019: Association Between Electronic Cigarette Use and Smoking Reduction in France

• This cohort study found that, among daily smokers in France, regular (daily) electronic cigarette use is associated with a significantly higher decrease in the number of cigarettes smoked per day as well as an increase in smoking cessation attempts. However, among former smokers, electronic cigarette use is associated with an increase in the rate of smoking relapse.
• PDF Version
• Citation: Gomajee, R., El-Khoury, F., Goldberg, M., Zins, M., Lemogne, C., Wiernik, E., … Melchior, M. (2019). Association Between Electronic Cigarette Use and Smoking Reduction in France. JAMA Internal Medicine. doi:10.1001/jamainternmed.2019.1483
• Acknowledgement: The CONSTANCES (Consultants des Centres d’Examens de Santé) Cohort Study was supported and funded by the Caisse nationale d’assurance maladie des travailleurs salariés. The CONSTANCES Cohort Study is an “Infrastructure nationale en Biologie et Santé” is funded by grant ANR-11-INBS-0002 from Agence Nationale de la Recherche. CONSTANCES is also partly funded by MSD, AstraZeneca, and Lundbeck. The present analyses were supported by grant 2016-082 from Institut National du Cancer.
• NOTE: Article that covers above study - Adults who vape are more likely to quit cigarettes, study finds
  • “The study did find that the heightened risk of relapse disappeared in those who quit smoking more recently, which the researchers said may be due to improved e-cigarette technology.”
  • “For example, the study as a whole considered anybody who quit smoking from 2010 onward and found that, in that sample, vaping increased the risk of relapse. But when researchers only considered people who quit cigarettes as of 2013, former smokers were not more likely to relapse if they vaped.”
  • “The researchers noted in their study that "measures of plasma nicotine levels have shown that, compared with older models of [e-cigarettes], the new generation delivers higher levels of nicotine to the bloodstream," which may make them more satisfying.”
  • “Other "technical improvements in [e-cigarettes] over time," they said, may also explain why people who recently quit smoking and switched to e-cigarettes were less likely to relapse than those who quit earlier.”

2019: Association of prevalence of electronic cigarette use with smoking cessation and cigarette consumption in England: a time–series analysis between 2007 and 2017

• The increase in prevalence of e‐cigarette use by smokers in England has been positively associated with an increase in success rates of quit attempts and overall quit rates
• PDF Version
• Citation: Beard, E., West, R., Michie, S., and Brown, J. (2020) Association of prevalence of electronic cigarette use with smoking cessation and cigarette consumption in England: a time–series analysis between 2006 and 2017. Addiction, 115: 961– 974. doi: 10.1111/add.14851.
• Acknowledgement: The STS is currently primarily funded by Cancer Research UK (C1417/A14135; C36048/A11654; C44576/A19501), and has previously also been funded by Pfizer, GlaxoSmithKline and the Department of Health.

2019: Electronic Cigarette Use and Cigarette Abstinence Over 2 Years Among U.S. Smokers in the Population Assessment of Tobacco and Health Study

• In this nationally representative longitudinal cohort study of US adult cigarette smokers, daily e-cigarette use, compared to no e-cigarette use, was associated with a 77% increased odds of prolonged cigarette smoking abstinence over the subsequent 2 years. Regular use of e-cigarettes may help some smokers to stop smoking combustible cigarettes.
• PDF Version
• Citation: Kalkhoran, S., Chang, Y., & Rigotti, N. A. (2019). Electronic Cigarette Use and Cigarette Abstinence Over Two Years among U.S. Smokers in the Population Assessment of Tobacco and Health Study. Nicotine & Tobacco Research. doi:10.1093/ntr/ntz114
• Acknowledgement: This study was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (K23HL136854 to Dr. Kalkhoran).
• Article: Daily e-cigarette use may help smokers quit regular cigarettes

2019: Indicators of cigarette smoking dependence and relapse in former smokers who vape compared with those who do not: findings from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey

• Vapers were more likely than non-vapers to report: (1) having smoked within 5 minutes of waking; having smoked > 10 cigarettes/day; (2) perceiving themselves to be still very addicted to smoking and feeling extremely confident about staying quit.
• In totality, therefore, our findings favour the first explanation, that in our sample the daily vapers had been a more highly dependent group than the non-vapers, which would support the suggestion that vaping might be offering a novel route out of smoking for this group of smokers, albeit maintaining their nicotine addiction.
• PDF Version
• Citation: McNeill, A., Driezen, P., Hitchman, S. C., Cummings, K. M., Fong, G. T., and Borland, R. (2019) Indicators of cigarette smoking dependence and relapse in former smokers who vape compared with those who do not: findings from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. Addiction, 114( S1): 49– 60. doi: 10.1111/add.14722.
• This study was supported by grants from the US National Cancer Institute P01CA200512, the Canadian Institutes of Health Research (FDN - 148477), and by the National Health and Medical Research Council of Australia (APP1106451). G.T.F. was supported in part from a Senior Investigator Award from the Ontario Institute for Cancer Research.

2019: Tobacco Product Use Among Adults — United States, 2019

• 4.3 million US adult nicotine vapers are ex-smokers.
• PDF Version
• Citation: Cornelius ME, Wang TW, Jamal A, Loretan CG, Neff LJ. Tobacco Product Use Among Adults — United States, 2019. MMWR Morb Mortal Wkly Rep 2020;69:1736–1742. DOI:10.15585/mmwr.mm6946a4

2019: E-Cigarettes and Smoking Cessation in Smokers With Chronic Conditions

• At a population level, e-cigarette use by smokers with chronic medical conditions is associated with more quitting activity and smoking abstinence.
• PDF Version
• Citation: Kalkhoran S, Chang Y, Rigotti NA. E-cigarettes and Smoking Cessation in Smokers With Chronic Conditions. Am J Prev Med. 2019;57(6):786-791. doi:10.1016/j.amepre.2019.08.017
• Acknowledgement: This study was supported by the National Heart, Lung, and Blood Institute of the NIH (K23HL136854 to Dr. Kalkhoran).

