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Benefits of e-cigarettes in smoking reduction and in pulmonary health among Chronic Smokers Undergoing a Lung Cancer Screening Program at 6 Months

DOI:10.1016/j.addbeh.2019.106222
Authors:
Claudio Lucchiari at University of Milan
Claudio Lucchiari
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Introduction: Electronic cigarettes (e-cigarettes) might be a valid and safe device to support smoking cessation. However, the available evidence is divergent. The aim of the present work was to assess the effects of an e-cigarette program on pulmonary health (cough, breath shortness, catarrh) and to evaluate the effectiveness of e-cigarettes in reducing tobacco consumption. Methods: The study is a double-blind randomized controlled trial. Two hundred and ten smokers were randomized into three groups: nicotine e-cigarette (8 mg/mL nicotine concentration), nicotine-free e-cigarettes (placebo), and control with 1:1:1 ratio. All participants received a 3 months cessation program that included a cognitive-behavioral intervention aimed at supporting people in changing their behavior and improving motivation to quit. Results: Pulmonary health, assessed with self-reported measures, clinical evaluations and the Leicester Cough Questionnaire, improved in participants who stopped smoking compared to their own baseline. No differences in pulmonary health were found between groups. Statistical tests showed a significant effect of Group (F (2, 118) = 4.005, p < .020) on daily cigarette consumption: after 6 months participants in the nicotine e-cigarette group smoked fewer cigarettes than any other group. Moreover, participants in this group showed the lowest level of exhaled carbon monoxide (CO) (M = 12.012, S.D. = 8.130), and the lowest level of dependence (M = 3.12, S.D. = 2.29) compared to the nicotine-free e-cigarette and control conditions. Conclusions: After 6 months about 20% of the entire sample stopped smoking. Participants who used e-cigarettes with nicotine smoked fewer tobacco cigarettes than any other group after 6 months (p < .020). Our data add to the efficacy and safety of e-cigarettes in helping smokers reducing tobacco consumption and improving pulmonary health status.
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... Ten studies were RCTs [33][34][35][36][37][38][39][40][41][42] and three used an observational study with control group design 34,43,44 (Table 1). The studies were published between 2004 and 2022, involved a total of 5076 people who smoked, with sample sizes ranging from 18 to 1248. ...
... 38,40 multiple weekly behavioural support calls and pharmacotherapy, 39,42 multiple weekly behavioural support, in clinic plus pharmacotherapy 33,44 or e-cigarettes. 36 Timing of the intervention delivery varied across included studies from immediately on the day of the screening clinic to 5 months after screening, average length of interventions was 13.2±13.6 weeks. ...
... signposting to local cessation clinics, written information leaflets and standard behavioural counselling, in addition to the intervention delivered before the lung health screening appointment. Of note Lucchiari et al., 36 used four sessions of behavioural counselling as their UC intervention, which is considerably more input compared to most UC interventions included. ...
Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis
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... As a result, 8 studies were included in this study for the following analysis, all of which were English studies published between 2004 and 2022 [26][27][28][29][30][31][32][33]. A total of 988 participants aged 57 to 63 were included. ...
... A total of 988 participants aged 57 to 63 were included. Two were from the United States [31,33], two were from Italy [28,30], two were from Canada [27,29], one was from Australia [32] and the last one was from England [26]. ...
... al [30]. and Lucchiari et al. [28] which were the same study with 3 and 6 months-observation time individually. Therefore, these four articles were considered as two studies, "S4 Tremblay, et al. " [27,29] and "Masiero & Lucchiari, et al. " [28,30] in this analysis. ...
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Article
Full-text available
  • Jun 2023
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... Recent studies suggest that vaping has substantially fewer health risks compared to smoking (Sobczak et al. 2020); namely, it reduces the adverse general and oral health effects of smoking (Cassidy et al. 2020;O'Connel et al. 2016, Polosa et al. 2020Tatullo et al. 2016). In addition, a clinical trial conducted in Italy identified that vaping helps smokers reduce tobacco consumption and improve pulmonary health conditions (Lucchiari et al. 2020). However, opponents of e-cigarettes emphasize that the health risks of vaping are considerably higher than supporters advocate as the implications for long-term health effects are not yet well researched (National Academies of Sciences, Engineering, and Medicine 2018; Singh et al. 2020;Wang et al. 2018). ...
