e-cigarette summit speaker: dr lynne dawkins
DESCRIPTION
Slides from Dr Lynne Dawkins' presentation at the E-Cigarette Summit, London November 12, 2013. Electronic Cigarettes: What are they, and are they effective? Full summary of the E-Cigarette Summit: http://ecigarettereviewed.com/e-cigarette-summit-london-summaryTRANSCRIPT
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Electronic Cigarettes:
What are they and are they
effective? Dr. Lynne Dawkins Drugs and Addictive Behaviours Research Group (DABRG), School of Psychology
http://www.uel.ac.uk/psychology/research/drugs
E-Cigarette Summit; November 2013
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Disclosures
E-cigarette Industry:
• Undertaken research for e-cigarette companies
• Received products for research purposes
• Received funding for speaking at research conferences
Tobacco Industry:
• No funding received
• No conflict of interest
Pharmaceutical Industry:
• No funding received
• No conflict of interest
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E-Cigarettes (ECs):
What are they?
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First Generation ECs (‘cigalikes’)
• Disposable
• Re-chargeable
with pre-filled
cartridges
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Second Generation ECs
• Refillable with
liquids
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Third Generation ECs (‘mods’)
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The Liquid
Contents
• Propylene glycol and/or
Vegetable glycerine (glycerol)
• Nicotine (in mg/ml; ranging from 0-36)
• Flavourings (e.g. tobacco, mint, fruit)
• Additives
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History
• Introduced into Chinese market in 2004 and Europe in 2006 (Ruyan)
• Rapidly growing market:
– EC use in smokers in UK increased from 2.7% in 2010 to 6.7% in 2012 (Dockrell et al., 2013)
– Estimated 1.3m current EC users in the UK (ASH, June 2013)
• Production mainly in China but increasing in EU and US.
Tobacco companies now
buying into the EC market.
China
2004
Europe
2006
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Who Uses Them? Findings from representative samples of the
general population:
• Proportion of EC users: 2 to 8 times higher in current smokers than in former smokers
• Little evidence of use in never smokers (0.5% tried ECs)
• Compared with non-users, EC users tended to be: – Younger
– Better educated
– Higher income
– No clear association with gender
Sources:
Cho (2011) J Adol Health; Choi (2013) Am J Public Health; Douptcheva (2013)
Epidemio Comm H; Li (2013) New Zealand Med J; Goniewicz (2012) Pediatrics;
King (2013) Nicotine Tob Res; McMillen (2012) J Environ Pub Health.
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Patterns of
use in regular
users
%
Product type
‘Cigarette-like’ 18
‘Second generation’ 72
‘Mods’ 9
Strengths used
18mg/ml 49
11mg/ml 33
combine strengths 21
0 mg/ml only 1
Preferred flavour
Tobacco 53
Fruit 33
Mint/menthol 28
From Dawkins et al. (2013) Addiction
Average duration: 10 months
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E-Cigarettes: Are they
effective?
• For tobacco craving
• For nicotine delivery
• For smoking cessation
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Effects on Tobacco Craving
• ECs can reduce craving in deprived smokers but not as effectively as tobacco cigarette (Bullen et al., 2010; Vansickel et al., 2010)
• Placebo (0mg/ml) EC also associated with decline in craving after 5 mins and..
• Further reduction in craving with nicotine EC after 20 mins (Dawkins et al., 2012)
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Nicotine Delivery in Naive EC Users
• Bullen et al. (2010):
– Compared the 0mg, 16mg (Ruyan)
EC with nicorette inhalator and
tobacco smoking
– EC reached max blood level of 1.3ng/ml in 20 mins
• Eissenberg (2010):
– Compared 2 brands of 16mg ECs to tobacco smoking
– Only tobacco smoking raised blood nicotine levels
• Ineffective vaping in naive users
• Ineffective first generation devices?
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Nicotine Delivery: Experienced
EC users using their own devices
Plasma Nicotine
-5 5 15 30 45 60 750
5
10
15
20
25
Time (minutes)10-Puff Ad-Lib
ng
/ml
From Vansickel
& Eissenberg,
(2013)
Effective nicotine
delivery in 8
experienced
‘vapers’ using 2nd
generation
devices
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Nicotine Delivery in regular users
Effective
nicotine delivery
with ‘cigalike’
cartomizer
device in 14
regular users 0
5
10
15
20
25
30
nic
oti
ne
ng/
ml b
loo
d
mean
p.1
p.2
From Dawkins &
Corcoran (2013)
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Surveys of EC users
Approx. 15 surveys report high quit rates e.g.:
• 74% reported not smoking for at least a few weeks since starting to use the EC
• 14% dramatically reduced their cigarette consumption
(Dawkins et al., 2013)
• 92%: EC helped to reduce my smoking
• 96% (ex-smokers): EC helped me to stop smoking
(Etter & Bullen, 2011)
• Non-representative samples = over-estimates of quit rates
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Effects of ECs on smoking
behaviour • Survey of smokers who had
purchased an EC:
– 31% abstinent from smoking at
6 months
– Those using EC > 20x/day: quit rate 70%
• Study of 40 smokers not willing to quit
– 6 months smoking abstinence or 50% reduction shown in 55%
Sources: Siegel et al. (2011): Polosa et al. (2011):
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Randomised Controlled Trials
• ‘Categoria’ 7.2mg nicotine EC vs. 4.8mg nicotine EC vs. no nicotine EC
• 300 smokers (unwilling to quit)
• 1 year abstinence rates: 13%, 9% and 4%
(Caponnetto et al. 2013)
• ‘Elusion’ 16mg nicotine EC vs. nicotine patch vs. no nicotine EC
• 657 participants
• 6 month abstinence rates: 7.3%, 5.8% and 4.1%
(Bullen et al. 2013)
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Summary:
• ECs deliver nicotine via inhaled vapour
• Used by smokers wanting to quit/replace or reduce tobacco smoking
• And with increasing popularity
• Moderately effective at alleviating tobacco craving...
• And can effectively deliver nicotine (at least in habitual users)
• RCTs suggest cessation rates at least comparable with NRT....
• But as yet no RCTs on non-‘cigalike’ devices.