2018: American Cancer Society Position Statement on Electronic Cigarettes

• Based on currently available evidence, using current generation e-cigarettes is less harmful than smoking cigarettes, but the health effects of long-term use are not known.
• The ACS has always supported any smoker who is considering quitting, no matter what approach they use; there is nothing more important that they can do for their health. Some smokers, despite firm clinician advice, will not attempt to quit smoking cigarettes and will not use FDA approved cessation medications. These individuals should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e- cigarettes is preferable to continuing to smoke combustible products.

2018: Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

• Despite the need for more evidence on their efficacy and long‐term safety, NVPs are now a more popular method for cessation than licensed NRT and prescription stop‐smoking medications in many countries.
• In light of this, HPs should be prepared to provide balanced information about NVPs, particularly to smokers who are unable to stop smoking with approved cessation therapies, and for those who are requesting guidance regarding NVPs as a smoking cessation aid
• Overall, the results from this study have shown that discussions between smokers and HPs about both quitting smoking, and the possible role NVPs could play as a cessation aid, were infrequent in the four countries in 2016. This may represent a lost opportunity for encouraging quitting smoking by providing a potentially attractive option to help smokers to quit.
• PDF Version
• Citation: Gravely, S., Thrasher, J. F., Cummings, K. M., Ouimet, J., McNeill, A., Meng, G., Lindblom, E. N., Loewen, R., O’Connor, R. J., Thompson, M. E., Hitchman, S. C., Hammond, D., Heckman, B. W., Borland, R., Yong, H.-H., Elton-Marshall, T., Bansal-Travers, M., Gartner, C., and Fong, G. T. (2019) Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey. Addiction, 114( S1): 71– 85. https://doi.org/10.1111/add.14527.
• Acknowledgement: This study was supported by grants from the US National Cancer Institute (P01 CA200512), the Canadian Institutes of Health Research (FDN-148477) and by the National Health and Medical Research Council of Australia (APP 1106451). S.G. was funded by a 3-year Canadian Cancer Society (CCS) Career Development Award in Cancer Prevention (703858). G.T.F. was supported by a Senior Investigator Award from the Ontario Institute for Cancer Research. B.W.H. was supported by NIDA (K23 DA041616).

2018: Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking

• This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. Vapers advised smokers to find the right combination of device, flavors and nicotine strength, continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
• PDF Version
• Citation: Christopher Russell, PhD, Tiffany Dickson, MSc, Neil McKeganey, PhD, Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking, Nicotine & Tobacco Research, Volume 20, Issue 8, August 2018, Pages 977–984, doi: 10.1093/ntr/ntx176
• Acknowledgement: Funding for this study was provided by Nicoventures.

2018: E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013–2015

• Daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. However, less frequent e-cigarette use was not associated with cigarette cessation/reduction. These results suggest incorporating frequency of e-cigarette use is important for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation.
• PDF Version
• Citation: Berry KM, Reynolds LM, Collins JM, et alE-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013–2015Tobacco Control 2019;28:42-49.
• Acknowledgement: Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health and the Center for Tobacco Products under Award Number P50HL120163.

2018: E-cigarette Usage Is Associated With Increased Past-12-Month Quit Attempts and Successful Smoking Cessation in Two US Population–Based Surveys

• Compared with 2006, past-12-month quit attempts and smoking cessation increased among adults aged 25–44 in recent years. Current e-cigarette use was associated with increased past-12-month quit attempts and successful smoking cessation among established smokers. These findings are relevant to future tobacco policy decisions.
• PDF Version
• Citation: Johnson L, Ma Y, Fisher SL, et al. E-cigarette Usage Is Associated With Increased Past-12-Month Quit Attempts and Successful Smoking Cessation in Two US Population-Based Surveys. Nicotine Tob Res. 2019;21(10):1331-1338. doi:10.1093/ntr/nty211
• Acknowledgement: Research reported in this paper was supported by National Institute on Drug Abuse (NIDA) grants R01DA036583 (LJB), R01DA042195 (RAG), R01DA038076 (LSC), R21DA033827 (RCC), and K12DA041449 (ATR); National Cancer Institute (NCI) grants U19CA203654 (LJB), P30CA091842 (LJB), and P30CA091842-16S2 (LSC); National Heart, Lung, and Blood Institute (NHLBI) grant R01HL109031 (TBB), National Institute on Alcohol Abuse and Alcoholism grant R21AA024888 (SMH), National Center For Advancing Translational Sciences grant TL1TR002344 (LJ), a grant from the Foundation for Barnes-Jewish Hospital (ATR), and by Grant 2015215 from the Doris Duke Charitable Foundation (SMH).

2017: E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys

• This study, based on the largest representative sample of e-cigarette users to date, provides a strong case that e-cigarette use was associated with an increase in smoking cessation at the population level. We found that e-cigarette use was associated with an increased smoking cessation rate at the level of subgroup analysis and at the overall population level. It is remarkable, considering that this is the kind of data pattern that has been predicted but not observed at the population level for cessation medication, such as nicotine replacement therapy and varenicline. This is the first statistically significant increase observed in population smoking cessation among US adults in nearly a quarter of a century. These findings need to be weighed carefully in regulatory policy making and in the planning of tobacco control interventions.
• PDF Version
• Citation: Zhu S, Zhuang Y, Wong S, Cummins S E, Tedeschi G J. E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys BMJ 2017; 358 :j3262 doi:10.1136/bmj.j3262
• Acknowledgement: This study was supported by the National Cancer Institute of the National Institutes of Health under the State and Community Tobacco Control (SCTC) Initiative (award No U01CA154280).

