March 26, 2018

expert reaction to ecigs and smoking cessation

A study published in the Annals of Internal Medicines attempts to determine whether e-cigarette use after hospital discharge is associated with subsequent tobacco abstinence among smokers who plan to quit and are advised to use evidence-based treatment.

Prof Paul Aveyard, Professor of Behavioural Medicine at the University of Oxford, said:

“This was a study of people trying to quit smoking while they were in hospital and trying to stay quit after discharge.  It showed that those who used an e-cigarette after discharge were less likely to stop smoking at six months than those who did not use an e-cigarette.

“There are two possible explanations: either e-cigarettes make quitting harder or there were differences between those who used an e-cigarette and those who didn’t that explain the results and this latter explanation seems more likely here.  Why would someone who stopped smoking and was finding it easy to quit choose to buy an e-cigarette?  On the other hand, a person who was struggling and lapsing might well choose to get extra help.  There is actually data in the paper that supports this explanation.

“The study data were taken from a randomised trial where people were randomly assigned either to get free medication to help them quit smoking or not get that medication.  (In the US, people usually have to buy medication to stop smoking).  Among those given free medication, using an e-cigarette was much more strongly related to failure of the quit attempt.  Among those not given the free medication, use of an e-cigarette was much more weakly related to failure of the quit attempt.  We know that people who are struggling in the early days of a quit attempt are much less likely to succeed than those who can keep off their cigarettes entirely.  In people given medication, only those who are lapsing are likely to choose to buy an e-cigarette.

“Randomised trials are much stronger designs to test whether e-cigarettes help people stop smoking.  In that case, the randomisation makes sure that the group who use e-cigarettes and the group who don’t have an equal chance of quitting at the outset, which this study could not do.  Trials of e-cigarettes show that e-cigarettes help people stop smoking and the data in this study are not strong enough to challenge that conclusion.”

Prof Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London, said:

“The headline of the press release (‘e-cigarettes hamper smoking cessation’) has no relationship to the study findings. The study just shows that smokers who did not manage to stop smoking with recommended treatments may have been more likely to try e-cigarettes than those who quit successfully. This provides no information on whether ecigs help smokers quit or not.  The key message is that the press release is misleading.”

* ‘Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization’ by Nancy A. Rigotti et al. published in Annals of Internal Medicine on Monday 26 March. 

Declared interests

Prof Paul Aveyard: I have led a trial in which GSK donated free nicotine patches.

Prof Peter Hajek: No conflicts.