AMHERST, Mass. — While e-cigarettes come along with their own unique set of potential health concerns, noteworthy new research finds that these devices may actually offer cigarette smokers their best chance of kicking the habit once and for all.
The latest Cochrane review co-led by a University of Massachusetts Amherst public health and health policy researcher reveals that nicotine e-cigarettes are more effective at helping smokers quit than conventional nicotine-replacement therapy (NRT) options.
After a review of the relevant smoking cessation studies, the annual analysis concluded nicotine vapes display an association with stronger odds of quitting than patches, gums, lozenges, or other traditional NRT.
“In England, quite different from the rest of the world, e-cigarettes have been embraced by public health agencies as a tool to help people reduce the harm from smoking,” says Jamie Hartmann-Boyce, an assistant professor of health policy and promotion in the School of Public Health and Health Sciences, in a media release.
On a global scale, cigarettes remain the leading cause of both preventable disease and death, attributed to over seven million deaths annually.
“Most of the adults in the U.S. who smoke want to quit but many find it really difficult to do so,” adds Prof. Hartmann-Boyce, who conducted research at the University of Oxford in England before joining UMass Amherst earlier this year. “We need a range of evidence-based options for people to use to quit smoking, as some people will try many different ways of quitting before finding one that works for them.”
Prof. Hartmann-Boyce, a Cochrane editor, is senior author of the review which featured 88 studies and over 27,235 participants. Those numbers represent an addition of 10 studies since the 2022 edition of the report. Most of the analyzed studies took place in the United States, United Kingdom, or Italy.
E-cigarettes do not actually burn tobacco but rather heat liquids that mix nicotine with various flavorings. This allows users to inhale a vapor that contains nicotine instead of inhaling harmful tobacco smoke. Conventional cigarettes, of course, expose users to a complex mix of chemicals known to cause many diseases.
“We have very clear evidence that, though not risk free, nicotine e-cigarettes are substantially less harmful than smoking,” Prof. Hartmann-Boyce adds. “Some people who haven’t had success in the past with other quit aids have found e-cigarettes have helped them.”
The analysis also found that for every 100 individuals using nicotine e-cigarettes to quit cigarettes, eight to 10 would be expected to actually succeed in quitting. In comparison, six of 100 people using traditional nicotine-replacement therapy will succeed, and four of 100 trying to stop with no support or behavioral support will actually quit.
Researchers explain that those who already abstain from tobacco should try to avoid e-cigarettes due to their potential health effects, but for people who are already smokers, e-cigarettes represent a way to improve their health and reduce their risks by quitting tobacco.
“Not everything is either entirely harmful or beneficial,” Prof. Hartmann-Boyce comments. “Different things can have different impacts on different populations. Evidence shows that nicotine e-cigarettes can help people quit smoking, and that people who don’t smoke shouldn’t use e-cigarettes.”
She goes on to compare tobacco smoking vs. e-cigarettes to treatments for a substance-use disorder involving opioids. “We’re not going to prescribe methadone to people who aren’t addicted to opioids,” she notes. “But for people addicted to opioids, we recognize that methadone is a helpful thing.”
The U.S. Food and Drug Administration (FDA), which is responsible for the regulation of e-cigarettes, has approved seven different medications shown to help adults quit cigarettes. E-cigarettes are not one of them.
“While certain e-cigarettes may help adult smokers transition completely away from, or significantly reduce their use of more harmful combusted cigarettes, the law’s public health standard balances that potential with the known and substantial risk with regard to youth appeal, uptake and use of these highly addictive products,” FDA commissioner Dr. Robert Califf said in a statement while updating the FDA’s tobacco program.
The study is published in the Cochrane Database of Systematic Reviews.