Interesting New Paper Explores Smoking Relapse Data

A new paper published in Addiction looks at an important but oft-overlooked question about smoking cessation via e-cigarettes.

Let’s see what’s going on.

The paper

A new paper from Peter Hajek et al, funded by The National Institute for Health Research and by Cancer Research UK, explores an interesting question: When people stop smoking by using e-cigarettes, how likely are they to relapse if they:

• continue using e-cigarettes
• cease using e-cigarettes.

I think the subtlety of this question gets lost in the debate and policymaking around the power of vapes to reduce smoking prevalence. We often hear people say things like, it’s just replacing one addiction with another.” However, if continuing to vape is the difference between relapsing back to cigarettes, we should review that stance.

The study is a secondary analysis of a large randomised controlled trial of smoking cessation treatments. The two stop‑smoking supports were:

• Combination nicotine replacement therapy (NRT), which was typically a patch plus one of a fast-acting gum, lozenge, nasal spray, or inhaler.
• A refillable nicotine e‑cigarette kit with e‑liquid.

The secondary analysis looked at people who were abstinent at 4 weeks or at 6 months after their quit date, then followed up at month 12.

The results

Like many people who vape, it’s hard to be fully objective when predicting the results of this kind of research. If vapes hadn’t invented, I think I’d still be a smoker. Similarly, I was never too concerned about quitting vapes, because the harms aren’t significant enough for me to stop accessing the benefits of nicotine.

Of course, I don’t expect my sentiment to be shared across the broader population, so I was very interested to read the results of this study once I’d read what it was about.

Here is a table from the study that lays bare the results.

You can read the table yourself, or indeed, the whole study, but I’ll quickly break down what happened below.

The table splits study subjects into “Using EC” or “Not Using EC”, which we’ve explained above as essentially e-cigarette vs combination NRT. The table shows the fate of smokers who were abstinent at 4 weeks and 6 months, and checks in on them after 12 months.

Among people who quit at 4 weeks

• EC group: 199 had quit at 4 weeks; by 12 months, 97 had started smoking again (48.7%).
• Non‑EC group: 132 had quit at 4 weeks; by 12 months, 80 had started smoking again (60.6%).

So, early quitters who were using ECs relapsed less often than early quitters not using ECs.

Among people who quit at 6 months

• EC group: 162 had quit at 6 months; by 12 months, 62 had relapsed (38.3%).
• Non‑EC group: 110 had quit at 6 months; by 12 months, 57 had relapsed (51.8%).

Again, those still using ECs at 6 months were less likely to relapse than those not using ECs.

So there we have it,

What do the results mean for people who want to quit

There are a few interesting implications for these results.

#1. E-cigarettes are a more effective quit aid when compared to combination NRT, which the original study underlined.

#2. Continuing to vape reduced the likelihood of relapse. Per the study, “Use of e‑cigarettes after stopping smoking is associated with a reduced risk of relapse.”

#3. Relapse risk ratios were 0.79 and 0.75, meaning about a 20–25% lower relapse risk in continuing EC users compared with non‑users over 12 months.

In a sane world, these results would affect policy and advice. Sure, vapes won’t help everyone quit, and they won’t ensure that everyone will stay abstinent, but health bodies should do what they can to ensure smokers know what products can both get them off cigarettes and reduce their likelihood of relapse.