E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis

Abstract

Summary Background Smokers increasingly use e-cigarettes for many reasons, including attempts to quit combustible cigarettes and to use nicotine where smoking is prohibited. We aimed to assess the association between e-cigarette use and cigarette smoking cessation among adult cigarette smokers, irrespective of their motivation for using e-cigarettes. Methods PubMed and Web of Science were searched between April 27, 2015, and June 17, 2015. Data extracted included study location, design, population, definition and prevalence of e-cigarette use, comparison group (if applicable), cigarette consumption, level of nicotine dependence, other confounders, definition of quitting smoking, and odds of quitting smoking. The primary endpoint was cigarette smoking cessation. Odds of smoking cessation among smokers using e-cigarettes compared with smokers not using e-cigarettes were assessed using a random effects meta-analysis. A modification of the ACROBAT-NRSI tool and the Cochrane Risk of Bias Tool were used to assess bias. This meta-analysis is registered with PROSPERO (number CRD42015020382). Findings 38 studies (of 577 studies identified) were included in the systematic review; all 20 studies with control groups (15 cohort studies, three cross-sectional studies, and two clinical trials) were included in random effects meta-analysis and sensitivity analyses. Odds of quitting cigarettes were 28% lower in those who used e-cigarettes compared with those who did not use e-cigarettes (odds ratio [OR] 0·72, 95% CI 0·57–0·91). Association of e-cigarette use with quitting did not significantly differ among studies of all smokers using e-cigarettes (irrespective of interest in quitting cigarettes) compared with studies of only smokers interested in cigarette cessation (OR 0·63, 95% CI 0·45–0·86 vs 0·86, 0·60–1·23; p=0·94). Other study characteristics (design, population, comparison group, control variables, time of exposure assessment, biochemical verification of abstinence, and definition of e-cigarette use) were also not associated with the overall effect size (p≥0·77 in all cases). Interpretation As currently being used, e-cigarettes are associated with significantly less quitting among smokers.

The association between environmental tobacco smoke exposure and childhood respiratory disease: a review

“…Reducing tobacco use through campaigns that depict cigarette smoking as undesirable and harmful has been implemented; however, the promotion of e-cigarettes threatens this with the risk of increasing nicotine addiction [120]. A recent systematic review also found no strong evidence for e-cigarettes as a smoking cessation tool [121]. Urgent legislation and regulation of e-cigarettes is required to prevent another form of nicotine addiction targeted at vulnerable groups [122].…”

Another Article About E‐Cigarettes: Why Should I Care?

“…In theory, a product that can deliver nicotine like a cigarette without the toxins found in smoke could be used instead of cigarettes would be a welcome invention 5, 6, 7. However, concerns have been raised about whether e‐cigarettes are an effective cessation aid or if they would actually reduce successful quitting by adult smokers, whether they are safe to use, and if they may be a gateway into smoking for youth 8, 9, 10. Most recently the popularity of the Juul e‐cigarette among high school and college students who have no intention of smoking has raised concerns about the risk of nicotine addiction in non‐smokers and its long‐term health effects 11…”

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

“…However, these interventions differ in their cost‐effectiveness and may also be associated with unintended consequences. For example, tax increases may create illicit markets 11, 12, while e‐cigarettes may prevent certain smokers from quitting 13. Compared with the United Kingdom 14, smoking cessation aids are used less frequently in Germany 15, 16, while the smoking prevalence (18.0 versus 24.5%) is higher 17, 18.…”