Does vaping help to quit smoking? The latest research, facts and data

With so much research and information out there on vaping vs smoking, it can be hard to know what to think! We’ve gathered information from a range of studies in the UK and US to ensure that you have the most up to date information and get the facts!

A study from the University of East Anglia found that…
A trial run by the University of East Anglia has found that offering free starter vape kits and referrals to smokers visiting emergency departments could help thousands more smokers to quit each year.

Those offered a vape were 76% more likely to quit smoking
The trial, which took place between January and August 2022, involved six UK emergency departments, and compared the likelihood of smokers quitting when offered an e-cigarette and a direct referral for help, compared to printed advice on quitting smoking.

All of the participants had attended A&E to receive care for existing conditions or injuries, but were offered the opportunity to take part if they were currently a smoker. 484 of the patients were provided with advice from a stop smoking adviser, a starter vape kit, and a referral to their local stop smoking services, while the other 488 patients were given written information about quitting and how to access support, without actually being directly referred.

The study found that those who received a free vape kit and were referred to stop smoking services were 76% more likely to have given up smoking after six months, than those who were not provided with a smoking cessation tool or a referral for help.

This research suggests that providing support in places like emergency departments can help reach groups within the population who may not be actively seeking out stop smoking support of their own volition, but are willing and capable of engaging when given the opportunity. In fact, the study suggests that such intervention could lead to thousands more people successfully quitting smoking each year.

Dr Ian Pope, lead author of the study, revealed:

"Swapping to e-cigarettes could save thousands of lives. We believe that if this intervention was widely implemented it could result in more than 22,000 extra people quitting smoking each year.

"Attending the emergency department offers a valuable opportunity for people to be supported to quit smoking, which will improve their chances of recovery from whatever has brought them to hospital, and also prevent future illness."

Vapes support smokers in choosing a less harmful alternative
Not only does this study suggest that actively helping people to access their local stop smoking services is effective, but also that offering them a less harmful alternative to smoking can help to kickstart their stop smoking journey. Smoking remains the biggest cause of preventable death in the UK, Professor Caitlin Notley, co-lead of the trial, explains:

"About half of all people who smoke will die prematurely, losing on average 10 years of life, and for every death caused by smoking, approximately 30 more people are suffering from a smoking-related disease."

There are currently an estimated 6.4 million adult smokers in the UK, and the NHS suggests that around 76,000 people die every year from smoking related illnesses in the UK alone. But knowing the health implications of continuing to smoke does not necessarily make it any easier to kick the habit. That is why e-cigarettes are such a crucial tool for smoking cessation, as they not only replace the physical act of smoking and help users manage their nicotine cravings, but they are also a far less harmful option than smoking.

The Office for Health Improvement and Disparities reiterated in their Nicotine vaping in England: 2022 evidence update that vaping is at least 95% less harmful than smoking, and research has shown that using an e-cigarette is twice as effective for long-term smoking cessation than nicotine replacement therapies like patches and nicotine gum.

Hazel Cheeseman, Deputy Chief Executive of Action on Smoking and Health (ASH), urged that the findings should be "carefully considered by those in the NHS and local government who are planning services for smokers", adding:

"This type of low-cost offer of support combined with an e-cigarette and located where smokers are accessing existing care is exactly what we need to make rapid progress in our efforts to reduce smoking, particularly for disadvantaged groups."

The Cochrane Review in 2023 found that…
A new Cochrane review has been released, revealing e-cigarettes to be as effective as stop smoking medications like varenicline at helping smokers successfully quit smoking.

E-cigarettes are a safer alternative to smoking
In their Nicotine vaping in England: 2022 evidence update summary the Office for Health Improvement and Disparities found vaping to be at least 95% less harmful than smoking, and the Government recently announced plans to offer 1 million smokers an e-cigarette to help them to quit smoking in their new ‘swap to stop’ scheme.

E-cigarettes can be considered a clean way to use nicotine, as they do not contain the many harmful substances and toxic chemicals like tar and carbon monoxide which are released in cigarette smoke. Nicotine itself does not cause cancer and is relatively harmless, having a similar effect on the body as caffeine. However, it is highly addictive, and is the reason that many smokers find it so hard to quit smoking.

Effectively managing nicotine cravings is an important part of making a quit attempt, as it helps avoid unpleasant withdrawal symptoms like headaches, irritability, and trouble sleeping. We took a closer look at the effects of nicotine in our post ‘Is nicotine harmful to the body?’

Speaking on the findings of the review, Jon Foster, Policy Manager at Asthma and Lung UK, said:

“Vaping can be a helpful way to give up smoking. There is really clear evidence that swapping tobacco for vaping leads to a substantial reduction in exposure to substances that can cause cancer, lung disease and heart disease.”

What makes vaping so effective?
E-cigarettes are used as a form of nicotine replacement therapy, which helps those attempting to quit smoking manage their nicotine dependence and stave off withdrawal symptoms.

A variety of nicotine strengths
Unlike most NRTs (nicotine replacement therapies), the e-liquids used with e-cigarettes are available in a wide variety of different nicotine strengths, which allows users to match the strength of their vape liquid to their previous nicotine intake from tobacco smoke, ensuring they are using the strength that will most effectively satisfy their cravings. We have lots of information on choosing how much nicotine you need in our blog post 'Which strength e-liquid should I use?'

Vaping also offers users the opportunity to reduce their nicotine intake over time, by gradually lowering the strength of their vape juice, whether just to reduce their nicotine use or with the aim to quit vaping altogether.

Replicating the feel of cigarette smoking
Another reason that e-cigarettes are an effective smoking cessation tool is because using a vape kit accurately replicates the feel of cigarette smoking. Not only are you repeating the hand to mouth action, but you are also inhaling a vapour in the same way you would when smoking cigarettes, and starter vape kits are designed to replicate the draw of a cigarette in order to feel familiar to new users. This helps also address the physical habit of smoking, along with the nicotine addiction.

A wide range of flavour options
As well as being available in different strengths, e-liquids are available in a wide variety of different flavours, which can help make the experience more enjoyable.
Having a flavour you enjoy makes you more likely to continue to pick up your vape in place of returning to smoking traditional cigarettes.

Affordable and accessible
One of the best things about e-cigarettes is that they are accessible, as there is no prescription needed and they are available to all adult smokers. They are a low cost alternative to smoking, with a University College London study finding that those who make the switch from smoking to vaping could save £780 per year. