A new quit smoking review from the Cochrane Library suggest e-cigarettes are the most effective way to stop smoking
Who are the Cochrane Library?
The Cochrane Library is a well-regarded medical and healthcare database. They collect and summarize healthcare studies to give people an independent overview of research on a particular topic. Their most recent review of vaping as a tool to help people quit smoking has been very promising.
Can Vaping Help People Quit Smoking?
Often scientific studies tell us something that we already know. You know the kind I’m talking about: People are Happier at the Weekend, or Talking on a Mobile Phone Makes You Worse at Driving. When we see more studies that support vaping to help people quit smoking, it can feel like stating the obvious.
For vapers, the results of these positive studies are rarely surprising. We know first-hand that vaping is a powerful tool to help quit smoking. We’ve seen it help friends and family quit or reduce their cigarette intake.
I guess these studies aren’t really for us at this point. But they can still help us and others. Many people are turning to e-cigarettes to help quit smoking, so they need to have independent research and reviews to inform their decisions. And if you’re trying to get a friend to give up smoking, it’s always good to come armed with facts.
Action on Smoking and Health (ASH) recently released the findings of their 2021 annual vaping survey. As usual, it makes for fascinating reading and contains lots of interesting information about people’s vaping preferences.
Two things struck me about this report. Firstly, the UK populations attitude towards vaping has gone backwards since 2020. 37% of the people surveyed believe vaping was more or equally harmful than cigarettes. Secondly, only 12% of survey respondents correctly suggested that vaping is far less harmful than cigarettes.
Cigarettes are the UK’s leading cause of preventative deaths. If we want people to quit smoking, we need to ensure they have good, independent information to help inform their decisions.
Unfortunately, there are several advocacy groups, lobbyists, and policymakers who try to discourage vaping. Sometimes their work takes the form of spreading misinformation or misleading comments to the public. Other times, they make reasonable arguments, like suggesting that there is not enough evidence that vaping helps people quit smoking or that it’s safe.
It’s precisely these people who we need to reach. Current smokers, regulators, and healthcare providers need to use the best data to inform their decisions and actions. Public Health England (PHE) and the NHS have been broadly supportive of vaping. Even our government have been pretty sensible.
We should all do what we can to counter misconceptions about vaping. And having a body of facts and studies that we can quote is a vital tool to counter misinformation.
The Cochrane Library is precisely that. For years, they’ve been collecting and collating studies and taking an overview of vaping. Sometimes a specific study might use a flawed method or have too few participants. These errors can skew data and produce bad results. By taking a bunch of studies and putting them together into a meta-analysis, we can have more confidence in the results.
What Was the Objective of the Cochrane Review?
The Cochrane Library has a pretty straightforward objective. They understand that you can lower the risks of lung cancer, heart attacks, strokes, and other illnesses if you stop smoking. However, they also understand that many people find it challenging to quit smoking.
So, they wanted to find out if e-cigarettes help people to quit smoking. Additionally, they wanted to understand if people who use e-cigarettes to quit smoking experience any unwanted effects.
How Did Cochrane Perform Their Meta-Analysis?
Cochrane’s approach was straightforward. They found studies that used e-cigarettes to help people quit smoking.
More specifically, they focused on randomized controlled trials. These are studies where each participant is given a treatment at random. For example, one group might be assigned an e-cigarette, while the other might get nicotine replacement gum or other similar therapy. These trials are considered the most reliable way to test how effective a treatment is in the scientific research community.
From here, Cochrane wanted to answer two questions:
1) How many participants quit smoking for six months or more
2) How many participants reported “unwanted effects” after using an electronic cigarette.
Cochrane focused on evidence that was published up until May 2021.
What Research Did Cochrane Find?
Cochrane found 61 studies designed to test the effectiveness of e-cigarettes to help people give up smoking. The combined total of participating adults was 16,759.
The studies compared e-cigarettes with a variety of aids that are used to help people quit smoking. These included:
- nicotine replacement therapy (NRT), i.e., patches, gum, etc.
- nicotine-free e-cigarettes
- varenicline (a medication that helps people quit smoking by reducing withdrawal symptoms and cravings)
- newer nicotine vaping devices like pods
- behavioural support, like counselling or advice
- no support to help quit smoking
More than half these studies took place in the US and the UK, with 26 and 11 respectively.
What Did The Review Find?
The results of the Cochrane review won’t be too surprising to most of us. Some of the key points to take away were:
1) In four studies with a total of 1924 people, more people quit smoking for six months or more using e-cigarettes versus using nicotine replacement therapy.
2) In five studies with a total of 1447 people, more people quit smoking for six months or more using e-cigarettes versus using nicotine-free e-cigarettes.
3) In six studies with a total of 2886 people, more people quit smoking for six months or more using e-cigarettes versus using either behavioural support or no support at all.
4) For every 100 people trying to quit smoking,
- 9 to 14 quit smoking through e-cigarettes
- 6 people quit smoking with nicotine replacement therapy
- 7 people quit using nicotine-free e-cigarettes
- 4 people quit smoking using either behavioural support or no support at all.
A fairly comprehensive win for e-cigarettes.
What About Unwanted Effects?
On the subject of unwanted effects, Cochrane was less conclusive. They suggest that they are uncertain if there was any difference between unwanted effects between e-cigarettes and the other methods listed above.
However, the report found that there was some evidence to suggest that “non-serious unwanted effects” were more likely to occur when using nicotine e-cigarettes versus behavioural support or no support at all.
The unwanted effects that users of nicotine e-cigarettes were:
- Throat irritation
- Mouth irritation
- Feeling sick
Cochrane goes on to add that these effects reduced over time as people continued to use nicotine e-cigarettes to quit smoking.
How Reliable are These Results?
The Cochrane Review had more to say about the reliability of these results.
Firstly, they stated that the review was “based on a small number of studies, and in some the data varied widely”. They say that they are “moderately confident that nicotine e-cigarettes help more people to stop smoking than nicotine replacement therapy or nicotine-free e-cigarettes.”
From here, they suggest that further studies are needed to confirm this. Additionally, they advise that the results for unwanted effects could change once they can review additional evidence.
Finally, they called on the need for further inquiry into newer types of e-cigarettes that have “better nicotine delivery” than older e-cigarettes. Most likely, this pertains to disposable e-cigarettes and nicotine salts.
There are a lot of interesting conclusions to draw here. As expected, e-cigarettes were the best way for people to quit smoking. Those results weren’t exactly surprising.
However, the Cochrane Review does bring up a good point about newer e-cigarettes. For example, Disposable vape bars filled with nic salts might be the easiest way for people to quit smoking. Nic salts closely replicate the sensation and chemical reactions involved with smoking a cigarette.
Because modern devices are anecdotally converting some of even the most hardened smokers, it’s interesting to think how they might do in similar trials. But the nature of these types of reviews means that they are taking studies over a longer time, so it could be a while before the impact of disposables and nic salts show up in these reports.
Overall, the Cochrane Library’s findings are more positive news about the safety and effectiveness of vaping. It’s great to have more evidence to show our friends and family that they can stop smoking.