Bret A. Moore, PsyD, ABPP
Board-Certified Clinical Psychologist, San Antonio, TX
Dr. Moore has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Review of: Beard E, West R, Michie S, et al. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. British Medical Journal 2016;354:i4645.
STUDY TYPE: Time series analysis
Do electronic cigarettes (e-cigs) help people quit smoking tobacco cigarettes? Clinical trials have indicated that e-cigs are as effective as nicotine replacement therapy (NRT) in quit rates, but what about population-level evidence? Can it show that increasing e-cig popularity in a country leads to a greater likelihood of quitting smoking?
To explore this issue, researchers from England drew on data from two national databases that house smoking information about British citizens. Specifically, they looked at over 170,000 tobacco smokers aged 16 and older to see if e-cig use was associated with quit attempts, rates of successful quitting, and the use of medications and support programs that aid quitting. The data collected was based on quarterly self-reports from smokers over a 10-year period. The study did not exclude patients with mental illness, nor did it stratify subjects by the severity of their smoking habits.
Results Use of e-cigs was indeed associated with quitting smoking. For every 1% increase in the prevalence of e-cig use by smokers, there was a 0.1% increase in quit rates. However, increasing use of e-cigs didn’t affect the rate of attempts to quit, use of NRT, use of prescription medications like varenicline and bupropion, or the use of behavioral support.
CATR’s Take This is an important study because it’s the first to examine the impact of e-cig use on smoking behavior in a large countrywide epidemiological study. We can be more confident that e-cig use helps people to quit smoking—at least in England.
Practice implications This is yet another study endorsing the controversial practice of recommending e-cigs to smokers who want to quit. Many of us balk at the idea of prescribing e-cigs, and the fact is we don’t know their long-term effects. Since we do know that NRT, bupropion, and varenicline are safe and effective for smoking cessation, these should be recommended first. But if these treatments fail or if patients insist on trying e-cigs for smoking cessation, we shouldn’t discourage them. As new e-cig data comes in, it’s likely we will be more tempted to endorse this latest method of kicking the habit.