7 February 2022
By: Lei Lei Wu, Source: MEDPAGETODAY
— Only 9.9% successfully abstained from cigarettes for over 12 months
E-cigarettes may not be helpful for people who want to quit smoking, an analysis of the Population Assessment of Tobacco and Health (PATH) cohort showed.
Among survey respondents who used e-cigarettes to quit prior to 2017, 9.9% successfully abstained from cigarettes for over 12 months, which was lower than for those who used nicotine replacement therapy (NRT) or a pharmaceutical aid only (15.2%) and for those who did not use any product in their attempt to quit (18.6%), reported John Pierce, PhD, of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California San Diego, and colleagues.
Those who used e-cigarettes in their last quit attempt had a significantly lower 12-month abstinence rate compared with those who used any other method (adjusted risk difference [aRD] -7.7, 95% CI -12.2 to -3.2) and compared with those who used NRT or a pharmaceutical aid (aRD -7.3, 95% CI -14.4 to -0.4), they noted in Tobacco Control.
Of those attempting to quit before 2017, 12.6% reported using e-cigarettes in their last quit attempt, which was down from 17.4% in previous years. By comparison, 20.6% used NRT or a pharmaceutical aid only, and 64.3% did not use any product to help quit.
Despite this, quarterly e-cigarette retail sales surged to over $400 million by the end of 2017, double of what they were 2 years prior and 20 times what they were in 2011.
The 2019 PATH survey did see a resurgence of e-cigarette use among recent former smokers, with 22% using e-cigarettes compared with 15.3% in 2017. One-fifth of these recent former smokers used e-cigarettes with high nicotine content.
However, perception that e-cigarettes were less harmful than traditional cigarettes fell from 23.8% in 2016 to 16.4% in 2019.
A previous review of randomized clinical trials suggested that e-cigarettes added four successful cigarette quitters per 100 quit attempters compared with users of pharmaceutical aids. However, in the current study, e-cigarettes were associated with seven fewer successful quitters per 100 quit attempters, Pierce and colleagues pointed out, and previous analyses of the PATH cohort have not found that e-cigarettes help smokers quit.
Last year, the FDA banned flavored e-cigarettes, which may incentivize children to vape, but approved its first e-cigarette with tobacco-flavored cartridges in October.
In 2017, JUUL — which accounted for 40% of e-cigarette retail market share by the end of 2017 — launched a marketing campaign supposedly aimed at adults, after facing scrutiny for the colorful ads it had run from its inception in 2015.
“Our analysis suggests that the 2017 JUUL marketing campaigns were not effective in encouraging smokers to use JUUL products to help with quit attempts, unlike their effectiveness in encouraging young people to initiate nicotine use with their products,” Pierce and team wrote.
Fewer than 2% of those who reported switching to e-cigarettes in 2017 said they used JUUL e-cigarettes, they reported.
This longitudinal analysis used data from the fourth and fifth survey waves (in 2017 and 2019, respectively) of the PATH cohort, a nationally representative cohort of tobacco users. In 2017, 27,757 adults were interviewed and 6,065 new participants were added to the cohort to “adjust for attrition and reset the cohort sample size,” Pierce and team noted. The weighted response rate for the replenishment screening survey was just over 50%, and the response rates for the surveys in 2017 and 2019 were 68% and 88%, respectively.
There were no differences between the continuing cohort and replenishment cohort in any key measures, the study group said.
Current and recent former smokers were asked about their smoking habits, whether they had attempted to quit in the last 12 months, and what products they used. Of note, the study included those using e-cigarettes or other tobacco products in their definition of cigarette abstinence, while tobacco abstinence was defined as abstinence from all tobacco products including e-cigarettes.
Pierce and colleagues acknowledged that their study was observational and therefore could have unmeasured confounding variables.