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Electronic Cigarettes

Electronic Cigarettes | Heart and Vascular Health | Scoop.it

Electronic cigarettes (E-cigarettes) are devices that deliver nicotine to a user by heating and converting to an aerosol a liquid mixture typically composed of propylene glycol, vegetable glycerin, flavoring chemicals, and nicotine. E-cigarette use doubled in just 1 year among both adults and children, from 3.4% to 6.2% in adults (2010–2011) and 3.3% to 6.8% in youth (2011–2012), with high levels of dual use with tobacco cigarettes.  Although most youth using e-cigarettes are dual users, up to one third of adolescents who tried an e-cigarette have never smoked a conventional cigarette, indicating that some youth are initiating use of the addictive drug nicotine with e-cigarettes.

Smoke-free policies are a critical intervention both to protect nonsmokers and to support smoking cessation attempts. To avoid reversing the effectiveness of these policies, e-cigarettes should not be used anyplace where smoking cigarettes is not allowed (including in homes that are smoke-free). There is no reason to reintroduce toxins into clean indoor air environments.

Seth Bilazarian, MD's insight:

I tell patients who want to use  E-cigarettes that we don't have adequate information to say that these new nicotine drug delivery devices are safer than cigarettes.  For patients who are motivated to quit smoking, use of  E-cigarettes has not been shown to be an effective  aid to end the addiction of smoking.

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Teen smoking rates stuck at 1 in 12.

Teen smoking rates stuck at 1 in 12. | Heart and Vascular Health | Scoop.it
For years, health officials watched with satisfaction as rates of teen smoking in New York City plummeted, far outpacing the national average. In 2007, the rate dipped to 8.5%. Then it stopped falling.
Seth Bilazarian, MD's insight:

To be sure, the 8.5% is still a dramatic improvement from 15 years ago, when nearly a quarter of the city's high school-age students smoked, according to data from the Department of Health and Mental Hygiene.

The stagnation mirrors a national trend, experts said, though the city's numbers remain well below the national teen-smoking average of 18.1% and even the state average of 12.5%.

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Electronic cigarettes for smoking cessation: Only work 7.3% at 6 months

Electronic cigarettes for smoking cessation: Only work 7.3% at 6 months | Heart and Vascular Health | Scoop.it

Electronic cigarettes (e-cigarettes) can deliver nicotine and mitigate tobacco withdrawal and are used by many smokers to assist quit attempts. We investigated whether e-cigarettes are more effective than nicotine patches at helping smokers to quit.657 people were randomised (289 to nicotine e-cigarettes, 295 to patches, and 73 to placebo e-cigarettes) and were included in the intention-to-treat analysis. At 6 months, verified abstinence was 7·3% (21 of 289) with nicotine e-cigarettes, 5·8% (17 of 295) with patches, and 4·1% (three of 73) with placebo e-cigarettes (risk difference for nicotine e-cigarette vs patches 1·51 [95% CI −2·49 to 5·51]; for nicotine e-cigarettes vs placebo e-cigarettes 3·16 [95% CI −2·29 to 8·61]). Achievement of abstinence was substantially lower than we anticipated.. We identified no significant differences in adverse events, with 137 events in the nicotine e-cigarettes group, 119 events in the patches group, and 36 events in the placebo e-cigarettes group. We noted no evidence of an association between adverse events and study product.E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events. Uncertainty exists about the place of e-cigarettes in tobacco control, and more research is urgently needed to clearly establish their overall benefits and harms at both individual and population levels.

Seth Bilazarian, MD's insight:

The lack of success using e-cigarettes to quit smoking is consistent with the experience of my patients.  The 7.3% rate is low and not different from nicotine patches. For my patients, I fear that the well intentioned switch to e-cigarettes, with plans to quit, results in permanent e-cigarette use.  We just don't have any safety data about the use of these devices that are not regulated for quality or purity by FDA and largely made outside the US.  This study was small and there was a trend toward more adverse events with e-cigs.  The best I can tell my patients is that short term use as a strategy to quit smoking is probably safe. My blog on the topic:  http://www.medscape.com/viewarticle/801964?t=1

 

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Chantix (varenicline) for smoking cessation does not increase risk of cardiovascular events:

Chantix (varenicline) for smoking cessation does not increase risk of cardiovascular events: | Heart and Vascular Health | Scoop.it

My comment:  There is significant concen about the safety of Chantix.  I explain to my patients that the risk of this drug has to be balanced against the risk of continued smoking (heart disease, stroke, cancer, erectile dysfunction) since this is the most effective strategy we have to help people succeed at qutitting  their addiction to niocotine.

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Danish registry of 35,000 patients comparing the safety of quitting smoking with Chantix (varenicline) comared to Wellbutrin or Zyban (bupropion) on safety of cardiovascular events.

At 6 months the rates were 0.69% vs. 7.1%.  This study found no increased risk of major cardiovascular events associated with use of varenicline compared with bupropion for smoking cessation.

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