ENDS Adults Who Smoke

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Studies, Surveys, Papers, and Case Studies

  • Sometimes it's necessary to view the PDF version to access the full study.
  • This page is for referencing the possible benefits of ENDS products vs. smoking cigarettes by adults. (Electronic Nicotine Delivery Systems are also known as vapor technology, ecigarettes, ecigs, EVP - electronic vapor product, etc.). They may also be referred to as ANDS - Alternative Nicotine Delivery System and SNP - safer nicotine product.



Dual Use

2021: Regulation of e-cigarette flavours – a response

  • Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
  • Signed by 24 experts from around the world
  • Covers 12 key points
    • Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
    • Adopts false and misleading claims about the risks of e-cigarettes.
    • Draws on irrelevant information about an outbreak of lung injuries in North America.
    • Misunderstands “dual-use”.
    • Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
    • Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
    • Ignores perverse consequences of prohibition, even though these are foreseeable.
    • Fails to show benefits for adolescents or address concerns it may cause harm to young people.
    • Ignores the harmful effects of a vaping flavour ban on adults.
    • Creates regulatory protection for the cigarette trade.
    • Violates important regulatory principles, including those underpinning the European Union internal market.
    • Proposes an illiberal policy and fails to recognise a major global public health opportunity.
  • Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.


2019: 2019 Perceived relative harm of using e-cigarettes predicts future product switching among US adult cigarette and e-cigarette dual users

  • Compared with those with other perceptions of e‐cigarette harm, dual users who perceived e‐cigarettes as less harmful than cigarettes were more likely to become exclusive e‐cigarette users 1 year later.
  • PDF Version


2019: Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

  • The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
  • The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
  • PDF Version
  • Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.
  • Acknowledgement: Grants from the National Cancer Institute of the National Institutes of Health (P20CA202921 to University of Oklahoma, and 5P20CA202923 to Cherokee Nation) supported this study.


2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions

  • Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
  • This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
  • PDF Version
  • Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435
  • Acklnowledgement: This work was supported by the National Institutes of Health (K01DA043413, K23DA039294, and K23DA042898). The funding source had no other role other than financial support.


2017: Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes

  • To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
  • Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
  • After e-cig initiation, dual users decreased tobacco consumption by 82% and were low-to-moderately cigarette dependent.
  • The two groups (dual users and switchers) reported mostly using a flavor other than tobacco.
  • PDF Version
  • Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.

Economic Impact

2019: The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications

  • In this study, we examined the growing use of electronic cigarettes and its implications. The wide use of e-cigarettes is a very recent development, and issues regarding their long-term effects and significance cannot be fully analyzed at this time. Using CDC and other data covering the last decade, however, we examined the relationship between the recent sharp increase in e-cigarette use among Americans and the contemporaneous acceleration in the declining rate of cigarette smoking.
  • We found that the sharp increase in e-cigarette use across many groups can explain as much as 70 percent of the accelerating decline in smoking rates. We also found no reasonable evidential basis for concerns that e-cigarettes are a gateway to cigarette smoking.
  • We further found that e-cigarettes are highly effective in helping people stop smoking cigarettes.
  • Finally, we analyzed the impact of the sharp increase in e-cigarette use and the accelerating decline in cigarette smoking on healthcare costs and economic productivity. *We found that while e-cigarette users incur lower healthcare costs than cigarette smokers or ex-smokers, the longer lifespans of e-cigarette users and ex-smokers who used e-cigarettes to quit smoking result in higher lifetime healthcare costs. However, we also found that the value of the additional years of life associated with using e-cigarettes instead of smoking is much greater than the additional healthcare costs.
  • Lastly, we found that the increase in e-cigarette use and the associated reduction in smoking rates results in large productivity benefits, mainly from lower rates of illness.
  • PDF Version


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 (behavioral) 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


2019: Expenditure on smoking and alternative nicotine delivery products: a population survey in England

  • In England, expenditure among e‐cigarette and nicotine replacement therapy users is approximately one‐third of the expenditure of smokers. The average smoker may save an estimated £15.06 per week by switching completely to e‐cigarettes or £13.04 per week by switching to nicotine replacement therapy, although this is likely to differ according to individual usage patterns.
  • PDF Version


2018: Behavioral Economic Purchase Tasks to Estimate Demand for Novel Nicotine/tobacco Products and Prospectively Predict Future Use: Evidence From The Netherlands

  • Smokers valued FMCs [factory made cigarettes] more than ECs [electronic cigarettes] or VLNCs, [very low nicotine cigarettes] and FMCs were less sensitive to price increases. Demand indices predicted use of commercially available products over a 15 month period.
  • To serve as viable substitutes for FMCs, ECs and VLNCs will need to be priced lower than FMCs.
  • PDF Version


Flavors

2021: Regulation of e-cigarette flavours – a response

  • Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
  • Signed by 24 experts from around the world
  • Covers 12 key points
    • Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
    • Adopts false and misleading claims about the risks of e-cigarettes.
    • Draws on irrelevant information about an outbreak of lung injuries in North America.
    • Misunderstands “dual-use”.
    • Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
    • Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
    • Ignores perverse consequences of prohibition, even though these are foreseeable.
    • Fails to show benefits for adolescents or address concerns it may cause harm to young people.
    • Ignores the harmful effects of a vaping flavour (flavor) ban on adults.
    • Creates regulatory protection for the cigarette trade.
    • Violates important regulatory principles, including those underpinning the European Union internal market.
    • Proposes an illiberal policy and fails to recognise a major global public health opportunity.
  • Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.


