New research shows electronic cigarettes better for quitting, than no aid; over the counter NRT worse than no aid

Grzegorz Krol | 7 February 2014

New research presented by Jamie Brown and colleagues at the Society for Research on Nicotine and Tobacco conference, 20th Annual Meeting, held in Seattle on Saturday, February 8, 2014 shows that smokers wishing to quit who used electronic-cigarettes had best outcomes.

The study was conducted on a large representative sample of the English population, and was based on people who had smoked during the last 12 months. It looked at those who had made at least one quit attempt using only an electronic cigarette, used only over-the-counter NRT, or used no aid in their most recent quit attempt. The outcome assessed was abstinence from cigarettes up to the time of the survey.

Users of electronic cigarettes performed best – 19.9% had stopped smoking, better than the 15.1% success for those who used no aid. Surprisingly (perhaps for some public health experts) OTC NRT users came off worst, with only 10.0% abstinent.

Caution is needed: this is an abstract, and publication of the full paper will give further details. More details are needed about the length of abstinence from smoking. Those using NRT may be a different segment of the smoking population than those using electronic cigarettes: however the research team found that the difference persisted after adjusting for factors that might influence outcome such as smokers’ levels of nicotine dependence.

The recent randomised controlled trial by Chris Bullen and colleagues showed that electronic cigarettes were equally as effective as NRT patches. It is difficult to extrapolate from RCTs to real world conditions. Hence the significance of the Jamie Brown study.

This study is complemented by growing evidence of the increasing popularity of e-cigarettes for switching from smoking. Robert West’s Smoking Toolkit data shows that since 2013 electronic cigarette use has surpassed NRT; that almost 1 in 3 quit attempts involve the use of electronic cigarettes, that they are now the most commonly used resource for the last quit attempt (exceeding OTC NRT, varenicline, prescribed NRT, and behavioural support) and that there has been a decrease in use of other aids to smoking cessation.

The findings raise further questions about the effectiveness of OTC NRT. As recently reported, OTC NRT use in self-initiated quit attempts confers no advantage over stopping without any aid (Kotz, Brown, & West, 2013). At a population level, there is no measurable effect of OTC NRT on the overall prevalence of smoking.

Implications for public health experts and advisors

Gerry Stimson says: ‘This study adds to the growing scientific evidence about the effectiveness of electronic cigarettes and the seemingly lesser effectiveness of over the counter NRT. It could be said that it is no longer ethical to give advice to smokers that discourages use of electronic cigarettes and that advises smokers who wish to quit to use only medically licensed products such as gums, tablets and patches.’

This is the full abstract of the study:

Abstract from Society for Research on Nicotine and Tobacco conference, 20th Annual Meeting

PA18-4

REAL-WORLD EFFECTIVENESS OF E-CIGARETTES: A POPULATION STUDY

Jamie Brown*, Ph.D., 1,2, Emma Beard, Ph.D., 1, Daniel Kotz, Ph.D., 1,3, Susan Michie, D.Phil., 2, 4, Robert West, Ph.D., 1, 4 1 Cancer Research UK Health Behaviour Research Centre, University College London, WC1E 6BT, UK 2 Department of Clinical, Educational and Health Psychology, University College London, London, UK 3 Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands 4 National Centre for Smoking Cessation and Training, London, UK

Background: Electronic cigarettes (e-cigarettes) are rapidly increasing in popularity. Two randomised controlled trials have suggested that e-cigarettes can aid smoking cessation but there are many factors that could influence their real-world effectiveness. This study aimed to assess, using an established methodology, the effectiveness of e-cigarettes compared with nicotine replacement therapy (NRT) bought over-the-counter and with unaided quitting in the general population.

Methods: A large survey of a representative sample of the English population. The study included 5726 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e-cigarette only (n=391), NRT bought over-the-counter only (n=2031) or no aid in their most recent quit attempt (n=3304). The primary outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including nicotine dependence.

Results: E-cigarette users were more likely still to be abstinent than either those who used NRT bought over-the-counter (OR=2•23, 95%CI=1•67- 2•97, 19•9% vs. 10•0%) or no aid (OR=1•40, 95%CI=1•07-1•82, 19•9% vs. 15•1%). The adjusted odds of non-smoking in users of e-cigarettes were 1•66 (95%CI=1•17-2•36) times higher compared with users of NRT bought over-the-counter and 1•60 (95%CI=1•15-2•23) times higher compared with those using no aid.

Conclusion: Among smokers stopping without professional support, those who use e-cigarettes appear more likely to be able to remain abstinent than those who use a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a wide range of smoker characteristics such as nicotine dependence.

FUNDING: JB’s post is funded by a fellowship from the UK Society for the Study of Addiction. RW is funded by Cancer Research UK. We are grateful to Cancer Research UK, the Department of Health and Pfizer for funding this study. This study is partly funded by Pfizer under an investigator initiated award.

SRNT abstracts can be found here – 2014 Rapid Response Abstract Book

Bullen, C., Howe, C., Laugesen, M., McRobbie, H., Parag, V., Williman, J., & Walker, N. (2013). Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet, 382(9905), 1629–37. doi:10.1016/S0140-6736(13)61842-5

Kotz, D., Brown, J., & West, R. (2013). “Real-world” effectiveness of smoking cessation treatments: a population study. Addiction doi:10.1111/add.12429

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