title: Are electronic nicotine delivery systems an effective smoking cessation tool?
abstract: BACKGROUND
  Recent studies have estimated that 21% of all deaths over the past decade are due to smoking, making it the leading cause of premature death in Canada. To date, many steps have been taken to eradicate the global epidemic of tobacco smoking. Most recently, electronic nicotine delivery systems (ENDS) have become a popular smoking cessation tool. ENDS do not burn or use tobacco leaves, but instead vapourize a solution the user then inhales. The main constituents of the solution, in addition to nicotine when nicotine is present, are propylene glycol, with or without glycerol and flavouring agents. Currently, ENDS are not regulated, and have become a controversial topic.
  
  
  OBJECTIVE
  To determine whether ENDS are an effective smoking cessation tool.
  
  
  METHODS
  A systematic literature search was conducted in February 2015 using the following databases: PubMed, Scopus and Web of Science Core Collection. Randomized controlled trials were the only publications included in the search. A secondary search was conducted by reviewing the references of relevant publications.
  
  
  RESULTS
  After conducting the primary and secondary search, 109 publications were identified. After applying all inclusion and exclusion criteria through abstract and full-text review, four publications were included in the present literature review. A low risk of bias was established for each included study using the Cochrane Collaboration risk of bias evaluation framework.
  
  
  CONCLUSIONS
  The primary outcome measured in all studies was self-reported abstinence or reduction from smoking. In three of the four studies, self-reported abstinence or reduction from smoking was verified by measuring exhaled carbon monoxide. In the remaining study, the primary outcome measured was self-reported desire to smoke and measured desire to smoke. All four studies showed promise that ENDS are an effective smoking cessation tool.
  
  
  CONCLUSIONS
  While all publications included in the present review revealed that ENDS are effective smoking cessation aid, further evaluation of the potential health effects in long-term use of ENDS remains vital.
authors.affiliation: Department of Respiratory Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba.
authors.forename: Christine
authors.initials: C
authors.lastname: Lam
authors.affiliation: Department of Respiratory Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba.
authors.forename: Andrew
authors.initials: A
authors.lastname: West
keywords: Electronic nicotine delivery system; Nicotine replacement; Quit smoking; Smoking cessation; Tobacco cessation