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. 2021 Sep 14;2021(9):CD010216. doi: 10.1002/14651858.CD010216.pub6

Tseng 2016.

Study characteristics
Methods Design: 2‐arm; double‐blind placebo‐controlled RCT
Recruitment: Advertisements placed in Craigslist as well as flyers distributed on the street and placed in New York City venues with details for how to contact study staff.
Setting: Community, USA
Study start date: July 2014 – 2015 (month unclear); Study end date: Not specified
Participants Total N: 99 (100 were randomized but 1 participant randomized to the control arm was found to be ineligible between randomization and baseline)
N per arm: Nicotine EC: 50; Placebo EC: 49
Inclusion criteria:
  • age 21 – 35 (confirmed with some form of identification document)

  • daily smoker

  • smoked ≧ 10 cigarettes a day (verified by a CO level of ≥ 8 ppm)

  • interested in reducing cigarette consumption

  • able to provide consent

  • had a cell phone and was willing/able to receive text messages and counseling on their cell phone

  • willing to use an EC for 3 weeks


Exclusion criteria:
  • Pregnant and/or breastfeeding

  • had a history of asthma, other airways diseases, or heart disease

  • were currently using smoking cessation medications (including other forms of NRT, bupropion, or varenicline), or enrolled in a smoking cessation program or another cessation trial.

  • Use of EC in the past 14 days or any other tobacco products (pipe, cigar, cigarillos, snuff, chewing tobacco, rolling tobacco, or hookah/shisha) in the past 30 days

  • having a moderate to severe drug use disorder defined as a score of at least 5 on the Drug Abuse Screening Test‐10 and/or a hazardous or active alcohol use disorder defined as at least 7 for men and at least 5 for women on the Alcohol Use Disorders Identification


Inclusion based on specific population characteristic: Young adults
32.3% women; mean age 28.43; mean cpd 14.33; FTND not measured but time to first cigarette was measured categorically. The mode category was 6 ‐ 30 mins (39/99; 41.5%) Smoking behavioral dependence scale (11 items): mode category ‘Moderate’ (51/99; 51.5%)
Motivated to quit: Readiness to quit (1 – 10 scale, 1 – 8 apply to current people who smoke): 5.57 ± 1.49
E‐cigarette use at baseline: No use of e‐cigs in past 14 days (eligibility criterion)
Interventions EC: Cig‐a‐like
E‐cigarette details:
3 weeks of disposable 4.5% nicotine NJOY, King Bold (NJOY, Inc, Scottsdale, AZ) which resemble conventional cigarettes. NJOY also manufactured the non‐nicotine placebo EC. Both nicotine and placebo ECs were tobacco‐flavored. The products were purchased by the investigators and provided to the participants free of charge
Other stop‐smoking pharmacotherapies: None
Behavioural support:
Prior to receiving the ECs, participants were required to complete a 20‐ to 30‐minute telephone counseling session with a trained tobacco cessation Counsellor. The purpose of the telephone counseling was to review current smoking patterns and offer behavioral and environmental change strategies. These included specific smoking reduction options, such as eliminating cigarettes at work and in the home, carrying only those cigarettes needed for that day, dropping cigarettes associated with less intense triggers first, avoiding smoking triggers, and other strategies to manage urges.18 participants were asked to reduce the number of cigarettes smoked daily by at least 50% of the total number of cigarettes smoked per day at baseline. To mimic real‐life EC use, minimum EC use instruction was provided. Participants were encouraged to replace cigarettes with as much or as little use of an EC as needed in order to reduce nicotine withdrawal symptoms
Outcomes Week 1, 3
Cessation: Not applicable
Adverse events and biomarkers: adverse events and symptoms related to EC use
Other outcomes measured:
  • self‐reported reduction of at least 50% in the number of cpd

  • percentage reduction in number of cpd

  • Use of ECs

  • satisfaction with ECs

Study funding “This work was supported by the National Center for Advancing Translational Sciences at the National Institutes of Health (grant number UL1TR000038).”
Author declarations “None declared”
Notes Study listed as ongoing study NCT02628964 in the 2016 review update
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: “computer generated”
Allocation concealment (selection bias) Unclear risk Quote: “…was concealed from research assistants. Blinding of the allocation of nicotine or placebo EC was ensured by the identical appearance of the ECs”. However, not enough information given on how allocation was concealed at the point of randomization
Blinding of participants and personnel (performance bias)
All outcomes Low risk Quote: “Blinding of the allocation of nicotine or placebo EC was ensured by the identical appearance of the ECs”
Blinding of outcome assessment (detection bias)
All outcomes Low risk Quote: "Blinding of the allocation of nicotine or placebo EC was ensured by the identical appearance of the ECs”
Incomplete outcome data (attrition bias)
All outcomes Low risk Nicotine EC ltfu: 10/50; Placebo EC ltfu: 10/49
Selective reporting (reporting bias) Low risk All expected outcomes reported