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... 26,28 Results from pulmonary studies in people who switch from tobacco cigarettes completely have reported either stabilization or improvement in respiratory performance. 29,30 Practically speaking, since many people who use electronic cigarettes to quit smoking tend to continue to use them in the long term, they may be more accurately considered as a harm reduction tool. 20,21 Data above describe acute or short-term effects of electronic cigarettes; and although benefits appear sustained at 6 months of combustible smoking cessation, definite evidence that electronic cigarettes are less harmful must depend on long-term outcome studies-data that do not yet exist. ...
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Full-text available
The remarkable decline in cigarette smoking since 1964 has plateaued; approximately 12.5% of Americans still smoke. People who continue to smoke are largely members of marginalized groups, such as people with behavioral health conditions (BHC), encompassing both mental health and substance use disorders. Certified smoking cessation interventions can increase smoking abstinence in trials in people with BHC, yet smoking rates remain markedly increased, leading to increased mortality from smoking-related diseases, and worsening health disparities. A novel approach tailored to the unique needs, characteristics, and circumstances of people with BHC is mandated. One promising approach, the electronic cigarette, has not been embraced in the USA, likely due to an understandable concern for non-smoking young people among whom electronic cigarettes have been popular. Recent data confirm that electronic cigarette use is declining among young people, yet cigarette smoking is not declining among people with BHC. We propose smoking cessation trials utilizing electronic cigarettes in people with BHC. To this goal, the UK has already begun allowing companies to submit their products for approval as medically licensed electronic cigarettes that can be prescribed as smoking cessation aids. Our proposal is timely, backed by evidence, and aims to save hundreds of thousands of American lives.
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... In this specific case, the e-cigarette is probably used by smokers as an 'aid' for facilitating smoking cessation. A recent randomized clinical trial in a sample of high-risk patients motivated to quit and enrolled in a lung cancer screening program highlighted that nicotine-free e-cigarettes might help to cut down the number of daily cigarettes in the short-run period (Masiero et al., 2019;Lucchiari et al., 2020Lucchiari et al., , 2022. ...
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  • Mar 2023
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Cardiopulmonary Impact of Electronic Cigarettes and Vaping Products: A Scientific Statement From the American Heart Association
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Vaping and electronic cigarette (e-cigarette) use have grown exponentially in the past decade, particularly among youth and young adults. Cigarette smoking is a risk factor for both cardiovascular and pulmonary disease. Because of their more limited ingredients and the absence of combustion, e-cigarettes and vaping products are often touted as safer alternative and potential tobacco-cessation products. The outbreak of e-cigarette or vaping product use-associated lung injury in the United States in 2019, which led to >2800 hospitalizations, highlighted the risks of e-cigarettes and vaping products. Currently, all e-cigarettes are regulated as tobacco products and thus do not undergo the premarket animal and human safety studies required of a drug product or medical device. Because youth prevalence of e-cigarette and vaping product use was as high as 27.5% in high school students in 2019 in the United States, it is critical to assess the short-term and long-term health effects of these products, as well as the development of interventional and public health efforts to reduce youth use. The objectives of this scientific statement are (1) to describe and discuss e-cigarettes and vaping products use patterns among youth and adults; (2) to identify harmful and potentially harmful constituents in vaping aerosols; (3) to critically assess the molecular, animal, and clinical evidence on the acute and chronic cardiovascular and pulmonary risks of e-cigarette and vaping products use; (4) to describe the current evidence of e-cigarettes and vaping products as potential tobacco-cessation products; and (5) to summarize current public health and regulatory efforts of e-cigarettes and vaping products. It is timely, therefore, to review the short-term and especially the long-term implications of e-cigarettes and vaping products on cardiopulmonary health. Early molecular and clinical evidence suggests various acute physiological effects from electronic nicotine delivery systems, particularly those containing nicotine. Additional clinical and animal-exposure model research is critically needed as the use of these products continues to grow.
