Electronic Cigarettes Show Promise as a Smoking Cessation Tool: New Study Finds E-Cigarettes May Be More Effective Than NRT for Quitting Smoking

A new study being published online ahead of print today in the American Journal of Preventive Medicine reports that electronic cigarettes are a promising tool to help smokers quit, producing six-month abstinence rates that are better than those for traditional nicotine replacement products (NRT). In a six-month follow-up survey of 222 first-time purchasers of electronic cigarettes, researchers from the Boston University School of Public Health found that 31.0% of respondents reported having quit smoking. This compares favorably to an average six-month abstinence rate of between 12% and 18% for NRT products. The authors conclude that electronic cigarettes are a promising method for smoking cessation. The study was led by Dr. Michael Siegel, Professor in the Department of Community Health Sciences at the Boston University School of Public Health.

The authors conducted an internet-based survey of a sample of first-time purchasers of electronic cigarettes distributed by a major electronic cigarette company six months after the initial purchase. The primary findings were the following:

• 31.0% of the respondents reported having quit smoking at six-month follow-up.
• Of those who had quit smoking, 34.3% had discontinued the use of electronic cigarettes as well.
• 66.8% of respondents reported having reduced the number of cigarettes they smoked after using electronic cigarettes.
• 48.8% of respondents reported having quit smoking for a period of time after using electronic cigarettes.
• Among respondents using electronic cigarettes frequently (more than 20 times per day), the six-month smoking abstinence rate was 70.0%.

The study’s main limitation is the low response rate of 4.5%. It is possible that those who responded to the survey were more likely to have quit smoking than those who did not respond. Nevertheless, despite this limitation, the study authors believe that this is the best evidence to date on the effectiveness of electronic cigarettes for smoking cessation. They point out that this is the first survey which relied upon an unbiased sampling frame. Despite the limitation, the authors conclude that electronic cigarettes “hold promise as a smoking-cessation method and that they are worthy of further study using more rigorous research designs.”

Dr. Siegel suggested that a major reason for electronic cigarettes’ apparent effectiveness as smoking cessation method is the fact that these devices address both the pharmacologic and behavioral aspects of addiction to smoking: “While it is well-recognized that nicotine plays a role in smoking addiction, little attention has been given to the behavioral aspects of the addiction. It is the fact that these devices simulate the smoking experience which appears to make them effective as a smoking cessation tool.”

A number of anti-smoking groups have argued that electronic cigarettes should be removed from the market because they have not been shown to be effective for smoking cessation, and several states – including New York – are considering bans on electronic cigarettes. “This study suggests that electronic cigarettes are helping literally thousands of ex-smokers to remain off cigarettes,” Dr. Siegel stated. “Banning this product would invariably result in thousands of ex-smokers returning to cigarette smoking. Removing electronic cigarettes from the market would substantially harm the public’s health.”

Co-authors of the study were Kerry L. Tanwar and Kathleen S. Wood, also of the Boston University School of Public Health.

The press release about the study issued by the Boston University School of Public Health can be found here.

The Rest of the Story

I think there are several important findings from the study that should be emphasized.

First, although the response rate was low, there is no particular reason to believe that smokers who quit were more likely to respond. The respondents were not told that this survey was about electronic cigarettes. They were told only that it was a survey about smoking experiences. Although it is possible that smokers who quit were more likely to respond, we do not have any particular reason to believe that was the case. Nevertheless, the results should be viewed as preliminary and further examination of this research question using more rigorous research designs is clearly warranted.

Second, regardless of the ultimate quit rates, the study suggests that electronic cigarettes are effective in helping smokers reduce the amount they smoke and at least temporarily quit smoking. This is critical because even reducing the amount smoked has a profound effect on health risk (despite the propaganda of the Surgeon General's office).

Third, the study suggests that electronic cigarettes may actually be more effective than traditional nicotine replacement therapy. I believe the reason for this is that these products address both the pharmacologic and behavioral aspects of smoking addiction. The fact that vaping looks like smoking is precisely the fact which drives the anti-smoking groups crazy, but it is also the fact which makes electronic cigarettes so promising as a smoking cessation tool.

Fourth, the study suggests that people who use electronic cigarettes more frequently are more successful in quitting smoking. This is important because it means that if public education campaigns were to instruct people on the proper use of the product, it could be even more effective than it already is. In other words, if anti-smoking groups and the FDA embraced electronic cigarettes as a smoking cessation method rather than working to ban the product, it could become an even more effective smoking cessation tool.

Finally, while there is widespread speculation that people who use electronic cigarettes are only substituting one addiction for another, our study found that one-third of customers who quit smoking using electronic cigarettes were actually nicotine-free at six months after first purchase of the product.

Nevertheless, it is important to point out that even if people who quit smoking using e-cigarettes continue to use these devices, they are still ex-smokers. They have quit smoking successfully and will reap enormous health benefits.