E-cigarettes have been touted as an aid to quit smoking tobacco cigarettes, but a new study suggests that's a myth.
Researchers found that using e-cigarettes resulted in fewer successful attempts than other smoking cessation aids. And, they added, e-cigarette users weren't less likely to relapse than those who didn't use them.
"I think the image of e-cigarettes as the one thing that's going to help everyone quit has dulled," said study author John Pierce, a professor emeritus from the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego. "Just replacing your source of nicotine is not the key here."
He noted that most smokers who tried e-cigarettes to quit didn't use high-nicotine vapes. Whether using doing so would improve the quit rate isn't known and is something researchers will be looking at.
In October, the U.S. Food and Drug Administration gave permission for the sale of one popular e-cigarette brand, saying it can help adults quit smoking traditional cigarettes.
Pierce said he's not sure what evidence the FDA is accepting as proof that e-cigarettes help people quit, given the outcome of this study.
Quitting isn't easy, he noted.
"Quitting is the hardest thing a lot of people can do. The success rates of quit attempts haven't changed in 30 years," Pierce said. "We don't have any really good successful ways of doing it -- the motivation's got to get high enough. It's just your motivation level."
For their study, Pierce and his colleagues collected data on more than 3,500 smokers who tried to quit and more than 1,300 who actually did as part of PATH (Population Assessment of Tobacco and Health Study).
Participants were asked what they used to try to quit, including e-cigarettes, nicotine patches, gums, inhalers, nasal sprays, lozenges or tablets, other tobacco products, or the drugs Chantix (varenicline), Wellbutrin or Zyban (bupropion). E-cigarette users were asked how much nicotine was in their vapes.
The participants were tracked for at least 12 months.
In 2017, more than 12% of those who had recently tried to quit said they used e-cigarettes alone or along with other products. About 2.5% said they used other tobacco products.
About 21% used nicotine replacements or one of the drugs, and 64% just stopped smoking without any substitutes.
Among former smokers, more than 15% switched to e-cigarettes and 16% said they used other tobacco products. The rest hadn't used anything, the researchers found.
Among e-cigarette users, about a quarter used vapes with a nicotine strength of 4% or more. In 2019, the number of former smokers who switched to e-cigarettes rose to 22%, and some were using high-nicotine vapes, Pierce said.
Those who used e-cigarettes to quit before 2017 were less likely to succeed by 2019 than those who used nothing -- 10% versus 19%. E-cigarettes were linked with 7 fewer successful quitters per 100 would-be quitters than other drug aids, the researchers said.
Nor did e-cigarettes lower the odds of relapse, compared with smokers who didn't vape. Close to 60% of former smokers who used e-cigarettes daily had returned to traditional cigarettes by 2019, researchers found.
"The data for e-cigarettes as a smoking cessation tool has never been very strong," said Dr. David Hill, a medical spokesman for the American Lung Association. "So this study confirms that they're not a great tool for people to stop smoking."
The best way to quit is not to go it alone, but to work with your doctor and a counselor, said Hill, who wasn't part of the study.
"Successfully quitting without that sort of comprehensive care is unlikely to achieve success," Hill said.
But, he added, anyone can stop smoking if they truly want to.
"I've rarely run into somebody who truly has their mind set on stopping who can't be helped to quit," Hill said. "Sometimes it takes multiple attempts and a variety of different approaches."
As for vaping, Hill is not a fan.
"The problem with e-cigarettes is they're still a nicotine combustion product, and our lungs are not designed to inhale heated products," Hill said. The long-term effects of continuous e-cigarette use aren't clear, he added, because they haven't been around long enough to know.
More than 25% of high school students vape, Hill said. So, he said, manufacturers are hooking a new generation as opposed to getting people who are addicted off these products.
The findings were published online Feb. 7 in the journal Tobacco Control.
For more on how to quit smoking, visit the U.S. Centers for Disease Control and Prevention.
SOURCES: John Pierce, PhD, professor emeritus, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; David Hill, MD, medical spokesman, American Lung Association; Tobacco Control, Feb. 7, 2022, online