E-cigarettes do have value as a smoking cessation aid, according to a new study just released by a team of MUSC Hollings Cancer Center researchers.
Whether e-cigarettes should be considered for smoking cessation is a hotly debated topic, and different countries have taken different approaches. E-cigarettes contain harmful chemicals, which has led many public health advocates to shun them. But they are less harmful than traditional cigarettes, which can cause a dozen types of cancer as well as heart disease, stroke, diabetes and chronic obstructive pulmonary disease. That’s prompted others to say that e-cigarettes should be considered as a step-down method for adults who smoke and haven’t been able to quit using FDA-approved aids, like nicotine replacement gum, lozenges or patches.
This new study, the largest trial of e-cigarettes in the U.S., showed that e-cigarette usage nudged people toward quitting smoking – even people who had entered the trial saying they had no intention of quitting. The results were published in eClinical Medicine this month.
“This is not a panacea for smoking cessation,” cautioned Matthew Carpenter, Ph.D., first author on the paper and co-leader of the Cancer Control Research Program at Hollings.
Nonetheless, he was surprised to find that all of the hypotheses tested in the study were confirmed.
“It’s rarely the case that you’re proven correct for almost everything that you predicted,” he said. “Here, it was one effect after another: 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.”
Carpenter and his colleagues, including Hollings members Tracy Smith, Ph.D., Jennifer Dahne, Ph.D., Michael Cummings, Ph.D., and Graham Warren, Ph.D., designed the study in a naturalistic way to mimic real-world conditions as much as possible – also a first for e-cigarette studies.
Previous studies that have shown a smoking cessation benefit of e-cigarettes have been very structured, Carpenter said, in that they recruited people who wanted to stop smoking and gave them very detailed instructions about how to use the e-cigarettes.
“Some people have said, ‘That’s fine, but the results of those studies don't apply to the real world because the real world isn’t as structured,’” he explained. “So what we did was take a hands-off approach – we called it a naturalistic approach.”
“First off, we took smokers who did and did not want to quit. So right off the bat, not everybody wanted to quit. Secondly, we gave them very little instruction on how to use it,” he continued.
Instead, people were given e-cigarettes and told they could use them or not, as much or as little as they wanted. A control group didn’t receive anything.
The study showed that people in the e-cigarette group were more likely to report complete abstinence from combustible cigarettes. They were also more likely to report that they’d reduced the number of cigarettes per day that they smoked and their number of “quit attempts.” Quit attempts are an important metric because people usually need multiple tries before they can successfully stop smoking.
The study included people from 11 cities across the U.S. and spanned four years. At the beginning, Carpenter intended to collect biochemical samples from participants in the Charleston area to verify their self-reports of smoking behavior. However, COVID interrupted that plan and made in-person sample collection impossible.
Although that was a disappointing aspect of the study, replying on participants’ self-reports of their smoking behavior is still considered highly reliable, he said.
The study will be another data point for the public health community and policymakers in deciding how to handle e-cigarettes. “No one wants e-cigarettes in the hands of kids, and we should do all we can to stop that. But we shouldn’t do so by denying this option for adult smokers who can’t otherwise quit,” Carpenter said. He noted that other countries have taken a much more liberal approach to e-cigarette use than the U.S.
For example, in April the U.K. announced a “Swap to Stop” program that will distribute vaping starter kits to 1 million people who smoke.
In the U.S., e-cigarettes are not approved as smoking cessation aids. But Carpenter and Smith have just received funding for a study that will test e-cigarettes as a smoking cessation aid for adult smokers who’ve already tried two different FDA-approved methods. And Benjamin Toll, Ph.D., director of the MUSC Health Tobacco Treatment Program, co-authored a commentary this month urging an education campaign for adult smokers to clarify that, while neither option is “safe,” traditional cigarettes are far more harmful than e-cigarettes.
About MUSC Hollings Cancer Center
MUSC Hollings Cancer Center is South Carolina’s only National Cancer Institute-designated cancer center with the largest academic-based cancer research program in the state. The cancer center comprises more than 130 faculty cancer scientists and 20 academic departments. It has an annual research funding portfolio of more than $44 million and sponsors more than 200 clinical trials across the state. Dedicated to preventing and reducing the cancer burden statewide, the Hollings Office of Community Outreach and Engagement works with community organizations to bring cancer education and prevention information to affected populations. Hollings offers state-of-the-art cancer screening, diagnostic capabilities, therapies and surgical techniques within its multidisciplinary clinics. Hollings specialists include surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, psychologists and other clinical providers equipped to provide the full range of cancer care, including more than 200 clinical trials across South Carolina. For more information, visit hollingscancercenter.musc.edu.
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
Article Publication Date
KMC has served as a paid expert witness in litigation filed against the tobacco industry. KMG has provided consultation to Jazz Pharmaceuticals and has received research funding from Aelis Farma. MLG has served as a member of the Scientific Advisory Board to Johnson & Johnson; he has also consulted with both the World Health Organization and Campaign for Tobacco Free Kids on toxicity of tobacco products and tobacco control products; MLG is also a Member of the IASLC Tobacco Control and Smoking Cessation Committee; and a leadership role with the American Association for Cancer Research. JD is a co-owner of Behavioral Activation Tech LLC, a small business that develops digital interventions for behavioral health treatment. E-cigarette products (tanks and liquids) were purchased directly from NJoy; no study support provided from industry. All other authors declare no competing interests.