Smokers who switched to e-cigarettes were nearly twice as likely to quit traditional cigarettes as people who used nicotine patches, gum, or similar nicotine replacement products, according to a new study published Wednesday in the New England Journal of Medicine.
Vaping companies have long argued e-cigarettes can help smokers quit, but until now, there's been no clear evidence from randomized control trials. As such, the devices have not been approved in the United States or elsewhere to be marketed as a smoking cessation tool.
The new study sought to fill that scientific gap and examine whether e-cigarettes are as effective as traditional smoking cessation products. For the study, researchers at Queen Mary University of London recruited 886 patients who wanted to quit smoking and divided them into two randomly assigned groups. One group received free traditional smoking cessation treatment—nicotine patches, gum, inhalers, and other nicotine replacement products—for up to three months. The other group received a free e-cigarette starter kit and a bottle of tobacco-flavored nicotine vaping liquid. Participants in the e-cigarette group were then instructed to buy more e-liquids or flavors of their choice
Participants in both groups also received up to four weekly in-person counseling sessions. The clinical trial spanned from May 2015 to February 2018, and participants were tracked for one year.
The study found participants who were randomly assigned to the e-cigarette group quit smoking traditional cigarettes at nearly double the rate of those in the nicotine replacement therapy group.
After one year, the researchers found 18% of participants in the e-cigarette group had abstained from traditional cigarettes, compared with 9.9% among those in the nicotine replacement therapy group.
However, the study found participants who had quit smoking using e-cigarettes were more likely than those in the nicotine replacement group to still rely on their cessation product. At the 12-month point, 80% of those who quit smoking using e-cigarettes were still vaping, while only 9% of participants who had quit smoking using nicotine replacement products continued to use them.
Maciej Goniewicz, a co-author of the study who is now a pharmacologist at the Roswell Park Comprehensive Cancer Center in New York, said there are a number of factors that likely contributed to the e-cigarettes' success as a smoking cessation method. "It's about the method of delivery, the quantity of nicotine and the user's behavior," he said, adding, "E-cigarettes have the advantage that the user decides how and when to puff. Nicotine replacement therapy products have specific instructions, which are different for different products."
What this means for the future of e-cigarettes
While some experts praised the study and noted it could be the first step in legitimizing e-cigarettes, others noted that several unanswered questions remain about the long-term health effects of vaping, the speed at which the vaping industry is advancing, and products' popularity among teens.
For instance, Neal Benowitz, chief of clinical pharmacology at the University of California, San Francisco, who was not involved in the study, said, "This is a seminal study" that "is so important to the field."
However he acknowledged that "[t]here is an unavoidable tension between protecting kids from e-cigarettes and smoking cessation, which is also very important."
An accompanying editorial published in NEJM called on FDA to ban all e-cigarette nicotine flavors because they appeal to teens. Juul, a leading seller of e-cigarettes in the United States, has become a "teen status symbol," according to recent media reports, and late last year the company voluntarily said it would stop selling several of its flavored e-cigarettes in retail stores. FDA shortly after said it planned to ban the sales of methanol-flavored cigarettes and cigars in the United States and limit the sales of flavored e-cigarettes.
However, experts also noted that e-cigarettes have advanced since the study launched and the finding may not be applicable to newer products, such as Juul, which have higher nicotine concentrations.
And while there's some research that e-cigarettes contain fewer toxic chemicals than conventional cigarettes, experts say the long-term health effects of vaping are still unknown. In a separate accompanying editorial, Belinda Borrelli, a behavioral health expert and George O'Connor, a pulmonologist, said those unknowns are particularly concerning given the high percentage of e-cigarette users in the study who continued to vape a year after they quit smoking.
Borelli and O'Connor recommended smokers take up e-cigarettes only if other cessation approaches have failed. They also advised people looking to quit via e-cigarettes to use the lowest dose of nicotine available and to work with their health care providers to set a clear timeline for ending e-cigarette use (Hoffman, New York Times, 1/30; Belluz, Vox, 1/30; Harris, "Shots," NPR, 1/30; McGinley, Washington Post, 1/30).
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