Study Compares E-Cigarettes to Quit-Smoking Aids

A new study is likely to influence the discussion surrounding electronic cigarettes and whether they can be effectively used as a quit-smoking aid. Researchers in New Zealand found that e-cigarettes were about as effective as nicotine patches in helping people in the study quit smoking. Published online September 8, 2013 in The Lancet, the study is the first to assess whether e-cigarettes work as well as an established quit-smoking aid.

The trial included 657 smokers who wanted to quit. For 3 months, 289 of the participants received e-cigarettes, 295 received nicotine patches, and 73 received placebo e-cigarettes, which contained no nicotine. The researchers then followed the participants for 3 more months to determine whether they had quit smoking. They found that 7.3% of those in the e-cigarette group had successfully quit smoking, compared with 5.8% in the nicotine patch group and 4.1% in the placebo e-cigarette group. The differences in results are not statistically significant, meaning each group had about an equal chance of quitting.

However, the e-cigarette users who did not quit completely reported smoking fewer cigarettes at the end of the trial. The study’s authors interpret this as a positive outcome, because harms from smoking are generally related to the number of cigarettes smoked as well as number of years smoking.

Reasons for caution

E-cigarettes look like regular cigarettes, but they are operated by battery. An atomizer heats a solution of liquid, flavorings, and nicotine that creates a mist that is inhaled. The devices are not yet regulated, though the US Food and Drug Administration (FDA) has announced its intention to begin doing so.

According to Thomas J. Glynn, PhD, American Cancer Society's director of cancer science and trends and international cancer control, e-cigarettes may one day turn out to be a useful tool to help people quit smoking. But until the FDA regulates them and more research is conducted, he says users won’t know for sure what they’re inhaling or how much nicotine they’re getting.

“The results suggest that e-cigarettes may be useful as a cessation tool, but no more so than nicotine patches, which are currently a commonly-used and physician-recommended cessation tool which have undergone years of testing and research. E-cigarettes are still in the early phases of testing.”

Until FDA regulation can provide users with a safety profile and research provides more evidence that e-cigarettes are a safe and effective quit-smoking aid, Glynn says people should stick to an FDA-approved quit smoking medication.

“The FDA-approved medications are not a panacea or a magic bullet, but they are safe and they do work,” said Glynn. “They work particularly well if one follows the directions carefully.” FDA-approved quitting aids include nicotine replacement products as well as certain prescription medicines. Counseling or other types of emotional support can help, too.

A changing industry

Sales of e-cigarettes have risen rapidly since their invention 10 years ago. According to the Centers for Disease Control and Prevention (CDC), about 1 in 5 adult smokers of traditional cigarettes in the US have also tried e-cigarettes.

In addition to requiring that e-cigarette labels list their ingredients, FDA regulations could also prohibit e-cigarette promotion and sale to youth. A recent report from the CDC found that youth are using e-cigarettes in increasing numbers, and calls for strategies to reduce the availability and attractiveness of e-cigarettes to children and youth.

More than 200 companies manufacture different types of e-cigarettes, and their quality and type vary considerably. According to Glynn, this year some of the major tobacco companies – including Lorillard, Philip Morris, and RJ Reynolds – began entering the e-cigarette market. While it will take some time to determine precisely what effect this will have, Glynn and others believe that, due to the companies’ long manufacturing history, the quality of e-cigarettes will improve. That could mean, for example, fewer contaminants and better nicotine delivery. But there is concern that tobacco companies may also begin to market e-cigarettes as a companion product to, rather than a substitute for, regular cigarettes. This could result in fewer people quitting smoking and, instead, simply using e-cigarettes when and where they cannot smoke a regular cigarette.

The authors of the study in The Lancet acknowledge the need for the rapid regulation of e-cigarettes and call for more research to determine their long-term health effects.

Read more about e-cigarettes in Dr. Tom Glynn’s Expert Voices blog: Electronic Cigarettes – Boon, Bane, Blessing, or Boondoggle?

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Electronic cigarettes for smoking cessation: a randomized controlled trial. Published online September 8, 2013 in The Lancet. First author Christopher Bullen, MBChB, The University of Auckland, Auckland, New Zealand.

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