Electronic Cigarettes Impact on Smoke Cessation

Topic: Healthcare Research
Words: 2890 Pages: 10

Picot Question

In smokers aged 25-65 years who use nicotine, are electronic cigarettes, compared to smoking cessation therapies, more effective at leading to smoking cessation over one year?


According to research, e-cigarettes do not affect the likelihood of stopping smoking. For persons who smoke cigarettes, e-cigarettes with nicotine are more likely to help them quit, and those who use them more frequently are more likely to quit. Since the FDA has yet to recognize electronic cigarettes as a smoking cessation aid, more research into the usefulness of electronic cigarettes for quitting smoking and their health impacts is required. According to the American Cancer Society, e-cigarettes are harmful to children, teenagers, pregnant women, and those who have never used tobacco. Adult smokers who currently use e-cigarettes must entirely quit smoking to gain the health benefits of the technology. To enjoy the most significant health benefits, people who have switched to e-cigarettes should seek to stop altogether using them.

Smoking cigarettes has been linked to increased cancer incidence and mortality since World War II, and it remains a significant public health concern today. The majority of smokers begin using tobacco as a teenager and try to quit around the age of 30 (especially for women) or after 50. One in every five people dies because of traffic accidents. As of 2020, 12.5 percent of adults in the United States aged 18 and older smoke (Pasquereau et al., 2017). Adult smokers in the United States currently number 30.8 million. About 16 million people in the United States have a smoking-related condition (Pasquereau et al., 2017). Nicotine aerosol is produced by heating a solution of nicotine, propylene glycol, glycerin, and flavorings in an e-cigarette, which has been demonstrated to help smokers quit smoking (such as menthol).

The Food and Drug Administration (FDA) Center for Tobacco Products regulates e-cigarettes in the United States in compliance with the Family Smoking Prevention and Tobacco Control Act of 2009 (TCA) There must be “suitability for the protection of public health” for a new tobacco product (such as e-cigarettes) to be sold. Advocating the use of electronic cigarettes to help people quit smoking while no electronic cigarettes have been approved as smoking cessation medications by the FDA’s Center for Drug Evaluation and Research as of November 2020.

Scientists are still investigating the long-term health impacts of e-cigarettes because the technology is so new. However, it has been found that E-cigarette aerosol contains fewer potentially dangerous compounds than tobacco smoke. However, e-aerosol cigarettes can include cancer-causing chemicals and particles. Most electronic cigarettes include nicotine, the addictive chemical found in tobacco. Tobacco use in teenagers and young adults can negatively impact brain development, which typically lasts until age 25 or so (Pasquereau et al., 2017). Pregnant women and their unborn children should avoid using nicotine. Nicotine salts are a common ingredient in more modern e-cigarettes (also called nic salts). It is common for long-standing tobacco products like e-cigarettes to include freebase nicotine, which can cause throat irritation when breathed at high levels. To help individuals trying to stop smoking by using these products, this feature enables more efficient nicotine administration, unlike in prior generations. Increasing start and reliance among adolescents and young adults may result from this, although the contrary may also be true.NRT, bupropion hydrochloride, and varenicline tartrate have all been shown to be effective in helping smokers quit, and behavioral therapies are practical.

The high cost of nicotine replacement therapy or smokers’ lack of knowledge about its effectiveness and safety may contribute to the low popularity of smoking cessation aids, which is why the majority of quiet attempts are made “cold turkey” (i.e., abruptly ceasing nicotine consumption) without the benefit of professional assistance or treatment. Not using smoking cessation products can be due to a person’s conviction that quitting on one’s own is the best path to happiness, strength, and self-determination. According to studies, smokers who use smoking cessation aids are more likely to remain abstinent. There has been a recent surge in the popularity of e-cigarettes (also known as electronic nicotine delivery systems). Adults in the US (15.3%) and Europe (14.6%) have both used ECs at some point in their lives (Pasquereau et al., 2017). Some 3.2% of Americans and 1.8% of Europeans smoke electronic cigarettes regularly, while 3.8% of French people do the same. Smokers who feel e-cigarettes are less harmful than regular cigarettes and are trying to quit or lessen their smoking habits are the most likely to use them. When it comes to smoking cessation, ECs have overtaken nicotine replacement therapy (NRT) in some countries, such as France (27 percent of smokers who attempt to quit use them) (18 percent) (Pasquereau et al., 2017). There is some debate about the efficacy of ECs as a smoking reduction and cessation aid. E-cigarettes are as successful or more effective than nicotine replacement therapy in the treatment of smoking cessation, according to randomized clinical trials (NRT). Using ECs and NRT simultaneously, on the other hand, may make it more challenging to quit smoking. On the other hand, previous research relied on small samples or short follow-up periods, resulting in weak external validity.

