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. These individuals are also more likely to remain dependent on nicotine.
That’s what John Pierce at the University of California, San Diego, and his colleagues found when they assessed attempts to quit smoking by thousands of people in the US. 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.
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, 2770 had attempted to quit. Around 24 per cent used e-cigarettes as a cessation aid, while about 19 per cent 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 per cent 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 per cent of those who had attempted to quit were still smoking by the end of the study period.
In a second piece of research, based on a separate group of 2535 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.”
The findings contradict several other studies that suggest that 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 UK.
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,” he says.
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.”
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,” says Brose. Counselling is an important factor, she says – 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.”
Journal reference: PLOS One, DOI: 10.1371/journal.pone.0237938
Journal reference: American Journal of Epidemiology, DOI: 10.1093/aje/kwaa161
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