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Electronic cigarettes ‘don’t aid quitting’, study says

But some researchers argue that it is too early to dismiss potential health benefits.

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Ina Fassbender/Reuters/Corbis

Electronic cigarettes deliver nicotine without smoke, but their health advantages have been controversial.

The controversy over electronic cigarettes has been reignited today with the publication of a study claiming that they do not help smokers to quit their habit.

Whether or not ‘e-cigarettes’ are an effective aid in the cessation of smoking has become a major issue for the rapidly growing industry that produces the devices, and for the tobacco researchers struggling to assess their impact. There is widespread agreement that inhaling from an e-cigarette, where a heating element vapourizes a liquid containing nicotine, is not as harmful as smoking a conventional cigarette, and proponents say that the products could save millions of lives. But some researchers and tobacco-control activists fear that the devices could make tobacco use seem socially acceptable again and may not assist people in actually reducing their addiction.

Pamela Ling, a tobacco researcher at the University of California, San Francisco, and her colleagues followed 949 people who detailed their smoking habits though an online survey, and found that 88 of those who had used e-cigarettes were no more likely to have quit or reduced their smoking after a year than other smokers. “We found that there was no difference in the rate of quitting between smokers who used an e-cigarette and those who did not”, even after controlling for factors such as the user's dependence on tobacco, Ling told Nature in an e-mail.

She added: “Advertising suggesting that e-cigarettes are effective for smoking cessation should be prohibited until such claims are supported by scientific evidence.” Her team reports the results today in JAMA Internal Medicine1.

Smokers' saviour?

Peter Hajek, director of the Tobacco Dependence Research Unit at the Barts and The London School of Medicine and Dentistry, says that many researchers think e-cigarettes represent “the best hope so far to put a stop to smoking-related death and disease by replacing deadly cigarettes with a safer alternative”.

Hajek says that the new paper shows only that e-cigarettes appeal to smokers who are heavily dependent on tobacco. The same results would be obtained if the survey looked at smokers who try nicotine-replacement treatments, he says, and the results have no bearing at all on whether e-cigarettes are or are not an effective method of smoking cessation. The conclusions the authors of the paper draw are “just not related in any way to the study finding", says Hajek.

The regulation of e-cigarettes is a hugely debated area. Some scientists want the products regulated as medical devices, which would mean that they would be subject to tough quality controls and limits on advertising, and that their manufacturers would have to supply evidence to back up claims made for their products, such as the ability to aid smoking cessation. Both the United States and the United Kingdom are currently considering such regulation.

But other scientists say that such heavy regulation could kill the nascent industry, or leave it in the hands of the big tobacco companies, which have the deep pockets necessary to comply with such regulations.

Vaughan Rees, deputy director of the Center for Global Tobacco Control at the Harvard School of Public Health in Boston, Massachusetts, says that many existing e-cigarettes do not deliver enough nicotine to support total switching from conventional cigarettes. He adds that the study “provides an important addition to the growing body of research suggesting that e-cigarettes are not particularly good at promoting quitting”.

“The public should be educated about the limits of e-cigarettes to support cessation,” he said in an e-mail.
 

Journal name:
Nature
DOI:
doi:10.1038/nature.2014.14918

References

  1. Grana, R. A., Popova, L. & Ling, P. M. J. Am. Med. Assoc. Int. Med. http://dx.doi.org/10.1001/jamainternmed.2014.187 (2014).