2020: Paper: Intended and Unintended Effects of Banning Menthol Cigarettes

  • Menthol bans significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates.
  • Menthol bans shifted smokers’ cigarette purchases away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not bind).
  • PDF Full Paper


2020: Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation

  • Adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors.
  • Banning flavors altogether may be too blunt an instrument for the current problem (youth use of vapor products).
  • PDF Version
  • Citation: Friedman, A. S., & Xu, S. (2020). Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation. JAMA Network Open, 3(6), e203826. doi:10.1001/jamanetworkopen.2020.3826
  • Acknowledgment: : Ms Xu was supported by a T32 National Research Service Award from the Agency for Healthcare Research and Quality (HS017589).


2020: Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states

  • Policymakers should proceed with caution when considering bans on flavored nicotine e‐liquids: restricting legal sales may push some vapers towards illicit sources, user‐modified e‐liquids (e.g. to add flavoring) or even conventional cigarette use. Given EVALI’s potential lethality and a myriad of work suggesting that conventional cigarette use is probably far more dangerous than vaping nicotine, these outcomes could be disastrous for public health. There is no link between nicotine liquids and EVALI. It appears to have come from illicit cannabis products.
  • Link above is to the PDF version
  • Citation: Friedman, A. S. (2020). Association of Vaping‐related Lung Injuries with Rates of E‐cigarette and Cannabis Use across US States. Addiction. doi:10.1111/add.15235
  • Acknowledgement: Research reported in this publication was supported by grant number 3U54DA036151‐08S2 from the National Institute On Drug Abuse of the National Institutes of Health and FDA Center for Tobacco Products (CTP).


2020: Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers

  • Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.
  • According to a time-series analysis of data from the Smoking Toolkit study, in which repeated cross-sectional surveys are conducted with a representative sample of households in England, increasing prevalence of e-cigarette use in current smokers was predictive of higher success rates of quit attempts.
  • Most participants were self-reported long-term abstinent smokers (86.3%).
  • Those who start on a low self-reported nicotine e-liquid concentration (strength) will be more likely to relapse to tobacco smoking than those starting on a higher nicotine e-liquid, after controlling for cigarettes per day (CPD) before cessation.
  • Results suggest a change in flavor choices over the course of vaping initiation and uptake. There was a reduction in the proportion of people using a tobacco flavor, and increase in the proportion using a fruit/sweet/food flavor, from initial to current flavor choice
  • According to the 2017 ASH-A survey, among current users, fruit flavors were the most popular.
  • PDF Version
  • Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8
  • Acknowledgement: This research was funded by Cancer Research UK (CRUK), Grant Number C54889/A22732.


2020: The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults

  • Among the 18–24 age group, there was a significant increase in cigarette smoking.
  • Cigarette smoking increased among 25–34 years old.
  • Banning flavors in e-cigarettes can push some e-cigarette users to turn to cigarette smoking and could prompt some youth to initiate into smoking instead of e-cigarette use.
  • The proportions of e-cigarettes, cigarettes, and cigars obtained over the internet increased after the ban, and the proportions obtained from retailers outside of San Francisco also increased overall.
  • PDF Version
  • Citation: Yang, Y., Lindblom, E. N., Salloum, R. G., & Ward, K. D. (2020). The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addictive Behaviors Reports, 11, 100273. doi:10.1016/j.abrep.2020.100273
  • Acknowledgement: This research was supported by the National Institute of Drug Abuse of the National Institutes of Health (R03DA048460).


2019: Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

  • Our results regarding anticipated reactions to FDA e-cigarette flavor regulation suggest complexities such that the benefits and risks of flavor ban need to be carefully evaluated.
  • A majority anticipated that they would personally attempt to circumvent potential FDA regulations of e-cigarettes by obtaining e-cigarette flavors from various illicit sources (e.g., Internet orders from foreign countries) or even self-making flavors.
  • The use of flavoring agents purchased from unregulated sources could lead to additional unanticipated toxicities.
  • It is also concerning that some established e-cigarette users believed that they would return to cigarette smoking if nontobacco e-cigarette flavors were banned. Thus, for adult e-cigarette users who use certain flavors to facilitate smoking cessation or reduction, banning all nontobacco flavors could precipitate relapse to smoking.
  • PDF Version
  • Citation: Ann Am Thorac Soc Vol 17, No 5, pp 573–581, May 2020, Copyright © 2020 by the American Thoracic Society, DOI: 10.1513/AnnalsATS.201906-472OC
  • Acknowledgement: Supported by the National Institute on Drug Abuse of the National Institutes of Health (NIH) and the Center for Tobacco Products of the U.S. Food and Drug Administration (FDA) (P50-DA-036107) for the Penn State Tobacco Center of Regulatory Science.


