People who use e-cigarettes to help them stop smoking are no more likely to be abstinent a year later than those who use alternative aids or nothing at all. John Pierce at the University of California – San Diego and colleagues assessed attempts to quit smoking by thousands of people in the United States, the New Scientist reports – and also found that e-cigarette users were more likely to remain dependent on nicotine.
But the findings don’t necessarily mean that e-cigarettes won’t help some people quit, argue researchers who weren’t involved in the work, writes Jessica Hamzelou in the New Scientist article published on 2 September 2020. The research has just been published in the American Journal of Epidemiology.
Pierce and his colleagues assessed data collected as part of a study that has recruited around 49,000 people across the US.
In one piece of research, the team looked at the outcomes of 32,320 adults who were asked about their use of tobacco products. A year later, each person was asked if they had attempted to quit smoking, the methods they had used and whether they had been successful. The following year, they were asked whether they had remained abstinent for 12 months or more.
Of the 9021 people who initially said they smoked on a daily basis, 2,770 had attempted to quit. Around 24% used e-cigarettes as a cessation aid, while about 19% used other aids, such as clinically approved drugs and other nicotine replacement therapies, like patches, sprays and lozenges. The remainder of the group didn’t use any products.
But the choice of product didn’t seem to make a difference to how successful their attempt to quit was.
Only around 10% of people managed to stay abstinent from tobacco products for 12 or more months by the end of the period, regardless of whether they had used e-cigarettes, other products or nothing at all. Around 82% of those who had attempted to quit were still smoking by the end of the study period.
More dependent on nicotine
In a second piece of research, based on a separate group of 2,535 adults from the same study, the team found similar results – the participants were equally likely to quit smoking regardless of the method they used.
But those that used e-cigarettes were more likely to still be using these products two years later, suggesting they were more likely to remain dependent on nicotine, says Pierce.
“When you look in the population, there’s no benefit to using e-cigarettes to quit,” he says. “And there is a potential problem with keeping people [dependent] on nicotine.”
Contradicts other studies
The findings contradict several other studies that suggest e-cigarettes can help people quit smoking – although many studies do find that people who stop smoking do continue to use e-cigarettes for more than a year, says Jamie Brown at University College London in the United Kingdom.
And we don’t yet know if long-term use of e-cigarettes will pose problems for health, says Pierce. “E-cigarettes are not harmless.”
Brown agrees. “It’s certainly not going to be as good for people as not using them,” he says. “But it’s also going to be a lot better for them than if they’d smoked cigarettes.”
Useful quitting tool
E-cigarettes might still provide a useful quitting tool for some people, says Leonie Brose at King’s College London. E-cigarettes might encourage “additional quitters” who might not have made an attempt to quit smoking otherwise, she says.
“In these studies, e-cigarettes don’t come out very well, but neither does anything else,” adds Brose. Counselling is an important factor – people who want to give up smoking should ideally have support and be informed of how best to avoid situations in which they are likely to smoke, and how to deal with cravings.
“It’s not all about nicotine delivery,” she says. “Quitting needs to be better supported. Without support, none of those options are very effective.”
Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16.
Published in the American Journal of Epidemiology, Plos One, on 2 September 2020.
John P Pierce, Tarik Benmarhnia, Ruifeng Chen, Martha White, David B Abrams, Bridget K Ambrose, Carlos Blanco, Nicolette Borek, Kelvin Choi, Blair Coleman, Wilson M Compton, K. Michael Cummings, Cristine D Delnevo, Karen Messer, Tara Elton-Marshall, Maciej L Goniewicz, Shannon Gravely, Geoffrey T Font, Dorothy Hatsukami, James Henrie, Karin A Kasza, Sheila Kealey, Heather L Kimmel, Jean Limpert, Raymond S Niaura, Carolina Ramoa, Eva Sharma, Marushka L Silveira, Cassandra A Stanton, Michael B Steinberg, Ethel Taylor, Maansi Bansal-Travers, Dannis R Trinidad, Lisa D Gardner, Andrew Hyland, Samir Soneji and Karen Messer.
More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy.
To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use.
Design and participants
Cohort study of US sample, with annual follow-up. US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013–14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443).
Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2.
Analysis and outcome measures
Propensity score matching (PSM) of groups using different methods to quit. Outcome measures: 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome.
Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3.
Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09).
Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products.
The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA.
Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1–2 years later.
E-cigarettes are no better than alternative aids to quit smoking
Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16