New study finds vaping and heated tobacco are important tools for reducing smoking rates

News today, April 20: According to foreign media reports, an important new study has found that smokers completely switched to safer heated tobacco products once they were given access to them—even if they had no intention of quitting, or had faced challenges in previous quit attempts.

The first-of-its-kind study, known as CEASEFIRE, enrolled 220 participants. Their average age was 41, and they smoked about a pack of cigarettes a day. On average, they had made two previous attempts to quit smoking.

Participants were randomly divided into two groups: one group was given refillable e-cigarettes, while the other was given heated tobacco products—a device that heats tobacco sticks to produce vapor, without combustion or smoke. The researchers aimed to compare the effectiveness and tolerability of the two harm reduction options.

High rates of smoking abstinence and cigarette reduction were observed in both groups, with one researcher describing the results as remarkable.

After recognizing the key role of flavors in helping people switch, the researchers also offered participants a choice of three different flavors. In addition, motivational counseling was provided throughout the 12-week study.

Quit rates were high in both groups, reaching 39.1% for those using the heated tobacco product (IQOS 2.4 Plus) and 30.8% for those using the e-cigarette (JustFog Q16). 

The results for both smoke-free devices were encouraging—the difference between the two rates was not considered significant—and notably, more than 95% of participants completed the study.

"The data confirm the effectiveness and tolerability of e-cigarettes, as well as the health potential of heated tobacco products for smokers who do not intend to quit," said principal investigator Maria Signorelli.

Both e-cigarettes and heated tobacco products are safer than combustible cigarettes, which cause more than 7 million deaths worldwide every year.

Some participants even became healthier during the short-term study.

"Compared with baseline, we observed improvements in participants' exercise tolerance," said another researcher, Pasquale Caponnetto. "Starting from the first month, many patients reported breathing more easily and feeling less fatigued during small but important daily activities such as climbing stairs or doing housework."

In Italy, where the study was conducted, heated tobacco products have been sold for years in tabaccherie (tobacco shops) and in vending machines alongside cigarettes. In Japan, where these products are also very popular, cigarette sales have seen an unprecedented decline in just a few years. This is tobacco harm reduction in action.

In 2020, the U.S. Food and Drug Administration authorized IQOS to be marketed with claims of reduced exposure to harmful chemicals compared with cigarettes. However, patent disputes delayed its launch in the United States.

Different products work for different people, and both e-cigarettes and heated tobacco products are important tools for reducing smoking rates.

Researchers from the Department of Clinical and Experimental Medicine and the Center of Excellence at the University of Catania conducted the study comparing the effectiveness, tolerability, and acceptability of heated tobacco products and refillable e-cigarettes as substitutes for cigarettes: CEASEFIRE, a randomized controlled trial by the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR).

Unfortunately, the study excluded people with mental health diagnoses or a history of problematic substance use other than tobacco. These two groups have the highest rates of smoking, smoking-related disease, and premature death. Including them in research on safer nicotine products is essential.

The researchers cautioned that longer follow-up studies are needed to confirm significant and sustained smoking abstinence, and to determine whether the results can be generalized to settings that do not provide such a high level of support.

Still, the CEASEFIRE study shows that giving smokers—even those with no intention of quitting—the option to use heated tobacco products or e-cigarettes can be highly effective. Different approaches work for different people, and both are important tools for reducing smoking rates.