Shout out to the ever-vigilant and entertaining @phil_w888 for catching this interesting study posted by Bündnis für Tabakfreien Genuss. The paper seems to have gone by the wayside among many, including the Canadian press. That detail is particularly galling because it was authored by Mimi M. Kim and colleagues at Thera‑Business, a research organisation based in Kanata, Ontario, Canada.
What does the paper say?
The paper is a recent systematic review and meta‑analysis of 214 studies in total and 22 randomised controlled trials. The big question it asks is whether e‑cigarette use is associated with quitting or reducing cigarette smoking among people who already smoke.
Here are five big takeaways, many of which won’t exactly shock readers in the harm reduction community.
#1. Behavioural support is not enough alone
While behavioural support has its place, it's far less effective when used alone. Instead, the study found that when people trying to quit smoking used nicotine vapes plus support (such as counselling), they were about 2-3x times more likely to have stopped smoking at follow‑up (3, 6 months, and the longest time measured) than people who just had the support without vapes.
It’s clear evidence that any stop-smoking program should do away with the stigma and seriously consider making vapes a central part of the support they offer smokers.
#2. Vapes reduce the number of cigarettes per day among smokers
Across various trials analysed by the paper, vape use was associated with a reduction of around 4–5 cigarettes per day versus control at multiple time points. While wacky researchers like Stanton Glantz manipulate data to claim that dual-use is very dangerous, in reality, any cigarette that a smoker doesn’t consume is a mini win.
What’s interesting about this stat is that it occurred consistently across the follow-up time frames of 1, 3, 6, and more months. Of course, this finding does raise its own question: While reducing the amount of cigarettes they use is good, is that a satisfactory goal in itself? What more can be done for dual users so they can quit smoking for good?
#3. NRT and vape effectiveness is mixed
When the researchers pooled all the trials together, they did not find clear evidence that vapes work better than traditional stop‑smoking medicines, such as nicotine patches or gum. However, when they looked at individual trials one by one, a different picture emerged where vapes often had higher quit rates or led to bigger cuts in cigarettes per day.
The researchers put these discrepancies down to a) poor adherence among trial subjects, b) contamination in the data, where people who were placed in the “no vape” groups were actually using vapes.
To surmise, in some studies, vapes work at least as well as traditional NRTs; in others, they work better. However, the big picture is a little murkier than we’d like.
#4. Regular vape use is key to quitting
This point might seem intuitive, but it’s good to have it confirmed. Essentially, the researchers found that how people use vapes had a bearing on overall quit rates. The meta-analysis shows that most of the clear, positive quit effects come from trials and cohorts where people are using nicotine vapes daily or most days, as a defined intervention.
People in studies who were non-regular (i.e., past 30 days) or had just tried vaping occasionally had lower quit rates. It’s worth noting that the study did not provide relative quit rates for the regular v irregular groups.
#5. The best quality studies support vaping as a quit aid
With so many studies to look at, you’re going to get a mixed bag of methodologies, sloppiness, and motivated reasoning. To counter this problem, the researchers looked hard at RCTs and found most of them were either good or excellent using the Downs & Black checklist.
When the best quality studies were examined, they contained solid proof that vapes help people quit or reduce their cigarette consumption. Of course, the researchers did have some slight concerns about their findings, including things like a lack of long-term data, small numbers among trial participants, and the fact that the vape product market moves quickly, meaning that results from early products might not fully apply to modern pods or high‑nicotine systems.
