CDC: E-Cigarettes More Popular Than FDA-Approved Quitting Aids

Cigarette smokers prefer e-cigarettes to FDA-approved quit methods, according to a research brief authored by the CDC Office on Smoking and Health, RTI International and the University of North Carolina (here).

Using a nationally representative online survey of 15,943 adult smokers who tried to quit during the past three months, they found that 75% used one or more methods to quit, and 25% used only one method, as shown below.

Weighted Prevalence (%) of Methods Used By 15,943 Adult Smokers Who Attempted to Quit in Past 3 Months
Quit Method	One Method Only	Multiple Methods
Gave up cigarettes all at once	14.7%	65%
Gradually cut back	6.6	62
Partially substituted e-cigarettes	1.1	35
Switched completely to e-cigarettes	1.1	25
Used nicotine gum or patch	0.8	25
Used Zyban or Chantix	0.4	12
Switched to “mild” cigarettes	0.3	20
Sought help – health professional	0.2	15
Sought help – website	less than 0.1	7
Sought help – telephone quitline	less than 0.1	7
All methods	25.3	75

E-cigarettes were far more popular single quit aids for partial or complete substitution (2.2%), compared with nicotine patches/gum (0.8%) or other prescription medicines (0.4%).  They were also more popular when more than one aid was used.

Of note, telephone quitlines were rarely used.  The government has poured millions of dollars into this mini-industry, yet quitlines were used by a mere 0.02% (unweighted, n=3) of smokers as single quit aids in this study.

Participants here were current smokers.  A similar analysis performed on former smokers will show even more impressive effects from vaping.

Despite the current study’s evidence of vaping’s popularity among smokers, the authors’ summation was understated: “Given that our data show that e-cigarettes are more commonly used for quit attempts than FDA-approved medications, further research is warranted on the safety and effectiveness of using e-cigarettes to quit smoking.”

The fact is that the CDC has documented with real-world data that e-cigarettes are preferred smoking cessation aids, negating the argument that evidence is merely “anecdotal” (here). 

Our government should adopt the UK Royal College of Physicians’ position that “the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.” (here).  In Britain e-cigs have been the leading quit-smoking aid since 2013 (here, page 46).

CDC Exaggerates Smoking Quitline Success

Acting Surgeon General Boris Lushniak marked the 50^th year of the federal government’s war on tobacco two years ago, noting, “We are at a historic moment in our fight to end the epidemic of tobacco use.” (here)  “The good news,” he continued, “is that we know which strategies work best… [to make] the next generation tobacco-free.”  The declaration left no room for consideration of tobacco harm reduction. The government’s grand plan does include telephone quitlines and web-based interventions for current tobacco users – two programs that in 2012 cost taxpayers about $100 million (here).

According to new study from the Centers for Disease Control, “…only 1% to 2% of adult tobacco users in the U.S. access quitlines each year.” (abstract here).  That's about one half to one million individuals. 

Do quitlines work?  The CDC offered results for calendar year 2011 telephone and web-based quitlines in Alabama, Arizona, Florida and Vermont.  Dr. Antonio Neri and CDC colleagues assessed rates of cessation (defined as not smoking by self-report for the past 30 days) seven months after each subject’s enrollment. 

The reported rates – 32% for quitline users and 27% for web-based users – were actually inflated by manipulating the numbers.

Of the 16,332 participants in the programs, just over half (n=8,277) were lost to follow-up.  The CDC researchers sought the missing subjects via email, postal mail, express mail, computer-assisted phone calls and $40 inducements.  These plus another 3,969 participants were dropped from the critical denominator. 

The fact that Neri et. al. based their calculations on only 25% of the original enrollees skewed the results.  Using the original enrollment numbers, success rates are only 8.1% for quitline users and 6.7% for web users.  Considering that in any given year about 5% of smokers quit on their own, about 800 of this study’s 16,000 smokers would have quit with no assistance.  The quitlines and web therefore generated about 400 quitters, a paltry number.

My estimates are consistent with real-world numbers.  The quitlines provided free nicotine medicines (which have been shown to work for 7% of smokers who try them) and counseling, which likely included current coping tips from the National Cancer Institute, such as, “take a time out; call or text a friend; take a walk, play a game, read a good book; make a list of fun events, do one a day; get out of the house when you can.”  It is doubtful that many of the 12,000 drop-outs actually used these tips to quit.

This CDC study was supported by the American Recovery and Reinvestment Act of 2009.  That legislation was aimed at creating jobs, assisting those most impacted by the recession, investing in infrastructure and stabilizing state and local government budgets (here), with $1 billion earmarked for “prevention and wellness.”  Using tax dollars to defend wasteful programs with contrived analytics is bad public policy.