2017: The Relationship of E-Cigarette Use to Cigarette Quit Attempts and Cessation: Insights From a Large, Nationally Representative U.S. Survey

• Consistent with randomized trials and those observational studies that measure frequency of e-cigarette use, both quit attempts and quit success were positively associated with increased frequency of e-cigarette use. Frequency of e-cigarette use was important in gauging the nature of these relationships.
• PDF Version
• Citation: Levy, D. T., Yuan, Z., Luo, Y., & Abrams, D. B. (2017). The Relationship of E-Cigarette Use to Cigarette Quit Attempts and Cessation: Insights From a Large, Nationally Representative U.S. Survey. Nicotine & Tobacco Research, 20(8), 931–939. doi:10.1093/ntr/ntx166
• Acknowledgement: Funding was received by Drs. Levy and Abrams from the National Institute on Drug Abuse under grant R01DA036497. Dr. Levy also received funding from the National Cancer Institute under grant P01-CA200512.

2017: Predicting Short-Term Uptake of Electronic Cigarettes: Effects of Nicotine, Subjective Effects, and Simulated Demand

• Mean cigarettes per day decreased by 37% when e-cigarettes were available relative to baseline. Nicotine-containing cartridges were associated with greater use and craving reduction than 0 mg. Alleviation of withdrawal symptoms and taste and enjoyment factors predicted e-cigarette use.
• PDF Versioin
• Citation: Tucker, M. R., Laugesen, M., Bullen, C., & Grace, R. C. (2017). Predicting Short-Term Uptake of Electronic Cigarettes: Effects of Nicotine, Subjective Effects, and Simulated Demand. Nicotine & Tobacco Research. doi:10.1093/ntr/ntx269
• Acknowledge: This research was funded by the Tobacco Control Research Tūranga: A programme of innovative research to halve the smoking prevalence in Aotearoa/New Zealand within a decade. The Tūranga is supported through funding from the Reducing Tobacco-related Harm Research Partnership, co-funded by the Health Research Council of New Zealand and the Ministry of Health of New Zealand (HRC grant: 11/818).

2017: Cohort study of electronic cigarette use: effectiveness and safety at 24 months

• Of the e-cigarette users, 61.1% remained abstinent from tobacco (while 23.1% and 26.0% of tobacco-only smokers and dual users achieved tobacco abstinence).
• PDF Version
• Citation: Manzoli L, Flacco ME, Ferrante M, et al. Cohort study of electronic cigarette use: effectiveness and safety at 24 months. Tob Control. 2017;26(3):284-292. doi:10.1136/tobaccocontrol-2015-052822
• Acknowledgement: The first 2 years of the study were unfunded. The next 3 years of follow-up are going to be funded through crowdfunding (Kickstarter project titled ‘E-cigarette long-term efficacy & safety: a study to complete’).

2017: Patterns of and reasons for electronic cigarette use in primary care patients

• In descriptive analyses, compared to never e-cigarette users, ever e-cigarette users were younger, non-Hispanic white, more educated, more likely to be daily smokers, smoked more cigarettes per day, and smoked their first cigarette within 30 min of waking.
• Among current e-cigarette users, 84% reported using e-cigarettes to quit cigarettes, to cut down on cigarettes, or because they believe they are less harmful than cigarettes. The least common reason for use was cost (48%). Among former e-cigarette users, 78% reported using e-cigarettes to quit cigarettes, to cut down on cigarettes, or because they believe they are less harmful than cigarettes, and the least common reason was also cost (30%).
• PDF Version
• Citation: Kalkhoran, S., Alvarado, N., Vijayaraghavan, M. et al. Patterns of and reasons for electronic cigarette use in primary care patients. J GEN INTERN MED 32, 1122–1129 (2017). doi:10.1007/s11606-017-4123-x
• Acknowledgement: This work was supported by NIH National Institute on Drug Abuse R01DA034253.

2017: Attitudes of Europeans towards tobacco and electronic cigarettes

• 7.5 million EU citizens have quit smoking with nicotine vapes (“e-cigarettes”)

2016: Long-term e-cigarette use and smoking cessation: a longitudinal study with US population

• Long-term use of e-cigarettes was associated with a higher rate of quitting smoking
• PDF Version
• Citation: Zhuang Y, Cummins SE, Y Sun J, et alLong-term e-cigarette use and smoking cessation: a longitudinal study with US populationTobacco Control 2016;25:i90-i95.
• Acknowledgement: This study was supported by the National Cancer Institute of the National Institutes of Health under the State and Community Tobacco Control Initiative, Award Number U01CA154280.

2016: Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends

• Changes in prevalence of e-cigarette use in England have been positively associated with the success rates of quit attempts. No clear association has been found between e-cigarette use and the rate of quit attempts or the use of other quitting aids, except for NRT obtained on prescription, where the association has been negative.
• PDF Version
• Citation: Beard E, West R, Michie S, Brown J. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends BMJ 2016; 354 :i4645 doi:10.1136/bmj.i4645
• Acknowledgement: The Smoking Toolkit Study is currently primarily funded by Cancer Research UK (C1417/A14135; C36048/A11654; C44576/A19501), and has previously also been funded by Pfizer, GlaxoSmithKline, and the Department of Health.

2016: E-cigarettes: a developing public health consensus

• From: Public Health England, Action on Smoking and Health, Association of Directors of Public Health, British Lung Foundation, Cancer Research UK, Faculty of Public Health, Fresh North East, Healthier Futures, Public Health Action, Royal College of Physicians, Royal Society for Public Health, UK Centre for Tobacco and Alcohol Studies, UK Health Forum
• We all agree that e-cigarettes are significantly less harmful than smoking. One in two lifelong smokers dies from their addiction. All the evidence suggests that the health risks posed by e-cigarettes are relatively small by comparison but we must continue to study the long-term effects.
• And yet, millions of smokers have the impression that e-cigarettes are at least as harmful as tobacco
• The public health opportunity is in helping smokers to quit, so we may encourage smokers to try vaping but we certainly encourage vapers to stop smoking tobacco completely.
• We know that e-cigarettes are the most popular quitting tool in the country with more than 10 times as many people using them than using local stop smoking services.
• The current national evidence is that in the UK regular e-cigarette among youth use is almost exclusively confined to those young people who have already smoked, and youth smoking prevalence is continuing to fall.
• We should not forget what is important here. We know that smoking is the number one killer in England and we have a public health responsibility to provide smokers with the information and the tools to help them quit smoking completely and forever.

