Nancy A. Rigotti, MD; Yuchiao Chang, PhD; Hilary A. Tindle, MD, MPH; Sara M. Kalkhoran, MD, MAS; Douglas E. Levy, PhD; Susan Regan, PhD; Jennifer H.K. Kelley, RN, MA; Esa M. Davis, MD, MPH; Daniel E. Singer, MD
Acknowledgment: The authors thank Tim Gomperts for assistance with manuscript preparation and their research staff for assistance in conducting the study.
Grant Support: By grant R01-HL11821 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.
Disclosures: Dr. Rigotti reports a grant and nonfinancial support from Pfizer and personal fees from UpToDate outside the submitted work. Dr. Kalkhoran reports personal fees from UpToDate outside the submitted work. Dr. Singer reports personal fees from Pfizer outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2048.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available through written agreement with the authors (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Nancy Rigotti, MD, Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114; e-mail, email@example.com.
Current Author Addresses: Drs. Rigotti, Chang, Kalkhoran, Levy, Regan, and Singer and Ms. Kelley: Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114.
Dr. Tindle: Vanderbilt Division of General Internal Medicine and Public Health, 2525 West End Avenue, Suite 370, Nashville, TN 37203.
Dr. Davis: University of Pittsburgh Medical Center, 230 McKee Place, Suite 600, Pittsburgh, PA 15213.
Author Contributions: Conception and design: N.A. Rigotti, Y. Chang, H.A. Tindle.
Analysis and interpretation of the data: N.A. Rigotti, Y. Chang, H.A. Tindle, S.M. Kalkhoran, D.E. Levy, D.E. Singer.
Drafting of the article: N.A. Rigotti, Y. Chang.
Critical revision of the article for important intellectual content: N.A. Rigotti, Y. Chang, H.A. Tindle, S.M. Kalkhoran, D.E. Levy, S. Regan, E.M. Davis, D.E. Singer.
Final approval of the article: N.A. Rigotti, Y. Chang, H.A. Tindle, S.M. Kalkhoran, D.E. Levy, S. Regan, J.H.K. Kelley, E.M. Davis, D.E. Singer.
Provision of study materials or patients: H.A. Tindle, J.H.K. Kelley, E.M. Davis.
Statistical expertise: Y. Chang.
Obtaining of funding: N.A. Rigotti, H.A. Tindle.
Administrative, technical, or logistic support: H.A. Tindle, J.H.K. Kelley.
Collection and assembly of data: N.A. Rigotti, H.A. Tindle, S. Regan, E.M. Davis.
Many smokers report using e-cigarettes to help them quit smoking, but whether e-cigarettes aid cessation efforts is uncertain.
To determine whether e-cigarette use after hospital discharge is associated with subsequent tobacco abstinence among smokers who plan to quit and are advised to use evidence-based treatment.
Secondary data analysis of a randomized controlled trial. (ClinicalTrials.gov: NCT01714323 [parent trial])
1357 hospitalized adult cigarette smokers who planned to stop smoking, received tobacco cessation counseling in the hospital, and were randomly assigned at discharge to a tobacco treatment recommendation (control) or free tobacco treatment (intervention).
Self-reported e-cigarette use (exposure) was assessed 1 and 3 months after discharge; biochemically validated tobacco abstinence (outcome) was assessed 6 months after discharge.
Twenty-eight percent of participants used an e-cigarette within 3 months after discharge. In an analysis of 237 propensity score–matched pairs, e-cigarette users were less likely than nonusers to abstain from tobacco use at 6 months (10.1% vs. 26.6%; risk difference, −16.5% [95% CI, −23.3% to −9.6%]). The association between e-cigarette use and quitting varied between intervention patients, who were given easy access to conventional treatment (7.7% vs. 29.8%; risk difference, −22.1% [CI, −32.3% to −11.9%]), and control patients, who received only treatment recommendations (12.0% vs. 24.1%; risk difference, −12.0% [CI, −21.2% to 2.9%]) (P for interaction = 0.143).
Patients self-selected e-cigarette use. Unmeasured confounding is possible in an observational study.
During 3 months after hospital discharge, more than a quarter of smokers attempting to quit used e-cigarettes, mostly to aid cessation, but few used them regularly. This pattern of use was associated with less tobacco abstinence at 6 months than among smokers who did not use e-cigarettes. Additional study is needed to determine whether regular use of e-cigarettes aids or hinders smoking cessation.
National Heart, Lung, and Blood Institute.
Rigotti NA, Chang Y, Tindle HA, Kalkhoran SM, Levy DE, Regan S, et al. Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study. Ann Intern Med. [Epub ahead of print 27 March 2018]168:613–620. doi: 10.7326/M17-2048
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Published: Ann Intern Med. 2018;168(9):613-620.
Published at www.annals.org on 27 March 2018
Cardiology, Coronary Risk Factors, Smoking, Tobacco, Alcohol, and Other Substance Abuse.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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