{"id":1144,"date":"2016-10-24T15:29:01","date_gmt":"2016-10-24T15:29:01","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=1144"},"modified":"2017-08-21T10:44:57","modified_gmt":"2017-08-21T10:44:57","slug":"primary-care-corner-with-geoffrey-modest-md-e-cigarettes-help-smoking-cessation","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/10\/24\/primary-care-corner-with-geoffrey-modest-md-e-cigarettes-help-smoking-cessation\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: E-Cigarettes Help Smoking Cessation??"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>There has been a lot of controversy about the potential benefits of using e-cigarettes to help current\u00a0smokers quit vs the potential harms of e-cigs in normalizing and promoting nicotine use for nonsmokers, possibly leading to smoking the much more toxic regular cigarettes.\u00a0A\u00a0recent large data analysis from the UK did suggest that e-cigs may be a\u00a0helpful aid for\u00a0smoking cessation (see doi.org\/10.1136\/bmj.i4645).<\/p>\n<p>Details:<\/p>\n<ul>\n<li>England has a &#8220;liberal regulatory framework for e-cigarettes and has seen a considerable\u00a0growth in their use&#8221;<\/li>\n<li>This study looked a 2 sources of information over time: the Smoking Toolkit Study (monthly household, face-to-face scripted\u00a0surveys of a representative UK population &gt;16 yo, with data from 2006 on 170,490 individuals, of whom 41K were past smokers, 38K were current smokers, with about 1200 smokers being surveyed quarterly); and statistics on the use of the\u00a0\u00a0English National Health Service (NHS) stop smoking services (8,029,012 people had set\u00a0quit dates)<\/li>\n<\/ul>\n<p>Results:<\/p>\n<ul>\n<li>The prevalence of self-reported quit attempts decreased over time (45.4% in 2006 to 31.2% in 2014), but the percent of successful quit\u00a0rate rose\u00a0from\u00a010.6% to 15.2%<\/li>\n<li>There as a striking increased use of e-cigs, beginning in 2012 and increasing to 35% by 2014<\/li>\n<li>E-cig use by smokers was positively associated with successful attempts to quit,\u00a0by 0.098% [0.064 to 0.132); P&lt;0.001]\u00a0for every 1% increase in the prevalence of e-cigarette use by smokers<\/li>\n<li>E-cig use in quit attempts was also positively associated with quit success, by058% [0.038 to 0.078; P&lt;0.001]\u00a0for every 1% increase in\u00a0e-cigarette use during a recent quit attempt<\/li>\n<li>Data were inconclusive about the association between current\u00a0e-cigarette use and the overall\u00a0rate of quit attempts, use of NRT (nicotine replacement therapy)\u00a0bought over the counter, use of prescription treatment, or use of behavioral support. [Note: \u201cinconclusive\u201d does not mean \u201cineffective\u201d]<\/li>\n<li>There was evidence that expenditure on mass media was positively associated with use of stop smoking services<\/li>\n<li>A negative association was found between e-cigarette use during a recent quit attempt and use of NRT obtained through prescription by 0.098% for every 1% increase in e-cig use in a quit attempt (P=0.04), and there was a pretty remarkable but apparently nonsignificant decrease in over-the-counter (OTC) NRT purchases from 40.0% to 20.6% of smokers [e., it appeared that the more e-cigs were used, the less NRT\u00a0used. Substitution by the patients??)<\/li>\n<\/ul>\n<p>Commentary:<\/p>\n<ul>\n<li>The above numbers were adjusted for changes in differences in stop smoking services over time, introduction of a smoking ban in 2007, change in minimum age of sale of\u00a0cigarettes\u00a0from 16 to 18 yo in 2007, and changes in price of cigarettes<\/li>\n<li>The overall\u00a0decrease in smoking prevalence in England dropped 1 percentage point between 2014-5.<\/li>\n<li>From\u00a0their mathematical modeling: in 2015, quit attempts was 32.5% (of 8 million smokers) and\u00a0the prevalence of e-cig use in quit attempts was 36%, so 54,288 more quitters stopped at least short to medium term. And if 2\/3 relapse (the usual %), then e-cigs would have contributed to 18,000 additional long-term quitters.<\/li>\n<li>And, a 40yo who quits smoking is likely to gain about 9 years of life<\/li>\n<li>The generalizability to other areas may be limited by their differences to UK policies on e-cigs as well as smoking cessation supports, media campaigns, etc<\/li>\n<li>Other studies do find a rise in e-cig experimentation in nonsmokers, though the rate of regular use is &lt;1%<\/li>\n<li>As mentioned in prior blogs (e.g., see <a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/05\/10\/primary-care-corner-with-geoffrey-modest-md-e-cigarettes-as-a-tool-to-quitting-smokingharm-reduction\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/05\/10\/primary-care-corner-with-geoffrey-modest-md-e-cigarettes-as-a-tool-to-quitting-smokingharm-reduction\/<\/a> ), I have had some impressive success with e-cigs (either initiated by the patient or by me) in getting some really long-term smokers to quit. I do regularly try the other motivational and medical therapies first, so the group who do finally quit with e-cigs is a pretty resistant one. So, my bottom line is that if e-cigs are legal and available, I do consider it part of my smoking cessation options, even as a means for\u00a0harm reduction (i.e., using e-cigs to decrease cigarettes, which have 3000 additives and some known to be carcinogenic). And I do counsel adolescents in particular about the potential harm of initiating e-cig use and nicotine\u2019s profound addiction potential.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: E-Cigarettes Help Smoking Cessation?? [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/10\/24\/primary-care-corner-with-geoffrey-modest-md-e-cigarettes-help-smoking-cessation\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-1144","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1144","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=1144"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1144\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=1144"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=1144"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=1144"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}