E-Cigarette Use Linked to Smoking-Cessation Increase on August 01, 2017

E-Cigarette Use Linked to Smoking-Cessation Increase

Study suggests vaping MAY help smokers quit. Do you agree?

Between 2014 and 2015 the population-level rate of smoking cessation increased in the United States for the first time in at least 15 years, and researchers credit the use of electronic cigarettes by smokers trying to quit for much of the decline.

Dual e-cigarette and traditional cigarette users attempted smoking cessation and succeeded in quitting at a higher rate than non-e-cigarette users who smoked, according to the analysis, which is based on the largest representative sample of e-cigarette users to date.

There was a statistically significant 1.1% increase in the smoking cessation, or "quit," rate during the study's 12-month period, which coincided with a dramatic rise in e-cigarette use starting around 2010, Shu-Hong Zhu, PhD, of the University of California, San Diego, and colleagues wrote in BMJ.

In an interview with MedPage Today, Zhu explained that quit rates in the U.S. remained steady, at around 4.5% a year, until 2014 when they increased to 5.6%.


"The quit rate at the population level is very hard to move, and tends to remain stagnant. A 1.1% increase doesn't sound like much, but that represents an additional 350,000 smokers who quit during this 12-month period."

He and his colleagues credited the Centers for Disease Control and Prevention's national TIPS from Former Smokers media campaign, which began airing in 2012, for some of the rise in smoking cessation at the population level, but Zhu said the campaign alone cannot possibly explain the population-level smoking-cessation increase seen: "I am very confident that the increase in e-cigarette use during this period contributed greatly to the quit-rate increase. It doesn't explain it all, but it played a big part."

The researchers explained that the population-level smoking quit-rate increase is particularly remarkable given that the introduction of accepted smoking-cessation measures -- including the nicotine patch, the drug Chantix, and huge cigarette tax increases -- appeared to have little or no impact on smoking-cessation rates among U.S. adults at the population level.

"This is the first statistically significant increase observed in population smoking-cessation rates among U.S. adults in the past 15 years," the team noted.

Stanton Glantz, PhD, of the University of California, San Francisco's Center for Tobacco Control Research and Education, called the study "well done."

Glantz has been a vocal critic of previous research suggesting a link between use of e-cigarettes and smoking cessation, and his own research on the topic, published last year in The Lancet Respiratory Medicine, suggested that dual use of e-cigarettes and traditional cigarettes may actually reduce smoker quit rates.

In a newly published blog post, Glantz noted that the vast majority of the studies examining e-cigarette use among cigarette smokers have shown no increase in quit rates associated with e-cigarette use, and said: "So while this study is an important contribution, on balance, the evidence still weighs against the conclusion that e-cigarettes are helping people quit on a population level."

For the study, Zhu et al examined data from the U.S. Current Population Survey-Tobacco Use Supplement (CPS-TUS) conducted at five different time points (2001-2002, 2003, 2006-2007, 2010-2011, and 2014-2015).

Data on e-cigarette use were obtained from the total sample of the 2014-15 CPS-TUS (n=161,054). Smoking-cessation rates were obtained from those who reported smoking cigarettes 12 months before the survey (n=23,270). Rates from 2014-15 CPS-TUS were then compared with those from 2010-11 CPS-TUS (n=27 280) and those from three other previous surveys.

Among the 161,054 respondents to the 2014-15 survey, 22,548 were current smokers and 2,136 were recent quitters. Among them, 38.2% of current smokers and 49.3% of recent quitters had tried e-cigarettes, and 11.5% and 19.0% used them currently (every day or some days).

Among the main findings:

  • E-cigarette users were more likely than non-users to attempt to quit smoking (65.1% versus 40.1% (change=25.0%, 95% CI, 23.2%-26.9%)
  • E-cigarette users were also more likely to succeed in quitting (8.2% versus 4.8%, 95% CI, 3.5%, 2.5%-4.5%)
  • The overall population cessation rate for 2014-2015 was significantly higher than for 2010-2011 (5.6% versus 4.5%) and higher for all other survey years (range 4.3% to 4.5%)

In the interview, Zhu said that many of the earlier studies showing a negative association or no association between e-cigarette use and smoking cessation assessed first- or second-generation e-cigarette products, which typically deliver less nicotine than products that are now widely available. Many of the studies also made no distinction between e-cigarette "ever" users and regular users.

In an accompanying editorial, Christopher Bullen, MD, PhD, of the University of Auckland in New Zealand, wrote that the findings have implications for legislators in the U.S. and other countries who are considering how to best regulate e-cigarettes.

He cited findings from a study in the United Kingdom, published last year in BMJ, which also suggested a link between increased e-cigarette use and higher rates of smoking cessation:

"Notably, both studies analyzed data from populations in countries with (currently) relatively liberal regulatory approaches towards e-cigarettes," and this approach gives smokers a cheaper, easily available, and safer alternative to cigarettes for nicotine delivery.

"In light of the evidence, policy makers in countries contemplating a more restrictive approach to the regulation of e-cigarettes should pause to consider if pursuing such a course of action is the right thing to do for population health," Bullen wrote.

Funding for this research was provided by the National Cancer Institute.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner









BMJ: Source Reference: Zhu SH, et al. "E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys" BMJ 2017;358:j3262.

BMJ: Source Reference: Bullen C "Rise in e-cigarette use linked to increase in smoking cessation rates" BMJ 2017;358:j3506.