E-cigarettes help smokers quit even without specialist support

E-cigarettes can help people stop smoking even when no specialist behavioural support is available, according to a randomised controlled trial conducted by Queen Mary University of London and funded by the National Institute for Health and Care Research. The study, published in NEJM Evidence, addresses a question that previous research had left open: earlier trials had almost always provided e-cigarettes alongside ongoing counselling, so it was unclear whether the devices remained effective on their own, and how much extra benefit counselling actually adds.

The trial involved 1,170 adults who were randomly assigned to one of three groups. The first received automated NHS stop-smoking emails. The second received an e-cigarette starter pack alone. The third received an e-cigarette starter pack together with telephone counselling, delivered as five telephone sessions offered over four weeks. Quitting was not based on self-report alone: it was verified using carbon monoxide breath tests, a standard objective measure of recent smoking.

At six months, 11.3 per cent of participants given e-cigarettes alone had successfully quit smoking, compared with 6.4 per cent of those who received the automated NHS supportive messages. That difference made the e-cigarette group 76 per cent more likely to quit. The result indicates that simply providing a vaping starter pack, without any ongoing specialist contact, outperformed automated supportive messaging.

Adding telephone-based behavioural support nearly doubled the quit rate. Among participants who received e-cigarettes alongside counselling, 21.1 per cent stopped smoking for six months, compared with 11.3 per cent of those who received e-cigarettes alone. Lead author Dr Katie Myers Smith, Senior Lecturer in Health Psychology at Queen Mary, said one of the most important findings is that smokers do not necessarily need specialist counselling to benefit from e-cigarettes, but that when counselling is available it can make a difference.

The benefits persisted at twelve months. Sustained quit rates were 16.8 per cent among those receiving e-cigarettes and counselling, nine per cent among those receiving e-cigarettes alone, and 5.4 per cent among those receiving supportive messages. The same ordering of outcomes held over the longer follow-up, with the combination arm remaining the most effective and automated messaging the least.

The trial also produced a striking finding about the automated messaging group. More than two-thirds of participants who successfully quit in that arm were using e-cigarettes at six months, suggesting they had obtained vaping products outside their allocated treatment. When participants who used treatments outside their allocated group were excluded, the quit rate in the supportive messages group fell to 2.7 per cent. This indicates that the apparent effect of the messages alone was substantially inflated by participants effectively self-treating with e-cigarettes.

Most participants who successfully quit smoking with e-cigarettes were still vaping a year later. The researchers note that vaping is not completely risk-free, but that it poses only a small fraction of the risks of smoking. They also point to potential secondary benefits: e-cigarette use can protect ex-smokers from post-cessation weight gain and mood changes, and from relapsing back to smoking.

Senior author Peter Hajek, Professor of Clinical Psychology at Queen Mary, said the trial adds to the strong evidence that e-cigarettes help people stop smoking and that clinicians can recommend them with confidence. He added that clinicians should take the opportunity to explain that vaping is far less harmful than smoking, and that ex-smokers can keep using an e-cigarette for as long as they need to feel sure they will not go back to smoking.

The findings have direct relevance for stop-smoking services and for policy. Hayden McRobbie, Professor of Population Health at Queen Mary and a collaborator on the study, said the results matter because not everyone who wants to quit is able or willing to attend regular counselling sessions, and the trial shows such people can still benefit from simply being offered an e-cigarette. At the same time, he emphasised that the extra benefit from telephone support still matters, and that services are needed to make both effective quitting aids and additional support available as widely as possible.

The results also lend strong support to Swap and Stop, a government initiative providing free vaping starter packs to help smokers quit. The initiative encourages smokers to enlist with UK stop-smoking services for behavioural support but does not make that mandatory. As the trial shows, e-cigarettes help smokers quit even without ongoing counselling, but behavioural support increases their efficacy further. Dr Myers Smith summarised the practical implication: counselling should not be a condition of receiving help to stop smoking, but it should be made as easy as possible for people to access that extra support.

Subject of Research: Effectiveness of e-cigarettes for smoking cessation with and without behavioural support

Article Title: E-cigarettes help smokers quit even without specialist support

Article References: E-cigarettes help smokers quit even without specialist support. Original publication (Bibliographic details unavailable.)

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Keywords: e-cigarettes, smoking cessation, randomised controlled trial, behavioural support, vaping, NHS stop-smoking services, Queen Mary University of London, NEJM Evidence, telephone counselling, Swap and Stop, public health, nicotine