In a landmark first, researchers from the MUSC Hollings Cancer Center have used real-life conditions to show that e-cigarettes are an effective smoking cessation aid. The study, which is entitled “Effect of unguided e-cigarette provision on uptake, use, and smoking cessation among adults who smoke in the USA”1M. Malas, J. van der Tempel, R. Schwartz, et al., “Effect of unguided e-cigarette provision on uptake, use, and smoking cessation among adults who smoke in the USA: a naturalistic, randomised, controlled clinical trial,” eClinicalMedicine, [Online]. Available: https://www.sciencedirect.com/science/article/pii/S258953702300319X, uses what it terms “naturalistic” conditions to give a realistic insight into the “impact of e-cigarettes among adults who may or may not want to stop smoking.”
There has been a lot of criticism levied against other studies that have similar aims, mainly because they are limited by “variable outcome assessments, inadequate sample size, and diverse study populations of smokers.”2L. A. R. Steinberg, A. M. Smith, and D. D. Williams, “Electronic Cigarette Solutions and Resultant Aerosol Profiles,” Journal of Chromatography A, vol. 1497, pp. 144-151, Jun. 2017. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480094/ In short, existing research is too structured and sparse and ultimately does not account for real-life conditions such as age, gender, socioeconomic status, and so on.
Matthew J. Carpenter, one of the contributors to the study, had a solution. “What we did was take a hands-off approach – we called it a naturalistic approach,”3M. Carpenter et al., “Largest U.S. study of e-cigarettes shows their value as smoking cessation aid,” EurekAlert!, Medical University of South Carolina, 18-Aug-2023. [Online]. Available: https://www.eurekalert.org/news-releases/998999 said Carpenter. As part of this “naturalistic” approach, Carpenter et al invited smokers who did not want to quit to participate in the trial. Some participants were given e-cigarettes and told that they could choose whether or not to use them, and the control group received nothing.
The study found that participants in the e-cigarette group were more likely to completely abstain from cigarettes, reduce the number of cigarettes they smoked per day, and reduce their quit attempts. “No matter how we looked at it, those who got the e-cigarette product demonstrated greater abstinence and reduced harm as compared to those who didn’t get it,” said Carpenter.
“Quit attempts” might seem like a strange metric for a study that measures the effectiveness of a cessation tool. But, according to the Centers for Disease Control and Prevention (CDC), smokers attempt to quit eight to 11 times before they quit completely4M. J. Carpenter et al., “E-cigarettes, smoking, and health: A complex evolving controversy,” Curr Cardiovasc Risk Rep., vol. 10, no. 7, p. 24, Jul. 2016. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908897/.
One of the downfalls of the study is that the researchers had to rely on participants to relay their own experiences. At the beginning of the study, researchers planned to collect biochemical samples from each participant spread over 11 U.S. cities for the entire four-year period. However, COVID-19 made this impossible, meaning that researchers had to ask participants to self-report. Despite this, Carpenter remains confident that the data is reliable.
Commenting on the rising anti-vape rhetoric in the U.S., Carpenter said “No one wants e-cigarettes in the hands of kids” but clarified that the government should not disregard e-cigarettes as a viable option for “adult smokers who can’t otherwise quit.”
The Food and Drug Administration (FDA) does not recognize e-cigarettes as a smoking cessation tool. Currently, the FDA has approved five nicotine replacement therapies (NRTs) and two prescription medications. Smokers who want to quit can access patches, lozenges, gums, nasal sprays, inhalers, Bupropion, and Varenicline through their doctor, but have to pay out of pocket for e-cigarettes.
Given the growing amount of research that proves e-cigarettes have a positive impact on smoking cessation, we hope that the FDA will reconsider its approach to the vape market.
