Investigating Electronic Nicotine Delivery Systems (Ends) Use Amongst Telephone Quitline Participants

Special Article – Tobacco and Smoking Cessation

J Fam Med. 2017; 4(2): 1108.

Investigating Electronic Nicotine Delivery Systems (Ends) Use Amongst Telephone Quitline Participants

Lukowski A* and Olson K

Health Initiatives, National Jewish Health, USA

*Corresponding author: Lukowski AV, Health Initiatives, National Jewish Health, 1400 Jackson Street, S113, Denver, CO 80206, USA

Received: January 20, 2017; Accepted: February 14, 2017; Published: February 16, 2017


Introduction: Tobacco cessation quitlines are effective in helping smokers quit. With recent classification of Electronic Nicotine Delivery Systems (ENDS) as a tobacco product further investigation is needed to understand the impact of ENDS on quit attempts. ENDS products have increased in popularity for a variety of reasons including public policies aimed at protecting others from secondhand smoke and claims that they aid in cessation. This report compares the proportion of quitline participants using ENDS products from those that do not.

Methods: National Jewish Health collected data from numerous state and corporate quitlines. Participants were separated into three groups including participants using only ENDS products (EcigO), participants using both ENDS and cigarettes (E&Cig) and participants using cigarettes but no ENDS products (CigO). Enrolled participants are eligible to receive up to 5 coaching sessions and 8 weeks of Nicotine Replacement Therapy (NRT).

Results: Both EcigO and E&Cig reported similar reasons for ENDS use, however, EcigO use ENDS more frequently compared to E&Cig (χ=317.619, p-value<.0001). EcigO completed more coaching calls (F-Value=86.85, p-value<.0001), had significantly higher proportion of males (χ=109.86, p-value<.0001) and were more likely to have a college education ( χ=1029.48, p-value<.0001) compared to E&Cig and CigO.

Conclusions: These findings highlight the increased use of ENDS year over year within a telephonic quitline population. Furthermore it outlines how this population differs from the traditional tobacco users and may need tailored coaching to quit both traditional tobacco and ENDS products.

Keywords: E-cigarettes; Electronic Nicotine Delivery Systems; Quitline; Telephone cessation


Electronic Nicotine Delivery Systems (ENDS) products were introduced into the market in 2007 and have seen steady growth in prevalence across all populations. ENDS have been marketed primarily as a replacement to combustible products, an option to use when traditional products cannot be used (i.e., where clean indoor air policies have been instituted), and as a cessation tool [1]. The prevalence of these products has grown steadily and significantly year over year since their introduction, across age groups with the most significant uptake by middle and high school students [2,3]. Current national trends for ENDS use show prevalence around 3.5% and 58.8% used ENDS products in addition to cigarettes [3]. However, ENDS have yet to pass the scientific and regulatory rigor required to be deemed a proven cessation aid or the data to be considered a safe product [4]. In addition, the FDA recently deemed ENDS as tobacco products in May 2016, providing more regulations than ever before [3]. Even with these latest regulations, there are still several outstanding questions for the public health community about how to about how to best help all populations to be completely tobacco free [5]. That coupled with the lack of significant data to support tobacco industry marketing claims call on the tobacco control community to better understand prevalence, use patterns and reasons for ENDS use.

The Current Study

One of the most successful evidence-based treatment modalities for tobacco cessation is telephonic (and Web-supported) quitlines, which offer education, support, phone coaching, and nicotine replacement therapy for most callers [6]. Available in all U.S. States since 2002, telephonic quitlines typically offer a combination of coaching and nicotine replacement therapy (NRT) to populations who want to quit tobacco [7,8]. These services are available to anyone in the U.S. and are available at low to no cost. For the general population, a recent Cochrane review found that proactive telephonic services help smokers to quit compared to brief counseling or selfhelp materials [7].

Since quitlines primary audience is to help tobacco users with cessation, they are well positioned to understand ENDS as well as other tobacco use behaviors in this population. In the current study, we report on data from National Jewish Health (NJH), which provides telephonic cessation services for 17 states along with various corporate and health plan clients. Our primary aim is to examine how ENDS users compare to non-ENDS users across the following domains: demographic characteristics, dual use of tobacco products, and time of first use. A better understanding of the unique characteristics of quitline callers who use ENDS may help direct future best clinical practices for a tobacco using quitline population. This analysis compares three defined groups including ENDS only users (EcigO), dual ENDS and cigarette users (E&Cig) and cigarette only users (CigO). A majority of participants who report using ENDS products also report cigarette use. Participants were excluded from the analysis if they did not answer “yes” or “no” to questions regarding use of ENDS products or Cigarettes.

Quitlines started collecting some data on ENDS use in 2011 but the questions have evolved just as ENDS products have changed and we learn more about prevalence. The percent of overall participants using the quitline that reported ENDS use increased from 2.85% in 2011 to 8.11% in 2016. Knowing the reasons for use is a critical part of understanding prevalence; therefore we collect information in this area. See Table 1 for questions and possible responses which include the reasons why participants use ENDS.