Smokers may think electronic cigarettes will help them quit, but a new study finds no evidence that's the case.
Researchers found that among Americans who'd recently quit smoking, those who were using e-cigarettes were just as likely to relapse in the next year as non-users were.
And the risk of relapse was actually slightly increased among former smokers who were using any type of non-cigarette tobacco product -- including e-cigarettes, hookahs and smokeless tobacco.
The findings, reported online Oct. 19 in JAMA Network Open, counter the idea that e-cigarettes can help former smokers abstain from traditional cigarettes.
The study comes on the heels of a decision by the U.S. Food and Drug Administration to grant its first-ever authorization to an e-cigarette product.
Last week, the agency announced it was allowing R.J. Reynolds to continue selling three of its Vuse tobacco-flavored "vaping" products. The FDA cited data from the company that the devices "could benefit addicted adult smokers who switch to these products -- either completely or with a significant reduction in cigarette consumption -- by reducing their exposure to harmful chemicals."
The agency stressed, however, that the products are not "FDA-approved" or endorsed as smoking-cessation aids.
The new study adds to a sometimes confusing body of research on the effects of e-cigarettes on smoking cessation. A couple of clinical trials have suggested that offering e-cigarettes as part of a quit program -- along with counseling -- can be more effective than counseling plus nicotine patches or gum.
But the key is that in trials, smokers were getting "behavioral support" and guidance on how to use e-cigarettes as a cessation aid, said Terry Pechacek, a professor and tobacco control expert at Georgia State University, in Atlanta.
In studies like the latest one -- which follow people in the "real world" -- e-cigarettes do not appear to be beneficial.
"And that's no surprise," said Pechacek, who wrote an editorial published with the new study. He said the same scenario played out when nicotine-replacement therapies became available over the counter, and people were using them on their own.
The best way to quit smoking, Pechacek said, is by "accessing help" -- including free counseling over the phone via government "quitlines."
In the United States, e-cigarettes are not approved or recommended as a smoking cessation aid, but two medications are: varenicline (Chantix) and the antidepressant bupropion (Wellbutrin).
"We already have FDA-approved therapies," said Dr. Jamie Garfield, a volunteer medical spokesperson with the American Lung Association.
In general, she said, varenicline is the first choice, followed by bupropion or nicotine replacement therapy -- used alongside counseling in all cases.
"I do not recommend e-cigarettes in any context to anyone," Garfield said. She noted that no clinical trials have compared e-cigarettes against the FDA-approved medications in helping smokers quit.
And beyond that, Garfield said, there are broader harms of widespread access to e-cigarettes: In the real world, many smokers do not forgo cigarettes once they start vaping, instead becoming "dual users."
Meanwhile, teenagers' use of e-cigarettes has become a major public health concern. Research shows that 30% of teens who use e-cigarettes go on to start smoking, Garfield noted.
For the new study, John Pierce and colleagues at the University of California, San Diego, collected data from over 13,600 U.S. adult smokers. During the first year of follow-up, just under 10% said they'd quit cigarettes.
Of those newly ex-smokers, many (37%) were still using an alternative tobacco product, which included e-cigarettes, hookahs, chewing tobacco and cigars. About 23% used e-cigarettes, specifically.
Overall, ex-smokers who used any alternative product were more likely to relapse in the next year: Only 41.5% remained cigarette-free, compared with half of ex-smokers who steered clear of all cigarette alternatives.
Those who used e-cigarettes, specifically, were not at increased risk of relapse -- but they weren't helped, either.
E-cigarettes have been sold in the United States for years, largely unregulated. But starting last year, the FDA began requiring manufacturers to apply for permission to sell their products, including ones already on the market. Companies were to submit data to help the FDA decide whether their products' potential benefits to adult smokers outweigh the potential harms to public health.
In recent months, the FDA has denied thousands of those applications, effectively banning the products.
The fact that the agency allowed certain Vuse products to remain on the market is not an endorsement of them as smoking-cessation aids, Garfield said.
Pechacek said that for any vaping products to truly become a "disruptive technology" that replaces cigarettes, the FDA has to curb the appeal of cigarettes -- by requiring reduced nicotine levels, for instance.
"Cigarettes are not just rolled up tobacco leaves," Pechacek said. "They're highly refined drug-delivery devices."
The U.S. Centers for Disease Control and Prevention offers free resources for quitting smoking.
SOURCES: Terry Pechacek, PhD, professor, health management & policy, Georgia State University, Atlanta; Jamie Garfield, MD, volunteer medical spokesperson, American Lung Association, Chicago, and associate professor, thoracic medicine and surgery, Lewis Katz School of Medicine, Temple University, Philadelphia; JAMA Network Open, Oct. 19, 2021, online