Monday, April 27, 2015

Another Pilot Study Shows Great Promise for Electronic Cigarettes in Smoking Cessation

A study published last October in the International Journal of Environmental Research and Public Health, which had escaped my attention until today, found a sizable six-month smoking cessation rate among smokers unwilling to quit at baseline who were exposed to electronic cigarettes.

(See: 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. International Journal of Environmental Research and Public Health 2014; 11, 11220-11248.)

This was a small pilot study from Belgium in which 48 smokers who were unwilling to quit at baseline were introduced to electronic cigarettes over an eight-week period and then followed for six months. By the end of the eight-week intake period (during which laboratory sessions were conducted to assess participants' responses to electronic cigarettes), all participants had been given electronic cigarettes, information about these products, and a web site address at which they could purchase e-liquid refills. They were then followed up for six months. Subjects who were lost to follow-up were considered to be treatment failures (i.e., continuing smokers with no reduction in cigarette consumption. The main study outcomes were smoking cessation, reduction of cigarette consumption by more than 80%, and reduction of cigarette consumption by more than 50%.

Interestingly, the researchers decided to include a subgroup of smokers who were not provided with e-cigarettes until after the initial eight-week period.

At six month follow-up, 21% of the subjects had quit smoking, 15% had reduced their cigarette consumption by more than 80%, 8% had reduced their cigarette consumption by more than 50%, and 56% were treatment failures.

Of note, at the eight week mark, none of the smokers in the group that was not provided with e-cigarettes had quit smoking.

The Rest of the Story

This is a small pilot study involving only 48 participants so the results must be interpreted with caution. In addition, there was no comparison group that received standard treatment (e.g., the nicotine patch) or no treatment, so it is somewhat difficult to assess the proportion of subjects who would have been expected to quit without having been introduced to electronic cigarettes.

Nevertheless, despite these limitations, the observed smoking cessation rate of 21% over six months is remarkable, especially given the fact that none of the smokers had any interest in quitting smoking at the time they were recruited into the study. Moreover, a total of 44% of the smokers had succeeded in either quitting or reducing their cigarette consumption by more than 50%.

One indication that the observed results are largely due to the electronic cigarettes is that none of the smokers in the group which did not receive these devices for the first two months of the study successfully quit smoking during that two-month period. However, at six month follow-up, 25% of these smokers had quit.

These results are consistent with those of Dr. Polosa and colleagues in Italy, who found similarly high cessation and reduction rates among smokers unwilling to quit at baseline.

It is possible that these favorable results are attributable to the use of a second-generation vaping device.

The results suggest that one distinct advantage of electronic cigarettes as a smoking cessation tool is that they can be effective even for smokers who have no initial desire to quit, unlike traditional cessation treatment, in which success if extremely low among unmotivated smokers.

Despite the repeated claims of e-cigarette opponents that vaping devices inhibit smoking cessation, actual studies which follow smokers over time continue to report favorable outcomes, both in terms of complete cessation and in terms of significant reduction.

Clearly, a rigorous clinical trial is needed. But until such time, the existing evidence suggests that electronic cigarettes are a bona fide smoking cessation strategy. They are not for everyone, but they can be helpful for many smokers. To reduce access to these products by banning online sales or eliminating all flavorings would likely cause significant public health harm by increasing smoking. These policies would undoubtedly inhibit smoking cessation.

(Thanks to Dr. Jean-Francois Etter for the tip.)

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