Randomized controlled trials using electronic nicotine delivery systems as smoking cessation aids require an accurate, empirically-based understanding of the nicotine delivery profile of the products under study

Understanding the nicotine dose delivered by electronic nicotine delivery systems in a single puff: the importance of nicotine flux and puff duration

Electronic nicotine delivery systems (ENDS) may lead to public health benefit if they help people who smoke quit smoking, and may lead to public health harm if they recruit a new generation of nicotine-dependent people. Regulators intent on maximising ENDS' public health benefit and minimising harm may be interested in regulating the nicotine dose delivered by ENDS in a single puff. The per-puff nicotine dose is the product of ENDS nicotine emission rate (or 'nicotine flux') and the duration of the puff taken by the person using the ENDS (or 'puff duration'). Nicotine flux can be measured or predicted mathematically for any ENDS device/liquid combination. Puff duration can be controlled electronically, as demonstrated by several ENDS marketed today. Combining nicotine flux and puff duration regulation is feasible today and provides authorities the means to limit nicotine dose per puff to a level that may help people who smoke quit smoking while reducing the possibility that nicotine-naive individuals will engage in repeated ENDS use. Tobacco regulatory science and product regulation will both be improved by a rigorous approach to understanding, characterising, and reporting the nicotine dose emitted by ENDS.

Feasibility of a primary care patient decision aid for smoking cessation with information about e-cigarettes

Decision aids can promote shared decision making and behavior change and may be effective in helping patients quit smoking. Patients are increasingly using e-cigarettes for smoking cessation; however, little is known about the impact of including e-cigarette information in smoking cessation decision aids. Our objective was to assess the feasibility and acceptability of a smoking cessation decision aid including e-cigarette information. This study was conducted at one family medicine clinic in the United States. We used a pre-post design. In Phase I, the decision aid presented information about approved cessation methods. In Phase II, current e-cigarette users and patients with no intention of quitting received additional information on switching to e-cigarettes. We assessed the impact of the decision aids on quit attempts and abstinence, confidence and readiness to quit, confidence and readiness to switch to e-cigarettes, and patient satisfaction. We enrolled 60 patients in each phase (N = 120). Patients reported higher confidence and readiness to quit after viewing the decision aids and consulting with their physician (p < 0.01). Patients reported the decision aid helped prepare them to make a decision about quitting smoking and expressed satisfaction with the decision aid and clinician consultation. We did not observe an impact of including e-cigarette information. Smoking cessation decision aids are acceptable to patients and may promote behavior change. Future studies should explore the impact of providing patients e-cigarette information using larger sample sizes and rigorous designs. Further research is needed to identify strategies to promote shared decision-making regarding e-cigarettes.