Tobacco smoking is the world’s leading cause of preventable death and disease, and quitting smoking can produce considerable and immediate health benefits. Most smokers who want to quit tend to do so without assistance, but some use prescription medication or nicotine replacement therapies. Initial efforts using these methods are often unsuccessful. In fact, approximately half of all smokers report trying to quit smoking, but only 7% succeed in any year.
Over the past decade, alternative nicotine products have evolved and are currently used by almost 100 million people. Preliminary evidence suggests that e-cigarettes may be a safe and effective way to help smokers quit, potentially adding a tool to the arsenal of smoking cessation products. A recent Cochrane Literature Review, that updates its 2014 report, includes new evidence that supports past findings that e-cigarettes help smokers quit.
The latest review consists of 50 studies from a diverse set of countries. There were 26 randomized controlled trials and 24 used other study designs. The ability of nicotine-containing e-cigarettes to promote smoking cessation was compared to the efficacy of nicotine-free e-cigarettes, nicotine replacement therapies, varenicline, behavioral support and counseling, and no support or counseling. E-cigarettes that contained nicotine produced better results after six months than any other cessation technique. The report found that 10 out of every 100 smokers who switched to nicotine-containing e-cigarettes were able to quit successfully compared to just six of 100 smokers using any other smoking cessation intervention. Few adverse effects were reported in any of the groups that were included in the review. The authors concluded that there is “moderate certainty evidence” that nicotine-containing e-cigarettes help more people quit smoking than nicotine replacement therapy or e-cigarettes without nicotine.
Because e-cigarettes are a growing and changing field, Cochrane will update their evidence base as new studies are completed. As novel nicotine products begin to emerge, such as nicotine pouches and heated tobacco products, researchers should explore whether these products can also promote cessation. The use of snus, a smokeless tobacco product, has surpassed the smoking of combustible cigarettes in Sweden and Norway, and these countries currently have lower rates of tobacco-related disease compared to other European nations.
Future studies on innovative nicotine products should explore whether these new alternatives confer a significant harm reduction benefit and can be used as cessation tools to reduce the harms of tobacco use.
