E-Cigarettes Vs. Pharmacotherapy: Why Nicotine Is Helping More Americans Quit Smoking
Cigarette smoking habits have been declining in the United States over the past decade. Prevention efforts, anti-smoking laws, a hike in cigarette taxes, and research on smoking and health risks have led the country's smoking rate to reach a record low of 15.1 percent. Now, a study published in the British Medical Journal suggests e-cigarettes have proven to be more useful than pharmacology in helping adults quit smoking traditional cigarettes.
The 2014-2015 Current Population Survey-Tobacco Use Supplement (CPS-TUS) survey, a national survey of adults 18 and older conducted to acquire information about the changes in the country's use of tobacco products, found smoking cessation rates rose to 5.6 percent — a 1.1 percent increase from the annual rate in recent years. The 1.1 percent increase represents about 350,000 additional smokers who quit in a 12-month period. Researchers believe smokers were able to curb their tobacco cravings with e-cigs, which prevented a relapse.
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The University of California San Diego School of Medicine and Moores Cancer Center research team noted the conjunction of national tobacco control media campaigns in 2012 and the popularity of e-cigs in 2014, are contributing factors to the high quitting rate.
"Use of e-cigarettes was associated both with a higher quit rate for individuals as well as at the population level; driving an increase in the overall number of people quitting," said Shu-Hong Zhu, study author and UC San Diego professor of Family Medicine and Public Health and director of the Center for Research and Intervention in Tobacco Control, in a statement.
Organizations like the U.K. Center for Tobacco and Alcohol Studies and the University of Geneva's Institute of Social and Preventive Medicine have touted e-cigs as a smoking-cessation tool. Unlike nicotine chewing gum and patches, e-cigs, which heat nicotine-laced liquid into vapor, mimic the experience of smoking a cigarette. Moreover, they do not contain the harmful, cancer-causing chemicals found in traditional cigarettes.
To examine the effects of e-cigs use on quitting smoking, Zhu and his colleagues collected data from the US Census CPS-TUS. It’s based on the largest representative sample of smokers and e-cigarette users available. Survey participants who used e-cigs were more likely doing so to quit smoking traditional cigarettes.
A total of 65 percent of smokers who used e-cigs within 12 months had attempted to quit smoking traditional cigarettes, compared to 40 percent of smokers who didn't use e-cigs. Overall, 8.2 percent of smokers who used e-cigs as smoking cessation successfully kicked the habit. Meanwhile, only 4.8 percent of smokers who did not use e-cigs were successful. More than 70 percent of those who quit smoking recently were successful, but they used e-cigs daily to prevent a relapse.
Zhu notes those who use e-cigs are a self-selected group.
"They may do better with e-cigarettes because they may already be motivated to quit," he said.
Zhu added: "It is important to look at the entire population including users and nonusers to determine if the overall cessation rate went up or down.
Read More: Is Vaping Really A Healthy Alternative To Smoking?
Other study limitations included not addressing the long-term effects of e-cigs or investigating if the use of e-cigs leads people to start smoking. Nor did the researchers explain details about the type of e-cigs being used, or if other smoking cessations tools like pharmacotherapy were used at the same time. FDA-approved pharmacotherapies for smoking cessation include: bupropion SR, nicotine gum, nicotine inhaler, nicotine nasal spray, and the nicotine patch.
Pharmacotherapy has been shown to help some people to quit smoking, but not at the same rate as e-cigs. Prior to e-cigs, the rate of smoking cessation among the entire population did not change significantly, despite the advocacy of pharmacotherapy.
Yet, a substantial amount of evidence suggests e-cigs are a safer alternative than cigarettes. For example, a 2016 study found e-cigs release far less formaldehyde than tobacco cigarettes. Traditional cigarette smoke is estimated to raise a smoker's' risk for cancer by less than 1 part in 1,000, therefore, the risk of formaldehyde in the vapor of e-cigs is not as significant.
Current approaches for smoking cessation do not work for a vast majority of smokers; this calls for the need of alternative approaches, like e-cigs.
"Other interventions that occurred concurrently, such as a national campaign showing evocative ads that highlight the serious health consequences of tobacco use and state tobacco control efforts, no doubt played a role," said Zhu, about the high numbers of smoking cessation.
However, he emphasizes the current study gives e-cigs a strong case for contributing to an increase in Americans quitting smoking at the population level.
E-cigs possess the potential to reduce a deadly habit that is responsible for more than 480,000 deaths per year in the U.S.
Source: Zhu SH, Zhuang YL, Wong S et al. E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys. BMJ. 2017.
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