New Study Reports Doubling of Mean Reduction in Cigarette Consumption Among Electronic Cigarette Users in International Survey

A study released this morning by the American Journal of Preventive Medicine reports that use of electronic cigarettes is associated with a significant reduction in cigarette consumption.

(See: Adkison SE, et al. Electronic Nicotine Delivery Systems: International Tobacco Control Four-Country Survey. Am J Prev Med. March, 2013.)

The study examined survey responses of 5,939 current and former smokers in the U.S., U.K., Australia, and Canada. It ascertained respondents' use of electronic cigarettes, smoking behavior, and reasons for trying electronic cigarettes. In addition, a longitudinal aspect of the study examined smoking patterns among electronic cigarette users and non-users in wave 7 of the survey (conducted October 2008 to July 2009) compared to wave 8 (conducted July 2010 to June 2011).

Among the electronic cigarette users interviewed at waves 7 and 8, the average level of cigarette consumption dropped from 20 cigarettes per day to 16 cigarettes per day, a reduction of about 20%. Among the non-users, consumption dropped from an average of about 17 cigarettes per day to 15 cigarettes per day, a reduction of about 12%. Thus, electronic cigarettes elicited about twice the overall level of reduction in cigarette consumption observed among non-users.

The study reports that 11% of electronic cigarette users quit from wave 7 to wave 8, but it is not possible to compare this to the proportion of nonusers who quit because that figure is not given in the paper.

Perhaps the most important finding of the paper is that the overwhelming majority of electronic cigarette users (85%) reported using these products in an attempt to quit smoking. Also, 75% of users stated that they were using the product to help them cut down on the number of cigarettes smoked, and 80% reported that they used electronic cigarettes to reduce the harmful effects of smoking.

The study concludes: "Because trial was associated with nondaily smoking and a desire to quit smoking, ENDS may have the potential to serve as a cessation aid once enforceable product standards are developed and effıcacy is established through clinical trials."  

The Rest of the Story

This study adds to the growing body of scientific evidence that electronic cigarettes show promise as a potentially effective strategy for smokers to either quit smoking or to cut down substantially on the amount that they smoke.

This study confirmed that the overwhelming majority of electronic cigarette users are using these products to try to quit smoking or at least to reduce the amount that they smoke, and to reduce their health risks associated with cigarette smoking.

The fears of anti-smoking groups that these products are being marketed and used mainly as a way to get around smoking bans and that there is no true intent to get off of cigarettes are not borne out by this research.

The study authors seem to be pleasantly surprised by their finding that so many non-daily smokers are using electronic cigarettes, suggesting that these products are helping many people to severely cut down on the amount that they smoke. They argue that: "the use of ENDS may have driven smokers to reduce their overall cigarette smoking to a nondaily pattern."

The authors also argue that if electronic cigarettes can be shown in subsequent studies to aid smoking cessation without increasing smoking initiation, then "the net public health effect is likely to be
positive."

This article also makes one very important additional point. It states that: "Should regulatory
authorities approve direct claims about reduced harm, one might expect greater adoption of these products, at least among current cigarette smokers."

This is important because it means that any FDA limits on the ability of electronic cigarette companies to point out the truth (that these products are safer than cigarettes) is going to discourage quit attempts using these products and therefore serve to help maintain and promote cigarette use. As I have argued previously, the FDA must not apply the modified risk provisions of the Tobacco Act to electronic cigarettes, or it will have devastating public health consequences.