1. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes and Smoking Cessation Sarah Boone, Carolyn Little, Clay Owens, Jeremy Randolph, Genny Tibbs

2. BELLARMINE UNIVERSITY, LOUISVILLE, KY Objectives Analyze Smoking in Kentucky List Methods of Smoking Cessation Acute Effects of Electronic Cigarettes Review the Evidence of Related Studies Compare Use of Electronic Cigarettes and Nicotine Patches

3. BELLARMINE UNIVERSITY, LOUISVILLE, KY Smoking in KY http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/ 2010/states/kentucky/

4. BELLARMINE UNIVERSITY, LOUISVILLE, KY Smoking in KY

5. BELLARMINE UNIVERSITY, LOUISVILLE, KY Smoking in KY http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/ 2010/states/kentuckyhttp://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/ 2010/states/kentucky/

6. BELLARMINE UNIVERSITY, LOUISVILLE, KY Smoking Cessation 80% of smokers who attempt cessation relapse within in first month of quitting 3-5% remain abstinent at 6 months (Polosa, BMC Public Health, 2011) Common Methods: –Electronic cigarettes –Nicotine Patches –Oral Medication –“Cold Turkey”

7. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes Westenberger, FDA, 2009 P: Smokers I: Electronic Cigarettes C: Nicotine Patches O: Smoking Cessation

8. BELLARMINE UNIVERSITY, LOUISVILLE, KY Acute Effects of E-Cigarettes Vansickel, American Association for Cancer Research, 2010

9. BELLARMINE UNIVERSITY, LOUISVILLE, KY Acute Effects of E-Cigarettes 32 tobacco cigarette smokers Four products: – Own brand cigarette, “NPRO” electronic cigarettes, “Hydro” electronic cigarettes, or sham Outcome Measures: –Heart rate, plasma nicotine content, Tiffany Drobes Questionnaire of Smoking Urges Brief Vansickel, American Association for Cancer Research, 2010

10. BELLARMINE UNIVERSITY, LOUISVILLE, KY Acute Effects of E-Cigarettes Results: –Own brand increased plasma nicotine, CO concentration and heart rate –NPRO EC, Hydro EC, and sham smoking did not –Both EC exposed users to no nicotine or CO –Both EC didn’t increase heart rate –Both EC increased subjective ratings of acceptability Vansickel, American Association for Cancer Research, 2010

11. BELLARMINE UNIVERSITY, LOUISVILLE, KY Acute Effects of E-Cigarettes Conclusion: –Neither electronic cigarettes exposed users to measurable levels of nicotine or CO –Both suppressed nicotine/tobacco abstinence symptom ratings Vansickel, American Association for Cancer Research, 2010

12. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes & Smoking Cessation Polosa, BMC Public Health, 2011

13. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes & Smoking Cessation Methods: –5 visits: baseline and four follow up visits at week 4, 8, 12, and 24 –Baseline Measurements: Demographics and detailed smoking history Level of carbon monoxide in exhaled breath (eCO) –4 week supply of 7.4 mg nicotine cartridges given –Max use of 4 cartridges/day Polosa, BMC Public Health, 2011

14. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes & Smoking Cessation ReducersHeavy ReducersQuittersSmoking Failure 50% reduction in number of cig/day compared to baseline 80% reduction in number of cig/day compared to baseline Smoking abstinence at 24 weeks < 50% reduction in number of cig/day compared to baseline Polosa, BMC Public Health, 2011

15. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes & Smoking Cessation Results: –50% reduction shown in 13/40 subjects –Combined sustained 50% reduction and smoking abstinence in 22/40 (p≤0.001) Conclusions: –Reduction in cigarette smoking with e-cigarettes may increase motivation to quit –Gradual reductions in cigarette smoking can increase cessation Polosa, BMC Public Health, 2011

16. BELLARMINE UNIVERSITY, LOUISVILLE, KY Case Series on Smoking Cessation Utilizing E-cigs Caponnetto, Journal of Medical Case Reports, 2011

17. BELLARMINE UNIVERSITY, LOUISVILLE, KY Case Series on Smoking Cessation Utilizing E-cigs Three chronic smokers (two male, one female) Severe dependence to nicotine –Fagerstrom Test of Nicotine Dependence (FTND) –Exhaled Breath Carbon Monoxide Concentration (eCO) Previous cessation efforts (patches & group counseling) Caponnetto, Journal of Medical Case Reports, 2011.