2016: Patterns of Electronic Cigarette Use Among Adults in the United States

• Results: Current e-cigarette use is extremely low among never cigarette smokers (0.4%) and former smokers who quit cigarettes 4 or more years ago (0.8%). Although e-cigarette experimentation is most common among current cigarette smokers and young adults, daily use is highest among former smokers who quit in the past year (13.0%) and older adults. Compared to daily cigarette smokers, recently quit smokers were more than four times as likely to be daily users of e-cigarettes.
• Conclusion: Extremely low e-cigarette use among never-smokers and longer term former smokers suggest that e-cigarettes neither promote widespread initiation nor relapse among adults. Recognition of the heterogeneity of smokers, including the time since quitting, is critical to draw accurate conclusions about patterns of e-cigarette use at the population level and its potential for public health benefit or harm.
• PDF Version
• Citation: Delnevo CD, Giovenco DP, Steinberg MB, et al. Patterns of Electronic Cigarette Use Among Adults in the United States. Nicotine Tob Res. 2016;18(5):715-719. doi:10.1093/ntr/ntv237
• Acknowledgement: This research was supported in part by funding from the National Institutes of Health (R01CA19044 [CDD and MBS] and K01DA037950 [JLP])

2016: Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries

• E‐cigarette use in the European Union appears to be largely confined to current or former smokers, while current use and nicotine use by people who have never smoked is rare. More than one‐third of current e‐cigarette users polled reported smoking cessation and reduction.
• PDF Version
• Citation: Farsalinos, K. E., Poulas, K., Voudris, V., & Le Houezec, J. (2016). Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries. Addiction, 111(11), 2032–2040. doi:10.1111/add.13506
• Acknowledgement: No funding was provided for this study

2016: Patterns of Smoking and Snus Use in Sweden: Implications for Public Health

• “Snus has both contributed to decreasing initiation of smoking and ...appears to facilitate smoking cessation. ...Snus has been a major factor behind Sweden’s record-low prevalence of smoking and lowest tobacco-related mortality among men in Europe.”
• PDF Version
• Citation: Ramström, L.; Borland, R.; Wikmans, T. Patterns of Smoking and Snus Use in Sweden: Implications for Public Health. Int. J. Environ. Res. Public Health 2016, 13, 1110. https://doi.org/10.3390/ijerph13111110

2015: E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis

• “This systematic review and meta-analyses assessed the findings of six studies which reported smoking cessation after using e-cigarettes. We found an association between nicotine-enriched e-cigarette use and smoking cessation, suggesting that the devices may be an effective alternative smoking cessation method. We also found that use of e-cigarettes was also associated with a reduction in the number of cigarettes used, suggesting they may also have a role in tobacco harm reduction programs. To our knowledge, this is the most comprehensive evidence to date on this issue, and while there are a number of important implications for further research, these findings provide timely information to inform regulatory strategies.”
• PDF Version
• Citation: Rahman MA, Hann N, Wilson A, Mnatzaganian G, Worrall-Carter L. E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis. PLoS One. 2015;10(3):e0122544. Published 2015 Mar 30. doi:10.1371/journal.pone.0122544
• Acknowledgement: The authors have no support or funding to report.

2015: A Longitudinal Study of Electronic Cigarette Use Among a Population-Based Sample of Adult Smokers: Association With Smoking Cessation and Motivation to Quit

• Results: At follow-up, 23% were intensive users, 29% intermittent users, 18% had used once or twice, and 30% had not tried e-cigarettes. Logistic regression controlling for demographics and tobacco dependence indicated that intensive users of e-cigarettes were 6 times more likely than non-users/triers to report that they quit smoking. Daily use of electronic cigarettes for at least 1 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.
• PDF Version
• Citation: Biener L, Hargraves JL. A longitudinal study of electronic cigarette use among a population-based sample of adult smokers: association with smoking cessation and motivation to quit. Nicotine Tob Res. 2015;17(2):127-133. doi:10.1093/ntr/ntu200
• Acknowledgement: This work was supported by a grant from the US National Cancer Institute, grant #R01CA151384-03.

2015: Associations Between E-Cigarette Type, Frequency of Use, and Quitting Smoking: Findings From a Longitudinal Online Panel Survey in Great Britain

• Whether e-cigarette use is associated with quitting depends on type and frequency of use. Compared with respondents not using e-cigarettes, daily tank users were more likely, and non-daily cigalike users were less likely, to have quit. Tanks were more likely to be used by older respondents and respondents with lower education.
• PDF Version
• Citation: Hitchman SC, Brose LS, Brown J, Robson D, McNeill A. Associations Between E-Cigarette Type, Frequency of Use, and Quitting Smoking: Findings From a Longitudinal Online Panel Survey in Great Britain. Nicotine Tob Res. 2015;17(10):1187-1194. doi:10.1093/ntr/ntv078
• Acknowledgement: All authors are members of the UK Centre for Tobacco & Alcohol Studies, a UK Clinical Research Collaboration Public Health Research: Centre of Excellence whose work is supported by funding from the Medical Research Council, British Heart Foundation, Cancer Research UK, Economic and Social Research Council, and the National Institute for Health Research under the auspices of the UK Clinical Research Collaboration is gratefully acknowledged (MR/K023195/1). JB’s post is funded by a fellowship from the UK Society for the Study of Addiction.

