Evaluating Nicotine Levels Selection and Patterns of Electronic Cigarette use in a Group of “Vapers” Who Had Achieved Complete Substitution of Smoking

Abstract

BackgroundElectronic cigarettes (ECs) are alternative-to-smoking nicotine delivery devices; consumers (commonly called vapers) use them in order to reduce or completely substitute smoking. The European Commission has released a proposal for a new Tobacco Product Directive that might reduce availability of nicotine-containing products, including ECs. In this study, the EC use patterns in subjects who have completely substituted smoking with EC use were examined by personal interviews. The study focused on nicotine levels used in order to achieve smoking cessation, reported benefits, associated side effects, and estimation of EC dependence compared with smoking.MethodsParticipants were 111 subjects who had completely substituted smoking with EC use for at least 1 month. Smoking abstinence was validated by measuring blood carboxyhemoglobin levels. Nicotine levels at initiation of EC use, at time of smoking cessation, and at time of interview were recorded. Dependence potential was assessed by asking the first question of the Fagerström Test for Cigarette Dependence (time until smoking the first cigarette and until first use of EC in the morning) and questions about perceived past dependence on tobacco cigarettes and present dependence on EC.ResultsForty-two percent of participants reported quitting smoking during the first month of EC use. Liquids with nicotine concentration >15 mg/mL were used by 74% of users at initiation of EC use, while 16.2% had to increase the initial nicotine levels in order to achieve complete smoking abstinence. Seventy-two participants (64.9%) reported that from the time of smoking cessation to the time of the interview (8 months median duration of EC use) they reduced the nicotine concentration they were consuming; however, only 12% of the total sample was using ≤5 mg/mL nicotine concentration at the time of the interview. Side effects were mild and temporary. The vast majority of participants reported better exercise capacity and improved olfactory and gustatory senses. Perceived EC dependenct was significantly lower compared to smoking.ConclusionsNicotine levels appear to play an important role in achieving and maintaining smoking cessation in the group of motivated subjects studied. High nicotine-containing liquids were used while few mild and temporary side effects were reported. Proposals about regulation should consider the pragmatic use patterns of ECs, especially in consumers who have completely substituted smoking.

First‐ versus second‐generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptoms

“…Although replication in a more highly dependent sample of abstinent smokers with a longer follow up time after e-cigarette use is essential, we can tentatively conclude that: i) cigarette-like appearance is important for many smokers when choosing an e-cigarette device although individual factors predicting choice remain unclear; ii) first generation cigalike devices have the ability to be as effective as second generation devices for reducing cigarette urges and WS; iii) second generation devices may be more satisfying to use which may explain why more people report successfully quitting with them [25]. Although there is concern that first generation cigalike products in particular may re-normalise smoking, they clearly appeal to many smokers and compare favourably to second generation devices for craving/WS alleviation at least in the short term.…”

“…Given the evidence that many regular users move on from first to second or third generation devices [23,25,36] we also predicted that those who had some experience of using an e-cigarette in the past would be more likely to opt for a second generation device. That prior e-cigarette use was not a significant predictor here may reflect the fact that most users (82%) had previously used an e-cigarette on fewer than five occasions.…”

“…Preliminary evidence based on retrospective reporting suggest that such devices may be superior for smoking cessation [25] and in experienced exclusive e-cigarette users, better than first generation devices for blood nicotine delivery and alleviation of craving [15].…”

Development of a Questionnaire for Assessing Dependence on Electronic Cigarettes Among a Large Sample of Ex-Smoking E-cigarette Users

“…Farsalinos et al 20 also found that e-cig users reported lower dependence on e-cigs than prior cigarette smoking, in a sample of 111 e-cig users with carboxyhemoglobin-validated abstinence from smoking. Overall, the most parsimonious explanation for these results is that e-cig users are generally less nicotine dependent than they were as cigarette smokers.…”

Risks of Attempting to Regulate Nicotine Flux in Electronic Cigarettes

“…Surveys of dedicated EC users (which were all former smokers) have shown that high nicotine levels are important especially for the initiation of EC use. 3,4 Although nicotine delivery to the aerosol can be similar or higher than tobacco cigarettes, 5,6 clinical studies of EC use have shown that the nicotine absorption potential is significantly lower compared with tobacco cigarettes, even when new generation devices are used. 7 This is mostly attributed to the low speed of nicotine absorption, and clearly indicates that nicotine intoxication is highly unlikely when ECs are used as intended.…”