Quitting smoking with the e-cigarette - what does science say?

Smokers who resolve to quit smoking or use less tobacco often turn to e-cigarettes - with frequent success. Even if the electronic cigarette is not "the" solution, it can be used to support the achievement of the goal. For successful smoking cessation, it must be taken into account that additionally learned behavioural patterns have to be changed. Behavioural therapy, therefore, plays an important role in smoking cessation.


The role of e-cigarettes in smoking cessation is receiving a lot of attention from research groups worldwide, and knowledge in this area continues to grow. How safe are e-cigarettes? How effective are they? Are there health benefits? Here we have summarised for you what the state of the science is.





Quitting smoking: How and where can e-cigarettes help me quit smoking?

E-cigarettes containing nicotine can, in fact, help you quit smoking successfully. Compared to conventional cigarettes, they cause less pollution in the body, and they can also reduce the withdrawal symptoms that smokers fear. There is also promising data on their efficacy and safety. Here you can read details about how e-cigarettes can help you quit smoking.


E-cigarettes - the most commonly used smoking cessation method in Germany

E-cigarettes are a popular method of quitting smoking. This is shown by the "German Survey on Smoking Behaviour" (DEBRA). This study investigated the extent to which tobacco control measures are implemented in the population and provides previously missing data on key indicators of smoking behaviour as well as on the consumption of new products such as e-cigarettes.

Methodology: A representative sample of approximately 2,000 people aged 14 years or older were interviewed in person-verbally throughout Germany at intervals of two months. Data from 12,273 individuals from six waves (June/July 2016 to April/May 2017) were included.


Results:

  • 16.9% were ex-smokers (including 1.0% new ex-smokers) and 54.8% never smokers.

  • 28.1% of smokers had made a quit attempt in the last year. The most frequently used method - apart from using one's own willpower and the social environment - was the e-cigarette with or without nicotine (9.1%).

  • The most frequently used evidence-based smoking cessation method was brief medical counselling (6.1 %). 7.0 % of the respondents used at least one pharmacological method (e.g. nicotine patches) to quit smoking.

  • The prevalence of current smoking was highest among men (7.8 percentage points higher than among women) and in the 25-29 age group (38.3%).

  • Higher tobacco use was linearly related to a low level of education and income.



Expert opinion: "E-cigarettes are 95% less harmful".

In 2015, an independent review was published by Public Health England (PHE) with the aim of evaluating the current evidence on e-cigarettes at that time and reviewing the evidence. The experts concluded that e-cigarettes are significantly less harmful to health than tobacco. According to the researchers, they have the potential to help smokers quit.


Results:

  • Experts estimate that e-cigarettes are about 95% less harmful than smoking conventional cigarettes.

  • Almost half of the population (44.8%) do not know that electronic aids are much less harmful than tobacco cigarettes.

  • So far, there is no evidence that e-cigarettes are a smoking initiation for children and non-smokers.

E-cigarette twice as successful as nicotine replacement products in stopping smoking

This finding is based on a clinical study by Hajek et. al. 2019 with 886 study participants, which makes an important contribution to scientific statements about the effectiveness of e-cigarettes in smoking cessation.


The adults were randomly assigned to receive either nicotine replacement products of their choice, including product combinations provided for up to three months. Or they were provided with an e-cigarette starter pack (a second-generation refillable e-cigarette) containing a bottle of nicotine liquid at 18 milligrams per millilitre. They were also advised to buy other e-liquids according to the flavour and strength of their choice. Weekly behavioural therapy was also added for at least four weeks.

Results:

  • The 1-year abstinence rate was 18.0 per cent in the e-cigarette group, compared with 9.9 per cent in the nicotine replacement group (primary outcome). E-cigarettes were thus more effective than nicotine replacement therapy for smoking cessation, providing both products were accompanied by behavioural therapy.


