Giving smokers free access to e-cigarettes significantly increases their chances of quitting or at least significantly reducing smoking. This is the result of a randomized control trial that followed 638 smokers in 11 US cities for six months.
"No matter which way we looked at it, smokers who were given free access to e-cigarettes smoked less. They also tried to quit more often and were much more successful than those who were not." Says Matthew Carpenter, researcher at the University of South Carolina.
How does access to e-cigarettes affect smoking habits in everyday life, outside clinical trials? A research team at the Hollings Cancer Center, under the University of South Carolina, USA, find out. Previous compilations, among others Cochrane reviewshas shown that e-cigarettes are very effective in smoking cessation. But that doesn't tell the whole story, says Matthew Carpenter responsible for the study.
"A common objection to previous studies is that they are too structured. They often include both behavioral support and instructions on how participants should use e-cigarettes in their attempt to quit smoking. We wanted to see what it looks like when use is not structured - but more unstructured. Like in real life." says Matthew Carpenter to Medical Xpress online magazine.
Different ambitions among smokers
Instead of repeating the methods used in other studies, the researchers chose to conduct a so-called naturalistic study. They selected 638 smokers in 11 US cities.
"We focused on two types of smokers. Firstly, those who explicitly wanted to quit smoking, and equally many who had no such ambitions. We then gave them e-cigarettes, but without any instructions on how to use them", says Matthew Carpenter, to the online magazine Medical Xpress.
The only encouragement participants received was that they could use e-cigarettes as much or as little as they wanted. Or not at all. They were then given free access to e-cigarettes for four weeks, in the form of pre-filled pod systems and five different flavors to choose from. The control group consisted of an equal number of smokers who did not receive free e-cigarettes.
Follow-up after 6 months
The researchers then monitored progress through online questionnaires. A final check was done after six months, a kind of standard to assess the effectiveness of smoking cessation interventions. It was originally intended to test some of the participants via clinical breath tests, but due to Covid-19 this was not possible.
"Self-reporting is not as reliable, but it is sufficient to get an acceptable and reliable result," says Matthew Carpenter.
More people quit smoking
The study showed that those given e-cigarettes were more likely than the others to be smoke-free after six months. People in the e-cigarette groups were also more likely to reduce the number of cigarettes smoked per day. They also reported more deliberate attempts to quit smoking than those who did not receive e-cigarettes.
"The number of quit attempts is important to note, as we know that most smokers need many attempts before they succeed in quitting," Matthew Carpenter told Medical Xpress. "We also noted that the number of quit attempts increased in the group that had no ambition to quit before"
The study, which is the first of its kind and the largest study of e-cigarettes in the US, was published in The Lancet. According to the researchers, the results could be important in light of new legislation and impact assessments on the control of e-cigarettes.
Criticism of de facto taste ban
In the United States, where the study was conducted, the FDA has only allowed a few varieties of e-liquid and vape models on the market. Users and companies regularly criticize the agency for de facto banning all flavors except tobacco flavors in e-cigarettes - a common denominator for the 20 or so different e-liquids and pod systems the FDA has approved so far.
In total, nearly 6 million applications have been submitted to the FDA, from thousands of independent operators, but only products from major tobacco companies have been approved. According to the FDA, the tight restrictions are due to an imminent concern about increased use among minors.
"We should do everything we can to prevent e-cigarette use among children," Matthew Carpenter told Medical Xpress. "But our study shows that this should not be at the expense of opportunities for adult smokers who are unable to quit smoking by other means"
