Rachel Grana, PhD, MPH; Neal Benowitz, MD; Stanton A. Glantz, PhD
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Context
Electronic cigarettes (e-cigarettes) are products that deliver a nicotine-containing aerosol (commonly called vapor) to users by heating a solution typically made up of propylene glycol or glycerol (glycerin), nicotine, and flavoring agents invented in their current form by Chinese pharmacist Hon Lik in the early 2000s. (1)
There has been rapid market penetration of e-cigarettes despite many unanswered questions about their safety, efficacy for harm reduction and cessation, and total impact on public health.
Purpose of the Review
It is important to assess e-cigarette toxicant exposure and individual risk, as well as the health effects, of e-cigarettes as they are actually used to ensure safety and to develop an evidence-based regulatory scheme that protects the entire population—children and adults, smokers and nonsmokers—in the context of how the tobacco industry is marketing and promoting these products.
Key Messages
- Clinicians must support a smoker’s quit attempt and try to ensure any that advice given does not undermine their motivation to quit. Clinicians should follow the 5 A’s of evidence-based treatment: ask, advise, assess, assist, and arrange. (2)
- Clinicians should assess their patient’s motivation and readiness to quit and recommend a treatment plan that should include setting a quit date and obtaining cessation counseling and, if appropriate, conventional smoking cessation medications.
- The safest and most proven smoking cessation pharmacotherapies are the nicotine replacement medications varenicline and bupropion.
- Referral to a free telephone quit line or another counseling support program enhances the effectiveness of smoking cessation medications.(2)
- If a patient has failed initial treatment, has been intolerant of or refuses to use conventional smoking cessation medication, and wishes to use e-cigarettes to aid quitting, it is reasonable to support the attempt. However, subjects should be informed that, although e-cigarette aerosol is likely to be much less toxic than cigarette smoking, the products are unregulated, contain toxic chemicals, and have not been proven as cessation devices.
- The patient should also be advised not to use the product indoors or around children because studies show that bystanders may be exposed to nicotine and other toxins (at levels much lower than cigarettes) through passive exposure to the e-cigarette aerosol.
- Because there are no long-term safety studies of e-cigarette use, patients should be urged to set a quit date for their e-cigarette use and not plan to use it indefinitely. It is also important to stress that patients should quit smoking cigarettes entirely as soon as possible because continued cigarette smoking, even at reduced levels, continues to impose tobacco-induced health risks (particularly for cardiovascular disease).
References
- Grana R, Benowitz N, Glantz SA. Background paper on E-cigarettes (electronic nicotine delivery systems). Center for Tobacco Control Research and Education, University of California, San Francisco, a WHO Collaborating Center on Tobacco Control. Prepared for World Health Organization Tobacco Free Initiative. December 2013. http://pvw.escholarship.org/uc/item/13p2b72n. Accessed March 31, 2014.
- Fiore M. Treating Tobacco Use and Dependence: 2008 Update: Clinical Practice Guideline. Darby, PA: DIANE Publishing; 2008.
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