E-cigarettes much more effective for traditional cigarettes finds study

A new large study from University College London researchers has shown that people who use E-cigarettes to aid them in quitting traditional cigarette smoking are 95 percent more likely to succeed when compared to those who are not using any “stop-smoking aids”. The study supported by the Cancer Research UK was titled, “Moderators of real‐world effectiveness of smoking cessation aids: a population study,” was published in the journal Addiction last week (22nd of May 2019).

Electronic cigarette in the back pocket of a blue jean. Image Credit: Cagkan Sayin / Shutterstock
Electronic cigarette in the back pocket of a blue jean. Image Credit: Cagkan Sayin / Shutterstock

The World Health Organization data reveals that smoking tobacco kills over 7 million individuals each year around the world. Poor and middle income countries hold around 80 percent of the 1.1 billion smokers, says the WHO data. The team explains that e-cigarettes do not contain tobacco but have liquids that contain lower levels of nicotine. The user inhales this liquid in the form of vapour. British American Tobacco, Imperial Brands and Japan Tobacco as well as other major tobacco brands sells e-cigarettes as well.

The team of researchers compared smoking de-addiction effectiveness of e-cigarettes, nicotine replacement therapy (NRT) patches and gum and drug Varenicline brand named Champix sold by Pfizer in UK. Other approaches include drug therapy with bupropion, telephone and face-to-face behavioural support, self help materials, self help websites and hypnotherapy. They did not just determine the individual efficacy of these aids but also took into consideration other factors that may affect the rates of quitting smoking such as age of the individual, socioeconomic parameters, level of cigarette addiction, earlier attempts to quit smoking and if the attempts were abrupt of gradual. This study looked at 18929 people living in England who had attempted to quit smoking in the past 12 months. Data was gathered from individuals for a 12 year period between 2006 and 2018. Those who said they were not smoking anymore were deemed to be successful quitters says the study.

Results revealed that those prescribed Champix were 82 percent more likely to quit smoking when compared to those who were not using any aids. On the other hand 95 percent success was seen among those using e-cigarettes when compared to those who were using no means to quit smoking. Those using NRT or nicotine replacement gums and patches were only 34 percent more likely to quit smoking, says the study. NRT was more successful among older individuals (more than 45 years) compared to younger. Self help websites showed some success in helping quitters especially those in lower socioeconomic status compared to those at a higher social grade. Other approaches were deemed to be ineffective in helping quitting smoking, write the researchers.

Study lead author Sarah Jackson, a professor at University College London explained, “Stopping smoking reduces the risk of chronic diseases and increases quality of life and life expectancy. It is therefore important that every quit attempt has the best possible chance of success. Our study adds to growing evidence that use of e-cigarettes can help smokers to quit.” She added, “It also raises concerns about the apparent lack of effectiveness of NRT bought from a shop.” The study showed efficacy of NRT when prescribed rather than when bought over the counter.

Dr Jamie Brown, study co-author added, “It is important that e-cigarettes appeared to be equally effective for smokers of all ages and social backgrounds. Smoking is one of the biggest contributors to health inequality between rich and poor and the growth in e-cigarette use may ultimately start to reduce this gap.”

Peter Hajek, director of the tobacco dependence research unit at Britain's Queen Mary University of London, in a statement said, “They (e-cigarettes) help smokers quit at least as much as stop-smoking medications, and they are used by many more smokers. This means they generate many more quitters and do this at no cost to the NHS (National Health Service).”

Dr Debbie Robson, a tobacco addiction researcher at King's College London, in a statement said, “They [smokers] may well be better off investing in alternative nicotine replacement such as e-cigarettes.”

Dr Leonie Brose, senior lecturer at the National Addiction Centre, King's College London, lauded the study saying, “This is in line with what has already been found in randomised controlled trials and extends these findings to adult smokers in the real world. While success rates were similar for varenicline and vaping, vaping is much more popular among smokers trying to quit smoking and thus helped more smokers quit.”

Dr Penny Woods, chief executive of the British Lung Foundation also said, “This study highlights how crucial face-to-face support is for helping people to stop smoking. This study also provides further evidence that e-cigarettes are an effective quitting tool. The choice to switch to e-cigarettes must be made easier.” She added, “Doctors and pharmacists should be very clear there's a range of quitting tools available including e-cigarettes, and smokers can try vaping as a way to quit.”

The Public Health England (PHE) also recommends prescription of e-cigarettes by the NHS saying that it is 95 per cent less harmful than cigarette smoking and can help people who wish to quit.

Martin Dockrell, tobacco control lead at PHE in a statement said, “This is yet more evidence, adding to a major recent UK trial, that vaping offers some of the most effective help for smokers to quit smoking, especially when combined with expert support. All we need for an e-cigarette to be available on prescription is for one to be licensed as a medicine.”

Several experts are however sceptical about promotion of e-cigarettes as an alternative to smoking saying that their long term effects are unknown and the “safe” tag may mean that more and more young persons may pick up smoking e-cigarettes. Professor Martin McKee, of the London School of Hygiene and Tropical Medicine voiced his concerns about safety of e-cigarettes last month. He said, “The nicotine in e-cigarettes is not a harmless drug and then there are all these other things such as flavourings that are inhaled. We haven't had e-cigarettes for long enough to know the true effects. But when we look at the evidence we do have, there are enough grounds for serious concerns.” “Given the short-term effects on lung function and cardiovascular effects, there is enough evidence to say we should be very, very careful,” he added.

Related study

This year in February authors Peter Hajek and colleagues from Queen Mary University of London, also published a study in the New England Journal of Medicine titled, “A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy.”

The team assigned 886 adults attending U.K. National Health Service stop-smoking services randomly either e-cigarettes starter packs or NRT. In addition all were provided weekly behavioral support for at least 4 weeks.

Results showed that 1 year of abstinence rate was 18 percent among those who used e-cigarettes and 9.9 percent among those who used NRT. At 52 weeks of the trial 80 percent of those on e-cigarettes were still using their prescribed therapy compared to 9 percent in the NRT group. Further cough and phlegm production was lower among e-cigarette users compared to those who used NRT, the researchers wrote.

Authors concluded, “E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.” The study was funded by the National Institute for Health Research and Cancer Research UK.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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