2019: The role of flavors in vaping initiation and satisfaction among U.S. adults

  • Most common reasons for vaping initiation were as an alternative to cigarettes (43.7%) and because respondents viewed e-cigarettes as less harmful than other tobacco products (31.2%). Flavor was the third most commonly reported reason.
  • Satisfaction among those who bought flavored e-liquid was higher than those who did not buy flavored e-liquid.
  • PDF Version
  • Citation: Landry, R. L., Groom, A. L., Vu, T.-H. T., Stokes, A. C., Berry, K. M., Kesh, A., … Payne, T. J. (2019). The role of flavors in vaping initiation and satisfaction among U.S. adults. Addictive Behaviors, 106077. doi:10.1016/j.addbeh.2019.106077
  • This research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) and the FDA Center for Tobacco Products (CTP) under Awards P50HL120163 and U54HL120163.


2018: Patterns of flavored e-cigarette use among adults vapers in the United States: an internet survey

  • Survey results submitted to the FDA
  • In conclusion, this cross-sectional study of a very large sample of adult US e-cigarette users, most of which were former smokers, identified the importance of non-tobacco flavors in e-cigarette use initiation and sustained use, and their contribution to smoking cessation and relapse prevention. *This information should be considered by regulators in order to avoid unintentional adverse effects of over-restrictive regulation on e-cigarette flavors.
  • PDF Version
  • Citation: Konstantinos Farsalinos, MD, MPH, Christopher Russell, PhD, George Lagoumintzis, PhD, Konstantinos Poulas, Submitted to: Docket No. FDA-2017 N-6565 for “Regulation of Flavors in Tobacco Products.”


2018: Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA

  • Adult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time. Restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes.
  • PDF Version
  • Citation: Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018 Jun 28;15(1):33. doi: 10.1186/s12954-018-0238-6. PMID: 29954412; PMCID: PMC6022703.
  • Acknowledgements: The authors are grateful to Julie Woessner and Alex Clark (Consumer Advocates for Smoke-free Alternatives Association), Stefan Didak and Danielle Bloss (Not Blowing Smoke), Gregory Conley (American Vaping Association), Cynthia Cabrera (Cating Group), and the Board of the Smoke-Free Alternatives Trade Association, without whose assistance this study would not have been possible. Fontem Ventures, a company that makes e-cigarettes, and a wholly owned subsidiary of Imperial Brands PLC provided funding for this study.


2018: Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment

  • A ban on flavoured e-cigarettes would likely increase the choice of cigarettes in smokers, the more harmful way of obtaining nicotine.
  • PDF Version
  • Citation:Buckell J, Marti J, Sindelar JLShould flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experimentTobacco Control 2019;28:168-175.
  • Acknowledgement: Research reported in this publication was supported by grant number P50DA036151 from the National Institute on Drug Abuse (NIDA) and FDA Center for Tobacco Products (CTP).


2017: Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes

  • To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
  • Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
  • After e-cig initiation, dual users decreased tobacco consumption by 82% and were low-to-moderately cigarette dependent.
  • The two groups (dual users and switchers) reported mostly using a flavor other than tobacco.
  • PDF Version
  • Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.


2016: Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings

  • The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates of people who smoke.
  • E-cigarette vaping rates are influenced by flavorings by people transistioning from smoking.
  • These findings have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of e-cigarettes for harm reduction.
  • PDF Version
  • Citation: Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings, Tobacco Control 2016;25:ii67-ii72.
  • Acknowledgement: Support for this project was provided by Grant 1 R01 DA036492 from the National Institute on Drug Abuse, and in part by General Clinical Research Center Grant M01-RR06192 from the National Institutes of Health.


2015: The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes

  • Nonsmoking teens’ interest in e-cigarettes was very low.
  • Adult smokers’ interest was significantly higher overall and for each flavor.
  • Teen interest did not vary by flavor, but adult interest did.
  • Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavor.
  • Nonsmoking teens who had never tried e-cigarettes had the lowest interest in flavors, followed by adults who had never tried e-cigarettes
  • PDF Version
  • Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333
  • Acknowledgement: This work was supported by NJOY, a company that markets electronic cigarettes, but does not make or sell any combustible tobacco products. All authors work for Pinney Associates and provide consulting services to GlaxoSmithKline Consumer Healthcare on their stop-smoking medications and to NJOY, Inc. on electronic nicotine delivery systems (ENDS). SS and JGG also own an interest in a novel nicotine medication in development. The study sponsor was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the manuscript, nor did the sponsor review the manuscript prior to submission.


