TDNet Discover

Background: Smoking cessation has become a primary focus for public health efforts given the high risk for morbidity and mortality associated with cigarette smoking worldwide. Following their introduction in 2007, electronic cigarettes (e-cigs) have grown in popularity as a smoking alternative. Health care providers are hesitant to recommend e-cigs as a smoking cessation method without United States Food and Drug Administration (FDA) approval. Current FDA-approved methods for smoking cessation include nicotine replacement therapy (NRT) and prescription medications such as bupropion HCl (Zyban®) and varenicline (Chantix®). Research is ongoing to determine the potential for e-cigs as a smoking cessation aid. Objective: The purpose of this systematic review is to determine if adult smoker use of e-cigs is an effective and safe alternative to current FDA-approved methods in long term smoking cessation (≥6-months). Methods: Three independent researchers conducted an extensive search of the following three databases: PubMed, Google Scholar, and EBSCOhost. The search for peer reviewed journal publications was conducted from October 2020 – February 2021. Each researcher searched one assigned database using specific search terms, limits, and inclusion and exclusion criteria. A duplicate review of the titles and abstracts against inclusion and exclusion criteria was performed. Full text articles were independently reviewed against all criteria. Once articles were determined to be included by researcher consensus and independent review by a South College faculty panel member, data extractions and quality assessments were completed. The National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool was utilized where each study was rated as “good”, “fair”, or “poor”. The rating supported by two out of the three researchers was confirmed as the quality rating result. After a researcher completed their primary data extraction for assigned articles, the two remaining researchers reviewed them for thoroughness and accuracy. Finalized extractions for each article underwent a qualitative analysis. Results: Five studies totaling 98,162 participants were included in this systematic review. Statistical significance varied among studies and factors assessed included nicotine versus non-nicotine containing e-cigs, NRT, possible smoking-related diseases (PSRD), self-reported health, adverse effects, and carbon dioxide levels. Four of the five studies suggest e-cigs are an effective tool in long-term smoking cessation (≥6 months). Furthermore, it was found nicotine-containing e-cigs are most effective in smoking cessation. When compared to NRT, it was found nicotine containing e-cigs may produce more successful smoking cessation attempts. Limited data was available regarding the safety of e-cig use in long-term smoking cessation. E-cig use was not shown to significantly decrease the risk of PSRD or improve self-reported health. Significant adverse effects were found to be associated with e-cig use. There was no significant difference in carbon dioxide levels before or after e-cig use therefore this biomarker is unsuitable to evaluate e-cig safety. Conclusion: Overall, the evidence demonstrates e-cigs effectively aid in smoking reduction and cessation. However, this research cannot conclude that e-cigs are safe when compared to other FDA approved smoking cessation aids. Longitudinal studies and studies directly comparing e-cigs to other FDA approved methods of smoking cessation are needed to adequately address.