Cigarette Smoking

In cigarette smokers highly motivated to quit, both varenicline and e-cigarettes were equally effective in achieving abstinence at 6 months (around 40%) and twice as effective as placebo (20%). James W. Mold, MD, MPH

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Importance: Little is known about the relative effectiveness of nicotine-containing electronic cigarettes (ECs) compared with varenicline as smoking cessation aids.

Objective: To determine the relative effectiveness of ECs in smoking cessation.

Design, setting, and participants: This randomized placebo-controlled single-center trial was conducted in northern Finland. Participants aged 25 to 75 years who smoked daily and had volunteered to quit smoking were recruited from August 1, 2018, to February 20, 2020, via local media. The trial included 52 weeks of follow-up. All data analyses were conducted from September 1, 2022, to January 15, 2024. The participants, study nurses, and researchers were masked to group assignment.

Intervention: The participants were assigned by block randomization to receive 18 mg/mL of nicotine-containing ECs together with placebo tablets, varenicline with standard dosing together with nicotine-free ECs, or placebo tablets together with nicotine-free ECs, all combined with a motivational interview, with the intervention phase lasting for 12 weeks.

Main outcome and measure: The primary outcome was self-reported 7-day conventional cigarette smoking abstinence as confirmed by the exhaled carbon monoxide level on week 26. The analysis followed the intent-to-treat principle.

Results: Of the 561 recruited participants, 458 (81.6%) eligible participants (257 women [56%]; 201 men [44%]; mean [SD] age, 51 [11.6] years) were randomized. The primary outcome occurred in 61 of 152 participants (40.4%) in the EC group, 67 of 153 (43.8%) in the varenicline group, and 30 of 153 (19.7%) in the placebo group (P < .001). In the pairwise comparison, placebo differed statistically significantly from ECs (risk difference [RD], 20.7%; 95% CI, 10.4-30.4; P < .001) and varenicline (RD, 24.1%; 95% CI, 13.7-33.7; P < .001), but the difference was statistically insignificant between ECs and varenicline (RD, 3.4%; 95% CI, -7.6 to 14.3; P = .56). No serious adverse events were reported.

Conclusions: This randomized clinical trial found that varenicline and nicotine-containing ECs were both effective in helping individuals in quitting smoking conventional cigarettes for up to 6 months.

Author/s:

Anna Tuisku, Mikko Rahkola, Pentti Nieminen, Tuula Toljamo

Association of Smoking Cessation and Cardiovascular, Cancer, and Respiratory Mortality

Rowan Hutchins — Sat, 09 Dec 2023 06:00:00 +0000

Date Added:

December 9, 2023

Journal/Publication:

JAMA

Publisher:

AMA

Publication Date:

November 27, 2023

URL:

Association of Smoking Cessation and Cardiovascular, Cancer, and Respiratory Mortality

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2023.6419

Keywords

PMID (1):

38010645

MeSH

Cardiovascular Risk Factors

Smoking Cessation*

Cigarette Smoking

Pulmonary

Quantification of reductions in adverse outcomes after smoking cessation. James W. Mold, MD, MPH

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There were an estimated 28 million current cigarette smokers in the US, and approximately twice as many former smokers, in 2021.1 Smoking cessation is associated with large reductions in excess mortality compared with continued smoking,2 but the timescale over which cause-specific mortality benefits of cessation may develop is unclear.3-6 Quantifying excess cause-specific mortality among former smokers by years since quitting may inform clinical decision-making and screening programs.

Author/s:

Blake Thomson, Farhad Islami

Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement

Devin Evans — Thu, 21 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

Journal of the American Medical Association

Publication Date:

January 19, 2021

Issue:

Volume:

Pages:

265-279

URL:

Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2020.25019

Keywords

Recommendation Statement

PMID (1):

33464343

MeSH

pregnancy

electronic nicotine delivery systems

2021 USPSTF recommendations regarding Interventions for Tobacco Smoking Cessation in Adults. James W. Mold, MD, MPH

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Tobacco use is the leading preventable cause of disease, disability, and death in the US. In 2014, it was estimated that 480 000 deaths annually are attributed to cigarette smoking, including second hand smoke exposure. Smoking during pregnancy can increase the risk of numerous adverse pregnancy outcomes (eg, miscarriage and congenital anomalies) and complications in the offspring (including sudden infant death syndrome and impaired lung function in childhood). In 2019, an estimated 50.6 million US adults (20.8% of the adult population) used tobacco; 14.0% of the US adult population currently smoked cigarettes and 4.5% of the adult population used electronic cigarettes (e-cigarettes). Among pregnant US women who gave birth in 2016, 7.2% reported smoking cigarettes while pregnant

