Smokers who want to quit are most likely to succeed when they use nicotine e-cigarettes, according to new Cochrane review. For someone trying to leave cigarettes behind, method chosen can make measurable difference.
An updated Cochrane review finds nicotine e-cigarettes help more people stop smoking than several widely used approaches. These include nicotine gum and patches, behavioral support, or attempting to quit without support. Smoking remains leading cause of preventable disease and death worldwide. It accounts for more than seven million deaths each year, including 1.6 million among non-smokers exposed to second-hand smoke, according to World Health Organization.
Nicotine E-Cigarettes Raise Quit Rates: What 80 Trials Show
To determine which approaches were most effective, researchers drew on ongoing living systematic review, meaning evidence is reassessed as new research becomes available. Latest analysis included 80 randomized controlled trials with 29,861 participants, including nine trials added in this update. Strongest evidence favored nicotine e-cigarettes over nicotine replacement therapy, NRT, including patches and gum. Review found high-certainty evidence that nicotine e-cigarettes produced about four additional quitters for every 100 people compared with NRT.
They also performed better than e-cigarettes without nicotine, with about two additional people per 100 successfully quitting. People given e-cigarettes also had higher quit rates than those receiving no support or behavioral support. Behavioral support included individual counseling and group programs. However, researchers have less confidence in this comparison because design of those studies carried greater risk of bias.
Analysis: Evidence Favors Regulated Nicotine Products Only
“We have very strong evidence that regulated nicotine e-cigarettes are substantially less harmful than smoking,” says Dr Jamie Hartmann-Boyce, senior author of review from University of Massachusetts Amherst.
“Based on consistency of findings here, it’s clear that they are proven and viable option for people wishing to quit traditional cigarettes. This update includes 9 new trials and our main conclusions haven’t changed,” Hartmann-Boyce added. Researchers found no evidence that using e-cigarettes to quit smoking increased serious harm, although longer-term research is still needed. Importantly, conclusions apply to regulated e-cigarettes containing nicotine. Illicit products and devices containing other substances, including THC, may present different risks. “It’s worth highlighting that our review looks at regulated e-cigarettes containing nicotine, but many available on market do not meet these standards,” says Dr Hartmann-Boyce.
“Unlicensed e-cigarettes are potentially dangerous, with issues including unstable batteries and harmful chemicals. Anyone looking to use e-cigarettes to quit should only purchase devices tested and approved by country’s regulatory body,” she warned.
Lists of regulated devices are available from FDA in US and MHRA in UK. Therefore, source of device matters critically for safety.
Vaping Still Carries Health Risks, WHO Warns
That advantage over smoking does not make vaping harmless. Major health organizations, including WHO, caution that e-cigarettes expose users to nicotine and other potentially harmful chemicals. Health experts have also raised concerns that vaping among children and young people can lead to nicotine addiction and tobacco smoking. Therefore, youth uptake remains serious public health concern.
Authors emphasize e-cigarettes may not be right quitting tool for everyone and recommend people seek advice from stop smoking support services or clinicians. Vaping has health risks of its own, but authors maintain those risks are far smaller than dangers associated with smoking. Dr Nicola Lindson, lead author based at University of Oxford, reflects on difficulty of quitting. “Quitting smoking is hard, and lot of people who smoke will have tried many times and been unsuccessful,” Lindson says.
“For that reason, it is important that there are number of different options available to help somebody quit, which could encourage them to keep trying,” she added. “Although nicotine vapes are unlikely to be completely risk-free, they are less harmful than smoking, and that is most important comparison for people still smoking tobacco.”
For Dr Hartmann-Boyce, moving from cigarettes to vaping can represent intermediate step rather than final goal. “For somebody already addicted to nicotine through cigarettes, having safer alternative like e-cigarette is worth considering, especially when other quit aids have proven unsuccessful,” she said.
“We are currently working on review of interventions to help people quit vaping, which could be next step along for people looking to transition to lower-harm product before quitting nicotine altogether,” Hartmann-Boyce concluded.
Q&A
Q: What is best way to quit smoking according to Cochrane review?
A: Updated review of 80 trials, 29,861 people finds nicotine e-cigarettes help more people quit than patches, gum, behavioral support, or no support.
Q: How much better are e-cigarettes than nicotine patches for quitting?
A: High-certainty evidence shows nicotine e-cigarettes produce about 4 additional quitters per 100 people compared to NRT patches and gum.
Q: Are regulated e-cigarettes safe?
A: Regulated nicotine e-cigarettes are substantially less harmful than smoking, but not risk-free; unlicensed devices may have unstable batteries and harmful chemicals.
FAQ
1. How many trials were in Cochrane e-cigarette review?
Latest living systematic review included 80 randomized controlled trials with 29,861 participants, including 9 new trials in this update.
2. Who led Cochrane review on vaping to quit smoking?
Senior author Dr Jamie Hartmann-Boyce from UMass Amherst and lead author Dr Nicola Lindson from University of Oxford led the review.
3. Do e-cigarettes without nicotine help quit smoking?
Nicotine e-cigarettes performed better than e-cigarettes without nicotine, with about 2 more quitters per 100 people successfully quitting.
4. Where can I find list of regulated e-cigarettes?
Lists of regulated devices are available from FDA in US and MHRA in UK; authors warn to avoid unlicensed products.
5. Does WHO say vaping is harmless?
No, WHO cautions e-cigarettes expose users to nicotine and harmful chemicals, and warns vaping among youth can lead to nicotine addiction and smoking.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Smoking causes more than seven million deaths yearly including second-hand exposure, per WHO. E-cigarettes are not recommended for non-smokers, children, or young people due to nicotine addiction risk.
