A new study by Queen Mary University of London, funded by the National Institute for Health and Care Research (NIHR), has found that e-cigarettes can help people quit smoking even without ongoing behavioural support.
The randomised controlled trial, published in NEJM Evidence and involving 1,170 adults given e-cigarettes, found that 11.3 per cent of participants given e-cigarettes alone successfully quit smoking for six months, compared with 6.4 per cent of those who received automated NHS stop-smoking messages – making them 76 per cent more likely to quit.
Adding telephone-based behavioural support nearly doubled quit rates. Among participants receiving e-cigarettes alongside counselling, 21.1 per cent successfully stopped smoking for six months, compared with 11.3 per cent receiving e-cigarettes alone.
Previous research has established that e-cigarettes can help smokers quit, but most clinical trials have provided them alongside ongoing behavioural support. This study addresses an important unanswered question: whether e-cigarettes remain effective when specialist counselling is unavailable or unwanted, and how much additional benefit counselling provides.
Participants were randomly assigned to receive automated NHS stop-smoking emails, an e-cigarette starter pack alone, or an e-cigarette starter pack alongside telephone counselling. Those receiving additional support were offered five telephone sessions over four weeks. Quitting was verified using carbon monoxide breath tests.
The researchers also found that more than two-thirds of participants who successfully quit in the NHS supportive messages group were using e-cigarettes at six months. 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.
Dr Katie Myers- Smith, lead author and Senior Lecturer in Health Psychology at Queen Mary said: "One of the most important findings is that smokers don't necessarily need specialist counselling to benefit from e-cigarettes, but when counselling is available, it can make a difference. In our trial, adding telephone support almost doubled the proportion of people who successfully quit.
"This suggests we shouldn't make counselling a condition of receiving help to stop smoking, but we should make it easy as possible for people to access that extra support."
The benefits were also evident at 12 months, with sustained quit rates of 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.
Most participants who successfully quit smoking with e-cigarettes were still vaping a year later. Vaping is not completely risk-free, but it poses only a small fraction of risks of smoking, and it can protect ex-smokers from post-cessation weight gain and mood changes, and from relapse back to smoking.
The findings strongly support Swap and Stop, a government initiative which provide free vaping starter packs to help smokers quit. The initiative encourages smokers to enlist with the UK stop-smoking services for behavioural support but does not make it mandatory. E-cigarettes help smokers quit even without ongoing counselling, but behavioural support increases their efficacy further.
Hayden McRobbie, a collaborator on the study and Professor of Population Health at Queen Mary and said: "These findings matter for stop-smoking services. Not everyone who wants to quit smoking is able or willing to attend regular counselling sessions, and our results show that they can still benefit from simply being offered an e-cigarette.
"At the same time, the extra benefit we saw from telephone support still matters. Stop smoking services are still needed to make both effective quitting aids and the additional support available as widely as possible."
Peter Hajek, senior author and Professor of Clinical Psychology at Queen Mary said: "This trial adds to the strong evidence that e-cigarettes help people stop smoking, and clinicians can recommend them with confidence. Clinicians should also 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 won't go back to smoking."