18. BELLARMINE UNIVERSITY, LOUISVILLE, KY Case Series on Smoking Cessation Utilizing E-cigs Results: –Cessation status following the usage of E-cigs No relapse 6 months following study –Reduction in eCO –Variation in E-cig composition Regulation? Limitation – Small sample size Caponnetto, Journal of Medical Case Reports, 2011.

19. BELLARMINE UNIVERSITY, LOUISVILLE, KY Comparison: Nicotine Patch Therapy Myung et al. 2007, Am J Health-Syst Pharm

20. BELLARMINE UNIVERSITY, LOUISVILLE, KY Comparison: Nicotine Patch Therapy Study: –Meta-analysis of studies investigating efficacy of nicotine patches vs. placebo. Purpose: –Assess current literature –Determine an odds ratio for smoking cessation Myung et al. 2007, Am J Health-Syst Pharm

21. BELLARMINE UNIVERSITY, LOUISVILLE, KY Comparison: Nicotine Patch Therapy Methods: –16 RCT’s –Total subjects: 9,457 6,084 nicotine group 3,373 placebo group Results of Meta-analysis: Pooled OR (odds ratio) for 16 studies was 1.79 http://www.nyc.gov/html/doh/html/pr2007/pr036- 07.shtml Myung et al. 2007, Am J Health-Syst Pharm

22. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes for Smoking Cessation Bullen, Nat Inst Health Innov, 2013

23. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes for Smoking Cessation: A Randomized Controlled Trial Purpose: –To assess whether E-cigarettes containing nicotine were more effective for smoking cessation than nicotine patches Methods: –657 subjects were selected for the study –Randomized by computerized block randomization –4:4:1 ratio Bullen, Nat Inst Health Innov, 2013

24. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes for Smoking Cessation: A Randomized Controlled Trial Procedures: –Subjects used respective smoking cessation products for 12 weeks before a specific “quitting day” –The primary outcome measured was smoking abstinence six months after “quitting day” –Verified by self-report and carbon monoxide measurement Bullen, Nat Inst Health Innov, 2013

25. BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes for Smoking Cessation: A Randomized Controlled Trial Results: –Abstinence rates after six months Nicotine E-cigarette 7.3% Nicotine Patches5.8% Placebo E-cigarette4.1% –Study was underpowered due to low abstinence rates and could not conclude if E-cigarettes were superior to nicotine patches or placebo Bullen, Nat Inst Health Innov, 2013

26. BELLARMINE UNIVERSITY, LOUISVILLE, KY Summary Smoking Cessation Electronic Cigarettes Levels of nicotine or eCO were reduced Suppressed nicotine/tobacco abstinence symptom ratings Highest rates of abstinence after six months Greater success rates with “rituals” of smoking Nicotine Patch Odds ratio for sustained abstinence after 1 year: 1.79 (compared to placebo) Lowest rates of abstinence after six months

27. BELLARMINE UNIVERSITY, LOUISVILLE, KY Additional Resources Stop Smoking Classes Louisville –http://www.louisvilleky.gov/health/iwantto/stopsmokingcla sses.htmhttp://www.louisvilleky.gov/health/iwantto/stopsmokingcla sses.htm Norton Healthcare Smoking Cessation Program –http://www.nortonhealthcare.com/smokinghttp://www.nortonhealthcare.com/smoking Kentucky Cabinet for Health & Family Services –http://chfs.ky.gov/dph/mch/hp/tobacco.htmhttp://chfs.ky.gov/dph/mch/hp/tobacco.htm

28. BELLARMINE UNIVERSITY, LOUISVILLE, KY References Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Nat Inst Health Innov. 2013; 13:1-9. Caponnetto P, Polosa R, Russo C, Leotta C, Campagna D. Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series. Journal of Medical Case Reports. 2011; 5: 585. Myung SK, Yoo KY, Oh SW, et al. Meta-analysis of studies investigating one-year effectiveness of trasdermal nicotine patches for smoking cessation. Am J Health-Syst Pharm.2007; 64: 2471. Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011; 11:786-797. doi:10.1186/1471-2458-11-786. Vansickel AR, Cobb CO, Weaver MF, Eissenberg TE. A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: nicotine delivery profile and cardiovascular and subjective effects. Amer Assoc Cancer Res. 2010; 19: 1945-1953.