BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes and Smoking Cessation
Sarah Boone, Carolyn Little, Clay Owens, Jeremy Randolph, Genny
Tibbs
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Objectives
• Analyze Smoking in Kentucky
• List Methods of Smoking Cessation
• Acute Effects of Electronic Cigarettes
• Review the Evidence of Related Studies
• Compare Use of Electronic Cigarettes and Nicotine Patches
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Smoking in KY
http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/states/kentucky/
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Smoking in KY
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Smoking in KY
http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/states/kentucky/
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Smoking Cessation
• 80% of smokers who attempt cessation relapse within in first month of quitting
• 3-5% remain abstinent at 6 months (Polosa, BMC Public Health, 2011)
• Common Methods: – Electronic cigarettes – Nicotine Patches – Oral Medication – “Cold Turkey”
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes
Westenberger, FDA, 2009
P: Smokers
I: Electronic Cigarettes
C: Nicotine Patches
O: Smoking Cessation
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Acute Effects of E-Cigarettes
Vansickel, American Association for Cancer Research, 2010
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Acute Effects of E-Cigarettes
• 32 tobacco cigarette smokers
• Four products:– Own brand cigarette, “NPRO” electronic
cigarettes, “Hydro” electronic cigarettes, or sham
• Outcome Measures: – Heart rate, plasma nicotine content,
Tiffany Drobes Questionnaire of Smoking Urges Brief
Vansickel, American Association for Cancer Research, 2010
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Acute Effects of E-Cigarettes
• Results:
– Own brand increased plasma nicotine, CO concentration and heart rate
– NPRO EC, Hydro EC, and sham smoking did not
– Both EC exposed users to no nicotine or CO
– Both EC didn’t increase heart rate
– Both EC increased subjective ratings of acceptability
Vansickel, American Association for Cancer Research, 2010
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Acute Effects of E-Cigarettes
• Conclusion:
– Neither electronic cigarettes exposed users to measurable levels of nicotine or CO
– Both suppressed nicotine/tobacco abstinence symptom ratings
Vansickel, American Association for Cancer Research, 2010
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes & Smoking Cessation
Polosa, BMC Public Health, 2011
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes & Smoking Cessation
• Methods:
– 5 visits: baseline and four follow up visits at week 4, 8, 12, and 24
– Baseline Measurements: • Demographics and detailed smoking history • Level of carbon monoxide in exhaled breath
(eCO)
– 4 week supply of 7.4 mg nicotine cartridges given
– Max use of 4 cartridges/day
Polosa, BMC Public Health, 2011
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes & Smoking Cessation
Reducers Heavy Reducers
Quitters Smoking Failure
50% reduction in number of
cig/day compared to
baseline
80% reduction in number of
cig/day compared to
baseline
Smoking abstinence at
24 weeks
< 50% reduction in number of
cig/day compared to
baseline
Polosa, BMC Public Health, 2011
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes & Smoking Cessation
• Results: – 50% reduction shown in 13/40 subjects– Combined sustained 50% reduction and
smoking abstinence in 22/40 (p≤0.001)• Conclusions:
– Reduction in cigarette smoking with e-cigarettes may increase motivation to quit
– Gradual reductions in cigarette smoking can increase cessation
Polosa, BMC Public Health, 2011
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Case Series on Smoking Cessation Utilizing E-cigs
Caponnetto, Journal of Medical Case Reports, 2011
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Case Series on Smoking Cessation Utilizing E-cigs
• Three chronic smokers (two male, one female)
• Severe dependence to nicotine– Fagerstrom Test of Nicotine Dependence
(FTND)– Exhaled Breath Carbon Monoxide
Concentration (eCO)
• Previous cessation efforts (patches & group counseling)
Caponnetto, Journal of Medical Case
Reports, 2011.
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Case Series on Smoking Cessation Utilizing E-cigs
• Results:
– Cessation status following the usage of E-cigs• No relapse 6 months following study
– Reduction in eCO– Variation in E-cig composition
• Regulation?
• Limitation – Small sample sizeCaponnetto, Journal of Medical Case Reports, 2011.
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Comparison: Nicotine Patch Therapy
Myung et al. 2007, Am J Health-Syst Pharm
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Comparison: Nicotine Patch Therapy
• Study:– Meta-analysis of studies investigating
efficacy of nicotine patches vs. placebo.
• Purpose:– Assess current literature– Determine an odds ratio for smoking
cessation Myung et al. 2007, Am J Health-Syst Pharm
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Comparison: Nicotine Patch Therapy
• Methods:– 16 RCT’s – Total subjects: 9,457
• 6,084 nicotine group• 3,373 placebo group
• Results of Meta-analysis:
Pooled OR (odds ratio) for 16 studies was 1.79
http://www.nyc.gov/html/doh/html/pr2007/pr036-07.shtml
Myung et al. 2007, Am J Health-Syst Pharm
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes for Smoking Cessation
Bullen, Nat Inst Health Innov, 2013
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes for Smoking Cessation: A Randomized Controlled
Trial
• Purpose:– To assess whether E-cigarettes containing
nicotine were more effective for smoking cessation than nicotine patches
• Methods:– 657 subjects were selected for the study– Randomized by computerized block
randomization– 4:4:1 ratio
Bullen, Nat Inst Health Innov, 2013
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes for Smoking Cessation: A Randomized Controlled
Trial
• Procedures:
– Subjects used respective smoking cessation products for 12 weeks before a specific “quitting day”
– The primary outcome measured was smoking abstinence six months after “quitting day”
– Verified by self-report and carbon monoxide measurement
Bullen, Nat Inst Health Innov, 2013
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Electronic Cigarettes for Smoking Cessation: A Randomized Controlled
Trial
• Results:
– Abstinence rates after six months• Nicotine E-cigarette 7.3%• Nicotine Patches 5.8%• Placebo E-cigarette 4.1%
– Study was underpowered due to low abstinence rates and could not conclude if E-cigarettes were superior to nicotine patches or placebo Bullen, Nat Inst Health Innov, 2013
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Summary Smoking Cessation
Electronic Cigarettes • Levels of nicotine or eCO
were reduced• Suppressed
nicotine/tobacco abstinence symptom ratings
• Highest rates of abstinence after six months
• Greater success rates with “rituals” of smoking
Nicotine Patch • Odds ratio for sustained
abstinence after 1 year: 1.79 (compared to placebo)
• Lowest rates of abstinence after six months
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Additional Resources
• Stop Smoking Classes Louisville – http://www.louisvilleky.gov/health/iwantto/
stopsmokingclasses.htm
• Norton Healthcare Smoking Cessation Program– http://www.nortonhealthcare.com/smoking
• Kentucky Cabinet for Health & Family Services – http://chfs.ky.gov/dph/mch/hp/tobacco.htm
BELLARMINE UNIVERSITY, LOUISVILLE, KY
ReferencesBullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Nat Inst Health Innov. 2013; 13:1-9.
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: 585.
Myung SK, Yoo KY, Oh SW, et al. Meta-analysis of studies investigating one-year effectiveness of trasdermal nicotine patches for smoking cessation. Am J Health-Syst Pharm.2007; 64: 2471.
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; 11:786-797. doi:10.1186/1471-2458-11-786.
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. Amer Assoc Cancer Res. 2010; 19: 1945-1953.