  • There were no significant differences between the two groups in terms of respiratory symptoms. In the e-cigarette group, a decrease in respiratory symptoms such as cough and mucus production — which were due to the previous inhalation of tobacco smoke — was even observed significantly more often (secondary outcomes).


Cochrane Review: E-cigarette 70% more effective at smoking cessation than nicotine replacement products

First, it is helpful to define the term "Cochrane Review". Cochrane Reviews are high-quality systematic reviews (overview papers) conducted by experts that analyse all the evidence on a specific health and social care topic. They have a particularly high informative value, especially with increasing numbers of studies and therefore participants.


In the Cochrane Review published in 2020, the aim was to assess the effect and safety of using electronic cigarettes to help people who smoke achieve long-term smoking abstinence. A total of 50 studies were considered. The last publication on this topic was from 2016, where only 15 studies were used for analysis. With the Cochrane Review, the previous state of knowledge was updated and expanded. In total, data from 12,430 people were considered.

Results:

  • Nicotine-containing e-cigarettes are 70% more effective than nicotine replacement therapies (for example, patches and gum) in helping smokers quit.

  • Nicotine-containing e-cigarettes are 70% more effective in helping smokers quit successfully than nicotine-free e-cigarettes.


Long-term study: "No damage to the lungs from e-cigarette use".

E-cigarettes have been shown to be less harmful than tobacco cigarettes. Nevertheless, there are concerns about whether long-term use can represent risks to human health. Italian researchers from the University of Catania conducted a prospective observational study to investigate the health parameters of nine e-cigarette users (daily use; mean age 29.7 (±6.1) years) over a period of 3.5 years. Twelve non-smokers served as the reference group. Parameters analysed included blood pressure, heart rate, body weight, lung function, respiratory symptoms, exhaled nitric oxide, exhaled carbon monoxide and high-resolution computed tomography of the lungs.

Results:

  • Due to the small sample size, the researchers checked all individual data sets one after the other for signs of negative changes. With regard to the various parameters such as blood pressure, heart rate, etc., there was no significant difference between the people in the e-cigarette group and those in the control group. There were no pathological abnormalities.

  • Despite the small sample size and the lack of comparison with smokers, the study contributes to the current understanding of the health effects associated with the use of e-cigarettes.

Use of e-cigarettes leads to "significant improvement in physical condition".

The use of e-cigarettes has increased exponentially in recent years. In 2014, a study was published (6) to assess the characteristics and experiences of a large sample (19,414 respondents) of e-cigarette users and to examine the differences between those who partially or fully replaced cigarette smoking with e-cigarettes.


Methodology/background:

The prepared questionnaire was translated into ten different languages and administered to e-cigarette users. They were asked to participate regardless of their current smoking status and were divided into two groups: former smokers and current smokers.

A total of 88 (0.5%) participants reported that they were not smokers at the time they started using e-cigarettes. Only 3.5% of participants were using zero-nicotine liquids at the time of the survey. Former smokers were heavily dependent and smoked more heavily (21 cigarettes per day) compared to current smokers.


81.0% of participants (former smokers) reported complete smoking substitution, while current smokers had reduced smoking from 20 to four cigarettes per day. They used the e-cigarettes for about ten months and on average at a nicotine concentration of the liquids of 18 mg/ml. 21.5% used more than 20 mg/ml.


Results:

  • The main reasons for using e-cigarettes were to reduce the harm associated with smoking and to reduce exposure of family members to tobacco smoke.

  • Most considered e-cigarettes to be less harmful than tobacco cigarettes, while 11.0% considered them to be absolutely harmless.

  • Side effects were reported by more than half of the participants (59.8%), with sore or dry mouth and throat frequently mentioned. These effects were generally mild in nature and in most cases subsequently disappeared (partially or completely).

  • Former smokers reported significant improvements in physical condition and pre-existing conditions (including respiratory conditions such as asthma and chronic obstructive pulmonary disease). E-cigarette use thus had positive effects on their health.