E-cigarette use may hamper smoking cessation for smokers planning to quit post-hospitalization

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. In a study of hospitalized smokers who planned to quit smoking post-discharge, users of e-cigarettes were not as likely as nonusers to refrain from using tobacco at 6 months.

2. However, e-cigarette use in the study population was irregular; further research is necessary to study whether regular e-cigarette use helps or hampers efforts to quit smoking.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Many cigarette smokers use e-cigarettes to assist with efforts to quit smoking.  However, it is unknown if e-cigarettes are effective aids for cessation.  The authors carried out a secondary analysis of information from a large randomized controlled trial (RCT) of smokers who were in the hospital and intended to quit smoking following discharge.  The authors examined whether or not using e-cigarettes following discharge from the hospital was linked to future abstinence from tobacco among 1 357 smokers intending to quit.  At 1 and 3 months post-discharge, self-reported e-cigarette use was collected.  Abstinence from tobacco was confirmed biochemically at 6 months.  The authors found that 28% of smokers trying to quit used e-cigarettes by 3 months post-discharge.  However, few smokers used them consistently.  E-cigarette use was linked to decreased tobacco abstinence at 6 months compared to non-users.  Further research is necessary to study whether regular e-cigarette use helps or hampers efforts to quit smoking in a larger patient population.

A strength of the study is that it was the first (to the authors' knowledge) to evaluate an interaction between e-cigarette use and treatment.  Limitations include self-selected e-cigarette use by the participants and use of self-reported data.  Furthermore there was also possible unmeasured confounding, meaning no conclusion can be made regarding a causal relationship.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: Electronic cigarettes for smoking cessation: a randomised controlled trial

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In-Depth [randomized controlled trial]: The authors used data from a large RCT to carry out a secondary analysis.  The original RCT involved 1 357 hospitalized smokers who intended to cease smoking post-discharge.  During their hospitalization, the smokers received counseling for smoking cessation.  At discharge, the smokers were assigned at random to a control group (a recommendation for tobacco treatment) or intervention group (tobacco treatment at no cost).  At 1 and 3 months post-discharge, self-reported e-cigarette use was collected.  At 6 months, abstinence from tobacco was lab-confirmed.  Within 3 months post-discharge, 28% of participants reported e-cigarette use.  Pairs were propensity score-matched.  Analysis of these pairs (n = 237) indicated that users of e-cigarettes were not as likely as nonusers (10.1% vs. 26.6%) to refrain from using tobacco at 6 months.  The propensity score analysis indicated that there was a large negative association between use of e-cigarettes and abstinence from smoking.  However, there are many variables to factor into this association, including irregular e-cigarette use, possible initiation of e-cigarette use after failure of established cessation aids, concurrent e-cigarette use and evidence-based treatment for smoking cessation, and use of e-cigarettes by smokers lacking access to conventional cessation aids.

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