Can E-Cigarettes Help You Quit Smoking? How Do They Work for Smoking Cessation?

There are major research gaps when it comes to proving the effectiveness of e-cigarettes as a smoking cessation aid. The 2020 Surgeon General’s report on smoking cessation found that there is “insufficient evidence” to conclude that e-cigarettes increase smoking cessation. Likewise, a 2018 report from the U.S. National Academies of Sciences, Engineering, and Medicine (NASEM) found limited evidence regarding the effectiveness of e-cigarettes in helping people quit smoking.

Can E-Cigarettes Help You Quit Smoking?

E-cigarettes have not been approved by the FDA or the U.S. Preventive Services Task Force as a smoking cessation aid.

Although some evidence supports the use of e-cigarettes as a smoking replacement device, more recent studies suggest that their effectiveness for smoking cessation may have been overstated.

The 2020 U.S. Surgeon General’s report on smoking cessation indicates that if users avoid prolonged dual use, e-cigarettes may help some adult users reduce the risk of smoking-related disease. However, the report found insufficient evidence to conclude that e-cigarette use generally increases smoking cessation, citing the variability of e-cigarette components, differences in usage patterns, and the lack of evaluative studies.

Some evidence suggests that compared with non-nicotine e-cigarettes, nicotine-containing e-cigarettes are associated with higher smoking cessation rates. A 2020 systematic review covering 50 studies of adult smokers in the United States and other countries found moderate-certainty evidence that nicotine e-cigarettes increased quit rates compared with nicotine replacement therapy or non-nicotine e-cigarettes. Nicotine e-cigarettes may also help more people quit smoking than support alone or behavioral support alone. The NASEM report also noted that more frequent e-cigarette use may increase a person’s likelihood of quitting smoking.

A 2018 study of U.S. adults examined whether e-cigarettes prompted more successful quit attempts and found that e-cigarette users had 70% lower odds of quitting than non-users.

A 2019 study published by the UK National Health Service in The New England Journal of Medicine found that e-cigarettes may help adults quit smoking. Compared with the group using nicotine replacement products, the group assigned to use e-cigarettes as a substitute for combustible tobacco was more likely to remain abstinent at one year (18% vs. 9.9%). However, at the one-year follow-up, most e-cigarette users were still using e-cigarettes. Researchers pointed out that the study was based on middle-aged adults (median age 41) who were actively seeking to quit and who received at least four weeks of behavioral support. It is also worth noting that the UK imposes strict restrictions on e-cigarette marketing.

Although some e-cigarettes may help some people quit smoking, product diversity, differences in quality, and the lack of regulation make it difficult to determine the smoking cessation potential of any specific product. Some smokers have switched to e-cigarettes or used them to quit smoking entirely; however, unlike FDA-approved smoking cessation therapies, e-cigarettes lack an evidence base proving their safety and effectiveness. Truth Initiative supports regulation and encourages the development of consistently lower-harm nicotine delivery alternatives that allow smokers to quit combustible cigarettes completely or switch entirely to lower-harm, well-regulated products.

A recent meta-analysis on the use of e-cigarettes as a smoking cessation tool suggests that their effectiveness depends on frequency of use and product type. Overall, among adult smokers and adult smokers who expressed motivation to quit, use of consumer e-cigarette products—those purchased in retail settings and used at the consumer’s discretion—was not significantly associated with smoking cessation. Among consumer e-cigarette users, only daily use was associated with increased smoking cessation, while less-than-daily use was associated with reduced smoking cessation. However, when combined with cessation treatment, randomized controlled trials found that e-cigarette use was significantly associated with increased smoking cessation. Current research suggests that e-cigarettes sold as consumer products may not be an effective quitting tool. More evidence is needed to understand how e-cigarettes may help with smoking cessation under supervision.

One study suggests that product appeal, including flavoring, may encourage smokers to try using e-cigarettes to quit. A 2020 study published in JAMA Network Open found that among adults, using flavored e-cigarettes was more likely to be associated with smoking cessation than using unflavored products, with the odds of quitting more than doubling. However, since flavored e-cigarettes make up the vast majority of the U.S. e-cigarette market, stronger empirical evidence is needed to understand whether and how flavors affect smoking cessation.

However, because the youth e-cigarette epidemic in the United States has coincided with the appeal of flavored e-cigarettes to young people, Truth Initiative strongly supports removing all flavored e-cigarettes from the market, regardless of device type. At a minimum, e-cigarette manufacturers should be required to demonstrate that a flavor is itself safe, helps smokers completely move away from combustible cigarettes, and does not attract youth before the product enters the market. In addition to flavor restrictions, Truth Initiative also supports strong regulations to keep all tobacco products, including e-cigarettes, away from young people. #p#Page Title#e#