A Pilot Randomized Crossover Trial of Electronic Cigarette Sampling Among Smokers

Electronic cigarette (EC) use is proliferating, but initial uptake patterns and their influence on smoking remains unclear. This study of EC sampling examines naturalistic uptake of ECs, as well as effects on smoking and perceived reward from smoking and vaping.

Within a double-blind randomized crossover design, smokers (n = 24; 75% male; M _age = 48.5 years) smoked as usual for 1 week, followed by two counterbalanced naturalistic (ie, ad libitum use) weeks of either placebo or active first generation ECs. Vaping and regular smoking was measured daily using diaries and at weekly clinic visits. Perceived reward from ECs and intentions/confidence to quit were also assessed. Analyses compared variables during the naturalistic smoking week and each EC week while controlling for sequence and baseline measurements of respective variables.

No significant differences emerged between active and placebo EC weeks in vaping or regular smoking, EC reinforcement, and intention/confidence to quit smoking. Satisfaction from smoking (p = .04) and smoking's ability to reduce cravings (p = .003) decreased from the naturalistic to active EC week. Behavioral dependence to cigarettes decreased from the naturalistic (M = 16.5, p = .02) to active (M = 14.7) and placebo (M = 14.2) EC weeks.

Few differences emerged in vaping, regular cigarette use, and overall reactions to ECs between active and placebo ECs. Active ECs appeared to decrease reinforcement from smoking, and both active and placebo ECs reduced behavioral dependence to cigarettes. Nicotine (per labeling) may have minimal influence on the uptake of first generation ECs among smokers.

First generation ECs provide an important behavioral/sensorimotor replacement for cigarettes, regardless of nicotine delivery, but substantial substitution may be minimal when smokers are only asked to use ad libitum. However, newer models of EC devices that provide better nicotine delivery should be examined for potential differential patterns of smoking and vaping (eg, decreased smoking and increased vaping) given their suggested greater ability to provide nicotine and behavior/sensorimotor replacement.