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There is evidence from case reports, user surveys and two randomized controlled trials that e-cigarettes may help some people to quit smoking, but the trials have been limited by product unreliability and lack of adequate statistical power on which to base a more robust assessment of cessation efficacy.

E-cigarettes have good potential to encourage cessation in those not intending to quit and/or to serve as a cessation aid for people who wish to quit smoking because, like nicotine replacement products, they are capable of alleviating nicotine withdrawal symptoms (Bullen et al., 2010; Eissenberg, 2010; Vansickel et al., 2010; Dawkins et al., 2012).

Evaluating the cessation potential of e-cigarettes is complicated by the rapidly changing array and potential efficacy (based on contents, designs, and emissions, including nicotine) of e-cigarettes available, a lack of guidance and instructions on use to ensure the optimal pattern of dosing most likely to produce benefits while minimizing side-effects, and the way people use these products (with regard to the efficiency of their puffing and ‘dual use’ with tobacco cigarettes).

Several small case reports (Capponetto et al., 2011; Capponetto et al., 2011b) suggest their potential to help people to quit smoking.  In addition, e-cigarette user surveys (for example Etter, 2010; Etter & Bullen, 2011; Siegel et al., 2011; Goniewicz et al., 2013) indicate many people report e-cigarettes helped them to quit smoking. However, some other surveys (for example Vickerman et al., 2013; Grana et al.,2014) do not show a significant improvement in cessation with the use of e-cigarettes vs. no use of e-cigs, although these studies have their limitations.

Prospective studies of smokers not willing to quit and a pilot study for a full randomized controlled trial among smokers unwilling to quit, provide evidence of the potential for e-cigarettes as cessation aids, (Polosa et al., 2011; Capponnetto et al., 2013) with quit rates similar to those of the effects on cessation of NRT use in smokers unwilling to quit.

However, randomized trial evidence is sparse, and is currently limited to two trials. A recently published randomized controlled trial in 300 smokers not wanting to quit found a verified cessation rate of about 9% at 12 months, but there was no cessation advantage of nicotine e-cigarettes over placebo e-cigarettes (Capponetto et al., 2013).

A larger (n=657) randomized controlled trial of e-cigarettes versus nicotine patches in adult smokers wanting to quit smoking found roughly equivalent but modest (4-8%) CO-verified quit rates at 6 months (Bullen et al., 2013).

Both studies were limited by low statistical power, product unreliability and low nicotine delivery.

Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013 Nov 16;382(9905):1629-37.

Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control. 2010 Apr;19(2):98-103.

Caponnetto P, Auditore R, Russo C, Cappello GC, Polosa R. Impact of an electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a prospective 12-month pilot study. Int J Environ Res Public Health. 2013 Jan 28;10(2):446-61.

Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One. 2013 Jun 24;8(6):e66317.

Caponnetto P, Polosa R, Auditore R, Russo C, Campagna D. Smoking Cessation with E-Cigarettes in Smokers with a Documented History of Depression and Recurring Relapses. International Journal of Clinical Medicine. 2011;2:281-84.

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;5:1-6.

Dawkins L, Turner J, Hasna S, Soar K. The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition. Addict Behav. 2012 Aug;37(8):970-3.

Eissenberg T. Electronic nicotine delivery devices: ineffective nicotine delivery and craving suppression after acute administration. Tob Control. 2010 Feb;19(1):87-8.

Etter JF. Electronic cigarettes: a survey of users. BMC Public Health. 2010 May 4;10:231.

Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011 Nov;106(11):2017-28.

Goniewicz ML, Lingas EO, Hajek P. Patterns of electronic cigarette use and user beliefs about their safety and benefits: an internet survey. Drug Alcohol Rev. 2013 Mar;32(2):133-40.

Grana R, Popova L, Ling P. A longitudinal analysis of electronic cigarette use and smoking cessation. JAMA Intern Med. 2014 May;174(5):812-3.

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 Oct 11;11:786.

Siegel MB, Tanwar KL, Wood KS. Electronic cigarettes as a smoking-cessation: tool results from an online survey. Am J Prev Med. 2011 Apr;40(4):472-5.

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. Cancer Epidemiol Biomarkers Prev. 2010 Aug;19(8):1945-53.

Vickerman KA, Carpenter KM, Altman T, Nash CM, Zbikowski SM. Use of electronic cigarettes among state tobacco cessation quitline callers. Nicotine Tob Res. 2013 Oct;15(10):1787-91. logo
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