Comment

Electronic cigarettes for smoking cessation

The relationship between e-cigarette use and cigarette smoking is the subject of ongoing debate. There is limited research on e-cigarette use and changes in the frequency of cigarette smoking. This study examines whether the frequency of e-cigarette use is associated with changes in cigarette smoking behavior among U.S. adults.

The study used data (n=20,558) from Waves 1 (2013–2014) and 2 (2014–2015) of the Population Assessment of Tobacco and Health, analyzed in 2019. Multivariable multinomial logistic regression assessed the association between e-cigarette use at Wave 1 and change in cigarette smoking frequency between Waves 1 and 2.

Every day cigarette smokers who used e-cigarettes some days (OR=1.95, 95% CI=1.27, 2.98) and every day (OR=3.37, 95% CI=1.78, 6.36) in Wave 1 had significantly higher odds of switching to some days cigarette smoking in Wave 2. Every day smokers who used e-cigarettes every day in Wave 1 had higher odds of becoming former cigarette smokers in Wave 2. Likewise, e-cigarette use at baseline among former cigarette smokers was associated with higher odds of switching to some days cigarette smoking (experimental e-cigarette use: OR=5.43, 95% CI=2.13, 10.72; some days e-cigarette use: OR=4.78, 95% CI=2.13, 10.72). In addition, experimental smokers who were also some days e-cigarettes users in Wave 1 had significantly lower odds of switching to experimental former smokers.

Although e-cigarette use may reduce cigarette smoking frequency among continuing smokers, findings suggest that e-cigarette use may be associated with cigarette smoking relapse among former smokers.

Le tabagisme est la première cause évitable de morbidité et de mortalité. On estime qu’il y a eu environ 14 millions de fumeurs en France en 2012 et que le tabac est responsable de 70 000 décès par an. Toute intervention qui réduit efficacement l’incidence et la prévalence du tabagisme est à considérer pour prolonger l’espérance de vie. La cigarette électronique (cig.e.) est un phénomène de société, mais elle est aussi un produit qui délivre des substances pharmacologiquement actives et qui concerne aujourd’hui plusieurs millions de personnes en France. De ce fait, il est devenu indispensable pour la pratique clinique, d’avoir un certain niveau de connaissances sur les cig.e. La très grande majorité des cig.e. contient de la nicotine ; c’est un système électronique de délivrance de nicotine (SEDEN) (electronic nicotine delivery system [ENDS]). Il est vraisemblable que les SEDEN, produits de consommation et non produits de santé, délivrent la nicotine avec une bonne biodisponibilité et peuvent contribuer, s’ils sont utilisés largement, à la réduction de la prévalence du tabagisme. Cependant, en l’absence de réglementation, à ce jour, le rapport bénéfice/risque des SEDEN comme aide à l’arrêt de la consommation tabagique et leur profil d’effets indésirables ne peuvent pas être évalués. C’est une responsabilité de santé publique de promouvoir l’acquisition des connaissances fondées sur les preuves pour connaître leur rapport bénéfice/risque.

Smoking is the first avoidable cause of morbidity and mortality. It is estimated that there were around 14 million smokers in France in 2012 and that smoking results in 70,000 deaths per year. All types of interventions reducing with efficacy the incidence and prevalence of smoking are to consider in prolonging life expectancy. Electronic cigarettes (e.cig.) are a social phenomenon but they also are a system delivering pharmacologically active substances; their use concerns today several millions of individuals in France. By this fact, it became important for clinical practitioners to acquire some knowledge about e. cig. Most of the e.cig. contains nicotine, thus, e.cig. are now called in the medical literature as electronic nicotine delivery system (ENDS). It is highly plausible that ENDS, which are, as of today, consumer products and not health products, deliver nicotine with a good bioavailability and could, if largely used, help to reduce smoking prevalence. However, because of current lack of regulations, as of today, the risk/benefit ratio of ENDS as an aid to help smokers quit and their adverse effect profile cannot be established. It is of public health responsibility to promote evidence based knowledge about e.cig. to know with confidence their risk/benefit ratio.

The recent popularity of electronic (e)-cigarettes and their rapid uptake by youth has ignited the debate about their role as a harm-reduction strategy. Harm reduction in the context of tobacco control contends that in societies that have achieved considerable success in curbing smoking, leaving the remaining hard-to-quit smokers with an abstinence-only option is unfair, especially when less-harmful choices are available. On one side of the debate are those who call for caution in endorsing such products until critical pieces of evidence about their safety and potential become available, whereas the other side argues that waiting until all questions about e-cigarettes are answered is dogma driven. In this piece, I try to discuss the unresolvable contention between harm-reduction goals of offering safer options to smokers, and those of e-cigarette makers of being commercially viable and profitable.