Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends

Abstract

ObjeCtivesTo estimate how far changes in the prevalence of electronic cigarette (e-cigarette) use in England have been associated with changes in quit success, quit attempts, and use of licensed medication and behavioural support in quit attempts. DesignTime series analysis of population trends. PartiCiPantsParticipants came from the Smoking Toolkit Study, which involves repeated, cross sectional household surveys of individuals aged 16 years and older in England. Data were aggregated on about 1200 smokers quarterly between 2006 and 2015. Monitoring data were also used from the national behavioural support programme; during the study, 8 029 012 quit dates were set with this programme. setting England. Main OutCOMe MeasuresPrevalence of e-cigarette use in current smokers and during a quit attempt were used to predict quit success. Prevalence of e-cigarette use in current smokers was used to predict rate of quit attempts. Percentage of quit attempts involving e-cigarette use was also used to predict quit attempts involving use of prescription treatments, nicotine replacement therapy (NRT) on prescription and bought over the counter, and use of behavioural support. Analyses involved adjustment for a range of potential confounders. resultsThe success rate of quit attempts increased by 0.098% (95% confidence interval 0.064 to 0.132; P<0.001) and 0.058% (0.038 to 0.078; P<0.001) for every 1% increase in the prevalence of e-cigarette use by smokers and e-cigarette use during a recent quit attempt, respectively. There was no clear evidence for an association between e-cigarette use and rate of quit attempts (β 0.025; 95% confidence interval −0.035 to 0.085; P=0.41), use of NRT bought over the counter (β 0.006; −0.088 to 0.077; P=0.89), use of prescription treatment (β −0.070; −0.152 to 0.013; P=0.10), or use of behavioural support (β −0.013; −0.102 to 0.077; P=0.78). A negative association was found between e-cigarette use during a recent quit attempt and use of NRT obtained on prescription (β −0.098; −0.189 to −0.007; P=0.04). COnClusiOnChanges in prevalence of e-cigarette use in England have been positively associated with the success rates of quit attempts. No clear association has been found between e-cigarette use and the rate of quit attempts or the use of other quitting aids, except for NRT obtained on prescription, where the association has been negative. stuDy registratiOnThe analysis plan was preregistered (https://osf.io/fbgj2/).

Should we recommend e-cigarettes to help smokers quit?

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Electronic Cigarettes in Germany: Patterns of Use and Perceived Health Improvement

“…Generally, e-cigarettes are used by smokers who want to quit or reduce the smoking of tobacco products [17,22,23,24]. It has been shown that the increased use of e-cigarettes is not associated with an increase in quit attempts, but with an increase in successful quit attempts [25]. …”

Review of the British Thoracic Society Winter Meeting 2017, 6–8 December 2017, London, UK

“…Recent data suggest that vaping does increase the success of quit rates 46. E-cigarettes are generally thought to be a safer alternative to smoking traditional cigarettes, but little is known about the long-term effects of vaping on lung health.…”