Nonpharmacologic Approaches

Behavioral interventions, alone or in combination with pharmacotherapy, improve achievement of tobacco cessation.7 These include physician- and nurse-delivered counseling, tailored self-help counseling materials, and telephone counseling.8

A burgeoning number of technologies are being used to augment smoking cessation counseling, including automatic voice recognition, in which a human voice delivers smoking cessation messages via telephone several times daily.9 Reliable apps recommended by the US Department of Health and Human Services (HHS) are available here.

The Promises and Pitfalls of Electronic Cigarettes

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E-cigarettes “have become popular nicotine-delivery devices,” with as many as 4.5% of US adults (or 10.8 million people) reporting use in 2015.11 Of these, nearly half also used combustible cigarettes.11

“We know that even though many people try vaping as part of an approach to quit smoking [combustible cigarettes], the most frequent outcome is that they become dual users, sometimes vaping and sometimes smoking combustible cigarettes,” according to Marc Steinberg, PhD, Associate Professor of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

When this happens, “people often wind up taking more nicotine than before and becoming even more dependent,” he told MPR

There is a widely held perception that e-cigarettes are “safer than combustible cigarettes” and their use “can help smokers quit combustible cigarettes,” however the evidence for this is conflicting and controversial.11

Moreover, the appealing flavors, lack of lingering odor, and perception of reduced stigma may make these products more appealing in many age groups, but especially among youth, a population in which use of combustible cigarettes has been declining.11 One survey found that among middle and high school students, >5 million were current users of e-cigarettes and vaping products, and almost 1 million were using them daily in 2019.12 

Despite the allure and reasons that many people turn to e-cigarettes from combustible cigarettes, most adult users do want to quit using e-cigarettes,13 Dr Steinberg noted.

Youngsters, however, are less likely to be interested in discontinuing use of e-cigarettes and vaping. There is scant guidance on how healthcare professionals can actually help these young patients seeking to quit vaping.14 

One important talking point is the high risk of vaping-associated lung injury (EVALI), a serious respiratory illness that claimed the lives of 55 individuals as of December 27, 2019. At that time, 2561 cases of EVALI had been reported to the CDC. While most of hospitalized users (80%) reported using tetrahydrocannabinol (THC)-containing products, 54% reported use of nicotine-containing products, and 40% reported use of both.15