E-cigarettes have emerged as an important public health issue, particularly with regard to their effectiveness in helping smokers quit. A recent study published in the New England Journal of Medicine provides definitive evidence: e-cigarettes are nearly twice as effective as traditional nicotine replacement products, such as patches and gum, in helping people quit smoking.
The study, conducted in the United Kingdom and funded by the National Institute for Health Research and Cancer Research UK, followed 886 smokers for one year. Participants were randomly assigned to use either e-cigarettes or traditional nicotine replacement therapies. Both groups also attended at least four weekly counseling sessions, which are considered crucial for success.
The results were striking. The quit rate was 18 percent for the e-cigarette group, compared with 9.9 percent for those using traditional nicotine replacement therapy. Although the success rate was still relatively low, many researchers saw it as the hard evidence they had been looking for.
This study could provide new legitimacy to e-cigarette companies, which have faced criticism for contributing to a vaping epidemic among teens. But it also highlights the challenge of keeping these devices away from young people while making them available for clinical use. Tobacco use causes nearly 6 million deaths worldwide each year, and if current trends continue, this number is projected to reach 8 million by 2030.
E-cigarettes deliver nicotine without the toxic tar and carcinogens found in burning tobacco. However, they have not been approved by regulators in the United States, the United Kingdom and elsewhere as a smoking cessation tool. Health professionals have been reluctant to recommend their use because of a lack of clear evidence from randomized controlled trials. This new study may change that.
The New England Journal of Medicine devoted much of its current issue to e-cigarettes, reflecting the complex public health debate surrounding the devices. An editorial noted that 80 percent of study participants who quit using e-cigarettes were still vaping after one year, raising concerns about ongoing nicotine addiction and the unknown health consequences of long-term e-cigarette use.
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The clinical trial was conducted from May 2015 to February 2018. Participants were typically middle-aged, smoked between half a pack and a pack a day, and had already tried to quit. The e-cigarette subjects were given a starter kit with a refillable device and a bottle of tobacco-flavored nicotine e-liquid. They were free to choose their preferred flavor and nicotine level after finishing the first bottle.
In contrast, nicotine replacement therapy users could choose from several products, including patches, gum, lozenges, and nasal sprays. They were encouraged to combine these products, with most choosing a patch and oral therapy.
The study’s success was validated by measuring carbon monoxide levels in participants’ breath, a more reliable method than self-reports of smoking abstinence. Researchers attribute the success of e-cigarettes to a combination of factors, including delivery method, nicotine level and user behavior.
E-cigarettes allow users to decide how and when to puff, unlike nicotine replacement therapy products, which come with specific instructions. In addition, e-cigarette users reported higher satisfaction with their devices than those using other products, which may explain the higher quit rates and compliance.
While this study provides valuable insights, it also raises questions about the long-term effects of e-cigarette use and the potential for continued nicotine addiction. Some researchers hypothesize that high-nicotine products like Juul may be even more effective at helping smokers quit because they deliver a powerful nicotine punch with fewer puffs, potentially reducing harmful aerosol inhalation.
However, recent studies on the harmful effects of nicotine have raised concerns. In Colorado, which led the nation in underage vaping in 2017, free counseling is available through the Colorado QuitLine for kids as young as 12 who are trying to quit any nicotine product.