Author/s:

US Preventative Services task Force

Association Between E-Cigarette Use and Chronic Obstructive Pulmonary Disease by Smoking Status: Behavioral Risk Factor Surveillance System 2016 and 2017

Brian Desmarais — Fri, 03 Jan 2020 20:33:58 +0000

Date Added:

January 3, 2020

Journal/Publication:

American Journal of Preventative Medicine

Publication Date:

January 1, 2020

URL:

Association Between E-Cigarette Use and Chronic Obstructive Pulmonary Disease by Smoking Status: Behavioral Risk Factor Surveillance System 2016 and 2017

Type:

Community-Based Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amepre.2019.10.014

Keywords

MeSH

Behavioral Risk Factor Surveillance System

bronchitis

Chronic Traumatic Encephalopathy

self report

Smokers

Cigarette Smoking

electronic nicotine delivery systems

Vaping

More evidence that e-cigarette smoking is hazardous to lungs apart from the adverse effects of regular cigarette smoking. James W. Mold, MD, MPH

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Introduction: The association between e-cigarette use and chronic bronchitis, emphysema, and
chronic obstructive pulmonary disease has not been studied thoroughly, particularly in populations
defined by concomitant combustible smoking status.

Methods: Using pooled 2016 and 2017 data from the Behavioral Risk Factor Surveillance System,
investigators studied 705,159 participants with complete self-reported information on e-cigarette use,
combustible cigarette use, key covariates, and chronic bronchitis, emphysema, or chronic obstructive
pulmonary disease. Current e-cigarette use was the main exposure, with current use further classified
as daily or occasional use. The main outcome was defined as reported ever having a diagnosis of

chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. For all the analyses, multi-
variable adjusted logistic regression was used, with the study population stratified by combustible ciga-
rette use status (never, former, or current). All the analyses were conducted in 2019.

Results: Of 705,159 participants, 25,175 (3.6%) were current e-cigarette users, 64,792 (9.2%) current
combustible cigarette smokers, 207,905 (29.5%) former combustible cigarette smokers, 432,462

(61.3%) never combustible cigarette smokers, and 14,036 (2.0%) dual users of e-cigarettes and combus-
tible cigarettes. A total of 53,702 (7.6%) participants self-reported chronic bronchitis, emphysema, or

chronic obstructive pulmonary disease. Among never combustible cigarette smokers, current e-ciga-
rette use was associated with 75% higher odds of chronic bronchitis, emphysema, or chronic obstruc-
tive pulmonary disease compared with never e-cigarette users (OR=1.75, 95% CI=1.25, 2.45), with

daily users of e-cigarettes having the highest odds (OR=2.64, 95% CI=1.43, 4.89). Similar associations
between e-cigarette use and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease
were noted among both former and current combustible cigarette smokers.
Conclusions: The results suggest possible e-cigarette−related pulmonary toxicity across all thecategories of combustible cigarette smoking status, including those who had never smoked combus-
tible cigarettes.

Author/s:

Osei , A.D., Mirbolouk, M., Orimoloye, O.A., Dzaye, O.

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

John Bayhi — Thu, 02 Jan 2020 20:08:03 +0000

Date Added:

January 2, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publisher:

Elsevier Inc.

Publication Date:

December 11, 2019

URL:

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2019.07.028

Keywords

e-cigarette or vaping product use-associated lung injury

PMID (1):

31859175

MeSH

Adult

electronic nicotine delivery systems

This longitudinal study documents an increase in respiratory problems associated with e-cigarette use and supports a mechanism distinct from those associated with respiratory problems associated with standard cigarettes. The combination of e-cigarettes and standard cigarettes appears to be particularly hazardous. James W. Mold, MD, MPH.

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INTRODUCTION:

E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use.

METHODS:

This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013-2016 and analyzed in 2018-2019.

RESULTS:

Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.

CONCLUSIONS:

Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.

Author/s:

Bhatta, DN, Glantz, SA