E-cigarettes in everyday life focus of major US study

Giving smokers free access to e-cigarettes significantly increases their chances of quitting or at least significantly reducing smoking. This is according to a randomised control trial that followed 638 smokers in 11 US cities for six months.
"Whichever 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 did not." Says Matthew Carpenter, a researcher at the University of South Carolina.

How does access to e-cigarettes affect smoking behaviour in everyday life, outside of clinical trials? This is what a research team at Hollings Cancer Centre, at the University of South Carolina, USA, to find out. Previous compilations, including Cochrane reviewshas shown that e-cigarettes are very effective in smoking cessation. But that doesn't tell the whole story, says Matthew Carpenter who was responsible for the study.

"A common objection to previous studies is that they are too structured. They often include both behavioural 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." Matthew Carpenter told the online magazine Medical Xpress.

Different ambitions among smokers

Instead of repeating the methods used in other studies, the researchers decided to conduct a naturalistic study. They selected 638 smokers in 11 American cities. 

'We focused on two types of smokers. Firstly, those who explicitly wanted to stop smoking, and an equal number who had no such ambitions. We then gave them e-cigarettes, but without any instructions on how to use them," Matthew Carpenter told 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 flavours to choose from. The control group consisted of the same 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 made after six months, a kind of standard for assessing 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 quite sufficient to get an acceptable and reliable result" says Mr Carpenter.

More people quit smoking

The study found that those who received e-cigarettes were more likely than others to be smoke-free after six months. People in the e-cigarette groups were also more likely to reduce the number of daily cigarettes 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. And according to the researchers, the results could be important in the light of new legislation and impact assessments on the control of e-cigarettes. 

Criticism of de facto flavour ban

In the US, 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 criticise the agency for de facto banning all flavours except tobacco flavours 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 by 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 overriding concern about increased use by 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 shouldn't be at the expense of opportunities for adult smokers who are unable to quit smoking by other means."

Sources in this article:
Effect of unguided e-cigarette provision on uptake, use, and smoking cessation amongst adults who smoke in the USA: a naturalistic, randomised, controlled clinical trial

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