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Another new study shows e-cigarettes could be hindering, not helping, quitting

Posted 9 Nov, 2020

Another new study shows e-cigarettes could be hindering, not helping, quitting

A new clinical trial from the US has shown that, among people motivated to quit, e-cigarette use significantly reduces the chances of quitting successfully.

Researchers analysed quitting outcomes in more than 2,600 people enrolled in a trial testing a web-based smoking support strategy. Independent of the main research plan, the investigators studied those subjects who self-initiated use of e-cigarettes daily, intermittently comparing them to those who did not use e-cigarettes at all when they were trying to quit.

People who used e-cigarettes intermittently had quit rates that were no better than those who did not use e-cigarettes at all. Daily e-cigarette users, concerningly, were 30% less likely to quit smoking than people who did not use e-cigarettes at all. 

These new data support the recent findings of a systematic review commissioned by the Australian Government that found there was no conclusive evidence that e-cigarettes are an effective quit aid. 

Dr Sarah White, director of Quit, said that the potential role of e-cigarettes in smoking cessation is becoming more limited - they might be effective in helping people to stop smoking, but only if they are used as part of a formal quit attempt with guidance from health professionals.  

“Only a couple of trials have shown e-cigarettes might be helpful in quitting, but these trials tested what happens when e-cigarettes are provided – along with behavioural coaching – to people who want to quit and who favour use of these devices. 

“This study looks at what happens in a slightly more real-world scenario, where people who are motivated and getting behavioural coaching to quit then self-select to purchase and use e-cigarettes as consumer products.” 

The authors of the study, from the renowned Fred Hutchinson Cancer Research Center, suggest that the overall perception and perceived usefulness of e-cigarettes may be different in those smokers who enrol in clinical trials and then are assigned e-cigarettes versus those who self-select their use.

Associate Professor Matthew Peters, from Concord Clinical School at Sydney University said the findings from this study were consistent with a recent analysis of smoking and e-cigarette use in Australia, UK, US and Canada.

“These data are consistent with a recent study that found the use of e-cigarettes did not improve rates of discontinued smoking and didn’t reduce the risk of relapse,” he said.

Professor Bruce Thompson, President of the Thoracic Society of Australia and New Zealand said this study supports the Therapeutic Goods Administration’s proposal to make nicotine-containing e-cigarettes available only on prescription and purchased from pharmacies in Australia. 

“If the success of e-cigarettes is dependent on them being viewed as cessation aides, and not consumer products, then we’re heading down the right path to make e-cigarettes available on prescription and not from the corner store,” he said.

Associate Professor Peters added that people rely on policy-makers to help them to make informed decisions. 

“Short-term use of e-cigarettes under supervision with behavioural support might be useful for smoking cessation, but significant numbers of severe adverse events and the absence of well-collected safety data clouds this picture. More data are needed,” he said.

“Furthermore, there is clearly no role for long-term e-cigarette use. It is harmful to the lung health of non-smokers, amplifies the harms of smoking in dual-users, does not achieve smoking cessation and does not prevent relapse.”   

Interestingly, people who had low nicotine dependence and used e-cigarettes were even less likely to quit than people who had high nicotine dependence. Dr White says this validates the stance of the RACGP, which is that e-cigarettes should be considered a last resort and recommended only when proven cessation aides had failed, but is also concerning for the Australian context.

“An estimated 227,000 Australians report daily e-cigarette use, and these are predominantly in the 14 to 17-year-old and 18 to 24-year-old age groups. These groups are very, very unlikely to be heavily addicted smokers with a high level of nicotine dependence, so these groups have significantly better options out there than to use e-cigarettes to try and quit,” said Dr White.

The study details are: Watson, Mull & Bricker. The association between frequency of e-cigarette use and long-term smoking cessation outcomes among treatment-seeking smokers receiving a behavioural intervention. Drug & Alcohol Dependence. Published online 1 November 2020.

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