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  1. Avatar for Kenneth Davies
    Kenneth Davies •
    So what. I don't want people puffing their smoke in my face in a public bus, whether it's from a real cigarette or an e-cigarette.
  2. Avatar for eric lopez
    eric lopez •
    I have successfully stopped smoking cigarettes and quit vaping thanks to e-cigs. I started at 30mgs of e-juice worked my way down to zero. Now I don't use any nicotine or smoke any regular cigarettes
  3. Avatar for Jim Himes
    Jim Himes •
    posts like this are detrimental to people attempting to use this method to stop smoking. Most of the damage is done because this is not at all factual it is Entirely Opinion based. I smoked for 25 years 1 1/2 to 2 packs of cigarettes a day and use e-cigarettes to stop smoking regular cigarettes. since the intent was to come off of nicotine dependance i have gone from 18mg to 6 mg liquid and soon to 0 mg and then i will be done with Electronic cigarettes as well. I have been using Electronic cigarettes for 13 months and when i first tried one as a test i put it down that first evening and tried another regular cigarette and could not stand the taste at all. I have not touched a regular cigarette since, and i do not ever intend to either. I have also gotten a friend in Canada to quit using e-cigarettes after 35 years of smoking and this was someone whom smoking was not just a habit. He REALLY loved his cigarettes. Now he REALLY loves his e-cigarette and like me he tried another regular cigarette and cannot stand them now. I sent another Older friend of mine and his girlfriend in Louisiana each were sent an e-cigarette and this gentleman smoked no less than 3 packs a day for 50 years and is now not smoking at all, only using e-cigarettes the same as his girlfriend. My friend in Canada has recruited his whole family and all of his friends and gotten over 35 people in total that he knows of to quit smoking using an e-cigarette so to say they are not a good cessation tool is just an out right Lie. However IF your mindset is not right the electronic cigarette will never work if you do not have it set in your mind that you are putting regular cigarettes down for good never to pick them up again, an electronic cigarette is no better than the patches, gums or pills that you can take to get off of the cigarettes which have also proven to not be effective in slowing down let alone encouraging people to stop smoking all together. I and my friends may not have ever been a part of any scientific study showing that electronic cigarettes do or don't work but you can't go posting articles saying they don't if you don't talk to people outside of the study that have actually tried and regularly use them how they feel about things either.
  4. Avatar for James T. Dwyer
    James T. Dwyer •
    As I understand, since e-cigs deliver vaporized liquid nicotine - see http://health.howstuffworks.com/wellness/smoking-cessation/10-facts-about-e-cigarettes.htm - rather than tobacco, any negative health aspects should be quite distinct from inhaled tobacco combustion products or even chewing tobacco and snuff (inhaled ground or pulverized tobacco leaves). Unless it's previously been established that direct nicotine exposure can cause cancer, IMO is should be considered that e-cigs likely offer significant health benefits compared to the inhalation of tobacco combustion products - pending independent research.
  5. Avatar for Mikel Phipps
    Mikel Phipps •
    I don't know very many people that smoked real cigarettes and changed to electric but out of the few I know, none switched to stop smoking but about half did quit. Not very good for the cigarette industry or all the education it funds?? I'm wondering how the same Government that penalized big tobacco can push marijuana on people like it doesn't effect your lungs or health at all. With the Government getting into healthcare they will have to curb or make illegal a lot of activities and hobbies people like to do but Government considers dangerous. Basically, whatever can be proven to add cost.
  6. Avatar for James T. Dwyer
    James T. Dwyer •
    I haven't paid much attention, but I was under the impression that e-cigs were primarily being marketed to those who do not want to quit smoking... If that's not the case, then this is a valid issue from the standpoint of marketing claims. Unless it can be shown that e-cigs share critical health risks with cigarettes for active or passive inhalers (none are mentioned here), it would seem that smokers that switch to exclusive e-cig usage have already quit smoking!
  7. Avatar for Mikel Phipps
    Mikel Phipps •
    Good point.
  8. Avatar for L. M. Colasanti
    L. M. Colasanti •
    Should there be some oversight and regulation for any inhaled product? Of course. But I can attest from personal experience that, after having smoked for fifty years, most of those at a pack-a-day, I tried quitting -- with and without alternatives for nicotine replacement. The best I ever managed was five cigarettes a day for about six months. But whenever something triggered me emotionally {usually anger}, I'd quickly go back to half a pack a day or more. I was never as much physiologically addicted; I could wake in the morning and not reach for a first cigarette until two hours later, when I was having that first cup of coffee. But I was certainly psychologically addicted. Pavlov's dog had nothing on me. Let the phone ring, and I'd reach to answer and light a smoke, all in one well-rehearsed and fluid motion. Then, last August, I decided to try e-cigarettes. The cartridges and re-chargeable batteries arrived on Wednesday. I had eight cigarettes remaining in the pack. I decided to ration them over the next three days, three, three, then two. Those were the last cigarettes I smoked. ...

