21st April 2015 – People who want to quit smoking by switching to electronic cigarettes should consider ‘vaping’ every day and use e-cigarettes with refillable tanks, according to new research.
The advice comes in two studies by the Institute of Psychiatry, Psychology & Neuroscience at King’s College London and University College London.
The two studies, published in the journals Addiction and Nicotine and Tobacco Research, highlight the need to distinguish between different types of e-cigarettes, as well as frequency of use.
“Cigalikes” or “tanks”
E-cigarettes come in two basic designs: ‘cigalikes’ – designed to resemble real cigarettes and which are disposable or use replaceable cartridges – and ‘tank models’.
Tank models look quite different from cigarettes and have containers that are refilled with the nicotine-containing ‘e-liquid’.
E-cigarette use has grown rapidly with Action on Smoking and Health (ASH) estimating last year that there were 2.1 million users in the UK.
E-cigarettes have provoked controversy, with some critics saying they could encourage people to take up smoking cigarettes. Others have focused on their potential to help people stop smoking or cut down on tobacco use.
The two new studies are based on a survey of smoking behaviour amongst more than 1,500 smokers in the UK.
The first study found that:
65% of daily e-cigarette users surveyed in December 2012 went on to make an attempt to quit smoking within the next year compared with 44% of non-users.
14% of daily users in December 2013 had reduced their cigarette consumption substantially (defined as halving their consumption) over the previous year compared with 6% of non-users.
However, overall, daily e-cigarette users were not more likely to quit during the period of study. Non-daily use showed no clear association with later quit attempts, quitting or reduction in cigarette consumption.
In a statement, lead author, Leonie Brose, says: “E-cigarettes are still a relatively new product, so this study adds important information about what happens when they are used alongside tobacco cigarettes. We already know that using an e-cigarette in an attempt to quit smoking increases the chances of success compared to quitting without any support.
“This study did not test how helpful they are as quitting aids because we looked at smokers who were using them for any reason, including just to cut down on their smoking or in situations when they cannot smoke. But it is encouraging to see that even then, regular e-cigarette use was linked to reduced numbers of lethal cigarettes smoked and increased attempts to quit smoking in the following year.”
As well as looking at how often e-cigarettes were used, the second study also examined what types were in use in 2013. The researchers found that of 587 people using e-cigarettes after one year:
76% used cigalikes and 24% used tank models
28% of tank users had quit smoking compared with 13% of those not using e-cigarettes
11% of daily cigalike users and 9% of non-daily tank users had quit smoking, but these were not significantly different from those not using e-cigarettes
Non-daily cigalike users were actually less likely to have quit compared with those not using e-cigarettes, with only 5% having quit smoking.
The researchers say this as a cause for concern because many of the most prominent brands of cigalikes in the UK are now owned by the tobacco industry.
Dr Sara Hitchman, lead author of the second study, says in a statement: “Our research demonstrates the importance of distinguishing between different types of e-cigarettes and frequency of use when examining the association between e-cigarettes and quitting.
“At this point we don’t know why people who use tank type e-cigarettes daily are more likely to have quit. Research suggests that tanks might deliver nicotine more effectively and perhaps be more satisfying to users, but there may also be other factors, including price and the ways that tanks allow the user to adapt the product, such as the nicotine content and flavour of the liquid.”
Commenting on the second study in a statement, Dr Mike Knapton, associate medical director at the British Heart Foundation, says: “This research suggests that smokers who use tanks on a daily basis may be more likely to have quit smoking after a year than those who use other types of e-cigarettes, or do not use them at all.
“This is an interesting insight, although the original survey was carried out in 2012 and may not reflect current use.”
Turning to the first paper he adds: “This study showed that e-cigarettes did not actually increase the number of successful quitters after one year, but may potentially help users to reduce smoking and make more attempts to quit.
“E-cigarettes are a nicotine product that may reduce the harm associated with smoking but there are also concerns about e-cigarette use in young people, re-normalisation of smoking, deterring successful smoking cessation and questions about the long-term safety.”
Professor Linda Bauld, professor of health policy at the University of Stirling, says in a statement: “What this new research tells us is what e-cigarette users already know. The type of device, how often it is used, and how much nicotine it contains, all matter.
“Some devices will be effective to help smokers to quit and others less so. Future studies need to maintain this focus and not treat all e-cigarettes, or all users, the same.”
Can reducing smoking help?
Professor Martin McKee, Professor of European Public Health, London School of Hygiene & Tropical Medicine, points to a study that concluded long-term follow-up provides no evidence that heavy smokers who cut down their cigarette consumption by greater than 50% reduce their risk of premature death significantly. Heavy smokers must not have false expectations that reduction in consumption is associated with reduction in harm.