The Efficacy and Safety of Electronic Cigarettes as a Tobacco Cessation Product

Background: Tobacco smoking or secondhand smoke exposure is the leading cause of preventable death in the U.S. Between 2000 and 2004, an estimated 442 100 deaths were attributable to smoking in the United States. Products exist that can increase cessation rates and reduce this risk. E-cigarettes have gained popularity for smoking cessation/reduction and mitigation of withdrawal effects while still continuing to have a “smoking experience”. Research investigating the efficacy and safety of electronic cigarettes is limited. This systematic review is a summary of applicable studies regarding the efficacy and safety of electronic cigarettes as a tobacco cessation product. Methods: An exhaustive medical literature search was performed using Medline-OVID, CINAHL, and Health Reference Center-Academic using the keywords: electronic cigarette, e-cigarette, and e cigarette. The included articles were assessed for quality utilizing GRADE. A search of the National Institute of Health (NIH) clinical trials website was performed to detect currently registered trials. Results: Three studies meeting inclusion criteria were included in this systematic review. All studies reported increased cessation rates without significant adverse effects. The first study, a randomized controlled trial with 657 participants, lacked statistical power to detect difference. The second study, a randomized control design study with 300 participants demonstrated statistical significance. The third study, an observational study with 40 participants, reported results that could be due to chance. Conclusion: E-cigarettes have been shown to increase cessation rates without significant adverse effects. However, quality of the e-cigarette was inconsistent. There is no regulatory oversight to guarantee safety in the U.S. Evidence is insufficient to properly assess the benefits and harms of e-cigarettes. There is a lack of evidence to support routinely recommending the use of electronic cigarettes for smoking cessation at this time. Further randomized controlled studies are in progress