2015: Preferred Flavors and Reasons for E-cigarette Use and Discontinued Use Among Never, Current, and Former Smokers

  • Never users had significantly lower prevalence of use of alcohol, marijuana, and other tobacco products (take less risks).
  • The most commonly reported reasons for e-cigarette use were “they might be less harmful than cigarettes” (77%); “they don’t smell” (77%); “they help people quit smoking” (66%); and “they cost less than other forms of tobacco” (62%); these reasons were more frequently endorsed by former smokers.
  • Among current e-cigarette users, the most commonly used flavor was fruit flavors (67%)
  • Over 90% of former cigarette smokers who were current e-cigarette users reported using e-cigarettes to quit smoking.
  • Over half of never smokers who are former e-cigarette users said they did not recently use e-cigarettes because they “just don’t think about it”, possibly indicating that addiction did not play a role in their use.
  • PDF Version
  • Citation: Berg CJ. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health. 2016 Mar;61(2):225-36. doi: 10.1007/s00038-015-0764-x. Epub 2015 Nov 18. PMID: 26582009; PMCID: PMC4808473.
  • Acknowledgement: This research was supported by the National Cancer Institute (1K07CA139114-01A1; PI: Berg) and the Georgia Cancer Coalition (PI: Berg).


2013: Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey

  • 4,618 participants were included in the analysis, with 4,515 reporting current smoking status (current vs. former smokers).
  • More than 90% were former smokers. The mean age was 40 years
  • At the time of participation, most commonly used flavors were fruits, followed by sweets.
  • Most participants (68.3%) were switching between flavours on a daily basis or within the day, with former smokers switching more frequently. More than half of the study sample mentioned that they like the variety of flavours and that the taste gets blunt from long-term use of the same flavour. The average score for importance of flavours variability in reducing or quitting smoking was 4 (“very important”). Finally, the majority of participants stated that restricting variability of flavours would make the EC experience less enjoyable while almost half of them answered that it would increase craving for tobacco cigarettes and would make reducing or completely substituting smoking less likely.
  • The results of this survey indicate that EC liquid flavourings play a major role in the overall experience of dedicated users and support the hypothesis that they are important contributors in reducing or eliminating smoking consumption.
  • PDF Version
  • Citation: Farsalinos, K., Romagna, G., Tsiapras, D., Kyrzopoulos, S., Spyrou, A., & Voudris, V. (2013). Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey. International Journal of Environmental Research and Public Health, 10(12), 7272–7282. doi:10.3390/ijerph10127272
  • Acknowledgement: No funding was received for this study.

Nicotine Levels

2020: Might limiting liquid nicotine concentration result in more toxic electronic cigarette aerosols?

  • Thus, if users seek a given nicotine yield, regulatory limits on nicotine concentration may have the unintended consequence of increasing exposure to aerosol and respiratory toxicants. This outcome demonstrates that attempting to control ECIG nicotine yield by regulating one factor at a time may have unintended health effects and highlights the need to consider multiple factors and outcomes simultaneously when designing regulations..
  • PDF Version


2020: Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers

  • Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.
  • According to a time-series analysis of data from the Smoking Toolkit study, in which repeated cross-sectional surveys are conducted with a representative sample of households in England, increasing prevalence of e-cigarette use in current smokers was predictive of higher success rates of quit attempts.
  • Most participants were self-reported long-term abstinent smokers (86.3%).
  • Those who start on a low self-reported nicotine e-liquid concentration (strength) will be more likely to relapse to tobacco smoking than those starting on a higher nicotine e-liquid, after controlling for cigarettes per day (CPD) before cessation.
  • Results suggest a change in flavor choices over the course of vaping initiation and uptake. There was a reduction in the proportion of people using a tobacco flavor, and increase in the proportion using a fruit/sweet/food flavor, from initial to current flavor choice
  • According to the 2017 ASH-A survey, among current users, fruit flavors were the most popular.
  • PDF Version
  • Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8
  • Acknowledgement: This research was funded by Cancer Research UK (CRUK), Grant Number C54889/A22732.


