If you believe the stuff you hear about vaping in the media or from outspoken critics of the technology in public health and tobacco control, you’d think that e-cigarettes were going to be a bad thing for the population. With claims that vaping will serve as a gateway to smoking, will “renormalize” smoking or will undermine attempts to quit, it’s not too surprising that many are unsure whether e-cigarettes are a positive development at all. But the claims of gateways and renormalization are basically nonsense, and a new analysis of UK data has revealed that e-cigarettes have led to an additional 16,000 to 22,000 smokers quitting in 2014 alone.
Professor Robert West, the lead author of the study, commented “E-cigarettes appear to be helping a significant number of smokers to stop who would not have done otherwise – not as many as some e-cigarette enthusiasts claim, but a substantial number nonetheless.”
The Analysis – How They Came Up With the Estimate
Robert West and colleagues Lion Shahab and Jamie Brown used data from the Smoking Toolkit Study, basing the analysis on 2014 data because it’s the most recent year for which full statistics are available. The full paper gives a run-down of the various steps in the calculation – and is only short, if you’re interested in reading it – but basically involves using known statistics on the number of people who attempted to quit by vaping and on the success rates of e-cigs to come up with the figure.
First, they worked out the number of smokers who attempted to quit in 2014, which was 3.16 million. Of these, about 28 percent attempted to quit by vaping without using prescription medicines or behavioral support – equating to about 891,000 people. If they’d tried to quit cold turkey or using nicotine replacement therapy bought over the counter, about 5 percent of them would have been successful, but vaping increases quit-rates by about 50 percent, so the total quit-rate for these smokers would be about 7.5 percent. This means that 2.5 percent of them quit by vaping who wouldn’t have stopped otherwise, or about 22,000 people.
However, the rise in vaping has been accompanied by a decline in smokers using prescription medicines and behavioral support in their quit attempts. The authors note that the decline doesn’t perfectly match up to the rise in vaping, but if you assume that vaping is responsible for about 80 percent of the decrease, then the estimate can be updated to account for this. Using both counseling and medication is the best method of quitting, according to the evidence, so if vaping has taken some smokers away from this approach, then it would detract from the additional positive effect of vaping. With this taken into account, the number of extra quitters thanks to vaping reduces to 16,000.
Is 16,000 to 22,000 Too Low?
The authors note that the estimate of 16,000 to 22,000 is much lower than the estimate of 560,000 ex-smoking vapers in England, but present plenty of reasons for this difference. The calculated figure is only for quitters in the past year, so many of the additional ex-smoking vapers (who quit longer than a year ago) won’t be included, and about 9 percent of recent ex-smokers started vaping after quitting smoking (probably to avoid relapsing).
The biggest points that reduce the estimate are the fact that only about one-third of vapers who’ve quit smoking wouldn’t have been expected to quit cold turkey or using NRT, and finally, about 70 percent of recent ex-smoking vapers will relapse to smoking in future (this figure is based on existing knowledge about quitting smoking, not something specific to vaping). When these factors (and similar ones) are taken into account, the estimates are roughly in agreement with each other.
The assumptions do seem reasonable, although the idea that 70 percent of smokers to recently quit by vaping will return to smoking is questionable – after all, we’re still getting nicotine through a similar delivery mechanism, so you’d hope this would reduce that percentage a little.
In a blog post from the New Nicotine Alliance, they also point out that the success rates used as part of the study are probably (or at least hopefully) a bit of an underestimate compared to what would be expected with modern devices. They also point out that the decline in use of other quitting approaches could have been to do with something other than e-cigarettes, so in reality a larger proportion of the vapers might not have quit if it wasn’t for e-cigs.
These last few points are ultimately speculation, though, so they should be taken with a pinch of salt. In any case, an extra 20,000 or so quitters thanks to vaping is hardly something to balk at.
Expert Responses from the Science Media Center
The Science Media Center has published a couple of comments from Professors Linda Bauld (from the University of Stirling and the UK Centre for Tobacco and Alcohol studies) and Peter Hajek (from the Tobacco Dependence Research Unit, Queen Mary University of London) addressing the study.
Linda Bauld comments:
This study provides valuable ‘real world’ evidence on electronic cigarettes and smoking cessation. From these data, it is clear that electronic cigarettes are appealing to smokers trying to stop and have helped a significant number of people in England to move away from tobacco, a product that kills one in two of its regular users. […] This ‘consumer revolution’, as it has been called, may well be saving lives.
And Peter Hajek adds:
E-cigarettes have a potential to reduce smoking related morbidity and many smokers are successful in making the switch from smoking to vaping. Specialist smoking cessation services are currently not offering e-cigarettes and are seeing a marked decline in interest. This is unfortunate, as it is likely that even more smokers would switch to vaping successfully if e-cigarettes were combined with behavioural support that the services provide. Hopefully, findings like this will encourage the services to start offering e-cigarettes as a part of their overall toolkit.
Like it Or Not, Vaping is Having a Positive Effect in Society
Of course, these figures are only for the UK, and they aren’t as jaw-droppingly impressive as we might have hoped, but they still paint a clear picture: e-cigarettes are helping reduce the number of smokers. With tens of thousands of smokers who otherwise would still be smoking having successfully quit thanks to vaping in just one year, it is still excellent news.
The doomsday scenarios where more people vaping causes some catastrophic “renormalization” or impedes quitting are looking increasingly out of touch with reality. In the UK, vaping is being received very positively, probably thanks to Public Health England’s controversial decision to just tell the truth about what the evidence says – I wonder how things would improve in the US if public health types were able to forget about their ideology and give vaping the support it deserves.