2015: Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study

• Follow-up data were available for 236 e-smokers, 491 tobacco smokers, and 232 dual smokers (overall response rate 70.8%). All e-smokers were tobacco ex-smokers. At 12 months, 61.9% of the e-smokers were still abstinent from tobacco smoking; 20.6% of the tobacco smokers and 22.0% of the dual smokers achieved tobacco abstinence. Adjusting for potential confounders, tobacco smoking abstinence or cessation remained significantly more likely among e-smokers...
• PDF Version
• Citation: Manzoli L, Flacco ME, Fiore M, et al. Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study. PLoS One. 2015;10(6):e0129443. Published 2015 Jun 10. doi:10.1371/journal.pone.0129443
• Acknowledgement: The authors have no support or funding to report.

2014: Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

• Conclusion: “Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.”
• PDF Version
• Citation: Brown J, Beard E, Kotz D, Michie S, West R. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. 2014;109(9):1531-1540. doi:10.1111/add.12623
• Acknowledgement: The research team is part of the UK Centre for Tobacco and Alcohol Studies. JB's post is funded by a fellowship from the UK Society for the Study of Addiction; R.W. is funded by Cancer Research UK; Cancer Research UK, the Department of Health and Pfizer funded data collection for this study (including a Pfizer investigator initiated award), and that at the outset data collection for the Smoking Toolkit Study was also supported by GlaxoSmithKline and Johnson and Johnson.

2014: E-cigarette versus nicotine inhaler: comparing the perceptions and experiences of inhaled nicotine devices

• Related Article: E-Cigarettes vs. Nicotine Inhalers
• “In conclusion, during this brief trial, the e-cigarette was found to be more acceptable, provided more satisfaction and rewards, and had higher perceived benefit than the nicotine inhaler. These findings may explain why the e-cigarette has become popular among smokers while the inhaler has not achieved the same favorability. Based on this difference, e-cigarettes could have the potential to become “tobacco cigarette substitutes,” owing to their high acceptance and perceived effectiveness. While toxicants have been identified in e-cigarettes, they are present at orders of magnitude lower than tobacco cigarettes. As such, e-cigarettes may hold value as a harm reduction strategy among those unwilling or unable to quit. However, given the large variation in the market with respect to brands, more data are needed to demonstrate their efficacy and safety, and to allow physicians to more appropriately inform their patients about these products.”
• PDF Version
• Citation: Steinberg MB, Zimmermann MH, Delnevo CD, et al. E-cigarette versus nicotine inhaler: comparing the perceptions and experiences of inhaled nicotine devices. J Gen Intern Med. 2014;29(11):1444-1450. doi:10.1007/s11606-014-2889-7
• Acknowledgement: This study was funded through a pilot grant from the Rutgers–Cancer Institute of New Jersey (P30CA072720).

2014: Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints

• When people, ready to switch to an e-cig, are severely restricted in terms of accessibility of nicotine-containing e-liquids, the success of e-cigs may be endangered. For the e-cig to be and remain successful, it is important that people have easy access to nicotine containing e-liquids.
• “In a series of controlled lab sessions with e-cig-naïve tobacco smokers, second-generation e-cigs were shown to be immediately and highly effective in reducing abstinence-induced cigarette craving and withdrawal symptoms, while not resulting in increases in eCO. Ad libitum use of e-cigs—in between and until six months after the lab sessions—resulted in remarkable reductions in or (biologically confirmed) complete abstinence from tobacco smoking in almost half of the participants who had no intention to quit smoking. Eight months after the start of the study 21% of all participants were completely abstinent from tobacco cigarettes. Similar reduction/cessation rates were obtained with guided versus non-guided switching to e-cigs. Part of the observed efficacy of e-cigs in this study may be related to the fact that they allowed to maintain relatively high blood nicotine levels and showed an excellent experienced benefits/complaints ratio, especially in comparison with continued tobacco smoking”...
• E-cigarette is an attractive long-term alternative and safer source of nicotine to conventional cigarette. Since their invention in 2003, there has been constant innovation and development of more efficient and appealing products. Here we show for the first time that second generation PVs can substantially decrease cigarette consumption without causing significant side effects in smokers not intending to quit. Moreover, overall participants’ perception and acceptance of these products was very good, in particular for those who quit or reduced smoking. Compared to our earlier work with first generation “cig-alikes”, technical problems and difficulties in use familiarization with second generation PVs were negligible. Improved products reliability and attractiveness might have contributed to the very low number of study failures and lost to follow-up and high success rates thus confirming the notion that these products are attractive substitutes for conventional cigarettes. Although large and carefully conducted RCTs will be required to confirm these preliminary encouraging observations, the notion that second generation PVs can substantially decrease cigarette consumption in smokers not intending to quit should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the vapour category
• PDF Version
• Citation: Adriaens K, Van Gucht D, Declerck P, Baeyens F. Effectiveness of the electronic cigarette: An eight-week Flemish study with six-month follow-up on smoking reduction, craving and experienced benefits and complaints. Int J Environ Res Public Health. 2014;11(11):11220-11248. Published 2014 Oct 29. doi:10.3390/ijerph111111220
• Acknowledgement: No external funding for this study was obtained.

2014: Success rates with nicotine personal vaporizers: a prospective 6-month pilot study of smokers not intending to quit

• Complete tobacco cessation is the best outcome for smokers, but the powerful addictive qualities of nicotine and of the ritualistic behavior of smoking create a huge hurdle, even for those with a strong desire to quit. Tobacco harm reduction (THR), the substitution of low-risk nicotine products for cigarette smoking, is a realistic strategy for smokers who have difficulty quitting. E-cigarettes are the newest and most promising products for THR. This approach has been recently exploited to reduce or reverse the burden of harm in smokers with mental health disorders and chronic airway disease.
• PDF Version
• Citation: Polosa R, Caponnetto P, Maglia M, Morjaria JB, Russo C. Success rates with nicotine personal vaporizers: a prospective 6-month pilot study of smokers not intending to quit. BMC Public Health. 2014;14:1159. Published 2014 Nov 8. doi:10.1186/1471-2458-14-1159
• Acknowledgement: The authors wish to thank FlavourArt. Authors wish to thank LIAF, Lega Italiana Anti Fumo (Italian acronym for Italian Anti Smoking League) for supporting this research.

