Studies Suggest E-cigarettes Don't Aid Long-term Smoking Cessation

Continued Rise in Teen E-cigarette Use Becomes Greater Concern

June 05, 2015 04:06 pm Chris Crawford
[Young woman smoking an e-cigarette]

An analysis of currently available research on electronic cigarettes (e-cigarettes) presented during the 2015 American Thoracic Society International Conference in mid-May found that the popular "vaping" devices haven't proven to be successful long-term solutions for patients who want to quit smoking.

The meta-analysis(www.atsjournals.org) incorporated four studies that met inclusion criteria for the efficacy of e-cigarettes (two randomized trials and two uncontrolled before-and-after studies) and 22 articles on the safety of the devices.

"While e-cigarettes have been shown to significantly improve abstinence at one month compared with placebo, no such evidence is available supporting their effectiveness for longer periods," said lead author Riyad al-Lehebi, M.B.B.S., of the University of Toronto, in a news release.(www.eurekalert.org) "Until such data are available, there are a number of other smoking cessation aids available that have a more robust evidence base supporting their efficacy and safety."

Story Highlights
  • An analysis of current research on electronic cigarettes (e-cigarettes) that was presented during the 2015 American Thoracic Society International Conference found that the popular "vaping" devices aren't a long-term solution for patients who want to quit smoking.
  • Although e-cigarettes worked significantly better than a placebo in helping study participants abstain from smoking traditional cigarettes for 30 days, this difference was not observed at three- or six-month follow-up.
  • One FP expert says he doesn't advocate smokers switch to e-cigarettes because they are not FDA-regulated, there is insufficient research on safety, and data on long-term effectiveness are lacking.

Although e-cigarettes worked significantly better than a placebo in helping study participants abstain from smoking traditional cigarettes for 30 days, this difference was not observed at three- or six-month follow-up. In one study, no significant difference was observed in six-month abstinence rates among participants who used e-cigarettes versus a placebo or between those who used e-cigarettes versus the nicotine patch.

Adverse effects of e-cigarette use noted in the studies included dry cough, throat irritation and shortness of breath. The incidence of serious adverse events did not differ between e-cigarettes and a placebo, but e-cigarette use was associated with a higher rate of adverse effects than the nicotine patch.

Family Physician Offers Expert Perspective

AAFP member Adam Goldstein, M.D., M.P.H., of Chapel Hill, N.C., lives and works in the heart of tobacco country and directs a nationally known nicotine dependence program(www.med.unc.edu) that treats more than 2,000 tobacco users a year.

Goldstein said most of his group's patients want to quit smoking, yet the majority of them are not successful without assistance. The group offers patients behavioral counseling and FDA-approved tobacco cessation medications to increase their success rate, but he won't recommend e-cigarette use without far more research, he said.

"I don't advocate smokers switch to e-cigarettes because they are not FDA-regulated, there is insufficient research on safety, and data on long-term effectiveness are lacking," he said. "They are not the most effective or safest way to quit smoking."

In addition to discouraging nicotine use overall among his patients, Goldstein tells current e-cigarette users to avoid smoking conventional cigarettes at the same time they're using these devices.

E-Cigarette Flavorings Alter Lung Function

According to new research presented at the 2015 American Thoracic Society International Conference in mid-May, certain e-cigarette flavorings may alter cellular function in lung tissue.

"The effects of the various chemical components of e-cigarette vapor on lung tissue are largely unknown," said lead author Temperance Rowell, a graduate student in the Cell Biology and Physiology Department of the University of North Carolina at Chapel Hill, in a news release.(www.eurekalert.org) "In our study using human lung epithelial cells, a number of cell viability and toxicity parameters pointed to five of 13 flavors tested showing overall adverse effects to cells in a dose-dependent manner."

In the study, researchers exposed cultured human airway epithelial cells to various doses of the 13 e-cigarette liquid flavors for 30 minutes or 24 hours. During the 30-minute exposure test, the flavors "Hot Cinnamon Candies," "Banana Pudding (Southern Style)" and "Menthol Tobacco" elicited a dose-dependent calcium response and were toxic to the cells at higher doses. During the 24-hour exposure test, these same three flavors decreased cell proliferation and cell viability in a dose-dependent manner. The toxic effects of these flavorings were not seen with either the nicotine or e-liquid vehicle, which consisted of propylene glycol and vegetable glycerin.

"Unfortunately, many e-cigarette users also are smokers of conventional cigarettes, and this dual use is highly dangerous," he said.

Goldstein explains to patients the risks of using e-cigarettes include burns (for anyone on oxygen, e-cigarettes are contraindicated), pulmonary damage (inhaled flavors and other ingredients may have adverse pulmonary effects) and possible exposure to known cancer-causing agents associated with heating the product.

Teen E-Cigarette Use Up

E-cigarette use among middle- and high-school students tripled from 2013 to 2014, according to an April 16 CDC news release(www.cdc.gov) that announced findings from the 2014 National Youth Tobacco Survey.

According to the release, this is the first time since the survey began collecting data on e-cigarettes in 2011 that their use among teens surpassed use of every other tobacco product.

In 2014, the nicotine-containing and -delivery products most commonly used by high-school students were e-cigarettes (13.4 percent), hookahs (9.4 percent), cigarettes (9.2 percent), cigars (8.2 percent), smokeless tobacco (5.5 percent), snus (1.9 percent) and pipes (1.5 percent).

The products most commonly used by middle-school students were e-cigarettes (3.9 percent), hookahs (2.5 percent), cigarettes (2.5 percent), cigars (1.9 percent), smokeless tobacco (1.6 percent) and pipes (0.6 percent).

The survey found that use of multiple tobacco products was common, with nearly half of all current tobacco-using middle- and high-school students using two or more types of tobacco products.

Goldstein said adolescents are at high risk of nicotine addiction from any form of nicotine-delivery product, electronic or otherwise.

"The increase in e-cigarette use by adolescents who have never previously used tobacco is a huge concern across the country," he said. "The use of flavors and advertising that show e-cigarette use as sexy and sophisticated promotes images of tobacco users that are highly appealing to youth, much like the way cigarette advertising appealed to youth and became a causal factor in adolescent smoking."

Goldstein suggested government regulation to limit e-cigarette advertising and banning the use of flavors that appeal to teens as possible ways to curb their ever-increasing appeal with this population.

Related AAFP News Coverage
FDA Denies R.J. Reynolds Request to Weaken Smokeless Tobacco Warning
AAFP Among Groups That Advocated Against the Change

(5/20/2015)

Offer Smokers Variety of Cessation Options, Says USPSTF
Evidence Lacking on Using E-Cigarettes as Cessation Tool

(5/12/2015)

Tobacco Resources Offer Context for Building a Tobacco-free Future
(4/9/2015)


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