Abstract Introduction Lung cancer screening (LCS) is an optimal time to offer tobacco treatment to adults who smoke, but many cannot quit even with treatment. Replacing combustible cigarettes (CC) with e-cigarettes (EC) could be a harm reduction approach, but few older adults use EC. No study has examined EC harm reduction potential among individuals undergoing LCS. Methods In a pilot mixed-methods single-arm clinical trial, we assessed the feasibility and short-term effects of providing EC to older adults not planning to quit after completing a smoking cessation trial at LCS. Participants were asked to use tobacco-flavored NJOY Ace EC (5% nicotine) for 4 weeks. Assessments occurred at weeks 1, 2, 3, 4, and 8, with qualitative interviews at week 4. Primary outcomes were study feasibility and change in cigarettes/day (CPD) during EC provision. Secondary outcomes included breath carbon monoxide (CO) and EC use. Results From 9/2024–2/2025, we enrolled 15 participants (54% of eligibles; mean age = 66.1 years, 40% female); 14 (93%) completed the study. Over the 4-week EC provision, mean CPD and breath CO declined significantly (CPD = 16.9 SD:7.2 to 10.4SD: 7.0, P.001; CO: 19.4SD:11.0 to 12.3SD: 8.5, P=.04). Mean CPD remained stable post-EC provision. At week 4, participants used EC on 5.5 (SD:2.4) days/week; 2 participants (13%) used only EC, 12 (80%) were dual users, and 1 (7%) used only CC. Conclusions This pilot trial showed the feasibility of recruiting older adults unable to quit smoking after LCS to use EC and suggested the short-term efficacy of EC to reduce CC consumption and CO exposure. Implications This pilot study demonstrates the feasibility and promising short-term effects of switching older adults who smoke and did not quit at LCS to use EC. Participants’ cigarette consumption and CO exposure declined over 4 weeks of EC provision, but most participants became dual users (EC and CC). Qualitative interviews illustrated benefits and challenges of switching. The findings deserve confirmation in a larger sample, but suggest that longer EC provision and behavioral support might help this group to completely replace CC use and gain the full harm reduction benefits associated with switching to EC.
Avila et al. (Thu,) studied this question.