A recent paper published in Addiction, “The effectiveness of using e-cigarettes for quitting smoking compared to other cessation methods among adults in the United Kingdom,” found that the odds of 30 day smoking cessation among smokers motivated to quit were cut by a factor or 4 among nondaily e-cig users compared to people who did not use any cessation aids.
Of course, that is not how the authors of the paper (Máirtín McDermott, Katherine East, Leonie Brose, Ann McNeill, and Timea R. Partos) summarized their results. The conclusion of the abstract says, “When used daily, electronic cigarettes appear to facilitate abstinence from smoking when compared with using no help.”
What explains the difference? Both statements are true. In their study of people motivated to quit cigarettes daily e-cig uses quit significantly more and nondaily e-cig users quit significantly less than people who did not use any quit aid.
The fact that the authors did not focus on the nondaily result is particularly problemmatic because their data shows that most (60%) of the e-cigarette users were nondaily users.
While they did not present the overall association between e-cigarette use and quitting, looking at their numbers suggests to me that there was likely no overall association.
Their finding of increased quitting among daily e-cig users and depressed quitting among nondaily users is consistent with the meta-analysis we recently published, which found the same pattern. We also found no overall association between e-cig use and quitting.
I’m surprised that Addiction’s editors and peer reviewers did not insist on a more accurate summary of the results in the conclusions presented in the paper, which a casual reader would take as an unvarnished endorsement of e-cigs for quitting.
Indeed, the fact that there are opposite effects depending on intensity of use adds to the case that e-cigs should only be considered for smoking cessation as part of a supervised program, i.e., treated as prescription drugs (assuming that the risk/benefit ratio is favorable).
Here is the abstract from the paper:
Background and aims
Evidence on the effectiveness of electronic cigarettes (ECs) to facilitate abstinence from smoking is limited. The current study aimed to estimate the relative effectiveness of ECs and smoking cessation medication compared with using no help, accounting for frequency of use of ECs.
Four consecutive wave‐to‐wave transitions (waves 1‐2, 2‐3, 3‐4 or 4‐5) of a longitudinal online survey collected between 2012 and 2017 were analysed. Time between waves ranged between 12 and 17 months. Cigarette smokers at the baseline wave who attempted to quit smoking between waves were included.
A total of 1155 respondents (aged 18‐81, 56.1% male, 64.6% in social grade C2DE, 93.8% white) provided 1580 pairs of observations for the primary analysis.
Primary outcome: abstinence from smoking for at least 1 month at follow‐up; secondary outcome: at least 1 month’s abstinence from smoking between baseline and follow‐up. The main predictor was stop smoking aid used (No help, nicotine replacement therapy only, smoking cessation medication only, disposable/cartridge EC, refill/modular EC, combination), adjusted for demographics.
Compared with using no help, the odds of abstinence were increased by daily use of disposable/cartridge ECs (OR=3.31 (1.32, 8.26), p=.010) and daily use of refill/modular ECs (OR=5.47 (2.70, 11.11), p<.001). Odds were reduced by non‐daily use of disposable/cartridge ECs (OR=0.23 (0.08‐0.63), p=.005), and by use of disposable/cartridge ECs to quit and no longer using at follow‐up (OR=0.10 (0.16‐0.62), p<.013). Secondary Results were similar to the primary outcome; however, odds of abstinence were also increased by use of smoking cessation medication (OR=4.15 (1.79, 9.62), p=.001).
When used daily, electronic cigarettes appear to facilitate abstinence from smoking when compared with using no help.
The full citation is: McDermott, M.S., East, K. A., Brose, L. S., McNeill, A., and Partos, T. R. (2021) The effectiveness of using e‐cigarettes for quitting smoking compared to other cessation methods among adults in the United Kingdom. Addiction, https://doi.org/10.1111/add.15474.