Electronic Cigarettes and Smoking Cessation

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Electronic Cigarettes and Smoking Cessation

• Sarah Boone, Carolyn Little, Clay Owens, Jeremy
  Randolph, Genny Tibbs

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Objectives

• Analyze Smoking in Kentucky
• List Methods of Smoking Cessation
• Acute Effects of Electronic Cigarettes
• Review the Evidence of Related Studies
• Compare Use of Electronic Cigarettes and Nicotine
  Patches

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Smoking in KY
http//www.cdc.gov/tobacco/data_statistics/state_d
ata/state_highlights/2010/states/kentucky/
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Smoking in KY
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Smoking in KY
http//www.cdc.gov/tobacco/data_statistics/state_d
ata/state_highlights/2010/states/kentucky/
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Smoking Cessation

• 80 of smokers who attempt cessation relapse
  within in first month of quitting
• 3-5 remain abstinent at 6 months (Polosa, BMC
  Public Health, 2011)
• Common Methods
• Electronic cigarettes
• Nicotine Patches
• Oral Medication
• Cold Turkey

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Electronic Cigarettes
P Smokers I Electronic Cigarettes C
Nicotine Patches O Smoking Cessation
Westenberger, FDA, 2009
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Acute Effects of E-Cigarettes

• Vansickel, American Association for Cancer
  Research, 2010

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Acute Effects of E-Cigarettes

• 32 tobacco cigarette smokers
• Four products
• Own brand cigarette, NPRO electronic
  cigarettes, Hydro electronic cigarettes, or
  sham
• Outcome Measures
• Heart rate, plasma nicotine content, Tiffany
  Drobes Questionnaire of Smoking Urges Brief

Vansickel, American Association for Cancer
Research, 2010
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Acute Effects of E-Cigarettes

• Results
• Own brand increased plasma nicotine, CO
  concentration and heart rate
• NPRO EC, Hydro EC, and sham smoking did not
• Both EC exposed users to no nicotine or CO
• Both EC didnt increase heart rate
• Both EC increased subjective ratings of
  acceptability

Vansickel, American Association for Cancer
Research, 2010
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Acute Effects of E-Cigarettes

• Conclusion
• Neither electronic cigarettes exposed users to
  measurable levels of nicotine or CO
• Both suppressed nicotine/tobacco abstinence
  symptom ratings

Vansickel, American Association for Cancer
Research, 2010
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Electronic Cigarettes Smoking Cessation

• Polosa, BMC Public Health, 2011

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Electronic Cigarettes Smoking Cessation

• Methods
• 5 visits baseline and four follow up visits at
  week 4, 8, 12, and 24
• Baseline Measurements
• Demographics and detailed smoking history
• Level of carbon monoxide in exhaled breath (eCO)
• 4 week supply of 7.4 mg nicotine cartridges given
• Max use of 4 cartridges/day

Polosa, BMC Public Health, 2011
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Electronic Cigarettes Smoking Cessation
Reducers Heavy Reducers Quitters Smoking Failure
50 reduction in number of cig/day compared to baseline   80 reduction in number of cig/day compared to baseline Smoking abstinence at 24 weeks lt 50 reduction in number of cig/day compared to baseline
Polosa, BMC Public Health, 2011
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Electronic Cigarettes Smoking Cessation

• Results
• 50 reduction shown in 13/40 subjects
• Combined sustained 50 reduction and smoking
  abstinence in 22/40 (p0.001)
• Conclusions
• Reduction in cigarette smoking with e-cigarettes
  may increase motivation to quit
• Gradual reductions in cigarette smoking can
  increase cessation

Polosa, BMC Public Health, 2011
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Case Series on Smoking Cessation Utilizing E-cigs

• Caponnetto, Journal of Medical Case Reports, 2011

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Case Series on Smoking Cessation Utilizing E-cigs

• Three chronic smokers (two male, one female)
• Severe dependence to nicotine
• Fagerstrom Test of Nicotine Dependence (FTND)
• Exhaled Breath Carbon Monoxide Concentration
  (eCO)
• Previous cessation efforts (patches group
  counseling)

