Aims to characterize e-cigarette use, users, and effects, in a sample of Electronic Cigarette Causacian, 44% educated to degree level or above. Findings 74% reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke.72% of participants used a 'tank' system, most commonly, the eGo-C (23%). Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine (0mg) 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' (t 1104 =11.16, P <0.001) suggesting a lower level of dependence to e-cigarettes. Exsmokers reported significantly greater reduction in craving than current smokers (χ 2 1 =133.66, P<0.0007) although few other differences emerged between these groups.Compared to males, females opted more for chocolate/sweet flavours (χ 2 1 =16.16, P< 0.001) and liked the e-cigarette because it resembles a cigarette(χ 2 3 = 42.65, P< 0.001). Conclusions E-cigarettes tend to be used for smoking cessation but for a longer duration than NRT and were generally regarded as efficacious. Future research should focus on possible long-term health risks, abuse liability and cessation efficacy.
Rationale Electronic cigarettes are becoming increasingly popular among smokers worldwide. Commonly reported reasons for use include: to quit smoking, avoid relapse, reduce urge to smoke, or as a perceived lower risk alternative to smoking. Few studies however, have explored whether e-cigarettes deliver measurable levels of nicotine to the blood.Objective This study in experienced users explores the effect of using an 18 mg/ml nicotine first generation e-cigarette on blood nicotine, tobacco withdrawal symptoms and urge to smoke.Methods Fourteen regular e-cigarette users (3 female), abstinent from smoking and ecigarette use for 12 h, each completed a 3 h testing session. Blood was sampled and questionnaires completed (tobacco-related withdrawal symptoms, urge to smoke, positive and negative subjective effects) at four stages: baseline, 10 puffs, 60 min of ad lib use and a 60 min rest period.Results Complete sets of blood were obtained from 7 participants. Plasma nicotine concentration rose significantly from a mean of 0.74 ng/ml at baseline to 6.77 ng/ml 10 min after 10 puffs, reaching a mean maximum of 13.91 ng/ml by the end of the ad lib puffing period. Tobacco related withdrawal symptoms and urge to smoke were significantly reduced, direct positive effects were strongly endorsed and there was very low reporting of adverse effects.Conclusions These findings demonstrate reliable blood nicotine delivery after acute use of this brand/model of e-cigarette in a sample of regular users. Future studies might usefully quantify nicotine delivery in relation to inhalation technique and the relationship with successful smoking cessation/harm reduction.
Rationale: Neurobiological models of addiction suggest that abnormalities of brain reward circuitry distort salience attribution and inhibitory control processes, which in turn contribute to high relapse rates. Objectives:To determine whether impairments of salience attribution and inhibitory control predict relapse in a pharmacologically unaided attempt at smoking cessation.Methods: 141 smokers were assessed on indices of nicotine consumption / dependence (e.g. the FTND, cigarettes per day, salivary cotinine), and three trait impulsivity measures. After overnight abstinence they completed experimental tests of cue reactivity, attentional bias to smoking cues, response to financial reward, motor impulsiveness, and response inhibition (antisaccades). They then started a quit attempt with follow-up after 7 days, 1 month, and 3 months; abstinence was verified via salivary cotinine levels ≤ 20ng/ml. Results:Relapse rates at each point were 52.5%, 64% and 76.3%. The strongest predictor was pre-cessation salivary cotinine; other smoking / dependence indices did not explain additional outcome variance and neither did trait impulsivity. All experimental indices except responsivity to financial reward significantly predicted one week outcome. Salivary cotinine, attentional bias to smoking cues and antisaccade errors explained unique as well as shared variance. At one and three months, salivary cotinine, motor impulsiveness and cue reactivity were all individually predictive; the effects of salivary cotinine and motor impulsiveness were additive.Conclusions: These data provide some support for the involvement of abnormal cognitive and motivational processes in sustaining smoking dependence and suggest that they might be a focus of interventions, especially in the early stages of cessation.2
Background: Incentive-motivation models of addiction suggest impairment of functional activity in mesocorticolimbic reward pathways during abstinence. This study tested implications for subjective and behavioral responses to nondrug incentives, cue-elicited craving, and prefrontal cognitive functions, particularly response inhibition. Methods:We tested 26 smokers after smoking and after overnight abstinence in counterbalanced order; 26 nonsmokers were also tested twice. Measures included a simple card-sorting test performed with and without financial incentive (the CARROT), the Snaith Hamilton Pleasure Scale as an index of subjective reward responsiveness, ratings of subjective craving and withdrawal before and after exposure to a cigarette, an index of oculomotor response inhibition (saccadic vs. antisaccadic eye movements), verbal fluency, and reversed digit span. Results:Compared with the smoking condition, and independently of withdrawal severity, abstinence was associated with reduced cue reactivity, pleasure expectancies, responsiveness to financial incentive, and response inhibition (antisaccadic eye movements). Verbal fluency and reversed digit span were unaffected, contrary to findings elsewhere with heavier smokers. Nonsmokers' scores either fell between those of abstainers and recent smokers or approximated those of recent smokers. Conclusions:The data were in general consistent with behavioral predictions derived from the incentive-motivational model of addiction and suggest that abstinence may be associated with impairments of motivation and response inhibition, which are independent of other subjectively experienced withdrawal symptoms.