2016: Protocol proposal for, and evaluation of, consistency in nicotine delivery from the liquid to the aerosol of electronic cigarettes atomizers: regulatory implications

  • Electronic cigarettes that use tank‐type atomizers appear to deliver nicotine in more consistent quantities (within the acceptable limits for medicinal nebulizers and similar to the nicotine inhaler) than electronic cigarettes that use cartomizers.
  • The protocol for testing nicotine delivery consistency described in this paper could be used effectively for regulatory purposes.
  • PDF Version


2013: Evaluating Nicotine Levels Selection and Patterns of Electronic Cigarette use in a Group of “Vapers” Who Had Achieved Complete Substitution of Smoking

  • Nicotine levels appear to play an important role in achieving and maintaining smoking cessation in the group of motivated subjects studied. High nicotine-containing liquids were used while few mild and temporary side effects were reported. Proposals about regulation should consider the pragmatic use patterns of ECs, especially in consumers who have completely substituted smoking.
  • 42% of participants reported quitting smoking during the first month of EC use.
  • Liquids with nicotine concentration >15 mg/mL were used by 74% of users at initiation of EC use, while 16.2% had to increase the initial nicotine levels in order to achieve complete smoking abstinence.
  • 64.9% reported that from the time of smoking cessation to the time of the interview (8 months median duration of EC use) they reduced the nicotine concentration they were consuming.
  • The vast majority of participants reported better exercise capacity and improved olfactory and gustatory senses.
  • Perceived EC dependency was significantly lower compared to smoking.
  • PDF Version


2013: Nicotine levels in electronic cigarettes

  • E-cigarettes (ECs) generate vapor that contains nicotine, but EC brands and models differ in their efficacy and consistency of nicotine vaporization. In ECs, which vaporize nicotine effectively, the amount inhaled from 15 puffs is lower compared with smoking a conventional cigarette.
  • PDF Version


Personal Testimonies from people who used to smoke

All Years: Video Collection: Golden Oldies Capitol Tours

  • People who used to smoke share how long they smoked and what flavors helped them to quit smoking.


All Years: Collection 13,000+ Testimonies: CASAA - REAL PEOPLE. REAL STORIES.

  • Online submissions of personal testimonies by people who switched from smoking to harm reduction products.


Quitting Smoking: E-cigarette vs. NRT OR E-cigarette with NRT

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).


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).


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.


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).


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).


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.


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).


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


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



Quitting Smoking / Preventing Relapse (No comparison to other methods)

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: 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: 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: 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).


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: 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


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.


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: 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


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: 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: 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: 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



Race / Ethnic / Socioeconomic / Education

2020: Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence

  • The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP (non-combustible nicotine products) for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups).
  • Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to:
    • wider circumstances of socioeconomic disadvantage;
    • lack of a perceived advantage of alternative products over smoking;
    • and a perceived lack of information about relative harms of NCNP compared to smoking.
  • Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage.
  • PDF Version
  • Citation: Lucherini M, Hill S, Smith K. Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence. BMC Public Health. 2020;20(1):943. Published 2020 Jun 15. doi:10.1186/s12889-020-09083-9
  • Acknowledgement: The review is part of a project funded by Cancer Research UK. The award number is: C55561/A21553.


2019: Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking

  • Furthermore, more educated smokers are more likely to switch to exclusive e-cigarette use than less educated smokers.
  • Such differential switching may exacerbate socioeconomic disparities in smoking-related morbidity and mortality, but lower the burden of tobacco-related disease.
  • PDF Version
  • Citation: Friedman, A. S., & Horn, S. J. L. (2018). Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking. Nicotine & Tobacco Research. doi:10.1093/ntr/nty120
  • Acknowledgement: This work was not supported by outside funding.


2019: Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

  • The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
  • The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
  • PDF Version
  • Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.
  • Acknowledgement: Grants from the National Cancer Institute of the National Institutes of Health (P20CA202921 to University of Oklahoma, and 5P20CA202923 to Cherokee Nation) supported this study.


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


2018: Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study

  • Compared with non-Hispanic Whites, non-Hispanic Black, and Hispanics were less likely to become exclusive e-cigarette users
  • Low-income smokers were less likely than higher-income smokers to become exclusive e-cigarette users
  • Black, Hispanic, and low-income smokers were more likely to believe e-cigarettes are more harmful than cigarettes and to have positive tobacco-related social norms.
  • Results of this study show that the exclusive use of e-cigarettes is more prevalent in higher-income and White smokers. Our data suggest that higher-income and White smokers may be more likely to use e-cigarettes as a means to quit combustible cigarettes compared with low-income and racial/ethnic minority smokers. These findings suggest that sociodemographic differences in e-cigarette uptake and use patterns may contribute to widening disparities in cigarette smoking.
  • PDF Version
  • Citation: Harlow AF, Stokes A, Brooks DR. Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res. 2019;21(10):1385-1393. doi:10.1093/ntr/nty141
  • Acknowledgement: Research 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.