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E-cigarette Price Impacts legal and Black-Market Cigarette Purchasing Under a Hypothetical Reduced-Nicotine Cigarette Standard
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Introduction: The Tobacco Control Act gives the US FDA authority to establish a reduced-nicotine content standard in combusted cigarettes. This future potential regulation may pose a significant public health benefit; however, black markets may arise to meet demand for normal-nicotine content cigarettes among smokers unwilling to transition to or use an alternative product. Methods: We determined the behavioral-economic substitutability of illicit normal-nicotine content cigarettes and e-cigarettes for reduced-nicotine content cigarettes in a hypothetical reduced-nicotine regulatory market. Adult cigarette smokers were recruited online to complete hypothetical cigarette purchasing tasks for usual-brand cigarettes, reduced-nicotine content cigarettes, and illicit normal-nicotine content cigarettes, as well as a cross-commodity task in which reduced-nicotine content cigarettes were available across multiple prices and illicit cigarettes were concurrently available for $12/pack. Participants completed two three-item cross-commodity purchasing tasks in which e-cigarettes were available for $4/pod or $12/pod alongside reduced-nicotine content cigarettes and illicit cigarettes. Results: Usual-brand cigarette purchasing was greater than illicit normal-nicotine content cigarettes and less than reduced-nicotine content cigarettes. In the cross-commodity purchasing tasks, illicit cigarettes and e-cigarettes both served as economic substitutes for reduced-nicotine content cigarettes; however, when e-cigarettes were available for $4/pod, they were purchased at greater levels than illicit cigarettes and resulted in greater reductions in reduced-nicotine content cigarettes purchasing than when available for $12/pod. Conclusions: These data suggest that some smokers are willing to engage in illicit cigarette purchasing in a reduced-nicotine regulatory environment, but e-cigarette availability at lower prices may reduce black-market engagement and shift behavior away from combusted cigarette use. Implications: E-cigarettes available at low, but not high, prices were stronger substitutes for legal, reduced-nicotine content cigarettes than illegal, normal-nicotine content cigarettes in a hypothetical reduced-nicotine tobacco market. Our findings suggest the availability of relatively inexpensive e-cigarettes may reduce illicit cigarette purchasing and combusted cigarette use under a reduced-nicotine cigarette standard.
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The perceptions of electronic cigarettes among young Chinese generation: Expanding the theory of planned behaviour. The Retail and Marketing Review, 18(1), 143-158
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The theory of planned behaviour (TPB) is recognized as powerful predictive model to explain consumer purchase behaviour. However, there have been relatively few studies that determine the role of TPB’s constructs in e-cigarettes decision-making process. Moreover, the TPB ignores the impulsive motivation (i.e., hedonism) and unconscious motivation (i.e., habit) and perceived knowledge in the literature. This study adopted a quantitative method based on a survey with 293 young respondents using e-cigarettes. The proposed hypotheses were empirically tested with SPPS and AMOS. This study revealed that perceived knowledge positively influenced attitude, subjective norm (SN), and perceived behavioural control (PBC) respectively. The results showed a positive relationship between attitude, SN, PBC and intention, and intention positively influenced actual e-cigarettes use behaviour. The results also demonstrated how consumers’ hedonic motivation and habit influence intention. Lastly, the theoretical and practical implications and limitations were discussed.
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Efficacy and Safety of E-Cigarette Use for Smoking Cessation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Background: People who smoke conventional cigarettes are increasingly turning to electronic cigarettes (e-cigarettes) as a pathway to quitting, however the efficacy and safety of e-cigarettes for smoking cessation remains controversial. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), identified through a systematic search of the MEDLINE, EMBASE, and Cochrane CENTRAL databases. Inclusion was restricted to RCTs with a follow-up duration ≥ 6 months. The primary endpoint was the most rigorous criterion of biochemically validated abstinence at maximum follow-up, and the primary comparison was nicotine e-cigarettes versus any conventional (i.e., non-e-cigarette) smoking cessation therapy. The Cochrane Risk of Bias Tool was used to assess bias. Count data were pooled across trials using random-effects models with inverse variance weighting to estimate relative risks (RRs) and corresponding 95% confidence intervals (CIs). We registered the study protocol with the Open Science Framework Registries (osf.io/26fkq). Results: A total of 5 RCTs (n=3,253) were included. Compared with conventional smoking cessation therapies, the use of nicotine e-cigarettes was associated with an increase in abstinence, defined by the most rigorous criterion of abstinence reported (RR: 1.77; 95% CI: 1.29-2.44). Nicotine e-cigarettes also increased abstinence (defined by the most rigorous criterion) compared to non-nicotine e-cigarettes (RR: 1.56; 95% CI: 1.13-2.15). The incidence of death or SAEs was low across all trials at maximum follow-up. Conclusions: Among individuals attempting to quit smoking, nicotine e-cigarettes are more efficacious than conventional nicotine replacement or behavioral smoking cessation therapies and may prove beneficial in reducing smoking-related health risks.