2014: Characteristics, Perceived Side Effects and Benefits of Electronic Cigarette Use: A Worldwide Survey of More than 19,000 Consumers

• The main results of this survey indicate that ECs may be an effective substitute for smoking even in highly dependent subjects who are heavy smokers. Significant benefits are experienced by these people in physiologic functions and in some disease conditions, with former smokers (those who completely substituted smoking with EC use) being more likely to report such beneficial effects.
• Both former and current smokers initiated EC use with high nicotine-containing liquids. More than one-fifth of the population initiated use with more than 20 mg/mL nicotine concentration, with higher prevalence in former smokers, supporting the hypothesis that nicotine plays an important role in the success of ECs as smoking substitutes. This can be attributed to the lower nicotine absorption from EC use compared to smoking. Such repeated observations should be taken into consideration by the regulatory authorities.
• The most important reasons for participants to initiate ECs were to reduce or completely quit smoking and to reduce exposure of family members to second-hand smoking. It seems that these subjects are well-informed about the adverse health effects of smoking and are willing to try an alternative product which they consider less harmful.
• In conclusion, in this large sample of dedicated EC users, it seems that ECs are used as long-term substitutes to smoking. They can be effective even in subjects who are highly dependent on smoking and are heavy smokers. Mild temporary side-effects and significant benefits are reported by this population. Motivation for using ECs comes from their expected less harmful potential compared to smoking.
• PDF Version
• Citation: Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V. Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers. Int J Environ Res Public Health. 2014;11(4):4356-4373. Published 2014 Apr 22. doi:10.3390/ijerph110404356
• Acknowledgement: The study was funded by a funding campaign of E-Cigarette Research Advocates Group, the owners of the website www.ecigarette-research.com. This is a non-profit group of electronic cigarette users with no relation to the electronic cigarette or other industry.

2014: Reasons for quitting cigarette smoking and electronic cigarette use for cessation help

• Thus, this may be the first study to suggest that smokers who want to quit smoking for immediate, extrinsic rewards may be attracted to use e-cigarettes to stop smoking cigarettes than smokers who want to quit smoking for intrinsic reasons such as health concerns. In conclusion, e-cigarettes appear to provide a “smoking” alternative to a section of cigarette smokers who may not quit smoking for health reasons. Public health efforts may need to consider employing e-cigarettes to promote tobacco-related harm reduction.
• PDF Version
• Citation: Pokhrel P, Herzog TA. Reasons for quitting cigarette smoking and electronic cigarette use for cessation help. Psychol Addict Behav. 2015;29(1):114-121. doi:10.1037/adb0000025

2014: Cigarette Users’ Interest in Using or Switching to Electronic Nicotine Delivery Systems (ENDS) for Smokeless Tobacco for Harm Reduction, Cessation, or Novelty: A Cross-Sectional Survey of US Adults

• This study highlights higher interest in ENDS versus smokeless tobacco and greater interest in both for harm reduction and cessation than due to novelty or smoking restrictions. Developing educational campaigns and informing practitioners about caveats around ENDS as cessation or harm reduction aids are critical.
• PDF Version
• Citation: Berg, C. J., Haardoerfer, R., Escoffery, C., Zheng, P., & Kegler, M. (2014). Cigarette Users’ Interest in Using or Switching to Electronic Nicotine Delivery Systems for Smokeless Tobacco for Harm Reduction, Cessation, or Novelty: A Cross-Sectional Survey of US Adults. Nicotine & Tobacco Research, 17(2), 245–255. doi:10.1093/ntr/ntu103
• Acknowledgement: This work was supported by the Centers for Disease Control and Prevention (3 U48 DP001909-04S1 to Principal Investigator (PI): CJB), the National Cancer Institute (U01CA154282-01 to PI: MK; 1K07CA139114-01A1 to PI: CJB), and the Georgia Cancer Coalition (PI: CJB).

2013: Electronic cigarettes for smoking cessation: a randomised controlled trial

• 657 people were randomised (289 to nicotine e-cigarettes, 295 to patches, and 73 to placebo e-cigarettes) and were included in the intention-to-treat analysis.
• At 6 months, verified abstinence was 7·3% (21 of 289) with nicotine e-cigarettes, 5·8% (17 of 295) with patches, and 4·1% (three of 73) with placebo e-cigarettes
• PDF Version
• Citation: Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013 Nov 16;382(9905):1629-37. doi: 10.1016/S0140-6736(13)61842-5. Epub 2013 Sep 9. PMID: 24029165.
• Acknowledgement: Funding: Health Research Council of New Zealand.

2013: A fresh look at tobacco harm reduction: the case for the electronic cigarette

• Smokers of any age can reap substantial health benefits by quitting. In fact, no other single public health effort is likely to achieve a benefit comparable to large-scale smoking cessation.
• E-cigs might be the most promising product for tobacco harm reduction to date, because, besides delivering nicotine vapour without the combustion products that are responsible for nearly all of smoking’s damaging effect, they also replace some of the rituals associated with smoking behaviour.
• Nicotine’s beneficial effects include correcting problems with concentration, attention and memory, as well as improving symptoms of mood impairments. Keeping such disabilities at bay right now can be much stronger motivation to continue using nicotine than any threats of diseases that may strike
• Nicotine’s beneficial effects can be controlled, and the detrimental effects of the smoky delivery system can be attenuated, by providing the drug via less hazardous delivery systems. Although more research is needed, e-cigs appear to be effective cigarette substitutes for inveterate smokers, and the health improvements enjoyed by switchers do not differ from those enjoyed by tobacco/nicotine abstainers.
• PDF Version
• Citation: Polosa R, Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduct J. 2013;10:19. Published 2013 Oct 4. doi:10.1186/1477-7517-10-19

