There are numerous research gaps in proving the effectiveness of e-cigarettes as smoking cessation AIDS. A 2020 Surgeon General’s report on smoking cessation found “insufficient evidence” to conclude that e-cigarettes increase smoking cessation. Similarly, a 2018 National Academy of Sciences (NASEM) report found limited evidence on the effectiveness of e-cigarettes in promoting smoking cessation.
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E-cigarettes are also not approved as smoking cessation AIDS by the FDA or the U.S. Preventive Services Task Force.
While some evidence supports the use of e-cigarettes as smoking cessation devices, recent research suggests that their efficacy for smoking cessation may be overstated.
A 2020 U.S. Surgeon General’s report on smoking cessation suggested that e-cigarettes may help some adult users reduce their risk of smoking-related diseases if users avoid using them twice for extended periods of time, but found there was not enough evidence to conclude that e-cigarette use generally increases smoking cessation. The reasons are the variable composition of e-cigarettes, the differences in how they are used, and the lack of evaluative studies.
Some evidence suggests that nicotine-containing e-cigarettes are associated with increased smoking cessation compared to non-nicotine e-cigarettes. A 2020 systematic review of 50 studies that included adult smokers in the United States and other countries found moderate-quality evidence that nicotine-containing e-cigarettes increased quit rates compared to e-cigarettes that used nicotine replacement therapy or nicotine-free e-cigarettes. Nicotine e-cigarettes may also help more people quit smoking, rather than providing support or behavioral support alone. The NASEM report also reported that more frequent use of e-cigarettes may increase an individual’s likelihood of quitting smoking.
A 2018 study among U.S. adults explored whether e-cigarettes inspired more successful smoking cessation attempts and found that e-cigarette users were 70% less likely to quit smoking than non-users.
A 2019 study by the UK’s National Health Service published in the New England Journal of Medicine found that e-cigarettes may help adults quit smoking. Compared to the group using nicotine replacement products, the group assigned to e-cigarettes as an alternative to combustible tobacco was more likely to remain abstinent at one year (18 percent versus 9.9 percent). However, at the one-year follow-up, most e-cigarette users were still using e-cigarettes. The researchers noted that the study was based on a middle-aged adult (median age 41) actively seeking to quit smoking and receiving behavioral support for at least four weeks. It is worth noting that the UK has also imposed strict restrictions on the marketing of e-cigarettes.
While some e-cigarettes can help some people quit smoking, the diversity of products as well as differences in quality and lack of regulation make it difficult to determine the potential of any particular product as a smoking cessation aid. Some smokers have switched to e-cigarettes or used them to quit altogether, however, unlike FDA-approved smoking cessation therapies, e-cigarettes lack an evidence base for their safety and effectiveness. The Truth Initiative supports regulation by encouraging the development of consistently less harmful nicotine delivery alternatives that allow smokers to quit altogether or switch entirely to less harmful, well-regulated products.
A recent meta-analysis of the use of e-cigarettes as a smoking cessation tool suggests that their efficacy depends on frequency and type of use. Overall, among adult smokers and adult smokers who expressed motivation to quit smoking, the use of consumer e-cigarettes – e-cigarettes purchased from a retail setting and used casually by consumers – was not significantly associated with smoking cessation. In terms of consumer e-cigarette use, only daily e-cigarette use was associated with an increase in smoking cessation, while daily use was associated with a decrease in smoking cessation. However, when used in combination with smoking cessation therapy, randomized controlled trials have found that e-cigarette use is significantly associated with increased smoking cessation. The current study provides evidence that e-cigarettes marketed as consumer products may not be an effective tool for smoking cessation. More evidence is needed to understand how e-cigarettes can help with supervised smoking cessation.
A study suggests that the appeal of products, including flavorings, may encourage smokers to try using e-cigarettes to quit. A 2020 study published in JAMA Network Open found that in adults, the use of flavored e-cigarettes was more likely to be associated with smoking cessation than the use of unflavored e-cigarettes, with an increased chance of smoking cessation in adults more than twice as high. However, given that flavored e-cigarettes account for the vast majority of the U.S. e-cigarette market, stronger empirical evidence is needed to understand whether and how taste influences smoking cessation.
However, as the popularity of teen e-cigarettes in the United States and the youth appeal of flavored e-cigarettes go hand in hand, the Truth Initiative strongly supports the removal of all flavored e-cigarettes from the market, regardless of device type. At the very least, e-cigarette makers must demonstrate that the flavor itself is safe, helps smokers get rid of combustible cigarettes altogether, and doesn’t appeal to young people before the product hits the market. In addition to taste restrictions, the Truth Initiative supports strong regulations to keep all tobacco products, including e-cigarettes, away from young people.