Author Insights: e-Cigarettes Not Associated with Quitting

Pamela M. Ling, MD, MPH, University of California, San Francisco, and colleagues found that despite advertising claims, e-cigarette use wasn’t associated with a reduction in smoking. Image: University of California, San Francisco

Pamela M. Ling, MD, MPH, University of California, San Francisco, and colleagues found that despite advertising claims, e-cigarette use wasn’t associated with a reduction in smoking. Image: University of California, San Francisco

Despite marketing campaigns suggesting that e-cigarettes help smokers quit, a new analysis published today in JAMA Internal Medicine finds that smokers who use these products are not more likely than nonusers to snuff out the habit.

e-Cigarettes have been touted as a safer alternative to conventional cigarettes and as a promising cessation tool. But these claims are much debated, with some experts viewing see these products as a viable harm reduction tool and others arguing they are no better than cigarettes.

To test the cessation claims, Pamela M. Ling, MD, MPH, an associate professor of medicine at the University of California, San Francisco, and her colleagues, analyzed prospective data on a cohort of about 1000 smokers who participated in an online survey. The researchers found that e-cigarette users were not more likely than nonusers to quit.

However, the authors note that it’s possible the study was underpowered to detect a small difference. Individuals who expressed an interest in quitting and those who reduced the number of cigarettes they smoked were more likely to quit than individuals who did not.

Dr Ling spoke with news@JAMA about her findings.

news@JAMA: Why did you decide to conduct this study?

Dr Ling: There has been a lot of interest in e-cigarettes, and we had a cohort study of smokers that were followed going forward.

news@JAMA: Were you surprised by what you found?

Dr Ling: We were surprised there was no difference between smokers who used e-cigarettes and those who didn’t. With all the advertisements and testimonials that it will help you quit, it is surprising there was no relationship.

Some previous studies reported smoking e-cigarettes allow you to reduce the number of cigarettes smoked; we examined that and didn’t see a significant reduction in cigarettes smoked per day. e-Cigarettes may not be a good substitute for cigarettes, or they are simply being added in certain contexts where smoking is not allowed. We had some smokers who used e-cigarettes and quit, but many more also continued to smoke.

We don’t know the reasons the people in our survey used e-cigarettes. But if you think about potential explanations, they either didn’t work [as a cessation tool] or, as they are sometimes advertised, were used as something you can use where you can’t smoke.

news@JAMA: What do you think is the study’s main take-home message?

Dr Ling: Because these products are advertised so heavily as smoking cessation tools without regulation, physicians and patients are going to hear these are a good way to quit. I would recommend they be skeptical of those claims before adopting e-cigarettes as a cessation aid.

From a policy perspective, these companies shouldn’t be allowed to make health claims. We did the first systematic content analysis of e-cigarette advertisements and over 90% made health claims, 64% made smoking cessation claims, and 22% had doctors.

The current e-cigarette advertising is so similar to what cigarette companies have done in the past. Because the ads are so prevalent, people may feel it is true. To regulate these ads, the US Food and Drug Administration would have to exercise authority. They have said they plan to issue a rule, but that is going to be a long process.



Categories: Primary Care/Family Medicine, Public Health, Tobacco

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