2016: Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample

  • This study found more similarities than differences among Whites, African Americans/Blacks, and Hispanics with a history of tobacco smoking.
  • African Americans/Blacks were significantly less likely to report ever-use compared to Whites and Hispanics (50% vs. 71% and 71%, respectively; p < 0.001).
  • African American/Black ever users were more likely to report plans to continue using e-cigarettes compared to Whites and Hispanics (72% vs. 53% and 47%, respectively, p = 0.01).
  • African American/Black participants were more likely to use e-cigarettes as a cessation aid compared to both Whites (p = 0.03) and Hispanics (p = 0.48)
  • White participants were more likely to use e-cigarettes to save money compared to Hispanics (p = 0.02).
  • PDF Version
  • Citation: Webb Hooper M, Kolar SK. Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample. Int J Environ Res Public Health. 2016;13(10):1009. Published 2016 Oct 14. doi:10.3390/ijerph13101009
  • Acknoledgement: We thank the Sylvester Comprehensive Cancer Center at the University of Miami for funding this study and Case Comprehensive Cancer Center for providing funds for open access publication.



Regulations and Taxes

2021: Regulation of e-cigarette flavours – a response

  • Testimony in Netherlands pertaining to a potential flavour / flavor ban. This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands.
  • Signed by 24 experts from around the world
  • Covers 12 key points
    • Sets conflicting objectives and takes a “war on drugs” approach to nicotine.
    • Adopts false and misleading claims about the risks of e-cigarettes.
    • Draws on irrelevant information about an outbreak of lung injuries in North America.
    • Misunderstands “dual-use”.
    • Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
    • Takes a simplistic approach to youth risk behaviours and fails to demonstrate benefits to adolescent public health.
    • Ignores perverse consequences of prohibition, even though these are foreseeable.
    • Fails to show benefits for adolescents or address concerns it may cause harm to young people.
    • Ignores the harmful effects of a vaping flavour ban on adults.
    • Creates regulatory protection for the cigarette trade.
    • Violates important regulatory principles, including those underpinning the European Union internal market.
    • Proposes an illiberal policy and fails to recognise a major global public health opportunity.
  • Acknowledgement: We confirm that signatories report no conflicts with respect to FCTC Article 5.3 and no financial conflicts of interest with respect to tobacco or e-cigarette companies under the International Committee of Medical Journal Editors (ICJME) reporting standard.


2020: Are E-Cigarette Regulations Jeopardizing the Public Health?

  • The demonization of e-cigarettes in the U.S. is counterproductive. As part of a tobacco harm reduction strategy, the potential public health benefits from e-cigarettes are substantial. Opposition to e-cigarettes, often fueled by misleading information, curbs their use as a smoking cessation aid by millions of adults.
  • E-cigarettes are far less harmful than combustible cigarettes and constitute one of the most common -- and effective -- smoking cessation aids. Overzealous or poorly designed restrictions on vaping, combined with misleading information about e-cigarettes’ true health risks, are deterring smokers from pursuing a potentially life-saving alternative.
  • If cigarette use were largely replaced by vaping over a 10-year period in the U.S., it would prevent as many as 6.6 million premature deaths.
  • A report by a government agency, the Public Health of England, an agency of England’s Department of Health and Social Care, reported that most consumers who vape do so in order to stop smoking.
  • The doses of toxins contained in e-cigarettes are typically hundreds or thousands of times lower than in regular cigarettes. While non-smokers would be ill-advised to take up vaping, smokers could reap significant health benefits from switching to e-cigarettes.
  • Underage vaping by nonsmokers is rare, which supports the correlation that the rise in vaping has led to a decline in smoking among teens.
  • Not only does the hysteria surrounding e-cigarettes endanger smokers and jeopardize public health, it also undermines the credibility of health authorities on other important issues like the coronavirus and vaccines. The American public should be told the truth about e-cigarettes.
  • Too often, policymakers have acted without carefully weighing the costs and benefits of their actions. Knee-jerk opposition to e-cigarettes, often fueled by misleading information, curbs their use as a smoking cessation aid by millions of adults.
  • Acknowledgement: Liam Sigaud, Dr. Krisztina Pusok, Janson Q. Prieb and Steve Pociask are with the American Consumer Institute, Center for Citizen Research, a nonprofit educational and research organization. A special thanks to Guy Bentley, Director of Consumer Freedom Research at the Reason Foundation, for his helpful comments. For more information about the Institute, visit www.TheAmericanConsumer.Org or follow us on Tweeter @ConsumerPal.


