A consensus on the effect of e-cigarettes on conventional cigarette smoking has so far been elusive. Some officials and regulators in the United States worry that e-cigarettes could lead more youths to take up smoking, although the proliferation of e-cigarettes has coincided with substantial reductions in the rates of youth smoking. But that might change. A new study finds that e-cigarette use is associated with higher rates of quit attempts and smoking cessation.
The FDA has recently signaled a willingness to incorporate recent research about the potential for harm reduction related to electronic nicotine delivery systems (ENDS), and these new findings should inform their regulatory approach moving forward.
In the peer-reviewed study published last week in The BMJ (formerly the British Medical Journal), Shu Hong-Zhu, Yue-Lin Zhuan, Shiushing Wong, Sharon E. Cummins, and Gary J. Tedeschi, all affiliated with the University of California, San Diego, analyzed survey data for more than 161,000 people over the period 2001 to 2015 to examine the relationship between e-cigarettes and smoking cessation.
The share of smokers attempting to quit is high for all groups, but substantially higher for those who used e-cigarettes in the previous year. Sixty-five percent of those smokers tried to quit, compared to 40 percent for others. E-cigarette users also had a higher cessation rate, successfully quitting for three months, at 8.2 percent compared to 4.8 percent, a 73 percent relative increase.
There are limitations to this study that make it less definitive than a randomized trial, as they note. Survey responses are susceptible to bias, and the results could be driven by other outside factors.
The authors look at two possible extraneous factors that may have influenced smoker behavior over the period: a 158 percent increase in the national cigarette tax and a national smoking-cessation media campaign.
While there was a small, statistically significant increase in quit attempts between 2006 and 2011, the total cessation rate held steady at 4.5 percent for both surveys. The authors suggest that the lack of an effect on successful efforts to quit smoking “accentuates the difficulty in improving quit rates at the population level.”
TIPS from Former Smokers was a large-scale media campaign with television ads that started in 2012 and ran up to 20 weeks in any given year. The campaign had a wide reach, as one survey found that 78 percent of smokers had seen at least one media spot after the first round, and there have been four rounds in total. The authors posit that the TIPS campaign is unlikely to be a major factor in the increase in quit attempts and cessation rates because there were not significant changes for the 77 percent of smokers who do not use e-cigarettes.
The e-cigarette users were the only subgroup of smokers to see higher rates of quit attempts and successful cessation. As the authors note, use of e-cigarettes “could be an indicator of motivation to quit smoking,” which could explain part of the difference. Even so, the higher rates for e-cigarette users drove up the overall cessation rate for all smokers from 4.5 percent to 5.6 percent.
To put that into a more relevant context, this represents about 350,000 additional smokers who successfully quit in the period 2014 to2015. While there are limitations to this study, two of the other big explanatory factors, tobacco tax increases and the media campaign, do not seem to be driving the results, and most of the improvements are in the subgroup of smokers who used e-cigarettes. Increasing successful quit rates is difficult, and the authors note this was the first “first time in almost a quarter of a century that the smoking cessation rate in the US has increased at the population level.”
Food and Drug Administration Commissioner Scott Gottlieb recently announced that the deadline for enforcement of a rule requiring e-cigarette and vaping producers to go through a lengthy approval process for all products that entered the market after February 2007 would be delayed. These products, some of which have been available for years, would have to attain FDA approval or lose access to the market.
The deadline for e-cigarettes and all ENDS has now been pushed back to August 2022. The extension is a welcome development and part of what the agency says is “demonstrating a greater awareness that nicotine – while highly addictive – is delivered through products that represent a continuum of risk and is most harmful when delivered through smoke particles in combustible cigarettes.”
In the interim, the agency will develop a more appropriate regulatory framework for these products. The deadline, though delayed, still looms, and the uncertainty over who will be crafting the rule when it goes into effect adds to the lingering cloud of uncertainty over producers.
This study, in conjunction with the recent youth smoking data that showed a continued decline in conventional cigarette smoking, should temper fears that the proliferation of e-cigarettes would lead to resurgence in youth smoking. If anything, these products are associated with a significant increase in people attempting to quit, and successfully doing so.
The recent announcement from the FDA is an indication the agency is considering the potential for harm reduction with these alternatives to conventional cigarette smoking. The agency should evaluate the new research and take pains to avoid driving out products that could help people quit smoking.
Charles Hughes is a policy analyst at the Manhattan Institute and author of the new report The Energy Bottleneck: Why America Needs More Pipelines. Follow him on twitter @CharlesHHughes.
Interested in real economic insights? Want to stay ahead of the competition? Each weekday morning, E21 delivers a short email that includes E21 exclusive commentaries and the latest market news and updates from Washington. Sign up for the E21 Morning Ebrief.