E-Cigarette or Drug-Delivery Device? Regulating Novel Nicotine Products

Cobb, Nathan K.; Abrams, David B.

doi:10.1056/nejmp1105249

Cited by 151 publications

(123 citation statements)

References 4 publications

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“…The high prevalence of e‐cigarette use among current smokers should be interpreted carefully. Some studies have implied that this result means that e‐cigarettes are being used as smoking‐cessation devices,21 whereas others stated that dual use increases exposure to nicotine and may perpetuate abuse liability instead of encouraging smoking cessation 22. Indeed, newer devices, even with low concentrations of nicotine, can deliver similar or higher levels of nicotine than cigarettes 23, 24…”

Section: Discussionmentioning

confidence: 99%

Electronic Cigarette Use Prevalence, Associated Factors, and Pattern by Cigarette Smoking Status in the United States From NHANES (National Health and Nutrition Examination Survey) 2013–2014

Jaber

Mirbolouk

DeFilippis

et al. 2018

JAHA

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BackgroundTo examine the prevalence and patterns of recent electronic cigarette (e‐cigarette) use in a nationally representative sample of US adults and adolescents.Methods and ResultsUsing tobacco information from NHANES (National Health and Nutrition Examination Survey) 2013–2014, 5423 adults and 895 adolescents (aged 13–17 years) were included in this analysis. Demographic, tobacco use, and drug use information were self‐reported. Recent e‐cigarette use (within the previous 5 days) was stratified by smoking status. Of 125 e‐cigarette users, 116 participants were aged ≥18 years, corresponding to 2.6% (95% confidence interval [CI], 2.0–3.1) and 1.21% (95% CI, 0.3–2.1) prevalence of e‐cigarette use among US adults and adolescents, respectively. E‐cigarette adult users were current smokers (68.1%), former smokers (23.7%), and never smokers (8.2%). The highest prevalence of e‐cigarette use was among current smokers (8.2%; 95% CI, 6.3–10.1), followed by former smokers (2.7%; 95% CI, 1.4–4.1), and then never smokers (0.4%; 95% CI, 0.2–0.6). After adjusting for age, sex, and ethnicity, e‐cigarette users had higher odds of being exposed to secondhand smoke (odds ratio: 6.3; 95% CI, 3.6–11.1) and drinking alcohol (odds ratio: 4.2; 95% CI, 1.8–10.0) and lower odds of having at least a college education or a higher income, compared with tobacco nonusers.ConclusionsBetween 2013 and 2014, e‐cigarette use in the United States was more common among younger people, those with low socioeconomic status, and current and former smokers. These findings will help inform future research as well as public policy and regulatory actions.

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Section: Discussionmentioning

confidence: 99%

Electronic Cigarette Use Prevalence, Associated Factors, and Pattern by Cigarette Smoking Status in the United States From NHANES (National Health and Nutrition Examination Survey) 2013–2014

Jaber

Mirbolouk

DeFilippis

et al. 2018

JAHA

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“…The finding that smokers who had used an e-cigarette in their most recent quit attempt were more likely to report abstinence than those who used NRT bought over-the-counter, and that the latter did not appear to give better results than not using any aid [33], contributes to the debate about how far medicine regulation can go in ensuring that products used for smoking cessation are or continue to be effective in the real world [14][15][16][17]. Randomized controlled trials are clearly important in identifying potential efficacy, but real-world effectiveness will depend upon a number of other contextual variables.…”

Section: (1) E-cigarettes (2) Nrt Over-the-counter (3) No Aid (1) Vermentioning

confidence: 99%

“…Therefore, it is a challenge to establish probable contribution to public health through randomized efficacy trials alone. Moreover, this kind of evidence will take many years to emerge, and in the meantime the products are developing rapidly and countries require evidence on effectiveness to inform decisions on how to regulate them [13][14][15][16][17][18][19]. As a result, there is an urgent need to be able to make an informed judgement on the real-world effectiveness of currently popular brands as chosen by the millions of smokers across the world who are using them in an attempt to stop smoking [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

