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BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes and Smoking Cessation Sarah Boone, Carolyn Little, Clay Owens, Jeremy Randolph, Genny Tibbs

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BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes and Smoking Cessation

Sarah Boone, Carolyn Little, Clay Owens, Jeremy Randolph, Genny

Tibbs

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Objectives

• Analyze Smoking in Kentucky

• List Methods of Smoking Cessation

• Acute Effects of Electronic Cigarettes

• Review the Evidence of Related Studies

• Compare Use of Electronic Cigarettes and Nicotine Patches

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Smoking in KY

http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/states/kentucky/

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Smoking in KY

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Smoking in KY

http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/states/kentucky/

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Smoking Cessation

• 80% of smokers who attempt cessation relapse within in first month of quitting

• 3-5% remain abstinent at 6 months (Polosa, BMC Public Health, 2011)

• Common Methods: – Electronic cigarettes – Nicotine Patches – Oral Medication – “Cold Turkey”

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes

Westenberger, FDA, 2009

P: Smokers

I: Electronic Cigarettes

C: Nicotine Patches

O: Smoking Cessation

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acute Effects of E-Cigarettes

Vansickel, American Association for Cancer Research, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acute Effects of E-Cigarettes

• 32 tobacco cigarette smokers

• Four products:– Own brand cigarette, “NPRO” electronic

cigarettes, “Hydro” electronic cigarettes, or sham

• Outcome Measures: – Heart rate, plasma nicotine content,

Tiffany Drobes Questionnaire of Smoking Urges Brief

Vansickel, American Association for Cancer Research, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acute Effects of E-Cigarettes

• Results:

– Own brand increased plasma nicotine, CO concentration and heart rate

– NPRO EC, Hydro EC, and sham smoking did not

– Both EC exposed users to no nicotine or CO

– Both EC didn’t increase heart rate

– Both EC increased subjective ratings of acceptability

Vansickel, American Association for Cancer Research, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acute Effects of E-Cigarettes

• Conclusion:

– Neither electronic cigarettes exposed users to measurable levels of nicotine or CO

– Both suppressed nicotine/tobacco abstinence symptom ratings

Vansickel, American Association for Cancer Research, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes & Smoking Cessation

Polosa, BMC Public Health, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes & Smoking Cessation

• Methods:

– 5 visits: baseline and four follow up visits at week 4, 8, 12, and 24

– Baseline Measurements: • Demographics and detailed smoking history • Level of carbon monoxide in exhaled breath

(eCO)

– 4 week supply of 7.4 mg nicotine cartridges given

– Max use of 4 cartridges/day

Polosa, BMC Public Health, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes & Smoking Cessation

Reducers Heavy Reducers

Quitters Smoking Failure

50% reduction in number of

cig/day compared to

baseline 

80% reduction in number of

cig/day compared to

baseline

Smoking abstinence at

24 weeks

< 50% reduction in number of

cig/day compared to

baseline

Polosa, BMC Public Health, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes & Smoking Cessation

• Results: – 50% reduction shown in 13/40 subjects– Combined sustained 50% reduction and

smoking abstinence in 22/40 (p≤0.001)• Conclusions:

– Reduction in cigarette smoking with e-cigarettes may increase motivation to quit

– Gradual reductions in cigarette smoking can increase cessation

Polosa, BMC Public Health, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Case Series on Smoking Cessation Utilizing E-cigs

Caponnetto, Journal of Medical Case Reports, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Case Series on Smoking Cessation Utilizing E-cigs

• Three chronic smokers (two male, one female)

• Severe dependence to nicotine– Fagerstrom Test of Nicotine Dependence

(FTND)– Exhaled Breath Carbon Monoxide

Concentration (eCO)

• Previous cessation efforts (patches & group counseling)

Caponnetto, Journal of Medical Case

Reports, 2011.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Case Series on Smoking Cessation Utilizing E-cigs

• Results:

– Cessation status following the usage of E-cigs• No relapse 6 months following study

– Reduction in eCO– Variation in E-cig composition

• Regulation?

• Limitation – Small sample sizeCaponnetto, Journal of Medical Case Reports, 2011.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Comparison: Nicotine Patch Therapy

Myung et al. 2007, Am J Health-Syst Pharm

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Comparison: Nicotine Patch Therapy

• Study:– Meta-analysis of studies investigating

efficacy of nicotine patches vs. placebo.

• Purpose:– Assess current literature– Determine an odds ratio for smoking

cessation Myung et al. 2007, Am J Health-Syst Pharm

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Comparison: Nicotine Patch Therapy

• Methods:– 16 RCT’s – Total subjects: 9,457

• 6,084 nicotine group• 3,373 placebo group

• Results of Meta-analysis:

Pooled OR (odds ratio) for 16 studies was 1.79

http://www.nyc.gov/html/doh/html/pr2007/pr036-07.shtml

Myung et al. 2007, Am J Health-Syst Pharm

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes for Smoking Cessation

Bullen, Nat Inst Health Innov, 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes for Smoking Cessation: A Randomized Controlled

Trial

• Purpose:– To assess whether E-cigarettes containing

nicotine were more effective for smoking cessation than nicotine patches

• Methods:– 657 subjects were selected for the study– Randomized by computerized block

randomization– 4:4:1 ratio

Bullen, Nat Inst Health Innov, 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes for Smoking Cessation: A Randomized Controlled

Trial

• Procedures:

– Subjects used respective smoking cessation products for 12 weeks before a specific “quitting day”

– The primary outcome measured was smoking abstinence six months after “quitting day”

– Verified by self-report and carbon monoxide measurement

Bullen, Nat Inst Health Innov, 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes for Smoking Cessation: A Randomized Controlled

Trial

• Results:

– Abstinence rates after six months• Nicotine E-cigarette 7.3%• Nicotine Patches 5.8%• Placebo E-cigarette 4.1%

– Study was underpowered due to low abstinence rates and could not conclude if E-cigarettes were superior to nicotine patches or placebo Bullen, Nat Inst Health Innov, 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Summary Smoking Cessation

Electronic Cigarettes • Levels of nicotine or eCO

were reduced• Suppressed

nicotine/tobacco abstinence symptom ratings

• Highest rates of abstinence after six months

• Greater success rates with “rituals” of smoking

Nicotine Patch • Odds ratio for sustained

abstinence after 1 year: 1.79 (compared to placebo)

• Lowest rates of abstinence after six months

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Additional Resources

• Stop Smoking Classes Louisville – http://www.louisvilleky.gov/health/iwantto/

stopsmokingclasses.htm

• Norton Healthcare Smoking Cessation Program– http://www.nortonhealthcare.com/smoking

• Kentucky Cabinet for Health & Family Services – http://chfs.ky.gov/dph/mch/hp/tobacco.htm

BELLARMINE UNIVERSITY, LOUISVILLE, KY

ReferencesBullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Nat Inst Health Innov. 2013; 13:1-9.

Caponnetto P, Polosa R, Russo C, Leotta C, Campagna D. Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series. Journal of Medical Case Reports. 2011; 5: 585.

Myung SK, Yoo KY, Oh SW, et al. Meta-analysis of studies investigating one-year effectiveness of trasdermal nicotine patches for smoking cessation. Am J Health-Syst Pharm.2007; 64: 2471.

Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011; 11:786-797. doi:10.1186/1471-2458-11-786.

Vansickel AR, Cobb CO, Weaver MF, Eissenberg TE. A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: nicotine delivery profile and cardiovascular and subjective effects. Amer Assoc Cancer Res. 2010; 19: 1945-1953.