Funding: This study was fully funded by the University of East London PhD Excellence Studentship to CK. Declaration of interests:We declare that we have received no support from any companies for this work and there are no non-financial conflicts of interest that would be considered relevant to this work. LED has previously conducted research for several independent electronic cigarette companies. These companies had no input into the design, conduct or write up of the projects. She has also acted as a consultant for the pharmaceutical industry and as an expert witness in a patent infringement case. CK and OC declare no competing interests. MD and CF have previously supported other research groups by the quantification of cotinine, 3-hydroxy cotinine and nicotine. These groups had no input into the design, conduct or write up of this project.Keywords: Nicotine, Titration, E-cigarette, Puffing topography, Compensation 2 Abstract Rationale Self-titration is well documented in the tobacco literature. The extent to which ecigarette users (vapers) self-titrate is unknown.Objective This study explored the effects of high and low nicotine strength liquid on puffing topography, nicotine delivery and subjective effects in experienced vapers.Methods Eleven experienced male vapers completed 60 minutes of ad libitum vaping under low (6 mg/mL) and high (24 mg/mL) nicotine liquid conditions in two separate sessions.Measurements included: puffing topography (puff number, puff duration, volume of liquid consumed); and changes in: plasma nicotine levels, craving, withdrawal symptoms, selfreported hit, satisfaction and adverse effects.Results Liquid consumption and puff number were higher, and puff duration longer, in the low nicotine strength condition (all ps < 0.01). The mean difference in nicotine boost from baseline in the low condition was 8.59 (7.52) ng/mL, 16.99 (11.72) ng/mL and 22.03 (16.19) ng/mL at 10, 30 and 60 minutes respectively. Corresponding values for the high condition were 33.77 (34.88) ng/mL, 35.48 (28.31) ng/mL and 43.57 (34.78) ng/mL (ps < 0.05). There were no statistically significant differences between conditions in self-reported craving, withdrawal symptoms, satisfaction, hit or adverse effects.Conclusions Vapers engaged in compensatory puffing with lower nicotine strength liquid, doubling their consumption. Whilst compensatory puffing was sufficient to reduce craving and withdrawal discomfort, self-titration was incomplete with significantly higher plasma nicotine levels in the high condition.
BackgroundWe have little understanding of how vapers use e-cigarettes beyond cessation. E-cigarettes may have a role to play in reducing the health-related harms of tobacco smoking, through not only assisting smoking cessation attempts but also supporting long-term abstinence from smoking. However, there are fears that vaping may lead to the ‘renormalisation’ of smoking type behaviours. This study aimed to explore patterns of use and reported experiences of vapers quitting smoking using an e-cigarette in relation to long-term smoking status (abstinence or relapse).MethodsA purposive sample of 40 UK vapers was matched to a sampling frame of demographic characteristics from a representative sample of UK quitters. Following full informed consent, semi-structured qualitative interviews were conducted. Data were thematically analysed by two members of the research team. Final thematic analysis was verified and agreed by consensus.ResultsThe sample self-reported long histories of tobacco use and multiple previous quit attempts which had eventually resulted in relapse back to smoking, although a small but important group had never before attempted to quit. Initiating e-cigarette use was experienced as a revelation for some, who were quickly able to fully switch to using e-cigarettes as an alternative to tobacco smoking. For others, periods of dual use or smoking relapse combined with attempts at vaping that were not initially satisfactory. Many of these chose a cheaper ‘cig-a-like’ device which they found to be inadequate. Experimentation with different devices and different setups, over time, resulted in some ‘sliding’ rather than switching to vaping. This involved periods of ‘dual use’. Some settled on patterns of vaping as a direct substitute of previous tobacco smoking, whereas others reported ‘grazing’ patterns of vaping throughout the day that were perceived to support tobacco smoking abstinence.ConclusionsOur data demonstrates that e-cigarettes may be a unique harm reduction innovation for smoking relapse prevention. E-cigarettes meet the needs of some ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction. Some vapers reported that they found vaping pleasurable and enjoyable—being more than a substitute but actually preferred, over time, to tobacco smoking. This clearly suggests that vaping is a viable long-term substitute for smoking, with substantial implications for tobacco harm reduction.
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