2014

Br Dent J

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Background and Aims Electronic cigarettes (e-cigarettes) are rapidly increasing in popularity. Two randomized controlled trials have suggested that e-cigarettes can aid smoking cessation, but there are many factors that could influence their real-world effectiveness. This study aimed to assess, using an established methodology, the effectiveness of e-cigarettes when used to aid smoking cessation compared with nicotine replacement therapy (NRT) bought overthe-counter and with unaided quitting in the general population. Design and Setting A large cross-sectional survey of a representative sample of the English population. Participants The study included 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e-cigarette only (n = 464), NRT bought over-the-counter only (n = 1922) or no aid in their most recent quit attempt (n = 3477). Measurements The primary outcome was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including nicotine dependence. Findings E-cigarette users were more likely to report abstinence than either those who used NRT bought over-the-counter [odds ratio (OR) = 2.23, 95% confidence interval (CI) = 1.70-2.93, 20.0 versus 10.1%] or no aid (OR = 1.38, 95% CI = 1.08-1.76, 20.0 versus 15.4%). The adjusted odds of non-smoking in users of e-cigarettes were 1.63 (95% CI = 1.17-2.27) times higher compared with users of NRT bought over-the-counter and 1.61 (95% CI = 1.19-2.18) times higher compared with those using no aid. Conclusions Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.

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“…Growth of the sector has outpaced safety studies and regulation, with the latter confounded firstly by a polarised debate regarding potential harms versus potential harm reduction [4] and secondly by the initial framing of ENDS as tobacco products rather than pharmaceuticals or drug delivery devices [5,6]. This regulatory dearth has enabled unmetered development of the industry with over 400 non-standardised ENDS brands now available [7].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Use of Electronic Nicotine Delivery Systems (ENDS) to Vape Recreational Drugs by Club Patrons in South London

et al. 2016

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Introduction Electronic nicotine delivery systems (ENDS, often called e-cigarettes) are nicotine delivery devices that heat nicotine into vapour that is inhaled, a process called 'vaping'. Use eclipsed nicotine-replacement therapy (NRT) in 2014 but ENDS role in smoking cessation remains controversial. Safety has not been proven and there have been reports to US poison centres regarding potential ENDS-related nicotine toxicity. A further concern is use of ENDS to vape recreational drugs, but there is limited data to substantiate this. The aim of this study was to report on ENDS use to vape recreational drugs in patrons of a South London nightclub where high prevalence of recreational drug use has previously been shown. Methods A convenience sample of 101 participants was surveyed in March 2015 as part of a larger survey on drug use. Individuals were asked if they used ENDS to vape nicotine and/or other substances (and if so which substances). Results Ninety (89.1 %) of respondents were male with median age of 28 years . Eighty (79.2 %) currently smoked cigarettes; 20 (19.8 %) currently used ENDS for nicotine. Six (5.9 %) reported using ENDS to take other substances: 2 for 'liquid cannabis' and 4 did not elaborate on the substance(s) used. Of these 6, 3 were using ENDS to vape nicotine and 3 had never used them for nicotine. Conclusion 5.9 % of individuals in this sample reported using ENDS to vape substances other than nicotine. Further work is required in larger populations to determine how common this is, evaluate which agents are being vaped and to inform appropriate public education.

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E-Cigarette or Drug-Delivery Device? Regulating Novel Nicotine Products

Cited by 151 publications

References 4 publications

Electronic Cigarette Use Prevalence, Associated Factors, and Pattern by Cigarette Smoking Status in the United States From NHANES (National Health and Nutrition Examination Survey) 2013–2014

Electronic Cigarette Use Prevalence, Associated Factors, and Pattern by Cigarette Smoking Status in the United States From NHANES (National Health and Nutrition Examination Survey) 2013–2014

Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

Prevalence of Use of Electronic Nicotine Delivery Systems (ENDS) to Vape Recreational Drugs by Club Patrons in South London

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