E-cigarettes less effective than other smoking cessation methods

smoking cessation
© iStock/AndreyPopov

Research from the US has illuminated that using e-cigarettes is not as effective at smoking cessation as other methods.

For tobacco smokers, there is a range of methods for smoking cessation – the act of quitting smoking – with one approach, popularised in recent years being the implementation of e-cigarettes. However, novel research has suggested that vape pens may not be the most optimal method to curb a smoking habit, finding that other aids, such as nicotine replacement therapy (NRT) or medication, may be more effective.

The study, published in the journal Tobacco Control, discovered that e-cigarettes were associated with seven fewer successful attempts per 100 compared to pharmaceutical aids. Moreover, former smokers were not less likely to relapse using e-cigarettes than those who did not use them.

The boom of e-cigarettes

E-cigarettes first rose to prominence in the US in 2007, becoming a widely used smoking cessation aid by the mid-2010s, with sales doubling between 2014 and 2016. Recent statistics estimate that over 50 million people use e-cigarettes globally, with other data from the US Food and Drug Administration demonstrating that five million high school children use vapes in the US.

Although clinical trial data shows that e-cigarettes help people quit smoking, studies performed in real-life situations have been more equivocal, such as the impacts of high dose nicotine (4%+) content. Due to the widespread utilisation of e-cigarettes, the team examined their performance as a smoking cessation aid between 2017 and 2019 in the US.

Evaluating smoking cessation aids

The team employed data from the 2017 Population Assessment of Tobacco and Health (PATH) Study, a country-wide, long-term analysis of tobacco use in the US and how it impacts health. PATH included data on 3,578 established smokers who had recently tried to quit and 1,323 recent former smokers.

Participants were questioned on what smoking cessation aids they had tried, such as e-cigarettes, NRT—nicotine patch, gum, inhaler, nasal spray, lozenge, or tablet; other tobacco products; or the pharmaceuticals Chantix, varenicline, Wellbutrin, Zyban or bupropion. Additionally, people who used e-cigarettes were asked what strength of product they used. Abstinence from cigarettes and tobacco was deemed to be a period of 12 or more consecutive months.

The team collected information on potentially influential factors, for example, ethnicity, household income, level of tobacco dependency, time since last quit attempt, and age when they started smoking. The performance of e-cigarettes as a smoking cessation aid was assessed as reaching over 12 months of abstinence and compared the e-cigarettes with NRT, listed pharmaceuticals, and no nicotine replacement at all.


E-cigarette sales significantly increased in 2017; however, the number of people who quit smoking did not mirror this rise. The findings elucidated that over 12% of people who had recently tried to quit smoking used e-cigarettes either exclusively or in combination with other products. 2.5% used other tobacco products, 21% used NRT or a pharmaceutical aid, and 64% did not use anything.

Of the recent former smokers, over 15% switched to e-cigarettes, and 16% said they had used another tobacco product, with the rest not using anything. Only 24% of the e-cigarette use reported using 4% or more nicotine strength. By 2019, the amount of recent former smokers who had switched to e-cigarettes rose to 22%, at which point they were using a high nicotine content.

Those who used e-cigarettes to quit smoking prior to the survey were less likely to have successfully quit by 2019 than those who used nothing at all – 10% versus 19%. After accounting for potentially influential factors, using e-cigarettes was attributed to seven fewer successful quitters per 100 would-be quitters than other pharmaceutical aids.

Furthermore, switching to e-cigarettes did not reduce the risk of relapse in comparison to people who did not use them; 60% of recent former smokers who used e-cigarettes daily returned to smoking by 2019.

Due to this being an observational study, the researchers cannot establish a cause, and it is unclear how the increase in high nicotine content e-cigarettes in 2019 will impact smoking cessation attempts.

The researchers concluded: “This analysis did not show a cessation benefit from using e-cigarettes either to help a cessation attempt or as a substitute for cigarette smoking. However, there is evidence that cigarette smokers were starting to use high nicotine e-cigarettes by 2019, and further follow-up in PATH is needed to see whether these changes result in future cessation benefit.”

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