Tobacco control: Up in E‐smoke?
Tobacco control: Up in E‐smoke?
复制标题
烟草控制：电子烟流行？
DOI：
10.1002/cncr.28810
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发表时间：
2014
期刊：
影响因子：
6.2
通讯作者：
S. Veeraraghavan
中科院分区：
文献类型：
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作者：
S. Veeraraghavan
电子香烟或电子香烟是递送尼古丁气雾剂的装置，并且以类似于吸烟传统香烟的方式使用。尼古丁溶液被加热产生气雾剂，然后被吸入。这也被称为vaping，并且被认为比吸烟传统香烟危害更小，因为它避免了吸入其他有毒燃烧产物。电子烟的使用在过去几年中大幅增加。据非专业媒体报道，2013年全球电子烟的零售额估计约为25亿美元，预计到2017年将翻两番。全国青少年烟草调查的结果显示，在2011年至2012年期间，美国高中生中电子烟的使用率从4.7%增加到10%。许多品牌可以在商店和互联网网站上购买。丙二醇溶液中的尼古丁是最常见的产品，但也提供非尼古丁液体。在竞争激烈的市场上，花哨的产品吸引着顾客。关于化学成分的数量和浓度的信息很少。虽然有几个使用和投掷墨盒，解决方案也可供用户自己重新填充设备。关于这一主题的专门印刷和电子杂志可供查阅。1969年的公共卫生吸烟法案，由尼克松总统于1970年签署成为法律，禁止在广播和电视上做香烟广告。从技术上讲，电子烟不受该法案的保护，推广这些产品的广告已开始出现在电视黄金时段。与这些产品在公共竞技场中越来越多的出现相比，关于电子烟对人类的影响，科学证据很少。在PubMed上搜索“电子烟”或“电子烟”显示，发表的文章不到200篇，其中几篇是医学期刊的新闻报道。在这种情况下，Borderud等人发表在本期癌症杂志上的研究对于理解电子烟在戒烟中的作用做出了宝贵的贡献。参与者是被诊断患有癌症并在癌症中心参加戒烟计划超过2年的吸烟者。在此期间，共有1074例患者入组该项目，699例参与者有资格进行最终分析。近四分之一的患者在过去30天内使用过电子烟。2012年至2013年间，电子烟的使用量大幅增加。虽然作者发现电子烟使用者和非使用者之间的人口统计数据没有显着差异，但电子烟使用者每天吸烟更多，具有更高的Fagerstrom尼古丁依赖测试评分（依赖性增加），并且比非电子烟吸烟者更频繁和更长时间的戒烟尝试。他们中失访的比例也高于非电子烟吸烟者。使用意向治疗分析，作者发现电子烟使用者在随访时吸烟的可能性是非使用者的两倍。虽然并非没有限制，但这些研究结果提出了电子烟在戒烟中的作用问题。据我所知，最近发表了迄今为止关于电子烟戒烟价值的最大规模随机研究。共有657名想要戒烟的患者被随机分为3组，分别接受16 mg尼古丁电子烟、安慰剂电子烟或21 mg尼古丁贴片。此外，还通过电话提供行为支持。两组之间在主要结局方面没有差异：6个月时生物学证实的自我报告的禁欲。戒烟率也很低，7.3%的尼古丁电子烟吸烟者，4.1%的安慰剂电子烟使用者和5.8%的尼古丁贴片使用者实现了从吸烟中解放出来。
Electronic cigarettes or E-cigarettes are devices that deliver an aerosol of nicotine and are used in a fashion similar to smoking conventional cigarettes. Nicotine in solution is heated to generate an aerosol that is then inhaled. This is also termed as vaping and is believed to be less harmful than smoking conventional cigarettes because it avoids the inhalation of other toxic combustion products. The use of E-cigarettes has increased significantly over the last few years. Reports in the lay press suggest that the retail sales of E-cigarettes worldwide were estimated to be approximately $2.5 billion in 2013 and are expected to quadruple by 2017. Findings from the National Youth Tobacco Survey indicate that the ever-use of E-cigarettes more than doubled from 4.7% to 10% between 2011 and 2012 among high school students in the United States. Numerous brands are available for purchase in stores as well as on Internet Web sites. Nicotine in a solution of propylene glycol is the most common product although nonnicotine liquids are also offered. Flavored products entice customers in what appears to be a highly competitive market. Minimal information is available regarding the amount and concentration of the chemical constituents. Although several use-and-throw cartridges are available, solutions are also available for users to refill the device on their own. Dedicated print and electronic magazines are available on the subject. The public health cigarette smoking act of 1969, signed into law by President Nixon in 1970, banned cigarette advertisements on radio and television. E-cigarettes are technically not covered under this act, and advertisements promoting these products have started appearing on prime time television. Compared with the increased presence of these products in the public arena, minimal scientific evidence is available regarding the effects of E-cigarette use in humans. A PubMed search of “E-cigarette” or “electronic cigarette” shows< 200 published articles, with several of these being news reports from medical journals. In this context, the study by Borderud et al published in this issue of Cancer is a valuable contribution in understanding the role of E-cigarettes in smoking cessation. Participants were smokers who had been diagnosed with cancer and enrolled in a tobacco cessation program at a cancer center over a 2-year period. A total of 1074 patients were enrolled in the program during the period and 699 participants were eligible for final analysis. Nearly one-quarter of the patients had used an E-cigarette within the past 30 days. E-cigarette use increased substantially between 2012 and 2013. Although the authors found no significant difference in the demographic data between E-cigarette users and nonusers, E-cigarette users were smoking more cigarettes per day, had a higher Fagerstrom Test for Nicotine Dependence score (increased dependence), and had more frequent and longer quit attempts than non–E-cigarette smokers. A higher percentage of them were lost to follow-up than non–E-cigarette smokers as well. Using an intent-to-treat analysis, the authors found that E-cigarette users were twice as likely to be smoking at follow-up compared with nonusers. Although not without limitations, these study findings raise the issue of the role of E-cigarettes in smoking cessation. What to my knowledge is the largest randomized study to date concerning the value of E-cigarettes in smoking cessation was published recently. A total of 657 patients who wanted to quit smoking were randomized into 3 groups receiving either a 16-mg nicotine E-cigarette, placebo E-cigarette, or a 21-mg nicotine patch. In addition, behavioral support was provided over the telephone. There was no difference noted between the groups in the primary outcome: biologically confirmed self-reported abstinence at 6 months. The cessation rates were also low, with 7.3% of nicotine E-cigarette smokers, 4.1% of placebo E-cigarette users, and 5.8% of nicotine patch users achieving liberation from cigarette smoking.