Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers With No Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial

Abstract

Introduction The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking is unclear. This exploratory analysis examined the effects of ENDS delivering different amounts of nicotine on cigarette abstinence up to 24-week follow-up, in comparison to placebo or a behavioral substitute. Methods This four-arm parallel-group, randomized, placebo-controlled trial took place at two academic medical centers in USA (Penn State Hershey and Virginia Commonwealth University). Participants were current adult smokers (N=520) interested in reducing but not planning to quit. They received brief advice and were randomized to one of four 24-week conditions, receiving either an eGo-style ENDS paired with 0, 8 or 36 mg/ml nicotine liquid (double-blind) or a cigarette-shaped tube, as a cigarette substitute (CS). Self-reported daily cigarette consumption and exhaled carbon monoxide (CO) were measured at all study visits. Outcomes included intent-to-treat, self-reported 7-day cigarette abstinence, biochemically confirmed by exhaled CO at 24 weeks after randomization. Results At 24 weeks, significantly more participants in the 36 mg/ml condition (14/130, 10.8%) than in the 0 mg/ml condition (1/130, 0.8%) and the CS condition (4/130, 3.1%) were abstinent (relative risk = 14 [95% CI=1.9-104.9] and 3.5 [95% CI=1.2-10.4], respectively). The abstinence rate in the 8 mg/ml condition was 4.6% (6/130). Conclusions When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute. Implications The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.

Associations between nicotine vaping uptake and cigarette smoking cessation vary by smokers' plans to quit: longitudinal findings from the International Tobacco Control Four Country Smoking and Vaping Surveys

“…Regardless of the directionality, our findings show contemporaneous associations between moving from daily smoking to no smoking alongside moving from no vaping to daily vaping specifically among those who were initially not planning to quit smoking. These findings are consistent with the one other population study that evaluated this question among smokers not planning to quit [3], as well as experimental studies that have shown that giving NVPs to smokers unmotivated to quit increases their motivation to quit [4][5][6] and is associated with reductions in their cigarette smoking [6,7].…”

“…[3] found that daily vaping uptake was associated with eightfold greater odds of smoking cessation among those who were not planning to ever quit. These findings are consistent with experimental studies that have reported that giving NVPs to unmotivated smokers is positively associated with change in quit intentions [4, 5] and reductions in cigarette smoking [6, 7]. However, no study has yet investigated whether the association between uptake of NVP use and cigarette smoking cessation differs as a function of smokers' initial plans to quit.…”

Comparison of biomarkers of exposure among US adult smokers, users of electronic nicotine delivery systems, dual users and nonusers, 2018–2019

“…Used as a harm-reduction strategy, ENDS are intended to draw smokers away from combustible cigarettes, which are the most harmful and addictive nicotine-delivery product. Consistent with these conceptual models of switching and nicotine delivery, data from observational studies 62 and randomized trials 63 , 64 support the concept that adequate levels of nicotine are likely necessary to facilitate switching away from smoking.…”

Part one: abuse liability of Vuse Solo (G2) electronic nicotine delivery system relative to combustible cigarettes and nicotine gum

“…Consistent with other published literature on ENDS 9 , 20 , 43 , 44 , Vuse Solo was able to reduce early smoking urges to a significantly greater degree than nicotine gum, and time to maximum reduction of urges after Vuse Solo use was closer to that of smoking. Since acute nicotine cravings have been shown to lead to smoking lapse within 10 min 45 , any replacement product for CC must deliver nicotine at a sufficient rate and level so as to adequately satiate the smoker and prompt switching 46 . The pharmacokinetic results suggest that Vuse Solo can serve as an appropriate replacement product for CC among adult smokers accustomed to a fairly rapid nicotine uptake and thus a faster onset of craving relief and reductions in urge to smoke.…”