Using e-cigarettes for smoking cessation neither improved the chance of quitting successfully nor helped to improve relapse rates, in a large nationally representative cohort study from the USA.

Data were analysed from respondents in the PATH Study who were established cigarette smokers in 2016 and who reported a recent quit attempt. In 2017, the study included data on 3,578 previous year smokers with a recent quit attempt and 1,323 recent former smokers. Respondents reported using e-cigarettes or other products to quit smoking cigarettes.

Study outcomes included at least 12 months of cigarette abstinence in 2019.

Smokers who reported using e-cigarettes to help them in their most recent cigarette quit attempt were less likely rather than more likely than other quit attempters to achieve successful cigarette cessation.

• Although sales of high nicotine e-cigarettes increased in the USA in 2017 this did not translate to more smokers using these e-cigarettes to quit smoking. In 2017, 12.6% (95% CI: 11.3-13.9%) of recent quit attempters used e-cigarettes to help with their quit attempt. This was a reduction compared with previous years

• Cigarette abstinence for e-cigarette users was lower than for those who used no product to help them quit; 9.9% (95% CI: 6.6-13.2%) vs 18.6% (95% CI: 16.0-21.2%)

• The adjusted risk difference (aRD) for e-cigarettes compared with pharmaceutical aids was −7.3% (95% CI: −14.4 to –0.4%); and for e-cigarettes vs no product use −7.7% (95% CI: −12.2 to –3.2%)

• A very small proportion, only 2.2% (95% CI: 0.0-4.4%) of recent former smokers switched to high nicotine e-cigarettes

• Those respondents who switched to e-cigarettes appeared to have a higher relapse rate to cigarette smoking than those who did not switch to e-cigarettes.

However, this difference was not statistically significant; aRD 9.4% (95% CI:-5.0 to 22.8%)

The study authors state: ‘In this analysis of the most recent PATH Study data, smokers who reported using e-cigarettes to help them in their most recent cigarette quit attempt were less rather than more likely than other quit attempters to achieve either successful cigarette cessation or to become tobacco and e-cigarette free.

‘Rather than e-cigarettes adding four additional successful cigarette quitters per 100 quit attempters compared with pharmaceutical aid users as concluded by a systematic review of RCT data,¹  in this study

e-cigarette use was associated with seven fewer successful quitters per 100 quit attempters.’

‘Furthermore, switching to e-cigarettes did not reduce the risk of relapse to cigarette smoking compared with other recent former smokers. Instead, nearly 60% of recent former smokers who were daily e-cigarette users had relapsed to cigarette smoking by 2019,’ they add.

Dr Jez Thompson