2013: Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review

• When compared to the harmful effects of smoking, these studies suggest that vaping could be used as a possible “harm reduction” tool. There is evidence supporting e-cigarettes as an aide for smoking cessation, at least as successful as currently available FDA-approved NRTs.
• Citation: Palazzolo, D. L. (2013). Electronic Cigarettes and Vaping: A New Challenge in Clinical Medicine and Public Health. A Literature Review. Frontiers in Public Health, 1. doi:10.3389/fpubh.2013.00056

2013: E-Cigarettes: Prevalence and Attitudes in Great Britain

• While we found evidence supporting the view that e-cigarette use may be a bridge to quitting, we found very little evidence of e-cigarette use among adults who had never smoked. British smokers would benefit from information about the effective use, risks, and benefits of e-cigarettes, as this might enable the use of e-cigarettes to improve public health.
• PDF Version
• Citation: Martin Dockrell, BA, Rory Morrison, BSc, Linda Bauld, PhD, Ann McNeill, PhD, E-Cigarettes: Prevalence and Attitudes in Great Britain, Nicotine & Tobacco Research, Volume 15, Issue 10, October 2013, Pages 1737–1744, doi: 10.1093/ntr/ntt057
• Acknowledgements: Fieldwork was supported by Action on Smoking and Health and members of the Smokefree Action Coalition. Linda Bauld and Ann McNeill are members of the UK Centre for Tobacco Control Studies. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (ESRC), the Medical Research Council (MRC), and the National Institute for Health Research (NIHR), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

2013: EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study

• In smokers not intending to quit, the use of e-cigarettes, with or without nicotine, decreased cigarette consumption and elicited enduring tobacco abstinence without causing significant side effects. In view of the fact that subjects in this study had no immediate intention of quitting, the reported overall abstinence rate of 8.7% at 52-week was remarkable.
• PDF Version
• Citation:Caponnetto P, Campagna D, Cibella F, et al. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study [published correction appears in PLoS One. 2014;9(1). doi:10.1371/annotation/e12c22d3-a42b-455d-9100-6c7ee45d58d0]. PLoS One. 2013;8(6):e66317. Published 2013 Jun 24. doi:10.1371/journal.pone.0066317
• Acknowledgement: This research was supported by a grant-in-aid from Lega Italiana AntiFumo.

2013: 'Vaping' profiles and preferences: an online survey of electronic cigarette users

• Seventy-four percent of participants reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. *Seventy-two percent of participants used a 'tank' system, most commonly. Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine containing liquid. E-cigarettes were generally considered to be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing; and be associated with low levels of craving. Among ex-smokers, 'time to first vape' was significantly longer than 'time to first cigarette' suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported significantly greater reduction in craving than current smokers.
• E-cigarettes are used primarily for smoking cessation, but for a longer duration than nicotine replacement therapy, and users believe them to be safer than smoking
• PDF Version
• Citation: Dawkins, L., Turner, J., Roberts, A., & Soar, K. (2013). “Vaping” profiles and preferences: an online survey of electronic cigarette users. Addiction, 108(6), 1115–1125. doi:10.1111/add.12150
• No funding was received for this study. The first author has a collaborative relationship with the Electronic Cigarette Company (TECC) and Totally Wicked E-Liquids (TWEL), and has received funds from these companies to attend academic conferences. TECC and TWEL reviewed and approved the content of the questionnaire and set up links from their websites to the host site at UEL.

2012: The electronic-cigarette: Effects on desire to smoke, withdrawal symptoms and cognition

• The e-cigarette can reduce desire to smoke and nicotine withdrawal symptoms 20 minutes after use.
• The nicotine content in this respect may be more important for males.
• The first study to demonstrate that the nicotine e-cigarette can improve working memory.
• PDF Version
• Citation: Dawkins, L., Turner, J., Hasna, S., & Soar, K. (2012). The electronic-cigarette: Effects on desire to smoke, withdrawal symptoms and cognition. Addictive Behaviors, 37(8), 970–973. doi:10.1016/j.addbeh.2012.03.004
• Acknowledgement: Electronic Cigarette Company (TECC) supplied the e-cigarettes and cartridges for this study. TECC had no involvement in the design or conduct of the study.

2011: Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series

• The most important message from this case series is that these smokers, with a documented history of recurring relapses, were able to quit smoking and to remain abstinent for at least six months after taking up an electronic cigarette.
• PDF Version
• Citation: Caponnetto, P., Polosa, R., Russo, C. et al. Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series. J Med Case Reports 5, 585 (2011). https://doi.org/10.1186/1752-1947-5-585

2011: Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study

• Sustained 50% reduction in the number of cig/day at week-24 was shown in 13/40(32.5%) participants; their median of 25 cigs/day decreasing to 6 cigs/day (p < 0.001). Sustained 80% reduction was shown in 5/40(12.5%) participants; their median of 30 cigs/day decreasing to 3 cigs/day (p = 0.043). Sustained smoking abstinence at week-24 was observed in 9/40(22.5%) participants, with 6/9 still using the e-Cigarette by the end of the study. Combined sustained 50% reduction and smoking abstinence was shown in 22/40 (55%) participants, with an overall 88% fall in cigs/day.
• The use of e-Cigarette substantially decreased cigarette consumption without causing significant side effects in smokers not intending to quit
• PDF Version
• Citation: Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011 Oct 11;11:786. doi: 10.1186/1471-2458-11-786. PMID: 21989407; PMCID: PMC3203079.
• Acknowledgement: We wish to thank Arbi Group Srl (Milano, Italy) for the free supplies of ‘Categoria’ e-Cigarette kits and nicotine cartridges. None of the authors have any competing interests to declare, but RP has received lecture fees from Pfizer and, from Feb 2011, he has been serving as a consultant for Arbi Group Srl.Arbi Group Srl (Milano, Italy), the manufacturer of the e-Cigarette supplied the product, and unrestricted technical and customer support. They were not involved in the study design, running of the study or analysis and presentation of the data.

