Population-Level Proof: E-Cigarettes Are Popular & Successful Quit-Smoking Aids

Tobacco harm reduction opponents have belittled reported use of e-cigarettes as smoking cessation aids, dismissing case studies as mere “anecdotes” (here) and claiming a lack of population evidence to support a quit-smoking claim. 

Now that evidence exists.

In a just published study, my colleague Nantaporn Plurphanswat and I use federal government data to demonstrate that e-cigarettes were one of the most commonly used quit aids by American smokers in 2013-2014, and that they were the only aid more likely to make one a former smoker (i.e., a successful quitter) than quitting cold-turkey. 

Our study, appearing in the International Journal of Environmental Research and Public Health (open access, available here), analyzed data in the Population Assessment of Tobacco and Health (PATH) Survey, a combined project of the U.S. Food and Drug Administration and the National Institutes of Health. 

The PATH survey asked current smokers which aids they used when they tried to quit, and former smokers which aids they used to quit, in the past 12 months.  Participants could pick from the following: (1) no aid, (2) support from friends and family, (3) other aids (counseling, quit line, books, pamphlets, videos, clinic, class, web program), (4) e-cigarettes, (5) other combustible tobacco (cigars, cigarillos, filtered cigars, pipe tobacco, hookah), (6) smokeless tobacco (dip, chew, or snuff, and dissolvable tobacco), (7) pharmaceutical nicotine (NRT: patch, gum, inhaler, nasal spray, lozenge or pill), and (8) prescription drugs (Chantix, varenicline, Wellbutrin, Zyban, or bupropion).

Here is a summary of the results for smokers using a single quit aid:

Single Quit Aids Used By American Smokers, 2013-2014
Aid	Current Smokers*	Former Smokers*	All*	% Former	Odds Ratio** (95% Confidence Interval
No aid	5,546,000	1,429,000	6,975,000	20.5	Referent
Support, friends family	1,992,000	446,000	2,438,000	18.3	0.98 (0.75-1.28)
Other aids	139,000	37,000	176,000	21.0	0.89 (0.36-2.17)
E-cigarettes	1,652,000	540,000	2,192,000	24.6	1.43 (1.12-1.83)
Other combustible	91,000	24,000	115,000	20.9	1.43 (0.78-2.63)***
Smokeless tobacco	92,000	32,000	124,000	25.8	1.43 (0.78-2.63)***
NRT	1,190,000	284,000	1,474,000	19.3	0.89 (0.61-1.28)
Prescription drug	347,000	70,000	417,000	16.8	0.97 (0.55-1.71)
All aids	11,049,000	2,862,000	13,911,000	20.6

*estimated from PATH survey weighting.  Some numbers do not appear in the peer-reviewed publication.

**Odds ratio of being a former smoker, adjusted for number of quit attempts, age, sex, race/ethnicity, education, income and region

***categories combined to produce a single OR

Overall, nearly 14 million smokers tried to or did quit using a single quit aid in 2013-2014.  As we note, “E-cigarettes were used…by 2.2 million smokers…, NRT by 1.47 million, prescription drugs by 418,000 and smokeless tobacco by 124,000.” 

While NRT and prescription drugs, combined, helped some 354,000 smokers quit, it was e-cigarettes, which are routinely condemned by many public health institutions, that produced the greater success, helping 540,000 smokers quit.  Given the government’s own evidence, it’s time to acknowledge the scientific legitimacy, value and benefit of e-cigarettes with respect to the health of the population.