Summary of the Database Used

To build the PICOT question, I investigated the resources on the two databases relevant to my PICOT inquiry. These are the PubMed and Web of Science Core Collection databases and the EMBASE databases. PubMed is a free database that enables users to search for and retrieve biomedical and life science publications to improve their global and personal health. Over 33 million citations and abstracts of biological literature are stored in the PubMed database. The database is beneficial since it is a sizable, reliable, and highly authoritative resource devoted exclusively to medicine and health. PubMed uses a variety of strategies to obtain the most relevant results. The Web of Science Core collection, which has been thoroughly curated by an in-house team of Web of ScienceTM Editors, enables you to conduct confident searches in the sciences, social sciences, arts, and humanities and to uncover deep citation links.

The Web of Science Core Collection is the platform’s most popular resource. It is the world’s first citation index for scientific and academic research. It is a curated collection of around 21,100 peer-reviewed, high-quality scientific papers published worldwide (including Open Access journals) in over 250 fields spanning the sciences, social sciences, arts, and humanities. Additionally, conference proceedings and book data are provided. While searching for materials, I used terms such as “vaping,” “electronic cigarette,” “smoking cessation therapies,” “stop,” “quit,” and “nicotine replacement therapy,” as well as “abstain” (see Appendix for search method) (search method in Appendix). The two databases were simple to use, and I was pleased with the speed with which I received the results. A third critical database that I used was the Cochrane database.

The Cochrane Library is a collection of databases that compiles various types of high-quality, independent evidence to use in healthcare decision-making. Wiley owns and publishes the Cochrane Library. Cochrane owns and publishes the Cochrane Library. The Cochrane Library is the most authoritative and up-to-date source of evidence-based information and it can assist physicians in making appropriate and successful health care decisions. Numerous research examining the efficacy of various health care treatments and activities is included in this section. I discovered one article in each of the three databases I searched for resources. Some of the articles in the databases contained errors and did not provide a clear representation of the PICOT questions’ primary terms. Two pieces had a bare minimum of information about electronic cigarettes and smoking cessation strategies. I strongly recommend using the PubMed database because it contains many scholarly publications in the medical field. The majority of the information I discovered came from this database, and the majority of the articles provided comprehensive information. The language utilized in the articles that comprise the database is straightforward. In general, it provides a diverse selection of articles on various topics, making it simple to navigate.

Article Chosen

Wang, R. J., Bhadriraju, S., & Glantz, S. A. (2021). E-cigarette use and adult cigarette smoking cessation: a meta-analysis. American journal of public health, 111(2), 230-246.

The above article is a meta-analysis whose main objective was to determine the association between e-cigarette use and smoking cessation. The method used for this study was searching through PubMed, the Web of Science Core Collection, and EMBASE and using random effect metanalyses s to determine the association between e-cigarette use and smoking cessation.64 articles (55 observational studies nine randomized clinical trials. From the study, there was no link between e-cigarette usage and the cessation of smoking in observational studies of adult smokers (odds ratio [OR] = 0.947; 95 percent confidence interval [CI] = 0.772, 1.160) and smokers who were motivated to stop smoking (odds ratio [OR] = 0.851). Tobacco cessation rates were lower among those who used an e-cigarette less than once a week and higher among those who used them daily (odds ratio = 1.529; 95 percent confidence interval [CI] = 1.158, 2.019). Study results that contrasted stopping rates between people given electronic cigarettes and people receiving standard treatment indicated that those who used electronic cigarettes had higher rates of quitting (relative risk = 1.555; 95 percent confidence interval [CI] = 1.172, 2.061) (Wang et al., 2021). Electronic cigarettes (e-cigarettes) heat a nicotine solution with propylene glycol, glycerin, and flavorings to produce an aerosol. E-cigarettes are regulated by the FDA’s Center for Tobacco Products under the 2009 Family Smoking Prevention and Tobacco Control Act (TCA) (CTP) in the US. CTP must approve a new tobacco product (including e-cigarettes) before being marketed.

