A new study published online ahead of print in the journal Internal and Emergency Medicine reports that among a sample of 40 patients with no desire to quit smoking who were offered electronic cigarettes, 16 of them (40%) were either completely smoke-free or had cut down on their cigarette consumption by more than one-half at two-year follow-up.
(See: Polosa R, Morjaria JB, Caponnetto P, et al. Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study. Internal and Emergency Medicine. Published online July 2013. DOI: 10.1007/s11739-013-0977-z.)
The study involved 40 smokers in Catania, Italy who were not interested in quitting smoking at the time of recruitment into the study. Subjects were offered electronic cigarettes and provided with up to a six-month supply if they were initially and continued to be interested. They were followed up for a total period of two years. The main outcome variable - success - was defined as either quitting smoking completely or cutting down by more than one half on the number of cigarettes smoked per day.
The chief study result was that, using an intent-to-treat analysis, 40% of the smokers with no initial desire to quit smoking had successfully either quit or cut down by more than half. Specifically, 12.5% of the smokers quit completely and 27.5% cut their consumption by more than half. In this latter group, median cigarette consumption dropped from 24 cigarettes per day at the beginning of the study to only 4 cigarettes per day at the 24-month mark.
The study concludes: "In conclusion, persistent long-term modifications in the smoking habit of smokers not intending to quit can be attained by using e-cigarettes. This behaviour could be sustained over a prolonged period of time by advancing to newer more efficient models, which were well tolerated by users. Although not formally regulated, the e-cigarette can help smokers unable or unwilling to quit to remain abstinent or reduce their cigarette consumption and currently may represent the ultimate tobacco cigarettes substitute."
The Rest of the Story
What is remarkable about these results, despite the small sample size, is that the 40% success rate was obtained among a sample of smokers who did not intend to quit and in the absence of any other intervention. There was no counseling, medication, or telephonic support. Nevertheless, a quit rate of 12.5% - based on intent-to-treat analysis - was obtained at 24 months and a greater than 50% reduction in cigarette consumption was achieved in 27.5% of the smokers.
Of course, with this small sample of 40 smokers, one has to interpret the results with caution. Nevertheless, these results are impressive and suggest that e-cigarettes may have great promise, especially for smokers who cannot or do not quit successfully with traditional therapies or who are not particularly motivated to quit smoking.
The rest of the story is that it is becoming more and more difficult for anti-smoking advocates to argue that there is no evidence that electronic cigarettes can help smokers quit. While these advocates continue to complain about smoking cessation claims made by some e-cigarette companies, it appears that these claims are actually true.