    One of the benefits of the e-cigs, I am certain, is that they mimic actual cigarette smoking, so much so that, on the third or fourth day, I absent-mindedly came very close to lighting my e-cig. At that point, I stopped carrying a lighter in my pocket. And today marks seven months that I've gone without the combustible elements of cigarette smoking that have been shown to be the culprits in most smoking-related diseases and disorders.

  9. Avatar for Ray Odavis
    Ray Odavis •
    Who sponsored this? I DARE them to actually put effort into the research. There are currently 2 main players in the ecig community. The first is the oldest, called cartomizer ecigs; they look like either larger or smaller cigarettes in various colors. MANY 'carto' style ecigs are horrible, taste horrible and deliver a variable amount of nicotine in each drag. I tired them, they either give you a headache or irritate you to heck. The second is the 'newer' era; lithium ion batteries connected to a container we call tanks that house the atomizer and juice. Those using the latter version *newer era ecig* have a wide option in nicotine strengths and flavors. There are variations to this version, however for this i'm placing them in the same 'club'. I, as a former smoker tried gum, patches, lozenges, and pills. Nothing ever worked. When will any of you realize SOME OF US HAVE A HARDER TIME QUITTING. Not everything works for everyone, however I was referred by a friend who kicked cigarettes using the newer ecig. He kicked the habit 2 years ago using them. I am also a new success story, as is my girlfriend, her dad and her mom. All 4 of us quit using the new ecigs. Cold Turkey. We all smoked our last cigarette the day we got our kits. In fact if you want to complain about the continued use of nicotine, not only is it in the gum but the patches and the lozenges as well, that aside i went from aprox 20mg nicotine to 6 in 2 weeks. Here's the math part; with the current methodology if you smoke a pack a day of 'reds' you're advised to get 18-24 mg blends of eliquid, HOWEVER; if you do not use approximately 4 ml *milliliters* of fluid you're not getting the same approximated amount of nicotine in that pack a day. I'm hardly vaping 2-3ml a day. I doubt i'm even getting 3 cigarettes worth of nicotine a day. My dependency on nicotine has diminished dramatically utilizing this wonderful creation, anyone who doubts me can ask anyone sucking on a tank of juice; i'll be more than happy to take the stand or take a polygraph. This stuff works. Carto's are crude, ugly, half cocked, primitive and do nothing but either make you irritated or give you a headache. It's high time we quit grabbing our pitch forks and torches every time something new comes out. If you're going to do a study for comparison, then do a REAL study utilizing the actual scientific method that has all the options in play not just the ones you know won't work. You want solid data; ask any 'vaper' when their last cigarette was. Ask some one who purchased Nicorette if it worked, or Nicoderm or your beloved Chantix.
  10. Avatar for Mikel Phipps
    Mikel Phipps •
    FYI there is an anti-depressant that makes people quit smoking as a side effect. Kinda like lopping a hand for some finger problems
  11. Avatar for Ingmar P
    Ingmar P •
    In France, tobacco sales dropped over 10%, pharma nicotine substitute sales dropped 40% in 2013 compared to 2012 while vaping exploded. I smoked 30-40 cigarettes a day for nearly 30 years, my mom did the same for over 50 years, my heavy smoking father died of lung cancer before the age of 60 about 10 years ago. My mom and I both managed to quit cigarettes in a couple of days in favour of vaping, we haven't touched tobacco since december 2012. Needless to say, our health has improved dramatically and our contribution to the French Tax system has gone down, we now spend about 30€/month combined on vaping where cigarettes would cost us about 25€ a day of which 80% is taxes. We order Chinese liquid and vape components directly from China, e-cigs were invented there after all and their liquids (the 2 large reputable brands) are lower on flavours of which health hazards are not known well when inhaled. For the record, I tried stopping tobacco several times, never lasted longer than a year even when medically assisted (Zyban, patches and gums, Champix). My 