The full report is titled “Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization. A Prospective Study.” The authors are N.A. Rigotti, Y. Chang, H.A. Tindle, S.M. Kalkhoran, D.E. Levy, S. Regan, J.H.K. Kelley, E.M. Davis, and D.E. Singer.
March 27, 2018
nicotine has not aided true cessation
abrupt cessation works best!
Aki Nilanga Bandara
Faculty of Land and Food Systems Vancouver Campus
April 2, 2018
Doctors need evidence based information
The Electronic cigarette (e-cigarette) industry uses websites and powerful social media to promote their products as a proven tobacco cessation tool. However, Rigotti et al’s study (1) and other available systematic review clearly shows that e-cigarettes are not a tobacco cessation tool (2, 3, 4, 5, 6, 7). The majority of systematic reviews available to date on the efficacy of e-cigarettes as a smoking cessation aid reveal limited evidence either for or against the practice (2, 3, 4, 5, 6, 7). Most importantly, a new congressionally mandated National Academies of Sciences, Engineering and Medicines’ (NASEM) comprehensive review of more than 800 peer reviewed scientific studies further reinforces Rigotti et al’s study findings (1):“There is insufficient evidence from randomized controlled trials about the effectiveness of e-cigarettes as cessation aids compared with no treatment or to Food and Drug Administration–approved smoking cessation treatments and overall, there is limited evidence that e-cigarettes may be effective aids to promote smoking cessation” (8).It is important that the Rigotti et al. study (1) and the NASEM study are both appropriately disseminated to reflect future patient care decision making in order to prevent tobacco related problems. The medical community is so divided on their opinion on the efficacy as a therapeutic tool and potential harm of e-cigarettes (8, 9, 10, 11). There is a growing interest among conventional tobacco users in e-cigarettes as a potential option to help them quit combustible cigarettes. The U.S. Preventive Services Task Force (USPSTF) concluded that there is insufficient evidence to recommend e-cigarettes for tobacco cessation (7). Further, the USPSTF recommends that clinicians direct patients who smoke tobacco to other cessation interventions with established effectiveness and safety (7).The evidence-based guideline advises that physicians provide brief cessation counseling to tobacco users (7). However, it is concerns that some physicians are not very often asking if patients are using e-cigarettes. Many physicians feel not comfortable discussing the health effects of e-cigarettes, obviously, due to limited knowledge and contradictory scientific information available on this topic (12).This information demonstrate that patients refer to practitioners as a source of e-cigarette guidance, yet many physicians feel confident advising. Therefore, the physicians need evidence-based information to help them address e-cigarettes in primary care (12).Although multiple professional medical associations such as American Medical Association, American Heart Association, and American Lung Association have developed guidelines about e-cigarettes, it is not clear that this information is being disseminated to medical community using the appropriate channels. It is clearly evident that the physicians need more evidence-based information, in addition to training and education (11, 12). I believe that there is sufficient evidence-based information out there (1) that physicians could utilize to convey the lack of evidence on the efficacy of e-cigarettes on smoking cessation to the patients (2, 3, 4, 5, 6, 7).At the same time, it is necessary to provide cessation support to patients, counselling, prescribe medicinal nicotine replacement therapy (NRT), and refer interested patients to quit lines whenever appropriate (7, 9, 10). Becoming more knowledgeable about e-cigarette use and health consequences, incorporating screening into routine practice, being aware of signs and symptoms of e-cigarette use is important. Being familiar with and considering evidence-based best practice recommendations for tobacco cessation is also very important (7, 8, 9, 10, 11, 12).I would like to propose that prior to health care community advocate efforts for enactment of any potential evidence-based legislation or policy strategies to curtail e-cigarette use by patients, there needs to be a strong public educational and awareness campaign to counter common myths and misconceptions about e-cigarettes. This is a logical first step to follow because legislation won’t be successful unless patients are convinced that according to current evidence, e-cigarettes are not a therapeutic or tobacco cessation tool.REFERENCES:(1). Rigotti NA, Chang Y, Tindle HA, Kalkhoran SM, Levy DE, Regan S, Kelley JHK, Davis EM, Singer DE. Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit Aftera Hospitalization: A Prospective Study. Ann Intern Med. 2018 Mar 27. doi: 10.7326/M17-2048. [Epub ahead of print](2). Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016 Feb;4(2):116-28. doi: 10.1016/S2213-2600(15)00521-4. Epub 2016 Jan 14.(3). Rahman MA, Hann N, Wilson A, Mnatzaganian G, and Worrall-Carter L: E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis. PLoS One 2015; 10: pp. e0122544 (4). Khoudigian S, Devji T, Lytvyn L, Campbell K, Hopkins R, O'Reilly D. The efficacy and short-term effects of electronic cigarettes as a method for smoking cessation: a systematic review and a meta-analysis. Int J Public Health. 2016 Mar;61(2):257-67. doi: 10.1007/s00038-016-0786-z. Epub 2016 Jan 29. Review.(5). Malas M, van der Tempel J, Schwartz R, Minichiello A, Lightfoot C, Noormohamed A, Andrews J, Zawertailo L, Ferrence R. Electronic Cigarettes for Smoking Cessation: A Systematic Review. Nicotine Tob Res. 2016 Apr 25. pii: ntw119. [Epub ahead of print] Review.(6). Lindson-Hawley N, Hartmann-Boyce J, Fanshawe TR, Begh R, Farley A, Lancaster T. Interventions to reduce harm from continued tobacco use. Cochrane Database Syst Rev. 2016; 13; 10:CD005231. (7). Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Ann Intern Med. 2015 Oct 20;163(8):608-21. doi: 10.7326/M15-0171. Epub 2015 Sep 22. Review.(8). National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. The National Academies Press, Washington, DC; 2018. Available at:https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes (Accessed, 3/31/2018)(9). Kandra KL, Ranney LM, Lee JG, Goldstein AO. Physicians' attitudes and use of e-cigarettes as cessation devices, North Carolina, 2013.PLoS One. 2014 Jul 29;9(7):e103462. doi: 10.1371/journal.pone.0103462. eCollection 2014.(10). Steinberg MB, Giovenco DP, Delnevo CD. Patient-physician communication regarding electronic cigarettes.Prev Med Rep. 2015 Feb 2;2:96-8. doi: 10.1016/j.pmedr.2015.01.006. eCollection 2015.(11). Pepper JK, Gilkey MB, Brewer NT. Physicians' Counseling of Adolescents Regarding E-Cigarette Use. J Adolesc Health. 2015 Dec;57(6):580-6. doi: 10.1016/j.jadohealth.2015.06.017. Epub 2015 Aug 19.(12). Doescher MP, Wu M, Rainwater E, Khan AS, Rhoades DA.Patient Perspectives on Discussions of Electronic Cigarettes in Primary Care.J Am Board Fam Med. 2018;31(1):73-82. doi: 10.3122/jabfm.2018.01.170206.
Use of E-Cigarettes Among Smokers Who Plan to Quit After a Hospitalization. Ann Intern Med. 2018;168:I–24. [Epub ahead of print 27 March 2018]. doi: https://doi.org/10.7326/P18-0004
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Published: Ann Intern Med. 2018;168(9):I-24.
Published at www.annals.org on 27 March 2018
Cardiology, Coronary Risk Factors, Smoking, Tobacco, Alcohol, and Other Substance Abuse.
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