Smoking remains one of the worst things we do to our health. We get hooked on the nicotine and then regularly ingest a list of poisons that slowly consume our organs. Health systems around the world are desperate to get people to stop smoking in a bid to reduce the healthcare burden of patients with smoking-related diseases. But their recommendations can only do so much when up against the physiological addictions in smokers’ brains.
As far as doctors and scientists today can tell, e-cigarettes do less bodily damage than traditional tobacco cigarettes, although our existing knowledge on their health risks is far from complete. With the overwhelming difficulty associated with going cold turkey on nicotine, vaping may provide a welcome aid on the journey to smoking cessation. Recent media attention has focused on the hazards of vaping, especially on its growing use among adolescents. While we should all agree that we need to curb the glamorous advertising of nicotine addictions to minors, we can still look for the potential advantages of e-cigarettes as a replacement device for smokers.
Do e-cigarettes actually help you quit smoking? At the end of January 2019, a noteworthy trial by researchers in the UK was published in the New England Journal of Medicine, and it targeted exactly that question.
The researchers recruited a group of people attending stop-smoking services within the UK National Health Service, and randomly split them into two groups: one group that was prescribed e-cigarettes and another that was given a choice from a list of other nicotine-replacement products including gum, patches, and nasal/mouth sprays. People in both groups also received one-on-one behavioral support every week from a local clinician. It’s worth noting that all of these people were clearly motivated to quit smoking given their attendance at the stop-smoking clinics. Without a strong motivation to quit, it seems unlikely that any smoking cessation aid would do much good.
The two groups of participants were asked to persist with their efforts to quit smoking for a full year, at which point the researchers followed up to measure outcomes. Of the 886 people who started the trial, almost 80% completed their final follow-up assessments at the end of their 52 weeks. As you’ve probably guessed, the most interesting question for the researchers was whether either group would have a significant advantage in overcoming their smoking habits.
The researchers considered a participant abstinent if they reported smoking less than five cigarettes from the two weeks after they started their trial. They confirmed this report with a breath test for carbon monoxide, which is a harmful element found in tobacco smoke but not in the products of typical e-cigarettes or nicotine-replacement products. 18% of participants in the e-cigarette group and 9.9% of participants in the nicotine-replacement group remained abstinent from smoking cigarettes at the end of the year. On top of that, among participants who failed to remain entirely abstinent, carbon monoxide tests confirmed that 12.8% of people in the e-cigarette group, compared to only 7.4% in the nicotine-replacement group, managed to cut their smoking by at least 50%.
In the group of participants who remained abstinent after a year, 80% were continuing to use their e-cigarettes while only 9% were using their alternative methods of nicotine replacement. Although neither method could rival the pleasure of a traditional cigarette, participants reported feeling greater satisfaction from using their e-cigarettes than other replacement products, and found them more helpful in quitting smoking. In the early days of their efforts to quit, e-cigarette users reported less trouble with irritability, restlessness, and failures to concentrate than the other nicotine-replacement users.
The data suggest that e-cigarettes are a helpful tool for people who want to ditch their cigarette habit. They reduce the severity of withdrawal symptoms, and they lead to greater success in continuing abstinence from tobacco. The proportion of successful quitters overall in the trial wasn’t enormous, which is a testament to just how difficult the challenge is. It takes motivation, effort, and probably a few encouraging nudges from friends and loved ones.
Several advantages of e-cigarettes could explain their greater success over other stop-smoking products. Perhaps the nicotine dosages are better-tailored to user needs than most other methods. As a behavioral scientist, my own mind leans toward the practical behavioral qualities of e-cigarettes as a delivery vehicle for nicotine. They don’t just drive nicotine into your system, they do it in a way that closely matches traditional cigarettes. They offer all of the habitual cues that smokers have adapted to: the small stick between the fingers, the glowing tip as nicotine is inhaled, and the gentle release of smoke during an exhale.
These behavioral elements might sound like nothing compared to the physical absence of nicotine in an addicted brain. Although nicotine absence may be the primary driving force behind failed attempts to quit smoking, all of the contextual elements that surround the habit of smoking may also make a difference between success and relapse.
In the days before e-cigarettes were widely available, I witnessed family members doing all kinds of bizarre things in their efforts to patch up the hole left in their lives from throwing out the cigarettes when they decided to quit. They played with prayer beads to keep their fingers busy, they held candy sticks between their lips to mimic cigarettes, and they enjoyed the feeling of blowing vapor out of their mouths on a cold day. Now, e-cigarettes offer all of these in a more convenient and less silly-looking package.
But let’s not forget the problems of e-cigarettes. Non-smokers who choose to take up vaping are still putting themselves at risk of becoming vulnerable nicotine addicts. As the results of the study above highlighted, e-cigarette users were far more likely to continue with their new habit than other nicotine-replacement users. If we are talking about adults who willingly make this decision while understanding the dangers, it’s not necessarily a big deal. But if we are talking about children and teenagers who will grow to regret their addiction, and are blindly driven to the habit by exciting adverts, the problem is more obvious. Although it currently seems as though the health hazards of e-cigarettes are less severe than tobacco cigarettes, we may identify harms as the science and evidence develops in this area. And, of course, vaping costs money. In hard times when you want to spend less, the last thing you want to deal with is a nicotine addiction.
If you are trying to beat a harmful cigarette habit, an assist from e-cigarettes may be a sensible bet. For now, they appear to be the best available product for dealing with smoking cessation. As a society, we can use them in efforts to reduce the prevalence of smoking-related diseases, while doing our best to avoid throwing vulnerable groups such as children and adolescents into just another vortex of addiction.