Experts Call For More Action to Thwart Youth Vaping ‘Epidemic’

Research by the Centers for Disease Control and Prevention (CDC) shows that the use of e-cigarettes to quit smoking has become a far more popular means of quitting smoking among adults than the use of FDA-approved methods such as nicotine patches, nicotine gum, or smoking-cessation medications. But does it work?

E-cigarettes are not approved by the FDA as a smoking-cessation aid, and the few studies on this issue have shown mixed results. “We don’t yet know if e-cigarettes can be effective in helping adults reduce their use of traditional, combustible tobacco cigarettes,” said Douglas Ziedonis, M.D., M.P.H., associate vice chancellor for health sciences and a professor of psychiatry at the University of California, San Diego. “There is a need for research studies to evaluate the safety and long-term efficacy of e-cigarettes in this role. But even if such initial studies were carried out, they would not likely include individuals with neuropsychiatric disorders.”

It turns out that adults with mental health conditions are even more likely to try e-cigarettes, be current users of e-cigarettes, and be susceptible to future use of e-cigarettes than adults without such conditions, and they smoke them for many of the same reasons other adults do—because they wish to cut back on smoking or because of the stigma associated with smoking, a study published in BMJ found.

The lifespan of people with severe mental illness is 26 years shorter than the general population, and this enormous health disparity is greatly influenced by their smoking, Ziedonis said. “It’s great that psychiatrists are becoming more aware of the huge negative impact smoking is having on their patients and that more are integrating treatment for tobacco use disorders into their practices.”

While the CDC found that 30 percent of e-cigarette users were former smokers who had transitioned off combustible cigarettes, it is not known whether the use of e-cigarettes helped them quit. Moreover, 60 percent of e-cigarette users were found to be “dual users”—that is, they continue to smoke both.

“Dual use is not an effective way to safeguard your health,” the CDC wrote. More troubling was that among young people (aged 18 to 24), 40 percent of e-cigarette users had never smoked, suggesting that for young people at least, e-cigarettes may be more of a gateway to smoking than anything else.

For adult patients who smoke, there are seven FDA-approved products that can increase the chances of successful quitting. Of the agents studied, varenicline was most effective in helping smokers achieve abstinence, outperforming bupropion, placebo, and nicotine patch. In addition, a study in 2016 found that use of varenicline or bupropion by people with psychiatric disorders did not increase neuropsychiatric adverse events.

“Balancing medication with psychosocial interventions can further boost success rates,” Ziedonis pointed out. Methods with the strongest evidence involve face-to-face psychotherapy, such as cognitive-behavioral therapy and group therapy, as well as state-operated quit lines (accessed by calling 1-800-QUIT-NOW).