Caponnetto, Journal of Medical Case Reports, 2011.
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Case Series on Smoking Cessation Utilizing E-cigs

• Results
• Cessation status following the usage of E-cigs
• No relapse 6 months following study
• Reduction in eCO
• Variation in E-cig composition
• Regulation?
• Limitation Small sample size

Caponnetto, Journal of Medical Case Reports,
2011.
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Comparison Nicotine Patch Therapy

• Myung et al. 2007, Am J Health-Syst Pharm

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Comparison Nicotine Patch Therapy

• Study
• Meta-analysis of studies investigating efficacy
  of nicotine patches vs. placebo.
• Purpose
• Assess current literature
• Determine an odds ratio for smoking cessation

Myung et al. 2007, Am J Health-Syst Pharm
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Comparison Nicotine Patch Therapy

• Methods
• 16 RCTs
• Total subjects 9,457
• 6,084 nicotine group
• 3,373 placebo group
• Results of Meta-analysis
• Pooled OR (odds ratio) for 16 studies was 1.79

http//www.nyc.gov/html/doh/html/pr2007/pr036-07.s
html
Myung et al. 2007, Am J Health-Syst Pharm
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Electronic Cigarettes for Smoking Cessation

• Bullen, Nat Inst Health Innov, 2013

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Electronic Cigarettes for Smoking Cessation A
Randomized Controlled Trial

• Purpose
• To assess whether E-cigarettes containing
  nicotine were more effective for smoking
  cessation than nicotine patches
• Methods
• 657 subjects were selected for the study
• Randomized by computerized block randomization
• 441 ratio

Bullen, Nat Inst Health Innov, 2013
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Electronic Cigarettes for Smoking Cessation A
Randomized Controlled Trial

• Procedures
• Subjects used respective smoking cessation
  products for 12 weeks before a specific quitting
  day
• The primary outcome measured was smoking
  abstinence six months after quitting day
• Verified by self-report and carbon monoxide
  measurement

Bullen, Nat Inst Health Innov, 2013
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Electronic Cigarettes for Smoking Cessation A
Randomized Controlled Trial

• Results
• Abstinence rates after six months
• Nicotine E-cigarette 7.3
• Nicotine Patches 5.8
• Placebo E-cigarette 4.1
• Study was underpowered due to low abstinence
  rates and could not conclude if E-cigarettes were
  superior to nicotine patches or placebo

Bullen, Nat Inst Health Innov, 2013
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Summary Smoking Cessation

• Electronic Cigarettes

• Nicotine Patch

• Levels of nicotine or eCO were reduced
• Suppressed nicotine/tobacco abstinence symptom
  ratings
• Highest rates of abstinence after six months
• Greater success rates with rituals of smoking

• Odds ratio for sustained abstinence after 1 year
  1.79 (compared to placebo)
• Lowest rates of abstinence after six months

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Additional Resources

• Stop Smoking Classes Louisville
• http//www.louisvilleky.gov/health/iwantto/stopsmo
  kingclasses.htm
• Norton Healthcare Smoking Cessation Program
• http//www.nortonhealthcare.com/smoking
• Kentucky Cabinet for Health Family Services
• http//chfs.ky.gov/dph/mch/hp/tobacco.htm

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References

• Bullen C, Howe C, Laugesen M, McRobbie H, Parag
  V, Williman J, Walker N. Electronic cigarettes
  for smoking cessation a randomised controlled
  trial. Nat Inst Health Innov. 2013 131-9.
• Caponnetto P, Polosa R, Russo C, Leotta C,
  Campagna D. Successful smoking cessation with
  electronic cigarettes in smokers with a
  documented history of recurring relapses a case
  series. Journal of Medical Case Reports. 2011
  5 585.
• Myung SK, Yoo KY, Oh SW, et al. Meta-analysis of
  studies investigating one-year effectiveness of
  trasdermal nicotine patches for smoking
  cessation. Am J Health-Syst Pharm.2007 64 2471.
• 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 11786-797.
  doi10.1186/1471-2458-11-786.
• 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. Amer Assoc Cancer Res. 2010
  19 1945-1953.