Electronic Cigarettes Do Not Appear to Promote Smoking Cessation

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Adult smokers who were recently hospitalized were included in the Helping HAND 2 clinical trial.
Adult smokers who were recently hospitalized were included in the Helping HAND 2 clinical trial.

Smokers who attempted to quit by using electronic cigarettes (e-cigarettes) after a hospital discharge were unable to remain abstinent at 6 months, according to a study published in the Annals of Internal Medicine.

Researchers evaluated adult smokers who were part of the Helping HAND 2 trial (ClinicalTrials.gov Identifier: NCT01714323) to determine whether e-cigarette use in the 3 months after hospital discharge would be associated with tobacco abstinence at 6 months. A total of 1357 adults were hospitalized in 3 different facilities and were randomly assigned at discharge to free tobacco treatment (intervention, n=680) or to a tobacco treatment recommendation (control, n=677).

A total of 18.3% of participants reported using e-cigarettes at 1 month after discharge, 28.0% of participants at 3 months, and 37.0% at 6 months (P <.001). However, at 6 months, e-cigarette users were less likely than nonusers to abstain from tobacco use (10.1% vs 26.6%; risk difference, –16.5% [95% CI, –23.3% to –9.6%]). The association between e-cigarette use and quitting carried between those in the intervention group who were given access to conventional treatment (7.7% vs 29.8%; risk difference, –22.1% [95% CI, –32.3% to –11.9%]) and those in the control group who received only treatment recommendations (12.0% vs 24.1%; risk difference, –12.0% [95% CI, –21.2% to 2.9%]; P for interaction =.143)

The analysis was limited because of its observational design as well as by the lack of data on type of e-cigarette and detailed information on frequency of use. In addition, these results apply only to people who smoked and had been recently hospitalized and therefore may not be applicable to other patient groups.

The researchers cautioned that, although there was a negative association between e-cigarette use and subsequent smoking cessation, “the association must be interpreted in the context in which the e-cigarettes were used: intermittently; often concomitantly with evidence-based tobacco cessation treatment; and more often by smokers without easy, free access to evidence-based cessation aids.”

They concluded that e-cigarettes may still promote smoking cessation if they are used consistently and as a complete replacement for cigarettes, which is the method recommended for conventional cessation medications.

Disclosures: Dr Rigotti reports a grant and nonfinancial support from Pfizer as well as personal fees from UptoDate; Dr Kalkhoran reports personal fees from UptoDate; and Dr Singer reports personal fees from Pfizer.

Reference

Rigotti NA, Chang Y, Tindle HA, et al. Association of e-cigarette use with smoking cessation among smokers who plan to quit after a hospitalization: a prospective study [published online March 27, 2018]. Ann Intern Med. doi:10.7326/M17-2048

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