New research concludes the rise of e-cigarette use in England is linked to higher rates of successful quitting attempts by smokers of regular cigarettes. The finding would suggest concerns that vaping undermines motivation and attempts to quit smoking are misplaced.
Researchers from University College London in the United Kingdom report their study in the BMJ, where a linked editorial suggests it shows successful attempts to quit smoking regular cigarettes by switching to e-cigarettes is a likely contributor the fall in smoking rates in the U.K.
E-cigarettes (electronic cigarettes) are growing in popularity. In the U.K. alone there are now over 2 million users.
Unlike conventional cigarettes, e-cigarettes do not burn tobacco but use battery power to vaporize a solution that the user inhales or "vapes." The solution comes in various flavors and may contain nicotine and other chemicals.
Although much controversy surrounds the use of e-cigarettes, there is a growing consensus among health organizations in the U.K. that because they allow users to inhale nicotine without the deadly toxins present in tobacco smoke, e-cigarettes could have a significant effect on reducing disease and premature deaths among regular smokers.
However, on the other side of the debate are concerns that e-cigarettes could reduce smokers' motivation to quit because they offer a socially acceptable way to consume nicotine in places where tobacco smoking is now banned.
The new study explores these concerns by analyzing two sources of information: the Smoking Toolkit Study, which gives the researchers 10 years of data gathered in a monthly survey of smoking, quitting, and e-cigarette use among adults in England; plus quarterly data on numbers of adults using National Health Service (NHS) stop smoking services in England and their quit rates.
From their analysis, the researchers suggest that in 2015, use of e-cigarettes may have resulted in an extra 18,000 long-term smokers joining the ranks of ex-smokers.
- Tobacco kills around 6 million people worldwide each year
- More than 1 in 10 of deaths from tobacco use are due to non-smokers being exposed to second-hand smoke
- Over 1.3 billion people (18 percent of global population) are protected by comprehensive, national smoke-free laws.
They remark that while this is not a big figure, it is "clinically significant because of the huge health gains from stopping smoking."
For example, the authors note that compared with continuing smoking, a 40-year-old smoker can expect to gain 9 years of life if they cease smoking for good.
They are careful to point out that the observational nature of their study - which is designed to look for links - cannot show that e-cigarette use has directly led smokers to quit conventional cigarettes.
However, given that the study shows increase in e-cigarette use is linked to an increase in success of quit attempts, they suggest this conflicts with the suggestion that "an increase in population use of e-cigarettes undermines quitting in general."
The researchers also looked at links between use of e-cigarettes and other trends such as rate of quit attempts (whether they succeeded or not), use of over-the-counter nicotine replacement products, overall use of prescribed treatments, and use of NHS quit smoking services.
Fall in prescription nicotine replacement treatments
The researchers found increased use of e-cigarettes does not appear to be linked with a detectable change in overall attempts to stop smoking (as opposed to successful attempts - where they did find a link).
However, they did find that rise in e-cigarette use is tied to a decline in prescription nicotine replacement treatments. They speculate this could be because e-cigarette users have already tried these alternatives, but that would have to be further investigated to be sure.
In a linked editorial, John Britton, professor of epidemiology at Nottingham University School of Medicine, says the study indicates that "successful quitting through substitution with electronic cigarettes is a likely contributor to the falling prevalence of smoking."
He suggests says a number of factors, including some not measured in the study, may have influenced the results, so it is not possible to say for sure how much the availability of e-cigarettes many have influenced people's quitting behavior in the U.K.
Nonetheless, he suggests the figures show "something in UK tobacco control policy is working," and people using e-cigarettes to help them give up smoking for good is likely to be a major factor.
"The challenge for public health is to embrace the potential of this new technology, and put it to full use."
Prof. John Britton