70 year old mother failed with patches and tried nothing else. With vaping we both had no major trouble switching over, iInitially I vaped 4-5ml/day at 24mg/ml and am now down to 2-3 ml/day at 16mg/l and not smoking on a 12 hour flight (without vaping :D) is no trouble at all compared to being a nightmare before. I know plenty of people who finally managed to stop cigarettes thanks to vaping after many failed attemps with other methods, and many more who reduced their cigarette intake by alternating between real and electonic versions. It's a real pity that almost everything today is controlled by economic interests and that real information doesn't make it to the average reader anymore.
  12. Avatar for Julian Harrison
    Julian Harrison •
    I have to agree with Darrin Gold's comment. I once smoked a pack and a half daily. I have used e-cigs to slowly ween myself off nicotine in hopes to stop the habit completely. First, the e-liquid used with vapor smoking--if purchased from U.S. makers so that you know the ingredients--is far less harmful than the toxins in tobacco cigarette smoke. I use to cough and get sick a lot when smoking cigarettes and that hasn't happened since I switched to e-cigs. Also, I buy my e-liquid from an American company http://www.southbeachsmoke.com/e-liquids/ and they offer e-liquid flavors in different nicotine levels; 0mg-24mg, I think. So, I lower my nicotine level every couple months in hopes to quit nicotine eventually. I think articles like this about the dangers of e-cig use has a lot to do with the big tobacco lobbyists. Our government has profited billions from tobacco smokers (taxes) and not to mention our medical industry.
  13. Avatar for darrin gold
    darrin gold •
    The Rest of the Story I'm sad to say that this is complete garbage. It is truly an example of bogus, or junk science. Why? Because the study does not examine the rate of successful smoking cessation among electronic cigarette users who want to quit smoking or cut down substantially on the amount that they smoke and who are using e-cigarettes in an attempt to accomplish this. Instead, the study examines the percentage of quitting among allsmokers who have ever tried electronic cigarettes - for any reason - in the past month. A large proportion of the 88 smokers who had tried an e-cigarette may have simply been trying these products to see what they are like. It is plausible, in fact probable, that many of these 88 smokers were not actually interested in quitting or trying to quit with electronic cigarettes. These products have become very popular and have gained widespread media attention and it is entirely possible that many of these smokers simply wanted to see what the big fuss is all about. It is easy to see how this fatal flaw in the research destroys the validity of the authors' conclusion. But that isn't the end of the story. If this were simply a bogus conclusion, then we could simply evaluate the article as being junk science, dismiss it as bogus, and leave it there. But unfortunately, it doesn't end there. Why? Because it is quite apparent from the study itself that the authors knew that the overwhelming majority of the 88 electronic cigarettes "users" in their study had little or no interest in quitting and were not using these products as part of a quit attempt. How do we know this? Because the authors tell us! In the Table, the authors report that of the 88 e-cigarette "users," only 8.0% reported that they were trying to quit at that time (that is, within the next 30 days). And only 39.8% of the e-cigarette users had any intention of quitting in the next six months. This means that we actually know for a fact that the majority of e-cigarette users in this study were not using these products as part of a quit attempt. What this indicates is that this is not simply junk science. Rather, it is a deliberate attempt on the part of the investigators to misuse data. They are using these data to draw a conclusion about whether electronic cigarettes are effective in helping smokers quit, yet they are knowingly drawing upon data from smokers who are using e-cigarettes for other reasons, who may have simply tried an electronic cigarette once, and who most definitely were not using these products as part of a current quit attempt. In other words, 92% of the e-cigarette users in the study were