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Common adverse events of electronic cigarettes compared with traditional nicotine replacement therapies: A systematic review and meta-analysis
Article
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MINI REVIEW Pediatric Blood Cancer Survivors and Tobacco Use across Adolescence and Emerging Adulthood: A Narrative Review
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Full-text available
  • Mar 2016
Scholars underline the pivotal role of tobacco cigarette smoking in carcinogenesis process for blood tumors. A controversial debate is represented by the diffusion of tobacco use in young cancer survivors that had a previous diagnosis of blood tumor during the childhood. Compared with their peers, scientific evidence highlights that pediatric survivors have more difficult to give-up cigarette smoking. Furthermore, tobacco-smoking is frequently linked with others risk behaviors as drinking or substance abuse. In reviewing the main knowledge on this topic, authors affirm the need for increasing research on blood cancer survivors in order to depict psychological characteristics of pediatric blood cancer survivors. Improving health decision-making skills in young survivors could reduce the risk to adopt un-healthy behaviors and increase psychological wellbeing. Furthermore, authors propose tailored antismoking interventions based on the knowledge of the psychological and cognitive factors that support smoking during the transition toward emerging-adulthood.
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Benefits of E-Cigarettes Among Heavy Smokers Undergoing a Lung Cancer Screening Program: Randomized Controlled Trial Protocol
Article
Full-text available
  • Feb 2016
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Success rates with nicotine personal vaporizers: A prospective 6-month pilot study of smokers not intending to quit
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Full-text available
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  • Oct 2018
Electronic cigarettes (e-cigarettes) deliver an inhaled aerosol to the user that typically contains nicotine, flavorings, and other additives.¹ e-Cigarettes come in many shapes and sizes but generally contain a battery, a heating element, and an e-liquid reservoir.
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ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
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  • Jul 2009
"Teachable moments" have been proposed as events or circumstances which can lead individuals to positive behavior change. However, the essential elements of teachable moments have not been elucidated. Therefore, we undertook a comprehensive review of the literature to uncover common definitions and key elements of this phenomenon. Using databases spanning social science and medical disciplines, all records containing the search term "teachable moment*" were collected. Identified literature was then systematically reviewed and patterns were derived. Across disciplines, 'teachable moment' has been poorly developed both conceptually and operationally. Usage of the term falls into three categories: (1) "teachable moment" is synonymous with "opportunity" (81%); (2) a context that leads to a higher than expected behavior change is retrospectively labeled a 'teachable moment' (17%); (3) a phenomenon that involves a cueing event that prompts specific cognitive and emotional responses (2%). The findings suggest that the teachable moment is not necessarily unpredictable or simply a convergence of situational factors that prompt behavior change but suggest the possible creation of a teachable moment through clinician-patient interaction. Clinician-patient interaction may be central to the creation of teachable moments for health behavior change.
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  • Jul 1983
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Testing a Self-Determination Theory Intervention for Motivating Tobacco Cessation: Supporting Autonomy and Competence in a Clinical Trial
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  • Feb 2006
A longitudinal randomized trial tested the self-determination theory (SDT) intervention and process model of health behavior change for tobacco cessation (N = 1006). Adult smokers were recruited for a study of smokers' health and were assigned to intensive treatment or community care. Participants were relatively poor and undereducated. Intervention patients perceived greater autonomy support and reported greater autonomous and competence motivations than did control patients. They also reported greater medication use and significantly greater abstinence. Structural equation modeling analyses confirmed the SDT process model in which perceived autonomy support led to increases in autonomous and competence motivations, which in turn led to greater cessation. The causal role of autonomy support in the internalization of autonomous motivation, perceived competence, and smoking cessation was supported.
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Helping patients to reduce tobacco 414 consumption in oncology: a narrative review
  • Jan 2016
  • C Lucchiari
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  • A Botturi
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Lucchiari, C., Masiero, M., Botturi, A., & Pravettoni, G. (2016). Helping patients to reduce tobacco 414 consumption in oncology: a narrative review. SpringerPlus. https://doi.org/10.1186/s40064-415 016-2798-9
La disassuefazione dal fumo: L'ambulatorio
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