Summary
Introduction:
This text provides an analysis of the effectiveness of e-cigarettes in helping adults quit smoking and the regulatory approaches towards e-cigarettes in different countries. It also discusses the issue of dual use of cigarettes and e-cigarettes and its impact on smoking cessation. The text also includes the results of a trial of an intervention specifically developed to promote cigarette cessation among dual users of cigarettes and e-cigarettes.
Key points:
* A Cochrane review in October 2020 found that e-cigarettes with nicotine help more adults to stop smoking than nicotine replacement therapy or nicotine-free e-cigarettes, with moderate confidence.
* Population-level time-series analyses and modelling studies suggest that increases in the prevalence of e-cigarette use are associated with higher rates of smoking cessation.
* The UK government and Public Health England support proportionate regulation of e-cigarettes that seeks to maximize their opportunities and minimize their risks, including an early ban on sales to children, limits on nicotine content, and clear addiction warnings.
* Several health organizations do not recommend e-cigarettes for smoking cessation, citing uncertainty about the balance of harms and benefits, which is often contrasted with the well-established profile of existing smoking cessation medications.
* Dual use of cigarettes and e-cigarettes is unlikely to reduce harm substantially unless it leads to people quitting cigarettes, and will cause harm if quitting is depressed as a result.
* A trial by Martinez and colleagues found that a theory-based intervention comprising a series of booklets advising how to use e-cigarettes to help with quitting increased smoking abstinence throughout the treatment period among dependent smokers.
* However, there is uncertainty about the immediate public health significance of the study due to minimal biochemical outcome verification and the lack of a significant effect on cessation in unplanned sensitivity analyses.
* Long-term relapse rates after quitting smoking with e-cigarettes are an important area for further research.
Main message:
While there is evidence that e-cigarettes with nicotine can help adults quit smoking, there is ongoing debate and uncertainty about the balance of harms and benefits, particularly in the context of dual use. Regulatory approaches towards e-cigarettes vary widely between countries, and further research is needed to inform judgments about their role in comprehensive tobacco control. The trial by Martinez and colleagues is an excellent contribution to the field, but more research is needed to establish the long-term effectiveness of e-cigarettes in promoting smoking cessation.
Citation
Brown J, Shahab L. Smoking cessation support for dual users of cigarettes and electronic cigarettes. The Lancet Public health. 2021;6(7):e441-e442. doi:10.1016/S2468-2667(21)00034-7