The FDA Center for Drug Evaluation and Research has not approved any e-cigarette as a smoking cessation therapy since November 2020. E-cigarettes are approved as either consumer items or medicinal devices by CTP and CDER. In determining whether e-cigarettes are “appropriate for the preservation of public health,” CTP must evaluate both population and individual implications. To help CTP make decisions, we need observational studies on the consequences of e-cigarettes as the public uses them. Efficacy (and dangers) of a suggested therapy provided to a defined class of persons at specified doses under medical care (Wang et al., 2021). Thus, randomized clinical trials (RCTs) in which e-cigarettes are administered to chosen patient populations as part of a medically supervised smoking cessation program are essential to CDER.In 2019, a federal court ordered e-cigarette businesses to submit premarket tobacco product applications to the FDA by September 2020 to continue selling e-cigarettes as consumer products. When deciding whether to authorize the sale of an e-cigarette, CTP must assess how e-cigarettes help smokers “transition away from combustible tobacco products.”Because premarket tobacco product approval is required, certain e-cigarette businesses may apply to CDER for approval as a therapeutic smoking cessation device. Thus, it is critical to evaluate both the impacts of e-cigarettes as consumer items and the effects of prescription smoking cessation therapy.


Electronic cigarettes might seem beneficial as a risk reduction method, but they are way far from harmless, and the combined possible advantages do not exceed the hazards at this time. Thus, the study concluded that using e-cigarettes for personal use does not appear to be connected with the cessation of cigarette smoking in the general population. A prescription for e-cigarettes could be considered for use in professionally monitored smoking cessation interventions, providing that the hazards associated with their usage outweigh the benefits (Wang et al., 2021).

Validity and Reliability of the Resource Given

The study was considered eligible since the target population was adults ages 18 and over. The exposure was e-cigarette use, as defined by the study authors. The outcome was smoking cessation, as expressed by the study authors (definitions included ever use, current use, and daily use).The (illustrations included point prevalence of abstinence, continuous abstinence, self-reported abstinence, and biochemically verified abstinence, among others) (Wang et al., 2021). Randomized controlled studies and observational studies were both evaluated in the study. There was no need to include studies that compared nicotine e-cigarettes to non-nicotine ones in the definition of e-cigarette use in RCTs.

Study Overview and Application in Nursing Practice

Different health practitioners have varying perspectives on the efficacy of electronic cigarettes in smoking cessation. There is considerable ambiguity among practitioners. While most practitioners consider e-cigarettes to be the ‘lesser of two evils’ and ‘less toxic than conventional cigarettes in comparison to conventional cigarettes, they also believe that e-cigarettes are ‘not risk-free’ compared to conventional cigarettes. E-cigarettes elicited various responses, the most prevalent of which was concern about the products’ long-term consequences. Concerns about e-cigarettes causing allergic reactions have been expressed. They have suspicions that non-smokers would begin using them due to their perception as ‘cool’ and fashionable among young people.

Along with potential interactions with other prescription medications, alcohol, and recreational drugs, some physicians expressed concern about the use of e-cigarettes. According to one physician, e-cigarette nicotine poses cardiovascular health risks. Additionally, some individuals brought up stories they had read or heard about in the news. Numerous medical professionals were unsure whether or not electronic cigarettes assisted people in permanently quitting smoking.

