What is the current status of e-cigarettes (electronic cigarettes) as a smoking cessation aid for adults?

Current Status of E-Cigarettes in Smoking Cessation

Current evidence does not support the use of e-cigarettes as a smoking cessation aid for adults due to insufficient data on efficacy and safety. 1, 2

Evidence on E-Cigarette Efficacy for Smoking Cessation

Guideline Recommendations

• The National Comprehensive Cancer Network (NCCN) states that e-cigarettes are not FDA-approved smoking cessation devices and there is insufficient evidence to support their use in smoking cessation 1
• The US Preventive Services Task Force (USPSTF) concludes that "current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) for tobacco cessation in adults" 1
• Multiple professional organizations including the American Heart Association, American Academy of Pediatrics, and American College of Cardiology recommend against using e-cigarettes for smoking cessation due to unique risks 2

Research Findings

• Limited high-quality data exists on e-cigarette use for smoking cessation 1
• In the largest randomized controlled trial to date (657 individuals), abstinence rates were unexpectedly low across all groups with no statistically significant differences between nicotine e-cigarettes, placebo e-cigarettes, or nicotine patch at 6 months 1
• A 2023 meta-analysis of 5 RCTs found nicotine e-cigarettes more efficacious than conventional smoking cessation therapies (RR 1.77; 95% CI, 1.29-2.44) 3, but this conflicts with guideline conclusions based on comprehensive evidence review

Concerns About E-Cigarette Use

Safety Concerns

• E-cigarette use is associated with respiratory symptoms, including cough, shortness of breath, chest pain, nausea, and vomiting 2
• In 2019-2020, over 2,800 cases of e-cigarette or vaping product use-associated lung injury (EVALI) were reported with 68 deaths 1, 2
• Nicotine exposure may have neurotoxic effects, particularly on developing brains 2
• Long-term safety data on e-cigarette use is lacking 1, 4

Patterns of Use Concerns

• E-cigarette users in a cancer center study were no more likely to have quit smoking than non-users at 6-12 month follow-up 1
• Using both combustible cigarettes and e-cigarettes simultaneously may maintain nicotine addiction without reducing health risks 2
• In a study of patients with head and neck cancers, non-users of e-cigarettes had significantly greater rates of smoking cessation compared to e-cigarette users (72% vs 39%) 1

Evidence-Based Smoking Cessation Approaches

Instead of e-cigarettes, the following evidence-based approaches are recommended:

• Combination of behavioral counseling and FDA-approved pharmacotherapy 2
• FDA-approved nicotine replacement therapy (NRT) products 1
• Varenicline as first-line pharmacotherapy for tobacco dependence 2
• Telephone quit lines and web-based interventions 2

Clinical Approach to Patients Inquiring About E-Cigarettes

1. Inform patients about the lack of sufficient evidence supporting e-cigarettes for smoking cessation
2. Explain potential risks associated with e-cigarette use
3. Recommend evidence-based smoking cessation methods
4. For patients already using e-cigarettes:
   • Continue to provide motivational and behavioral support
   • Encourage transition to evidence-based cessation methods
   • Remind that repeated quit attempts may be necessary to achieve abstinence

Research Needs

The USPSTF has identified urgent research needs including:

• Well-designed RCTs comparing e-cigarette interventions with placebo and established cessation methods
• Studies on both short and long-term harms of e-cigarette use
• Research on dual users of e-cigarettes and conventional cigarettes
• Standardization of how to quantify e-cigarette use and nicotine exposure 1

Based on the current evidence, the answer to the question is D: Current evidence does not support the use of e-cigarettes as a smoking cessation aid for adults.