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Successful Nicotine Intake in Medical Assisted Use of E-Cigarettes: A Pilot Study

Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation National Institute of Health, Roma 00161, Italy
Ospedale San Giovanni Bosco, ASL TO2 Torino 10154, Italy
Author to whom correspondence should be addressed.
Academic Editors: Coral Gartner and Britta Wigginton
Int. J. Environ. Res. Public Health 2015, 12(7), 7638-7646;
Received: 29 May 2015 / Revised: 25 June 2015 / Accepted: 26 June 2015 / Published: 8 July 2015
(This article belongs to the Special Issue Tobacco Control 2015)
PDF [687 KB, uploaded 8 July 2015]


The electronic cigarette (e-cig) has gained popularity as an aid in smoking cessation programs mainly because it maintains the gestures and rituals of tobacco smoking. However, it has been shown in inexperienced e-cig users that ineffective nicotine delivery can cause tobacco craving that could be responsible for unsuccessful smoking reduction/cessation. Moreover, the incorrect use of an e-cig could also led to potential nicotine overdosage and intoxication. Medically assisted training on the proper use of an e-cig plus behavioral support for tobacco dependence could be a pivotal step in avoiding both issues. We performed an eight-month pilot study of adult smokers who started e-cig use after receiving a multi-component medically assisted training program with monitoring of nicotine intake as a biomarker of correct e-cig use. Participants were tested during follow-up for breath carbon monoxide (CO), plasma cotinine and trans-3’-hydroxycotinine, and number of tobacco cigarettes smoked. At the end of the first, fourth, and eighth month of follow-up, 91.1, 73.5, and 76.5% of participants respectively were e-cig users (‘only e-cig’ and ‘dual users’). They showed no significant variation in plasma cotinine and trans-3’-hydroxycotinine with respect to the start of the study when they smoked only tobacco cigarettes, but a significant reduction in breath CO. The proposed medically assisted training program of e-cig use led to a successful nicotine intake, lack of typical cigarette craving and overdosage symptoms and a significant decrease in the biomarker of cigarette combustion products. View Full-Text
Keywords: smoking cigarette; cotinine; trans-3’-hydroxycotinine; electronic cigarette; tobacco harm reduction smoking cigarette; cotinine; trans-3’-hydroxycotinine; electronic cigarette; tobacco harm reduction
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Pacifici, R.; Pichini, S.; Graziano, S.; Pellegrini, M.; Massaro, G.; Beatrice, F. Successful Nicotine Intake in Medical Assisted Use of E-Cigarettes: A Pilot Study. Int. J. Environ. Res. Public Health 2015, 12, 7638-7646.

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