Could E-Cigarettes Help People Quit Smoking? Study Suggests Yes
Over the past decade or so, electronic cigarettes have become much more widely used by smokers in England. A new study has tied this trend to an increase in people being successful when trying to quit but found no rise in their number of attempts to stop smoking. Several other changes occurring in the country at the same time, however, make it difficult to draw any firm conclusions.
Taking into account expected relapses in the majority of quitters, researchers led by Emma Beard, PhD (University College London, England), estimate that e-cigarettes may have helped about 18,000 people kick the habit in that country in 2015.
The investigators acknowledge that the observed changes in smoking behavior are relatively small, but say in a paper published online September 13, 2016, ahead of print in the BMJ that they “are clinically significant because of the huge health gains from stopping smoking.”
Commenting for TCTMD, Douglas Jorenby, PhD (University of Wisconsin Center for Tobacco Research and Intervention, Madison), cautioned against using the results to conclude that e-cigarettes aid in smoking cessation, adding that there is no definitive evidence from any study that that’s the case.
“Because of the nature of this study, it’s not legitimate to draw causal inferences,” he said. “The jury is out.”
Although it’s tempting to attribute the uptick in successful quit attempts to greater use of e-cigarettes, the issue is muddied by the occurrence of other changes in England during the study period that could have had an impact, Jorenby said.
As noted by John Britton, MD (UK Centre for Tobacco and Alcohol Studies, Nottingham, England), in an accompanying editorial, spending on mass media campaigns aimed at smoking cessation was cut dramatically after a new UK government was elected in 2010 and funding for the country’s stop-smoking services fell after policy changes moved the services from the National Health Service to local authorities.
“Uncertainties over the safety and role of e-cigarettes also generated reluctance in many stop-smoking services, at least until recently, to integrate e-cigarettes into treatment protocols; hence potentially discouraging e-cigarette users from accessing the services,” Britton writes. “These are all potentially strong confounders of the reported associations, but the authors were able to control only for spending on mass media campaigns.”
Thus, Britton says, it remains unclear how much e-cigarettes are helping people quit.
“However, the key arbiter of this and other controversies over the role of e-cigarettes lies less in these data than in trends in smoking prevalence, which in 2015 fell by nearly 1 percentage point relative to 2014,” he writes. “This significant year-on-year fall indicates that something in UK tobacco control policy is working, and successful quitting through substitution with e-cigarettes is one likely major contributor. The challenge for public health is to embrace the potential of this new technology, and put it to full use.”
Concerns That E-Cigarettes Hamper Quit Attempts
There are concerns that the rise in popularity of e-cigarettes could be undercutting efforts to get people to stop smoking, the authors note, pointing to previous research showing that licensed treatments and behavioral support programs for smoking cessation are being used less often over time.
To explore the potential impacts of growing e-cigarette use, the investigators examined data from the Smoking Toolkit Study, which involves repeated, cross-sectional household surveys of people ages 16 and older in England. The study included about 1,200 smokers quarterly between 2006 and 2015. The researchers also looked at data from the nation’s stop-smoking services.
During the course of the study, the use of e-cigarettes among smokers increased from a negligible proportion to 21.3%. The percentage of smokers who reported using e-cigarettes in a quit attempt reached 35.0% by the end of the study.
After adjustment for potential confounders, the success rate of quit attempts increased by 0.098% for every 1% increase in the prevalence of e-cigarette use and by 0.058% for every 1% increase in e-cigarette use during a quit attempt.
The use of prescription nicotine replacement therapy fell with growing e-cigarette use, but there were no clear relationships seen for the overall rate of quit attempts or use of over-the-counter nicotine replacement therapy, prescription medications, or behavioral support.
“The study findings conflict with the hypothesis that an increase in population use of e-cigarettes undermines quitting,” the authors write.
Perception That E-Cigarettes Are Useful
Despite the lack of evidence to support it, there is a perception among smokers that e-cigarettes can be a useful tool to aid quit attempts, Jorenby said. The reason is unclear, he added, pointing out that the US Food and Drug Administration has been strict in disallowing smoking-cessation claims in marketing by e-cigarette manufacturers.
It could be that e-cigarettes simply represent a more convenient alternative to other methods for quitting smoking, which might involve getting a prescription or going to a clinic, he said. “We’ve known for a long time that those are barriers,” Jorenby said. “It’s one of the reasons that [US] Public Health Service clinical practice guidelines have pushed so heavily for smoking cessation to be integrated into routine medical care.”
What place e-cigarettes might have in getting people to stop smoking remains to be worked out in future studies, as do the health effects of using them, which are currently unknown, Jorenby noted.
Beard E, West R, Michie S, Brown J. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. BMJ. 2016;Epub ahead of print.
Britton J. Electronic cigarettes and smoking cessation in England. BMJ. 2016;Epub ahead of print.
- The Smoking Toolkit Study is currently primarily funded by Cancer Research UK, and has previously also been funded by Pfizer, GlaxoSmithKline, and the Department of Health.
- Beard reports being funded by a fellowship from the National Institute for Health Research’s School for Public Health Research; receiving support from Cancer Research UK; and receiving unrestricted research funding from Pfizer.
- Britton reports serving as chair of the tobacco advisory group of the Royal College of Physicians and as a member of the board of trustees of Action on Smoking and Health.
- Jorenby reports no relevant conflicts of interest.