Two small studies show lower cig consumption in people using second gen ecigs

One reason that has been offered as to why e-cigarettes have not been effective at helping people stop smoking is that the e-cigarettes were "first generation" that worked at relatively low voltages and had other design features that made them less than optimal from the perspective of delivering an adequate dose of nicotine to users.  Two small studies were recently published presenting data that these "second generation" e-cigarettes are more effective at delivering nicotine.
 
Karolien Adriaens and colleagues published "Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints" in International Journal of Environmental Research and Public Health that compared cotinine levels (a measure of nicotine exposure) and several measures of  nicotine craving in 48 people divided between smokers given two brands of second generation e-cigarettes and smokers who simply continued to smoke their regular cigarettes.  They found that the e-cigarette users reduced cigarette consumption without reporting increased cravings while the cigarette smokers consumption remained about the same and concluded, reasonably, that the smokers given e-cigarettes were substituting e-cigarettes for many of their cigarettes.
 
Riccardo Polosa and colleagues published another small study (50 smokers), "Success rate with nicotine personal vaporizers: A prospective 6-month pilot study of smokers not intending to quit" in BMC Public Health that also found that smokers given second generation e-cigarette systems substantially reduced cigarette consumption.  Unlike the Adriaens study, however, they did not have a control group of smokers who were not given e-cigarettes, so their conclusion that  second generation e-cigs decreased cigarette consumption is a lot weaker.
 
Both papers reported high smoking cessation rates (21% in Adriaens and 36% in Polosa), but neither of these results is reliable because neither study had a control group for the cessation results.
 
One thing that struck me in reading both these papers is the fact that the literature reviews and discussion secfions completely ignore the consistent population-levels evidence that, among all smokers, e-cigarettes discourage cigarette cessation.  They also ignore the fact that e-cigarettes deliver loads of ultrafine particles as bad or worse than conventiional cigarettes.  Good scientific practice requires putting a study in the context of the entire literature.
 
Konstantinos Faralinos, who is funded by e-cigarette interests, served as external editor for the Adriaens study.