Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

Posted 29th August 2014 by Toby Kilroy
Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study was carried out by Jamie Brown, SSA Research Fellow, Emma Beard, Research Associate, Daniel Kotz, Assistant Professor, Susan Michie, Professor of Heath Psychology, Robert West, Professor of Health Psychology on behalf of Cancer Research UK Health Behaviour Research Centre, University College London, WC1E 6BT, UK, the Department of Clinical, Educational and Health Psychology, University College London, London, UK, the Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands and the National Centre for Smoking Cessation and Training, London, UK.

This research was published in Addiction magazine. Due to other reports released at the same time this work ought to be considered in conjunction with them, and so reference is made where relevant in this review.

Prior to the report:

The ASH UK report was released shortly before this one. It confirmed that:

  • There is no evidence of harm in the short to medium term.
  • Electronic cigarettes are far safer than cigarettes.
  • There is no evidence of children using them as a gateway into smoking.
  • Plenty of evidence exists to the contrary.
  • Flavours do not encourage children to vape.
  • As sales of e-cigarettes have increased the sales of cigarettes fell.

The previous edition of Addiction carried an article by Nicolas Franchitto from the Poisons and Substance Abuse Treatment Centre in Toulouse. He wrote:

  • French judges have decided to define e-cigarettes as tobacco products even though they may not contain any tobacco as they “look like cigarettes”.
  • The judges have ignored all scientific evidence and public health benefits
  • The judges have focussed on the commercial and financial aspects of e-cigarettes.

How was the research paid for?

Funding came from the following:

  • UK Society for the Study of Addiction
  • Cancer Research UK
  • The Department of Health
  • Pfizer, GlaxoSmithKline, Johnson and Johnson, McNeil, Nabi, Novartis, Sanofi-Aventis

Of note:

There are companies with direct interests in NRT. Also, there is no funding from any electronic cigarette or juice manufacturer.

Participants:

  • 5,863 adults were consulted.
  • Each adult was a smoker and had made a minimum of one failed quit attempt in the previous year.
  • A cross-section of households representing the population of the UK were surveyed on a monthly basis between 2009 and 2014.
  • 8% had tried and failed using electronic cigarettes.
  • 33% had tried and failed using NRT.
  • 59% had tried and failed by going without any nicotine substitute.

Measurements:

  • Measured by reported abstinence from smoking

The findings:

  • The largest success in quitting was achieved by people using electronic cigarettes. 
  • Electronic cigarettes are more successful than NRT and going without either regardless of the quantity, strength or length of time a smoker had been smoking.

The report references:

  • Up to 6,000,000 die from preventable smoking-related diseases each year.
  • Diseases are directly linked to cigarette smoke, not nicotine.
  • Vapour appears to reduce nicotine craving when used to replace smoke.
  • Electronic cigarettes are orders of magnitude safer than cigarettes due to the measurably smaller quantities of poisonous toxins.
  • Electronic cigarettes have increased in use, from 2% in 2010 to 30% in 2012 in the USA. This is replicated in UK adoption rates.
  • Effectiveness depends on the type of electronic cigarette used, the way it was used and whether the individual chose to use them.
  • Several studies including one long-term study consistently reported users claiming that electronic cigarettes helped them to reduce or stop cigarette use.
  • People who began studies as electronic cigarette users were likely to remain using electronic cigarettes.
  • ASH UK’s “The Smoking Toolkit” has been tracking electronic cigarette use since 2009. 

How “non-smokers” were measured:

  • Subjects were asked: "How long did your most recent serious quit attempt last before you went back to smoking?” If they replied they were still not smoking they were classified as non-smokers.
  • They were asked how often they felt the urge to smoke a cigarette.
  • They were asked how strong the urge was.
  • The answers were categorised by age, sex and into two social groups.

Conclusion:

  • Electronic cigarettes help people to quit smoking
  • NRT offers little benefit over any other method of trying to quit,
  • Robert West asks why medicine regulation should be applied to electronic cigarettes, an already successful and safer method.
  • The report does not look at the re-normalisation of smoking but notes that the growth in the use of e-cigarettes has happened since 2010 with a linked reduction in general smoking, begging the conclusion that electronic cigarettes they do renormalise smoking.

Also in this issue of Addiction:

Hitchman, McNeill and Brose contributed an article entitled “Electronic cigarettes: time for an accurate and evidence-based debate”. They wrote:

  • Current research and commentaries on electronic cigarettes…vary widely in quality, accuracy and objectivity. While these issues are not limited to the research community, we believe that researchers need to demonstrate better scholarship in this area.”
  • That the electronic cigarette should be considered in its own category for the reason that cars are not the same as horse-drawn carriages.
  • That they do not contain tobacco and should not be considered together with tobacco products.
  • That in the absence of any reliable evidence they lead to smoking no further reference should be made to it without sound research data.

Quotes following the release of the report:

Professor Robert West: “E-cigarettes could substantially improve public health because of their widespread appeal and the huge health gains associated with stopping smoking. However, we should also recognise that the strongest evidence remains for use of the NHS stop-smoking services. These almost triple a smoker’s odds of successfully quitting compared with going it alone or relying on over-the-counter products.”

Clive Bates: “I am just sick of being told that medicine regulation guarantees the efficacy of these products and medicine regulation will make e-cigarettes better products, or that e-cigarettes need to be evaluated scientifically… blah blah… all of that has been done for NRT and what has it led to?

Jonathan Lampon, Radio Leicester: “Do electronic cigarettes work?”

Louise Ross, Leicester Stop Smoking Service: “Yes, they do!”

Katherine Devlin, ECITA: “Further research studies will always be welcome but it is so important other stop smoking campaigns adopt Louise’s approach. NRT can work well when coupled with a behavioural approach but that it now needs to be done in tandem with electronic cigarettes – the end goal being to save lives.”

Top Photo credit: MattysFlicks via photopin cc


 Toby Kilroy
Article by Toby Kilroy
Toby set up Planet of the Vapes in 2012 after another major vaping site was taken down. With a history in web development and running websites for clients he was well placed to use his previous knowledge to build and run a site on the scale of POTV.