Sales of e-cigarettes – particularly those with high nicotine content, similar to traditional cigarettes – skyrocketed in the US in 2017. Proponents of e-cigarettes say this jump in sales should lead to a jump in those quitting smoking, pointing to some clinical trials as evidence of this.

Unfortunately, this didn’t work out in practice. According to a new paper in BMJ Tobacco Control, e-cigarettes were linked to lower success rates for those who tried to quit smoking, and they weren’t any better at preventing relapses.

The study examines data from a US national long-term study on smoking. The researchers looked specifically at data from 2017-2019, on 3,578 established smokers who’d recently tried to quit and 1,323 recent former smokers.

“We found little evidence that smokers took part in the 2017 surge in e-cigarette sales, which was associated with the introduction of the high-nicotine JUUL e-cigarette,” says co-author Professor John Pierce, a researcher at UC San Diego and UC San Diego Moores Cancer Centre, US.

“This is the first survey in which e-cigarettes were less popular as a smoking cessation aid than FDA-approved pharmaceutical aids. Not only were e-cigarettes not as popular, but they were associated with less successful quitting.”

In 2017, over 12% of recent quitters reported using e-cigarettes to quit – either by themselves or with other aids. About 2.5% used other tobacco products, and 21% used pharmaceutical aids or nicotine replacement therapy. Almost two-thirds of respondents (64%) didn’t use anything.

By 2019, those who had used e-cigarettes were less likely to have successfully quit than those who’d gone cold-turkey – 10% versus 19%. In this study, “successful quitting” was defined as having gone 12 months without using tobacco products.

However, the number of respondents who were using or planning to use e-cigarettes to quit had nearly doubled – to 22% of all respondents.

The researchers stress that their study is observational – this data can’t show that e-cigarettes are the cause for these failed quitting attempts. But they do point out that their real-world data sits in contrast to other randomised clinical trials, which tend to slightly favour e-cigarettes over other quitting methods.

“RCTs [randomised clinical trials] are usually conducted under optimal conditions, which means that they may not translate to the effectiveness of the product in community settings,” point out the authors in their paper.

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