E-cigarette Users Less Likely To Quit, Decrease Use Overall Versus Traditional Cigarette Smokers

E-cigarettes, championed by some as a smoking-cessation tool, may actually decrease the likelihood of quitting smoking, according to a recent population-based study of 1,000 smokers published in The American Journal of Public Health.

Researchers at the University of California, San Diego School of Medicine found that smokers who used e-cigarettes were 59 percent less likely to quit smoking compared with smokers who never used e-cigarettes. They were also 49 percent less likely to decrease cigarette use overall compared to non e-cigarette users.

“Based on the idea that smokers use e-cigarettes to quit smoking, we hypothesized that smokers who used these products would be more successful in quitting,” says Wael Al-Delaimy, MD, PhD, professor and chief of the Division of Global Public Health in the Department of Family Medicine and Public Health. “But the research revealed the contrary. We need further studies to answer why they cannot quit. One hypothesis is that smokers are receiving an increase in nicotine dose by using e-cigarettes.”

The study also found that daily smokers and women were more likely to have tried e-cigarettes.

It is currently unknown if e-cigarettes, which deliver nicotine, flavor, and other chemicals in an aerosol form, are safe, as extensive studies have not been conducted. Nurses and other oncology professionals should be aware of the concerns surrounding e-cigarettes and advise patients accordingly, says Lisa Schulmeister, MN, RN, ACNS-BC, OCN, FAAN.

“Oncology clinicians need to be informed about e-cigarettes and how they work because our patients are increasingly asking about them,” says Schulmeister. “However, patients also need to be informed that it is unknown if e-cigarettes are safe and effective, and it’s not known if they have a role in smoking cessation programs.”

Much of the concern around e-cigarettes stems from the fact that they are currently unregulated by the FDA.

In 2014, the FDA proposed a rule to extend its authority over all unregulated tobacco products to include e-cigarettes, cigars, hookah tobacco, nicotine gels, and dissolvable nicotine products. Thirty health organizations including the Oncology Nursing Society (ONS), the American Society of Clinical Oncology (ASCO), and American Association for Cancer Research (AACR), called for the FDA to issue its final rule by April 25, 2015. When that deadline passed, the groups sent a letter to President Obama urging him to take action to protect public health.

The letter put a particular emphasis on the risks unregulated e-cigarette marketing could have on children and teens.

“There are no restrictions in place to protect public health against the risks these products pose, particularly to the health of our children. For example, at present, FDA has no authority to stop manufacturers from using candy and fruit flavors in these tobacco products, and they cannot require manufacturers to disclose their ingredients or even require them to use childproof packaging for liquid nicotine containers. The unnecessary delay in regulating these products has put children at risk,” stated the letter.

Data from the Centers for Disease Control and Prevention (CDC) states that the number of high school students that use e-cigarettes tripled between 2013 and 2014, from 4.5 to 13.4 percent and from 1.1 to 3.9 percent among middle school students. The CDC estimates that there were 2.4 million youth e-cigarette users in 2014.