Potential smoking cessation aid
A 2010 study in New Zealand compared the use of a nicotine inhaler with an e-cigarette to aid smoking cessation.4 The study determined that the use of an e-cigarette in smoking cessation is extremely similar to the use of a nicotine inhaler. This was due to the similar delivery method of nicotine and the option to specify a predetermined amount based on user preference.4 However, unlike the nicotine inhaler, the e-cigarette is not an approved smoking cessation device.4 A more recent study completed in 2013 studied 300 subjects to focus on the efficiency and safety of using electronic cigarettes as a tobacco cigarette substitute for a 12-month period.26 The researchers found that the use of electronic cigarettes decreased tobacco cigarette consumption and elicited tobacco abstinence without causing significant side effects (i.e., elevated heart rate, blood pressure, weight gain).26 In several surveys, e-cigarette users have reported that electronic cigarettes are effective for assisting with smoking cessation.10,11,27 The American Heart Association position states that there is insufficient evidence to recommend e-cigarettes as a primary smoking cessation aid and maintains that it is reasonable to support a patients’ desire to use e-cigarettes for smoking cessation when initial conventional tobacco cessation treatment has failed or when the patient refuses conventional treatment.2
A few small studies indicate that electronic cigarettes can assist with smoking cessation and produce less negative effects on the body when compared with conventional tobacco cigarettes.4,26,28 However, data are available only for short-term use, and no larger rigorous long-term studies have been completed. With the long-term smoking cessation rates and health effects unknown, further research is in high demand.
When confronted with a patient’s questions about e-cigarette use, the PCP must consider patient preferences, the patient’s current circumstances, and previous attempts at smoking cessation to determine the best recommendations for each individual patient. Preliminary evidence suggests that although e-cigarettes are not considered healthy by any means, they may be the lesser of two evils when compared with traditional tobacco cigarettes. The majority of patients who inquire about electronic cigarettes are searching for healthier lifestyles. Therefore, providers should make it clear that electronic cigarettes cannot be considered healthy, and they are not regulated by the FDA but may provide some health benefits for patients depending on their personal smoking habits. As research related to e-cigarettes and their efficacy as smoking cessation aids expands, PCPs should critically evaluate the results to best counsel patients to make healthy lifestyle choices.
Cara N. Wilt, MS, RN, AGNP-BC, is an adult and gerontological primary care nurse practitioner, Emergency Department, University of Maryland Medical Center in Baltimore. Laura W. Koo, MS, RN, FNP-BC, is an assistant professor, Department of Organizational Systems and Adult Health, University of Maryland Baltimore School of Nursing.
- CDC. CDC vital signs—Adult smoking in the US. 2011. Available at:cdc.gov/VitalSigns/AdultSmoking/index.html#StateInfo
- Bhatnagar A, Whitsel L, Ribisl K, et al. Electronic cigarettes: A policy statement from the American Heart Association. Circulation. 2014;130(16):1418-1436. Available at: circ.ahajournals.org/content/early/2014/08/22/CIR.0000000000000107
- Odum LE, O’Dell KA, Schepers JS. Electronic cigarettes: Do they have a role in smoking cessation? J Pharm Pract. 2012;25(6):611-614.
- Bullen C, McRobbie H, Thornley S, et al. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomized cross-over trial. Tob Control. 2010;19(2):98-103.
- King BA, Alam S, Promoff G, et al. Awareness and ever use of electronic cigarettes among U.S. adults, 2010-2011. Nicotine Tob Res. 2013;15(9):1623-1627.
- Where to buy blu eCigs electronic cigarettes: blu eCigs retailers near you. Retrieved March 19, 2015. Available at: store.blucigs.com/store-locator
- PR Newswire. NE-WHERE electronic cigarettes now available at 7-eleven stores. February 14, 2013. Available at: prnewswire.com/news-releases/ne-where-electronic-cigarettes-now-available-at-7-eleven-stores-191178131.html
- McQueen A, Tower S, Sumner W. Interviews with “vapers”: implications for future research with electronic cigarettes. Nicotine Tob Res. 2011;13(9):860-867.
- Goniewicz ML, Kuma T, Gawron M, et al. Nicotine levels in electronic cigarettes. Nicotine Tob Res. 2013;15(1):158-166.
- Goniewicz M, Lingas EO, Hajek P. Patterns of electronic cigarette use and user beliefs about their safety and benefits: An internet survey. Drug Alcohol Rev. 2013;32(2):133-140.
- Etter JF. Electronic cigarettes: A survey of users. BMC Public Health. 2010;10:231.
- Blu cigs: Products. 2013. Retrieved from blucigs.com/store
- Jampel S. What a pack of cigarettes costs now, state by state. 2013. Available at: theawl.com/2013/07/what-a-pack-of-cigarettes-costs-now-state-by-state
- Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes? J Public Health Policy. 2011;32(1):16-31.
- Etter JF. Saliva cotinine levels in users of electronic cigarettes. Eur Respir J. 2011;38(5):1219-1220.
- Flouris AD, Poulianiti KP, Chorti MS, et al. Acute effects of electronic and tobacco cigarette smoking on complete blood count. Food Chem Toxicol. 2012;50(10):3600-3603.
- Flouris AD, Chorti MS, Poulianiti KP, et al. Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function. Inhal Toxicol. 2013;25(2):91-101.
- Farsalinos K, Romagna G. Chronic idiopathic neutrophilia in a smoker, relieved after smoking cessation with the use of electronic cigarette: A case report. Clin Med Insights Case Rep. 2013;(6):15-21.
- Vansickel AR, Cobb CO, Weaver MF, Eissenberg TE. A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: nicotine delivery profile and cardiovascular and subjective effects. Cancer Epidemiol Biomarkers Prev. 2010;19(8): 1945.
- Vardavas C, Anagnostopoulos N, Kougias M, et al. Short-term pulmonary effects of using an electronic cigarette. Chest. 2012;141(6):1400.
- Pearson J, Richardson A, Niaura RS, et al. E-cigarette awareness, use, and harm perceptions in US adults. Am J Public Health. 2012;102(9):1758-1766.
- FDA. FDA proposes to extend its tobacco authority to additional tobacco products, including e-cigarettes. April 24, 2014. Available at: www.fda.gov/newsevents/newsroom/pressannouncements/ucm394667.htm
- Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nicotine delivery systems and public health: The rise of the “E-cigarette.” Am J Public Health. 2010;100(12):2340-2342.
- Cobb N, Abrams DB. E-cigarette or drug-delivery device? Regulating novel nicotine products. N Engl J Med. 2011;365(3):193.
- Trehy M, Ye W, Hadwiger ME, et al. Analysis of electronic cigarette cartridges, refill solutions, and smoke for nicotine and nicotine related impurities. J Liquid Chromatog Rel Technol. 2010;34(14):1442.
- Caponnetto P. Electronic cigarette: A possible substitute for cigarette dependence. Monaldi Arch Chest Dis. 2013;79(1):12-19.
- Caponnetto P. Smoking cessation with E-cigarettes in smokers with a documented history of depression and recurring relapses. Int J Clin Med. 2011;2(3):281.
- Polosa R, Caponnetto P, Morjaria, et al. Effect of an electronic nicotine delivery device (e-cigarette) on smoking reduction and cessation: A prospective 6-month pilot study. BMC Public Health. 2011;11(1):786.