2020: A rational approach to e-cigarettes: challenging ERS policy on tobacco harm reduction

  • We believe that blanket opposition to e-cigarettes is misguided and will lead to a number of important consequences that are adverse to health.
    • First, smokers who would otherwise have quit smoking by switching to a lower risk product will continue to smoke, and die prematurely from cancer, cardiovascular and respiratory disease.
    • Second, people who have successfully switched to vaping may relapse to smoking if they come to believe that there is no health benefit from vaping, and thus increase their risk of avoidable morbidity and premature death.
    • Third, the pursuit of arguments that vaping can’t help people to quit smoking, in the face of clear evidence that it does, risks undermining public trust in science.
  • PDF Version
  • Citation: A rational approach to e-cigarettes: challenging ERS policy on tobacco harm reduction, John Britton, Jacob George, Linda Bauld, Sanjay Agrawal, John Moxham, Deborah Arnott, Ann McNeill, Nicholas S. Hopkinson - European Respiratory Journal May 2020, 55 (5) 2000166; DOI: 10.1183/13993003.00166-2020


2020: The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data

  • We simulate that for every one standard e-cigarette pod (a device that contains liquid nicotine in e-cigarettes) of 0.7 ml no longer purchased as a result of an e-cigarette tax, the same tax increases traditional cigarettes purchased by 6.2 extra packs.
  • PDF Version
  • Citation: Cotti, C., Courtemanche, C., Maclean, J. C., Nesson, E., Pesko, M., & Tefft, N. (2020). The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data. doi:10.3386/w26724
  • Acknowledgement: Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA045016 (PI: Michael Pesko).


2020: Vape shop owners/managers’ opinions about FDA regulation of e-cigarettes

  • Vape shop owners/managers reported:
    • 1) entering the industry with positive intentions for their customers;
    • 2) training their personnel to adhere to regulations and provide good customer service; and
    • 3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors.
  • PDF Version
  • Citation: Carla J Berg, PhD, MBA, Dianne C Barker, MHS, Steve Sussman, PhD, Betelihem Getachew, MPH, Kim Pulvers, PhD, MPH, Theodore L Wagener, PhD, Rashelle B Hayes, PhD, Lisa Henriksen, PhD, Vape Shop Owners/Managers’ Opinions About FDA Regulation of E-Cigarettes, Nicotine & Tobacco Research, Volume 23, Issue 3, March 2021, Pages 535–542, https://doi.org/10.1093/ntr/ntaa138
  • Acknowledgement: This work was supported by the National Cancer Institute (R01CA215155-01A1; PI: Berg).


2019: 2019: E-Cigarettes and Adult Smoking: Evidence from Minnesota

  • We provide some of the first evidence on how e-cigarette taxes impact adult smokers, exploiting the large tax increase in Minnesota. That state was the first to impose a tax on e-cigarettes by extending the definition of tobacco products to include e-cigarettes. This tax, which is 95% of the wholesale price, provides a plausibly exogenous deterrent to e-cigarette use.
  • Our results suggest that in the sample period about 32,400 additional adult smokers would have quit smoking in Minnesota in the absence of the tax. If this tax were imposed on a national level about 1.8 million smokers would be deterred from quitting in a ten year period. The taxation of e-cigarettes at the same rate as cigarettes could deter more than 2.75 million smokers nationally from quitting in the same period.
  • PDF Version
  • Citation: Saffer, Henry and Grossman, Michael and Dench, Daniel and Dave, Dhaval, E-Cigarettes and Adult Smoking: Evidence from Minnesota (December 12, 2019). Available at SSRN: https://ssrn.com/abstract=3503054 or http://dx.doi.org/10.2139/ssrn.3503054
  • Acknowledgement: This project was funded by grant number R01-DA039968 entitled “The Economics of Electronic Nicotine Delivery Systems: Advertising and Outcomes”, from the National Institute of Health to the National Bureau of Economic Research, Inc. This study employs data from the A.C. Nielsen Company, which was purchased from the Kilts Center of the University of the Chicago Booth School of Business.


2019: The Effect of E-Cigarette Taxes on Pre-pregnancy and Prenatal Smoking

  • We show that e-cigarette taxes increase pre-pregnancy smoking, increase prenatal smoking, and lower smoking cessation during pregnancy. These findings imply that e-cigarettes and traditional cigarettes are substitutes among pregnant women.
  • PDF Version
  • Citation: The Effect of E-Cigarette Taxes on Pre-Pregnancy and Prenatal Smoking, and Birth Outcomes - Rahi Abouk, Scott Adams, Bo Feng, Johanna Catherine Maclean, and Michael F. Pesko, NBER Working Paper No. 26126, July 2019, JEL No. I12
  • Acknowledgements: Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA045016 (PI: Michael Pesko).


2019: E-cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation with the Potential Benefits of Increasing Smoking Cessation

  • Potential life-years gained as a result of vaping-induced smoking cessation are projected to exceed potential life-years lost due to vaping-induced smoking initiation. These results hold over a wide range of plausible parameters
  • Our analysis strongly suggests that the upside health benefit associated with e-cigarettes, in terms of their potential to increase adult smoking cessation, exceeds their downside risk to health as a result of their possibly increasing the number of youthful smoking initiators. Public messaging and policy should continue to strive to reduce young people's exposure to all nicotine and tobacco products. But, they should not do so at the expense of limiting such products' potential to help adult smokers to quit.
  • PDF Version
  • Citation: Warner, K. E., & Mendez, D. (2018). E-cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation with the Potential Benefits of Increasing Smoking Cessation. Nicotine & Tobacco Research. doi:10.1093/ntr/nty062
  • Acknowledgements: This work was not supported by any external funding.


