e-Cigarettes Can 'Help Smokers to Stop'

Theresa Bebbington

July 27, 2017

New evidence shows that a rise in e-cigarette use may be associated with an increase in people giving up smoking tobacco products, suggesting there should be a more liberal approach to e-cigarette regulations.

e-Cigarettes – or vapourizers – are battery-powered electronic cigarette devices that usually contain liquid nicotine and provide a vapour when inhaled instead of smoke.

Using an e-cigarette is often known as vaping, and vaping can be used a substitute for smoking tobacco products.

The UK charity ASH (Action on Smoking and Health) says that e-cigarettes are safer than smoking tobacco products. While vaping can provide nicotine (the addictive substance) to the user, it does so without the dangerous chemicals linked to smoking tobacco products such as tar.

International Regulations

Regulation policies on e-cigarettes vary across countries.

In the UK, they are licensed as a smoking cessation aid but must deliver nicotine in a similar way as existing nicotine replacement therapies and must pass safety standards.

In Australia, however, they are banned if they contain nicotine.

In the USA, they are often sold as a recreational product to avoid tighter regulations that come with a claim of being a smoking cessation aid.

The scientific community has been divided on the use of e-cigarettes: could they lead to more people stopping smoking tobacco products, or do they encourage smokers to continue to smoke because they reduce the urgency to stop smoking?

One argument is that if smokers who use e-cigarettes along with cigarettes delay attempts to stop smoking, although e-cigarettes may help some people to stop smoking, the overall population impact would be negative.

An editorial published in The BMJ (formerly the British Medical Journal) notes that there's been considerable debate on the subject since e-cigarettes first appeared almost a decade ago, saying that claims and counterclaims on the device's effectiveness on stop smoking rates are based more on speculation than evidence.

Meanwhile, the use of e-cigarettes has been on the rise. In Great Britain, for example, ASH estimates that about 2.9 million adults are currently using e-cigarettes, an increase of 700,000 people since 2012. There has also been a rise in the use of e-cigarettes in the US. It first became obvious in about 2010 and increased dramatically by 2014.

Researchers based in California set up a study, published in the BMJ, to examine whether the increased use of e-cigarettes in the US has led to a change in the use of tobacco products. They looked at whether e-cigarette users stopped smoking at a higher rate than non-users, and whether smokers in 2014–15 stopped smoking at a higher rate than those in 2010–11.

Analyzing Population Studies

The team, led by Professor Shu-Hong Zhu of the University of California, examined data from 5 population surveys taken between 2001 and 2015.

They identified e-cigarette users in a 2014–15 survey – the largest representative sample of e-cigarette users in the US population – and smoking cessation rates of those who reported smoking cigarettes 12 months before the survey.

There were 161,054 respondents, and of these 22,548 were current smokers and 2,136 had recently stopped smoking. Of the current smokers, 38.2% had tried e-cigarettes, and of those who stopped smoking, 49.3% had tried e-cigarettes.

The researchers compared the rates from the 2014–15 survey to the four earlier surveys. They found:

  • e-Cigarette users were more likely than non-users to try to stop smoking (65% compared to 40%)

  • e-Cigarette users were more likely than non-users to stop smoking for at least 3 months (8.2% compared to 4.8%)

  • The overall US population stop smoking rate for 2014–15 was significantly higher than in 2010–11 (5.6% compared to 4.5%) – this 1.1% represents about 350,000 additional people who stopped smoking in the USA

In responding to the study, Professor Linda Bauld, professor of Health Policy at University of Stirling, notes: "This is the largest observational study carried out anywhere in the world so far examining trends in smoking cessation amongst adults who have used e-cigarettes."

She points out that similar trends have been observed in the UK, although using much smaller samples. Dr Bauld says: "The fact that patterns are similar between two countries that permit e-cigarette use (and do not heavily regulate them) is important. It suggests that e-cigarettes may have acted to accelerate existing downwards trends in smoking, and this needs to be carefully considered by governments in other countries who still ban these devices or make them very difficult for smokers to obtain."

ASH has also responded to the study, saying that it's findings are in line with UK trends and noting the charity's views that smokers using e-cigarettes are more likely to try to quit smoking and be more successful.

In a recent 2017 ASH survey, of the people who use e-cigarettes, 52% are now ex-smokers. The main reason ex-smokers give for vaping is to help them stop smoking.

Deborah Arnott, chief executive of ASH, says: "Smokers should be reassured that e-cigarettes are significantly less harmful than smoking tobacco and that switching to vaping is a positive choice which could help them quit."

Could There Be Other Reasons Participants Stopped Smoking?

The US study led by Professor Shu-Hong Zhu has certain limitations. The questions used in the survey were limited, so the researchers would not have been able to make a detailed analysis, including on the impact e-cigarettes have on different population groups, such as those with the highest smoking rates. In addition, it would be difficult for the researchers to adjust their findings for other interventions that occurred during the survey periods. For example, since 2012, there has been a national campaign in the USA with TV advertisements highlighting the serious health consequences of tobacco use. There was also a huge increase in federal tax on tobacco products in 2009.

Dr Bauld points out that the survey "…did not ascertain what types of e-cigarette devices smokers were using, or how frequently, both factors that have been shown in other studies to be important for smoking cessation". She says more research is necessary to examine long-term trends, using similar large samples but with more detailed measures.

Dr Jamie Hartmann-Boyce, senior researcher in Health Behaviours, University of Oxford, and managing editor of the Cochrane Tobacco Addition Group, says: "Observational studies of this type have several limitations, the main one being that it is difficult to establish causation – for example, was it the electronic cigarettes that caused people to stop smoking or was it something else about the e-cigarette users that made them more likely to quit?"

However, Dr Hartmann-Boyce also says that the "findings from this study are promising", and that along with evidence from other studies, it suggests "that electronic cigarettes with nicotine may help people stop smoking".

SOURCES:

E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys, BMJ Editorial and press release

ASH (Action on Smoking and Health)

Science Media Centre

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