E-cigarettes an evidence update A report commissioned by Public Health England

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E-cigarettes: an evidence updatePolicy implicationsooConsideration could be given to a proactive strategy to encourage disadvantagedsmokers to quit smoking as quickly as possible including the use of EC, whereappropriate, to help reduce health inequalities caused by smoking.EC should not routinely be treated in the same way as smoking. It is not appropriateto prohibit EC use in health trusts and prisons as part of smokefree policies unlessthere is a strong rationale to do so.Summary of Chapter 6: E-cigarettes and smoking behaviourRecent studies support the Cochrane Review findings that EC can help people to quitsmoking and reduce their cigarette consumption. There is also evidence that EC canencourage quitting or cigarette consumption reduction even among those not intendingto quit or rejecting other support. It is not known whether current EC products are moreor less effective than licensed stop smoking medications, but they are much morepopular, thereby providing an opportunity to expand the number of smokers stoppingsuccessfully. Some English stop smoking services and practitioners support the use ofEC in quit attempts and provide behavioural support for EC users trying to quit smoking;self-reported quit rates are at least comparable to other treatments. The evidence onEC used alongside smoking on subsequent quitting of smoking is mixed.Policy implicationsoooSmokers who have tried other methods of quitting without success could beencouraged to try EC to stop smoking and stop smoking services should supportsmokers using EC to quit by offering them behavioural support.Research should be commissioned in this area including: longitudinal research on the use of EC, including smokers who have not usedEC at the beginning of the study the effects of using EC while smoking (temporary abstinence, cutting down) onquitting, and the effects of EC use among ex-smokers on relapse research to clarify the factors that i) help smokers using EC to quit smoking andii) deter smokers using EC from quitting smoking, including different ECproducts/types and frequency of use and the addition of behavioural support,and how EC compare with other methods of quitting which have a strongevidence baseIt would be helpful if emerging evidence on EC (including different types of EC) andhow to use EC safely and effectively could be communicated to users and healthprofessionals to maximise chances of successfully quitting smoking.10
E-cigarettes: an evidence updateSummary of Chapter 7: Reasons for use and discontinuationA number of surveys in different populations provide evidence that reducing the harmfrom smoking (such as through cutting down on their cigarette consumption or helpingwith withdrawal during temporary abstinence) and the desire to quit smoking cigarettesare the most important reasons for using EC. Curiosity appears to play a major role inexperimentation. Most trial of EC does not lead to regular use and while there is lessevidence on why trial does not become regular use, it appears that trial due to curiosityis less likely to lead to regular use than trial for reasons such as stopping smoking orreducing harm. Dissatisfaction with products and safety concerns may deter continuedEC use.Policy implicationsoSmokers frequently state that they are using EC to give up smoking. They shouldtherefore be provided with advice and support to encourage them to quit smokingcompletely.o Other reasons for use include reducing the harm from smoking and such effortsshould be supported but with a long-term goal of stopping smoking completely.Summary of Chapter 8: Harm perceptionsAlthough the majority of adults and youth still correctly perceive EC to be less harmfulthan tobacco cigarettes, there has been an overall shift towards the inaccurateperception of EC being at least as harmful as cigarettes over the last year, for bothgroups. Intriguingly, there is also some evidence that people believe EC to be lessharmful than medicinal nicotine replacement therapy (NRT).Policy implicationsooClear and accurate information on relative harm of nicotine, EC and tobaccocigarettes is needed urgently (see also Chapter 10).Research is needed to explore how health perceptions of EC are developed, inrelation to tobacco cigarettes and NRT, and how they can be influenced.Summary of Chapter 9: E-cigarettes, nicotine content and deliveryThe accuracy of labelling of nicotine content currently raises no major concerns. Poorlylabelled e-liquid and e-cartridges mostly contained less nicotine than declared. EC used11
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E-cigarettes an evidence update A report commissioned by Public Health England

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