The proof obtained from the study will be valuable when advising clients on the approach to support smoking cessation. I am familiar with the adverse effects of electronic cigarettes and how they operate to assist people in quitting smoking. Smoking an electronic cigarette can help you control your tobacco cravings. You can get the most out of it if you use the perfect amount of nicotine in your e-liquid at the optimum frequency. Apart from using electronic cigarettes and nicotine replacement medication, I learned various other tactics for smoking cessation throughout the program.

Various scientifically proven smoking cessation options are both safe and effective. Here are a few examples: You are more likely to quit smoking when you receive therapy from a behavioral health expert. Psychotherapy can take place in various venues, including individual, group, and telephone sessions. Individuals interested in quitting smoking can potentially benefit from web- and text-based therapy. The Food and Drug Administration (FDA) have approved seven drugs to aid in smoking cessation. These medications include five different types of nicotine replacement therapy and two non-nicotine therapies (bupropion and varenicline). While counseling and medication are both successful treatments on their own, combining the two can more than double the likelihood of success. This knowledge would be tremendously valuable in my nursing profession.

Bias in the Study

Bias in the media is always possible. Most of the entire study found no evidence of publication bias, but Egger’s test has low power when there are few studies to compare. It is also possible that other randomized control studies utilizing e-cigarettes as a smoking cessation therapy with negative results were never published as we only looked at published studies. The effectiveness of e-cigarettes in the fight against tobacco dependence and smoking was undervalued, as indicated in the chosen research. The term “reason to quit” was defined broadly in this review, which follows the design of observational studies.

Study participants who reported a desire to quit smoking (as determined by the study investigators) were sampled in some studies. In contrast, those who expressed no desire to leave were not tested in others (Wang et al., 2021). In contrast to RCTs, only three observational investigations offered biochemical evidence of smoking status. Population studies rarely use biochemical confirmation. Self-reporting is the acknowledged standard for population observational research, however. “Self-reported statistics have been shown to accurately reflect the patterns of cigarette smoking among adults, including whether the respondent who has smoked in the past is presently not smoking, using scientifically validated biomarkers and other approaches (Wang et al., 2021). Only two prior meta-analyses of e-cigarette use on smoking cessation contained at least ten papers. It determined that “the odds of quitting cigarettes were 28 percent lower in those who used e-cigarettes than those who did not use e-cigarettes.


In conclusion, I searched the PubMed, Web of Science Core Collection, and EMBASE databases for the PICOT query. More than 33 million citations and abstracts of biological literature are in PubMed. I used terms like “vaping,” “electronic cigarette,” “smoking cessation therapies,” and “nicotine replacement therapy” when looking for materials. I searched for resources using terms like “vaping,” “electronic cigarette,” “smoking cessation therapies,” “stop,” “quit,” and “abstain” (search method in Appendix). I highly advocate the usage of the PubMed database, which contains thousands of scholarly medical papers. The FDA’s Center for Tobacco Products regulates electronic cigarettes (CTP). Before e-cigarettes may be sold, CTP must authorize them. To date, the FDA has not approved any e-cigarette for smoking cessation. E-cigarette use appears to be unrelated to overall cigarette smoking cessation. If the risks outweigh the benefits, an e-cigarette prescription could be considered in professionally controlled smoking cessation treatments.

The study assessed both randomized controlled trials and observational studies. Medical specialists are divided on the use of electronic cigarettes in smoking cessation. In the eyes of some, e-cigarettes are the lesser of two evils. However, they are ‘not risk-free’ compared to regular cigarettes. One expert says e-cigarette nicotine is terrible for your heart. Smoking an electronic cigarette can help you quit smoking. The best results come from using the right amount of nicotine and using it at the right time. Psychotherapy is offered in individual, group, and telephone settings. The FDA has approved seven drugs to help smokers quit.


Pasquereau, A., Guignard, R., Andler, R., & Nguyen-Thanh, V. (2017). Electronic cigarettes, quit attempts and smoking cessation: a 6-month follow-up. Addiction, 112(9), 1620-1628.

Wang, R. J., Bhadriraju, S., & Glantz, S. A. (2021). E-cigarette use and adult cigarette smoking cessation: a meta-analysis. American journal of public health, 111(2), 230-246.

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