10.2. SR 09-08-2015 - Laserfiche WebLink

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E-cigarettes: an evidence update 47 O’Brien et al., 2015 [42] conducted a secondary analysis of the RCT data from Bullen et al., 2013 [43] to examine the effectiveness of EC with and without nicotine compared to the nicotine patch among individuals with mental illness (MI). They identified 86 participants among the original 657 participants (all motivated to quit) using secondary data from the trial on reported use of any medications associated with MI. Overall, when compared to participants without MI, there were no significant differences for those with MI on the primary outcomes of smoking reduction and smoking cessation. One exception was that the six-month quit rate was higher among participants with MI in the patch condition compared to those without MI. Although not a primary outcome, there was evidence of a greater rate of relapse among participants with MI. In the analysis that only included participants with MI, there were no significant differences in quit rates across the three conditions, however participants allocated to 16mg EC showed greater smoking reduction than those allocated to patch. The authors concluded that EC appear to be equally effective for smoking cessation among individuals with and without MI, building on other promising research involving EC and people with MI. Adriaens et al., 2014 [41] conducted an eight-week RCT in Belgium with control where they randomised 48 smokers who did not want to quit to one of two conditions: (1) use of tank model EC, and training on how to use, with no encouragement to quit, and (2) no use of EC. Both groups attended similar periodic lab sessions over an eight -week period where measurements of craving, withdrawal, saliva cotinine, and expired-air CO levels were taken. Adriaens found that after eight weeks of use 34% of those given EC had quit smoking compared to 0% of those not given EC, the EC group also showed substantially greater cigarette reduction. After eight weeks, the group which did not receive EC at baseline was given EC, but no training on how to use the products. At the final eight-month follow-up, 19% of the original EC group and 25% of the control group (given EC at week eight) had quit smoking. Significant reductions in cigarette consumption were also found. Population studies One problem with RCTs is that because of the time taken to set up and implement trials, the EC used in the trials are often no longer available for sale by the time the research is published. This is problematic because many new EC enter onto the market and it is possible they may be more effective at delivering nicotine than the products used in the trial, and possibly more effective for smoking cessation. Additionally, the controlled environment of RCTs is unable to provide evidence of the effectiveness of EC in the real world where use is much more subject to external forces, such as availability, price and social norms around use. RCTs also reveal little about the attractiveness of the products and thus likely uptake of the products used and what happens after a successful or failed attempt to stop smoking with an EC in the long-term.