Jury Out on e-Cigs for Smoking Cessation

Megan Brooks

May 04, 2015

There is still insufficient evidence to weigh the balance of benefits and harms of electronic cigarettes for smoking cessation, experts say.

In an updated draft recommendation on behavioral interventions and medications for tobacco smoking cessation in adults, the US Preventive Services Task Force (USPSTF) issued an "I" statement, meaning it cannot at this time recommend for or against electronic nicotine delivery systems to help smokers kick the habit.

An estimated 42.1 million US adults (almost 18% of the population) continue to smoke tobacco. Smoking is the chief preventable cause of disease, disability, and death in the United States. Smoking causes more than 480,000 premature deaths annually and accounts for approximately 1 in every 5 deaths. Smoking during pregnancy raises the risk for multiple complications before birth, as well as low birthweight and impaired lung function in childhood.

"Quitting smoking can be difficult, but it is one of the most important actions people can take for their health. Fortunately, there are many effective smoking cessation aids available to help," USPSTF chair Albert Siu, MD, said in a statement.

The task force reviewed the latest evidence on smoking cessation interventions.

For nonpregnant adults, they recommend behavioral therapy or US Food and Drug Administration–approved medications, including nicotine replacement therapy, alone or in combination. This is a grade "A" recommendation.

For pregnant women, the task force recommends behavioral interventions. This is also a grade "A" recommendation. They found insufficient evidence for the use of smoking cessation medications, including nicotine replacement therapy, in pregnant women, and therefore issued an "I" statement and called for more research.

Given the common perception by the public and clinicians that electronic nicotine delivery systems may be an option for quitting conventional cigarettes, the USPSTF reviewed the evidence in support of this, but found little strong evidence.

No studies evaluated the use of these products for tobacco cessation in adolescents. The task force identified only two randomized, controlled trials that evaluated the effect of e-cigarettes on smoking abstinence in adults and found mixed results. Neither study reported any serious adverse events related to their use. Although not reported in either study, potential concerns about the use of electronic cigarettes include the unknown safety and toxicity of their components and vapors and poisoning in children who mishandle nicotine cartridges, the task force said.

Overall, the USPSTF concluded that the evidence is insufficient regarding the balance of benefits and harms and therefore did not recommend for or against these products as smoking cessation aids, issuing an "I" statement.

"Clinicians should ask all patients whether they smoke, and provide appropriate interventions to help smokers quit," task force member Francisco Garcia, MD, MPD, said in a statement. "We're fortunate that doctors and patients have a choice of many interventions that have been proven to be effective."

A useful mnemonic to help involve patients in discussions about smoking cessation is the "5-A" behavioral counseling framework: (1) Ask about tobacco use; (2) Advise to quit, using clear, personalized messages; (3) Assess willingness to quit; (4) Assist in smoking cessation; and (5) Arrange follow-up and support.

The task force is seeking comment on the updated draft recommendation statement and draft evidence review. Comments can be submitted from May 5 until June 1, 2015, on their website.

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