2011: Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy

• Almost all (97%) used e‐cigarettes containing nicotine.
• Most (96%) said the e‐cigarette helped them to quit smoking or reduce their smoking (92%).
• Reasons for using the e‐cigarette included the perception that it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%).
• Most ex‐smokers (79%) feared they might relapse to smoking if they stopped using the e‐cigarette.
• Users of nicotine‐containing e‐cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non‐nicotine e‐cigarettes.
• PDF Version
• Citation: Etter, J.-F., & Bullen, C. (2011). Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction, 106(11), 2017–2028. doi:10.1111/j.1360-0443.2011.03505.x

2011: Electronic cigarettes (e‐cigs): views of aficionados and clinical/public health Perspectives

• The health risks from smoking are large and are known with certainty. Comparatively, the health risks from e‐cig use are likely much smaller (if any) and temporarily switching to e‐cigs will likely yield a large health benefit.
• If the patient perceives that the e‐cig is helping them to stay off cigarettes and is not reporting any health problems likely attributable to the e‐cig, then the focus should be on staying smoke‐free rather than e‐cig free.
• PDF Version
• Citation: Foulds, J., Veldheer, S., & Berg, A. (2011). Electronic cigarettes (e-cigs): views of aficionados and clinical/public health perspectives. International Journal of Clinical Practice, 65(10), 1037–1042. doi:10.1111/j.1742-1241.2011.02751.x

2011: Electronic Cigarettes As a Smoking-Cessation Tool: Results from an Online Survey

• A large percentage of respondents reported a reduction in the number of cigarettes they smoked (66.8%) and almost half reported abstinence from smoking for a period of time (48.8%). Those respondents using e-cigarettes more than 20 times per day had a quit rate of 70.0%. Of respondents who were not smoking at 6 months, 34.3% were not using e-cigarettes or any nicotine-containing products at the time.
• The distinct and unique advantage of e-cigarettes is that they allow individuals to utilize one device that can simultaneously address nicotine withdrawal, psychological factors, and behavioral cues that serve as barriers to smoking abstinence.
• PDF Version
• Citation: Siegel, M. B., Tanwar, K. L., & Wood, K. S. (2011). Electronic Cigarettes As a Smoking-Cessation Tool. American Journal of Preventive Medicine, 40(4), 472–475. doi:10.1016/j.amepre.2010.12.006

2011: Interviews With “Vapers”: Implications for Future Research With Electronic Cigarettes

• Experienced users report health gains typical for smoking cessation despite continued vaping.
• There were pervasive themes including the language and culture of vaping; social and informational support among vapers, motives and perceived benefits of using e-cigs versus cigarettes including cigarette-like enjoyment, cost, restored sense of taste and smell, and improved breathing and exercise tolerance; rapidly reduced nicotine tolerance and dependence; and a strong interest in e-cig–related research and policy.
• PDF Version
• Citation: McQueen, A., Tower, S., & Sumner, W. (2011). Interviews With “Vapers”: Implications for Future Research With Electronic Cigarettes. Nicotine & Tobacco Research, 13(9), 860–867. doi:10.1093/ntr/ntr088
• Acknowledgement: This research was conducted independent of grant funding. AM is supported by a Mentored Research Scientist Grant from the American Cancer Society (CPPB-113766).

2010: Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial

• Conclusions “The 16 mg Ruyan V8 ENDD alleviated desire to smoke after overnight abstinence, was well tolerated and had a pharmacokinetic profile more like the Nicorette inhalator than a tobacco cigarette. Evaluation of the ENDD for longer-term safety, potential for long-term use and efficacy as a cessation aid is needed.”
• PDF Version
• Citation: Bullen, C., McRobbie, H., Thornley, S., Glover, M., Lin, R., & Laugesen, M. (2010). Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tobacco Control, 19(2), 98–103. doi:10.1136/tc.2009.031567
• Acknowledgement: This project was funded by Ruyan Group (Holdings) Limited, Beijing and Hong Kong, via Health New Zealand Ltd. The study sponsors supplied the ENDDs used in the trial and funded the trial. The Clinical Trials Research Unit contracted with Health New Zealand Ltd to conduct the trial, independently of Ruyan Group (Holdings) Ltd. The trial design conduct, analysis and interpretation of results were conducted independently of the sponsors.

2010: Electronic cigarettes: a survey of users

• Our results suggest that ecigarettes are used mainly to quit smoking, and may be useful for this purpose.
• PDF Version
• Citation: Etter, JF. Electronic cigarettes: a survey of users. BMC Public Health 10, 231 (2010). https://doi.org/10.1186/1471-2458-10-231

2006: Role of snus in initiation and cessation of tobacco smoking in Sweden

• Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker, and increased likelihood of stopping smoking
• Citation: Ramström LM, Foulds JRole of snus in initiation and cessation of tobacco smoking in Sweden, Tobacco Control 2006;15:210-214.
• Acknowledgement: LR owns shares in Pfizer Inc, and both he and JF have done paid consultancy work for Pfizer Inc and other agencies involved in public health. LR has periodically been employed as short term consultant with WHO and JF has provided testimony for plaintiffs in law suits against tobacco companies. None of the authors has received any financial support from the tobacco industry.

2005: Is Swedish snus associated with smoking initiation or smoking cessation?

• “Among males participating in a large population based twin study in Sweden, snus use was associated with smoking cessation but not initiation.”
• PDF Version
• Citation: Furberg H, Bulik CM, Lerman C, et alIs Swedish snus associated with smoking initiation or smoking cessation?Tobacco Control 2005;14:422-424.
• Acknowledgement: This work was supported by CA-085839 to PFS

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• We evaluated adult daily cigarette smokers initially not planning to ever quit.
• Subsequent daily e-cigarette use was related to changing plans to quit smoking.
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• Moreover, if vape product sales were restricted to tobacco flavors, 39.1% of users reported being likely to continue using e-cigarettes but 33.2% were likely to switch to cigarettes. If vape product sales were entirely restricted, e-cigarette users were equally likely to switch to cigarettes versus not (~40%).

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• Approximately three-quarters of tweets that cited potential adverse consequences of the policy mentioned smoking relapse as their primary concern.