2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions

  • Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
  • This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
  • PDF Version
  • Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435
  • Acklnowledgement: This work was supported by the National Institutes of Health (K01DA043413, K23DA039294, and K23DA042898). The funding source had no other role other than financial support.


2017: Does the Regulatory Environment for E-Cigarettes Influence the Effectiveness of E-Cigarettes for Smoking Cessation?

  • This study shows that in a less restrictive EC (E-Cigarette) regulatory environment, use of ECs during a quit attempt facilitates, but in a more restrictive environment it inhibits, short-term sustained abstinence. The findings underscore the need for careful consideration on how best to regulate this emerging product so that EC benefits for smoking cessation are maximized and its risks to public health are minimized.
  • PDF Version
  • Citation: Hua-Hie Yong, PhD, Sara C Hitchman, PhD, K Michael Cummings, PhD, Ron Borland, PhD, Shannon M L Gravely, PhD, Ann McNeill, PhD, Geoffrey T Fong, PhD, Does the Regulatory Environment for E-Cigarettes Influence the Effectiveness of E-Cigarettes for Smoking Cessation?: Longitudinal Findings From the ITC Four Country Survey, Nicotine & Tobacco Research, Volume 19, Issue 11, November 2017, Pages 1268–1276, https://doi.org/10.1093/ntr/ntx056
  • Acknowledgement: KMC has received grant funding from Pfizer, Inc. to study the impact of a hospital based tobacco cessation intervention and also has served as an expert witness in litigation filed against the tobacco industry. Ethical Approval: All waves of the study have received ethical approval from the relevant research ethics committee at the Cancer Council Victoria (Australia), Medical University of South Carolina (USA), University of Waterloo (Canada) and the University of Strathclyde (UK).


2016: A Framework for Evaluating the Public Health Impact of E-cigarettes and Other Vaporized Nicotine Products

  • The primary aim of tobacco control policy should therefore be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to VNPs (vaporized nicotine products) rather than quitting all nicotine use. Countries whose policies discourage VNP use run the risk of neutralizing a potentially useful addition to methods of reducing tobacco use.
  • PDF Version
  • Citation: Levy, D. T., Cummings, K. M., Villanti, A. C., Niaura, R., Abrams, D. B., Fong, G. T., & Borland, R. (2016). A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction, 112(1), 8–17. doi:10.1111/add.13394
  • Acknowledgment: Funding was received from the Food and Drug Administration through the National Institute on Drug Abuse under grant 1R01DA036497-01.
  • Article: Public health benefits of e-cigarette use tend to outweigh the harms, new study says
  • Article: Top tobacco control experts to FDA: Studies of e-cigs suggest more benefit than harm


2015: Ethical issues raised by a ban on the sale of electronic nicotine devices

  • Respect for autonomy: prohibiting ENDS infringes on smokers’ autonomy to use a less harmful nicotine product while inconsistently allowing individuals to begin and continue smoking cigarettes.
  • Non‐maleficence: prohibition is supposed to prevent ENDS recruiting new smokers and discouraging smokers from quitting. It also perpetuates harm by preventing addicted smokers from using a less harmful nicotine product.
  • Beneficence: ENDS could benefit addicted smokers by reducing their health risks if they use them to quit and do not engage in dual use.
  • Distributive justice: lack of access to ENDS disadvantages smokers who want to reduce their health risks. Different national policies create inequalities in the availability of products to smokers internationally.
  • PDF Version
  • Citation: Hall, W., Gartner, C., & Forlini, C. (2015). Ethical issues raised by a ban on the sale of electronic nicotine devices. Addiction, 110(7), 1061–1067. doi:10.1111/add.12898
  • Acknowledgement: C.G. is supported by an NHMRC Career Development Award. C.F. is supported by funding from the Australia Research Council for research on the use of stimulant drugs as cognitive enhancers. We would like to thank Sarah Yeates for her assistance in preparing this paper for publication.



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Implementation of smokefree prisons in Scotland: findings from the Tobacco in Prisons (TIPs) study

Expression of Key Inflammatory Proteins Is Increased in Immune Cells From Tobacco Cigarette Smokers But Not Electronic Cigarette Vapers: Implications for Atherosclerosis

Can E-Cigarettes and Pharmaceutical Aids Increase Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally Representative Cohort of American Smokers

Patients with lung cancer: Are electronic cigarettes harmful or useful?

Based on current knowledge, for patients with lung or other forms of cancer who would otherwise continue to smoke, e-cigarettes offer an alternative way to quit smoking while they undergo medical treatment. The option to switch to e-cigarettes should be considered by healthcare practitioners with patients with cancer who would otherwise continue to smoke.


Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication

Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation.

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