Controversy Surrounding E-Cigarettes as Smoking Cessation Tool

In December of last year, the UK's Office for National Statistics (ONS) confirmed the "key role" that e-cigarettes have played in driving smoking rates in the country to their lowest point in history. However, a study published in the Tobacco Control journal shortly after claims that e-cigarettes are not effective tools for quitting smoking. This report has come under criticism from experts and the UK Vaping Industry Association (UKVIA).

This study has sparked a headline in the Daily Mail claiming "study finds e-cigarettes cannot help people quit regular cigarettes." The headline came just seven days after the UK encouraged smokers to switch to e-cigarettes as a means of quitting traditional smoking.

A record-breaking 4 million people in the UK are now using electronic cigarettes, according to the UK National Statistics Office. This widespread shift towards e-cigarettes is believed to be partially responsible for a decrease in the smoking rate in the UK to just 13.3% - the lowest recorded figure to date.

Professor Peter Hajek from Queen Mary University of London states that the conclusion 'e-cigarettes have not made a significant contribution to smoking cessation among the population' cannot be drawn from the available data.

A new study from George Washington University in the United States focuses on "dual users" - people who smoke cigarettes and use electronic cigarettes. The study analyzed data from 2013 to 2019 and concluded that "before 2019, the use of electronic nicotine delivery systems (ENDS) did not contribute to substantial smoking cessation at the population level.

The authors of the study stated that their findings "suggest that reducing smoking can help dual users quit using both products," but critics argue that the study has limitations.

Dr. Sarah Jackson, Head Researcher of the Tobacco and Alcohol Research Group at University College London (UCL), stated that this study did not assess whether or not e-cigarettes help smokers quit smoking.

To determine whether using electronic cigarettes can help people quit smoking, we need to study the difference in smoking cessation rates between users of electronic cigarettes and non-users.

Other studies have already done so, using observational and experimental research designs, and indicate that smokers who attempt to quit smoking using e-cigarettes are more likely to succeed.

The UKVIA believes that vaping can aid smokers in quitting | Source: moffitt.org

Professor John Britton, esteemed epidemiologist at the University of Nottingham, stated, "The design of this study selected individuals who either found it difficult to quit smoking or did not want to quit. In this scenario, the good news is that some individuals were able to achieve success.

This study cannot tell us whether smokers who become dual users are more successful at quitting smoking than smokers who do not become dual users.

Therefore, the message of this paper is that quitting smoking is very difficult, but using electronic cigarettes may help you achieve it. Saying that e-cigarettes can stop you from quitting smoking in the "real world" is incorrect.

Peter Hajek, the director of the Tobacco Dependence Research Unit at Queen Mary University of London, stated that the conclusion that "e-cigarettes make no significant contribution to people quitting smoking" cannot be drawn from the data.

This study focused only on individuals who did not quit smoking and became "dual users" of e-cigarettes, excluding those who quit smoking altogether. Despite the selection of individuals who did not immediately receive full benefits, more than 25% of dual users actually quit smoking.

Excluding those who completely switch to using e-cigarettes and only evaluating their effectiveness on those who become dual users presents a serious methodological problem. It is like picking the best apples from a fertilized orchard, measuring the remaining apples, and declaring that the fertilizer is ineffective.

The tobacco control press release is particularly misleading. It claims that dual use is harmful, but in reality it is associated with reduced smoking and subsequent smoking cessation, making it actually beneficial. It also asserts that the study found e-cigarettes do not help smokers quit more easily, but the paper did not make such a statement.

Professor Robert West, Honorary Professor of Health Psychology at University College London, stated that "this study cannot resolve whether e-cigarettes at a population level help or hinder smoking cessation, but this conclusion may be temporary - so it is surprising to see such a statement from a reputable scientific journal.

A recent study on population trends reveals that individuals attempting to quit smoking are more likely to succeed if they use electronic cigarettes. Moreover, the increasing use of electronic cigarettes in the population is positively correlated with an increase in successful attempts to quit smoking over time.

This confirms strong evidence from randomized trials in which smokers were randomly assigned to receive either electronic cigarettes or products such as nicotine patches, gum, and lozenges. These studies clearly demonstrate that electronic cigarettes are superior.

The press release claims that data suggests the use of e-cigarettes may not be helpful in aiding a sample population to quit smoking, which is particularly surprising given that at the start of the research, individuals who used e-cigarettes daily were more likely to quit smoking in the following two years compared to non-daily users. This is contrary to the direction they seem to be asserting.

John Dunne, the Director General of UKVIA, stated, "No wonder smokers are feeling confused when faced with such mixed messages.

At a recent vaping summit in London, Rosanna O'Connor from the Health Improvement and Differentiation Office advised attendees not to always trust what they read in the media. I fully agree with her statement.

When the same newspaper tells you one day how e-cigarettes can help people quit smoking in the UK, and then contradicts itself the next day, it may seem amusing, but there is a serious point to be made here.

Misinformation about e-cigarettes has prevented smokers from switching to e-cigarettes, which in turn means that lives will continue to be unnecessarily lost due to deadly combustible cigarettes.

When the UK Office for National Statistics expresses enough confidence to say that electronic cigarettes have played a "major role" in reducing smoking rates in the UK, we can be certain that this is true.

If anyone truly doubts whether e-cigarettes can really help people quit smoking, they can ask any of the country's four million e-cigarette users for their thoughts!