not trying to quit. We know for a fact that 92% of the e-cigarette users were not making a quit attempt. And yet the study authors interpret the data as if these smokers were trying to quit using e-cigarettes, but failed! This is dishonesty in research. Unfortunately, it does not appear that these investigators are truly interested in whether e-cigarettes help many smokers quit or not. Instead, I believe that these researchers have a pre-determined conclusion that e-cigarettes are ineffective and that they are trying to manufacture results that support their pre-determined conclusion. It would be a tragedy if policy makers use the conclusions of this "study" to draw conclusions about the effectiveness of electronic cigarettes for smoking cessation purposes. By Dr. Michael Siegel, Professor in the Department of Community Health Sciences, Boston University School of Public Health.
  14. Avatar for James Rothenberger
    James Rothenberger •
    I'm one of the anecdotes that nobody wants to include in these bogus studies, particularly those coming out of UCSF. "I smoked 43c years, 2-3 PAD until I used my first e cig almost 5 years ago. I have not had a drag on a cigarette for 4 years 1 month and 10 days, to be exact. UCSF and others are drawing conclusion from studies where the facts are not in evidence. If vaping ever reaches its full potential to reduce the death toll of cigarettes, it will be despite the best efforts of our researchers, lawmakers and tobacco control.particularly the prohibitionists that work under Stan Glantz at UCSF.
  15. Avatar for Elliot Sumner
    Elliot Sumner •
    The entire situation is badly positioned. there is a huge difference between 'smoking' and 'nicotine use'. Most people that switch to e-cigarettes do it not because they want to give up nicotine, but because they want to give up *smoking*. And it should be positioned accordingly. They are excellent as an aid for giving up smoking, but not as an aid for giving up nicotine. But if you're using an e-cigarette, you've removed the serious problem anyway, so the nicotine addiction can be dealt with (if required) at your own leisure.
  16. Avatar for Ian Maguigan
    Ian Maguigan •
    I have recently given up smoking tobacco 3 weeks ago and taken up vaping e-cigarettes. I smoked tobacco for 45 years and smoked 25-30 a day and I now can consider myself a none smoker. Yes, e-cigarettes DO assist you in giving up smoking, I am living proof. The sample of 949 people is far too small a sample to give a true picture. According to recent surveys, 1.3 MILLION people in the UK are now using e-cigarettes and the majority are ex-smokers. I am very disappointed such a respected and prestigious journal as Nature would publish so called 'results' as above as fact when using such a small and dubious sample.
  17. Avatar for Crunchy Crunchy
    Crunchy Crunchy •
    E-cigarettes work for tobacco smoking cessation. I tried the patches, gum and ignored the mood changing drugs. I stopped smoking the day I started vaping. I had a pack-a-day tobacco habit for forty years. The ingredients in e-liquid are safe. Even nicotine's 40-60mg/kg body weight LD50 level is being re-evaluated to 500-1000mg/kg body weight after two attempted suicides where both lived. The long term use of the base ingredients in e-liquid have shown to be safe in studies as far back as 1946. Here, the United States National Library of Medicine is your friend. I didn't switch without doing my due diligence. I didn't wish to trade one bad habit for another. Glantz and Grana belong to the same anti-smoking organization at UCsf. This leads me to wonder about what this group is trying to accomplish. Are they trying to protect the patch and gum manufacturers. In the end, this looks like the junk science against 2nd hand smoke that was found to be un-believeably bad in 1998 by the Honorable Judge Osteen.
  18. Avatar for Astilbe Martin
    Astilbe Martin •
    Glycerol pyrolyzes to acrolein. Deeply inhaling that will be supportive of quitting. "Butter flavored" fog employing butanedione as fiavorant will work. A vast craft of rendering victimless use personally destructive validates administered US social policy at all levels. I have no elegant solution for adding inhaled cellulose triacetate microfibers shed from cigarette filters.

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