A Pilot Randomized Crossover Trial of Electronic Cigarette Sampling Among Smokers

Abstract

Introduction: Electronic cigarette (EC) use is proliferating, but initial uptake patterns and their influence on smoking remains unclear. This study of EC sampling examines naturalistic uptake of ECs, as well as effects on smoking and perceived reward from smoking and vaping. Methods: Within a double-blind randomized crossover design, smokers (n = 24; 75% male; M age = 48.5 years) smoked as usual for 1 week, followed by two counterbalanced naturalistic (ie, ad libitum use) weeks of either placebo or active first generation ECs. Vaping and regular smoking was measured daily using diaries and at weekly clinic visits. Perceived reward from ECs and intentions/confidence to quit were also assessed. Analyses compared variables during the naturalistic smoking week and each EC week while controlling for sequence and baseline measurements of respective variables. Results: No significant differences emerged between active and placebo EC weeks in vaping or regular smoking, EC reinforcement, and intention/confidence to quit smoking. Satisfaction from smoking (p = .04) and smoking's ability to reduce cravings (p = .003) decreased from the naturalistic to active EC week. Behavioral dependence to cigarettes decreased from the naturalistic (M = 16.5, p = .02) to active (M = 14.7) and placebo (M = 14.2) EC weeks. Conclusions: Few differences emerged in vaping, regular cigarette use, and overall reactions to ECs between active and placebo ECs. Active ECs appeared to decrease reinforcement from smoking, and both active and placebo ECs reduced behavioral dependence to cigarettes. Nicotine (per labeling) may have minimal influence on the uptake of first generation ECs among smokers. Implications: First generation ECs provide an important behavioral/sensorimotor replacement for cigarettes, regardless of nicotine delivery, but substantial substitution may be minimal when smokers are only asked to use ad libitum. However, newer models of EC devices that provide better nicotine delivery should be examined for potential differential patterns of smoking and vaping (eg, decreased smoking and increased vaping) given their suggested greater ability to provide nicotine and behavior/sensorimotor replacement.

A Naturalistic, Randomized Pilot Trial of E-Cigarettes: Uptake, Exposure, and Behavioral Effects

“…In fact there is reason to suggest that outcomes would be even stronger (vs. control conditions) for newer and more powerful ENDS devices, if only because they are generally more efficient in nicotine delivery, offer improved battery duration, and wider flavor assortment (45,47), all of which presumably increase consumer appeal and eventual uptake. Third, our comparison group herein was a non-sampling control, as opposed to a placebo e-cigarette condition, studied elsewhere (49). We were less interested in the nicotine-specific effects of e-cigarette uptake and more interested on the aggregate experience of trying a new product vs. not.…”

Electronic cigarettes: A position statement from the Thoracic Society of Australia and New Zealand*

“…Three studies investigated smokers not motivated to quit. They found that the addition of free e‐cigarettes to usual care (information and motivational text messages) did not increase sustained smoking abstinence; 35 provision of free e‐cigarettes for use entirely at the discretion of participants did not significantly influence quit attempts or biologically verified abstinence; 36 and randomization to ad libitum nicotine‐containing rather than non‐nicotine‐containing e‐cigarettes did not reduce regular cigarette use 37 …”

Biomarkers of Exposure Among “Dual Users” of Tobacco Cigarettes and Electronic Cigarettes in Canada

“…12 This variability is reflected in switching studies, which show that some, but not all, smokers have successfully switched from tobacco cigarettes to e-cigarettes, compensating for nicotine via a new nicotine-delivering product. 10,[13][14][15][16][17][18][19] To date, several studies indicate that e-cigarettes do not expose users to carbon monoxide [13][14][15][16][17][18][20][21][22][23] ; however, evidence regarding other tobacco smoke constituents is limited. Comparative analyses indicate that exposure to polycyclic aromatic hydrocarbons (PAHs) was significantly lower among exclusive vapers compared to smokers.…”