Novel nicotine delivery products, such as electronic cigarettes (e-cigarettes), have dramatically grown in popularity despite limited data on safety and benefit. In contrast, the similar U.S. Food and Drug Administration (FDA)-approved nicotine inhaler is rarely utilized by smokers. Understanding this paradox could be helpful to determine the potential for e-cigarettes as an alternative to tobacco smoking.
To compare the e-cigarette with the nicotine inhaler in terms of perceived benefits, harms, appeal, and role in assisting with smoking cessation.
A cross-over trial was conducted from 2012 to 2013
Forty-one current smokers age 18 and older used the e-cigarette and nicotine inhaler each for 3 days, in random order, with a washout period in between. Thirty-eight participants provided data on product use, perceptions, and experiences.
The Modified Cigarette Evaluation Questionnaire (mCEQ) measured satisfaction, reward, and aversion. Subjects were also asked about each product’s helpfulness, similarity to cigarettes, acceptability, image, and effectiveness in quitting smoking. Cigarette use was also recorded during the product-use periods.
The e-cigarette had a higher total satisfaction score (13.9 vs. 6.8 [p < 0.001]; range for responses 3–21) and higher reward score (15.8 vs. 8.7 [p < 0.001]; range for responses 5–35) than the inhaler. The e-cigarette received higher ratings for helpfulness, acceptability, and “coolness.” More subjects would use the e-cigarette to make a quit attempt (76 %) than the inhaler (24 %) (p < 0.001). Eighteen percent (7/38) of subjects abstained from smoking during the 3-day periods using the e-cigarette vs. 10 % (4/38) using the inhaler (p = 0.18).
The e-cigarette was more acceptable, provided more satisfaction, and had higher perceived benefit than the inhaler during this trial. E-cigarettes have the potential to be important nicotine delivery products owing to their high acceptance and perceived benefit, but more data are needed to evaluate their actual efficacy and safety. Providers should be aware of these issues, as patients will increasingly inquire about them.
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This study was funded through a pilot grant from the Rutgers–Cancer Institute of New Jersey (P30CA072720).
Conflict of Interest
Michael B. Steinberg – none; Mia Hanos Zimmermann – none; M. Jane Lewis – none; Cristine D. Delnevo – none; Parth Shukla – none; Elliot Coups – none; Jonathan Foulds – primarily funded by National Institutes of Health grants: P50-DA-036107-01 & P50-DA-036105-01 and by Penn State Cancer Institute and Social Science Research Institute. He has done paid consulting for pharmaceutical companies involved in producing smoking cessation medications, including GSK, Pfizer, Novartis, J&J, and Cypress Bioscience.
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Steinberg, M.B., Zimmermann, M.H., Delnevo, C.D. et al. E-Cigarette Versus Nicotine Inhaler: Comparing the Perceptions and Experiences of Inhaled Nicotine Devices. J GEN INTERN MED 29, 1444–1450 (2014). https://doi.org/10.1007/s11606-014-2889-7