Many physicians have misconceptions about e-cigarettes

Many physicians incorrectly believe all tobacco products are equally harmful and thus are less likely to recommend e-cigarettes for people seeking to quit smoking or those being treated for a tobacco-caused disease, according to a Rutgers study.

About 480,000 people die each year in the United States from smoking tobacco. Although the Food and Drug Administration has not approved e-cigarettes as a cessation device, many people ask their physicians about using them as an alternative to tobacco cigarettes or as a way to help them stop smoking. E-cigarettes use a heated liquid containing nicotine.

"As the evidence grows showing e-cigarettes as potentially effective for smoking cessation, they may play a pivotal role in reducing use of cigarettes and subsequently tobacco-caused disease," said study author Michael Steinberg, medical director of the Rutgers Tobacco Dependence Program at the Center for Tobacco Studies and division chief in the Department of Medicine at the Rutgers Robert Wood Johnson Medical School. "It's important to understand physicians' perspectives on e-cigarettes as a means for harm reduction."

The study, published in JAMA Network Open, asked 2,058 U.S. physicians in 2018 and again in 2019 about their communication with patients about e-cigarettes. The researchers asked how they would advise two different patients who wanted to quit smoking: a young woman who is a lighter smoker and had not yet tried to quit and an older man who smoked heavily and had tried to quit many times using different methods.

The study found that physicians were significantly more likely to recommend e-cigarettes for the heavy smoker while recommending FDA-approved medications, like nicotine gum or lozenges, for the light smoker. Nearly 70 percent of the physicians reported that patients have asked them about e-cigarettes, and one-third said they were asked in the past 30 days. More than 60 percent of the doctors incorrectly believed that all tobacco products are equally harmful.

"These findings show it is critical to address physicians' misperceptions and educate them on e-cigarettes' efficacy, particularly correcting their misperceptions that all tobacco products are equally harmful, as opposed to the fact that combusted tobacco is by far the most dangerous," said lead author Cristine Delnevo, director of the Rutgers Center for Tobacco Studies and professor of Health Behavior, Society and Policy in the Rutgers School of Public Health.

The study also found that pulmonologists, cardiologists and physicians who used the U.S. Public Health Service Clinical Practice Guidelines for treating tobacco use and dependence were more likely to recommend e-cigarettes to patients as were those who endorsed a harm-reduction perspective and had themselves smoked cigarettes. Physicians were also more likely to recommend e-cigarettes, however, if a patient asked about them first.

Other Rutgers authors in the study included Michelle Jeong, Arjun Teotia, Michelle M. Bover Manderski, Binu Singh, Mary Hrywna and Olivia A. Wackowski.