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British Study Offers New Evidence that Some E-Cigarettes May Help Smokers Quit, but Limitations Underscore the Need for More Research and Effective Regulation

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
February 04, 2019

WASHINGTON, DC – A new United Kingdom study published last week in The New England Journal of Medicine found that certain electronic cigarettes were more effective at helping smokers quit traditional cigarettes when provided by a health care provider as part of a clinical stop smoking program. This study provides important new information, but it is equally important to understand its limitations.

The study examined one type of e-cigarette – a refillable, open-tank device that differs from e-cigarettes like Juul that now dominate the U.S. market. It involved smokers who received the e-cigarette when they sought help quitting through the U.K. National Health Service’s stop-smoking program and received face-to-face counseling support.

The study found that this particular category of e-cigarettes, when provided as part of a formal smoking cessation program and combined with professional counseling, was more effective for smoking cessation than existing, approved nicotine replacement therapies (NRTs). This is a potentially important finding.

The study does not allow conclusions with regard to all e-cigarettes because e-cigarettes vary widely, including in how much nicotine they deliver, how efficiently and for how long. It is also important to realize that the e-cigarette market changes rapidly and often the e-cigarette that was the subject of a particular study may no longer be available. Changes in products impact their effectiveness in helping smokers quit cigarettes. Furthermore, up to now, the large majority of e-cigarette users in the U.S. also continue to smoke cigarettes, and studies indicate these “dual users” actually reduce their likelihood of quitting.

While this study adds useful information, it is important not to draw broad conclusions from any single study, even a well-done clinical study. FDA has the authority to review tobacco cessation products, and no e-cigarette has been approved by the FDA for cessation.

This study also needs to be put in context. A much smaller study published in March 2018 by researchers at Boston University (Berry et. al.) examined different types of e-cigarettes. The study found that while daily use of tank-based or non-cartridge-based e-cigarettes increased the likelihood of cessation, other types of e-cigarettes did not, even when used daily. The variation in the results of these different studies demonstrates the importance of not reaching overly broad conclusions based upon any single product or any single study.

The new study raises questions about the health consequences of long-term use of e-cigarettes because it finds that among participants who had quit smoking at one year, 80 percent in the e-cigarette group were still using e-cigarettes. Only nine percent of participants in the NRT group who had quit smoking were still using NRTs at one year.

Even as research continues to determine whether e-cigarettes are effective at helping smokers quit, we know little about the net population effect of the current e-cigarette market among adults and we must confront the serious epidemic of youth e-cigarette use in the United States. In contrast to the limited evidence on the effectiveness of e-cigarettes in helping smokers quit, there is no question that youth use of e-cigarettes has skyrocketed. The recently-released 2018 National Youth Tobacco Survey found that e-cigarette use among high school students rose by 78 percent in just one year (to 20.8 percent). Nearly 28 percent of high school e-cigarette users used the products on at least 20 days in the past month, which is strong evidence that e-cigarettes are addicting many kids.

An editorial in the same issue of The New England Journal of Medicine concludes: “We think the FDA should simply ban the sale of flavored nicotine products for use in e-cigarettes. The public health problem that e-cigarettes can help solve by helping people who are users of combustible tobacco products stop smoking by switching to vaping — is adequately addressed by liquids that are not flavored to appeal to adolescents. We urge the FDA to use its statutory powers in regulating nicotine delivery devices to take the bold step of removing these flavored products from the market.”

The need for the FDA to do more has never been clearer. The FDA must step up its efforts to address the youth epidemic by prohibiting all flavored e-cigarettes that have not been subject to public health review by the agency, halting online sales of e-cigarettes until stronger safeguards are in place to prevent sales to kids, restricting marketing that attracts kids, and enforcing rules prohibiting the sale of new products without FDA authorization.