France and England are both on the verge of regulating or banning electronic cigarettes, also known as e-cigarettes, and officials within the U.S. Food and Drug Administration (FDA) expect to enact long-delayed regulations for e-cigarette use by October. But while health officials scramble to govern e-cigarettes, many are torn between their potential to help smokers quit and their dangers shared with regular tobacco. Little evidence existed to support either claim, until now. The first study to examine the efficacy of e-cigarettes to help people quit has found that they are comparable, and in some ways better, than nicotine patches.
Last week, the Centers for Disease Control and Prevention (CDC) found that e-cigarette use more than doubled among middle and high school students. With most adult smokers admitting that they begin smoking before 18, the CDC director Dr. Tom Frieden said that teens could be condemning themselves “to struggling with a lifelong addiction to nicotine and conventional cigarettes,” according to CBS News.
E-cigarettes vs. Nicotine Patches
But although e-cigarettes may contain some of the same chemicals as regular cigarettes, the lack of cigarette smoke lead many to believe they're at least a comparatively healthier alternative.
In a study led by Chris Bullen, director of the National Institute for Health Innovation at the University of Auckland, 657 smokers who wanted to quit smoking were randomized into three groups. A group of 292 people were given commercially available e-cigarettes, each containing about 16 milligrams of nicotine, another 292 were given nicotine patches, and 73 participants were given placebo e-cigarettes. For 13 weeks, participants were asked to use their cessation aids, and followed up with researchers six months later.
Overall, one in 20 participants quit smoking. Among those who used nicotine-laden e-cigarettes, 7.3 percent quit successfully for at least six months. When compared to patches and a placebo e-cigarette, 5.8 percent and 4.1 percent of participants quit, respectively.
While these differences were not significant, the study did find other measures of success in the use of e-cigarettes. Over 57 percent of participants who used e-cigarettes but didn’t manage to quit after six months were still able to cut their daily cigarette consumption in half, compared to 41 percent of those who took patches.
“While our results don’t show any clear cut differences between e-cigarettes and patches in terms of quit success after six months, it certainly seems that e-cigarettes were more effective in helping smokers who didn’t quit to cut down,” Bullen said in a statement.
Health Effects and Government Regulations
There was also no difference in rates of adverse health effects among those who used e-cigarettes compared to those who used nicotine patches, suggesting that they can be safe in the short-term, researchers said.
“Our study establishes a critical benchmark for e-cigarette performance compared to nicotine patches and placebo e-cigarettes, but there is still so much that is unknown about the effectiveness and long-term effects of e-cigarettes,” Bullen said in the statement. “Given the increasing popularity of these devices in many countries, and the accompanying regulatory uncertainty and inconsistency, larger, longer-term trials are urgently needed to establish whether these devices might be able to fulfill their potential as effective and popular smoking cessation aids.”
The FDA expects to determine regulations for e-cigarettes by October. The agency can only regulate e-cigarettes that claim to help people quit smoking. Those that don’t make such claims are largely unregulated. The agency has remained quiet about how it plans to govern them when evidence is scarce about their health effects. “No one knows what will come out. The FDA has played its cards close to the vest,” Georgetown University pulmonologist Nathan Cobb, told USA Today.
Bullen’s work suggests that e-cigarettes will give people the hope needed to quit. “The day I got my e-cigarette (four years ago) is the last day I smoked a cigarette,” Jan Johnson, who used to be addicted to Marlboros, told USA Today.
Source: Bullen C, Laugesen M, Parag V, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. The Lancet. 2013.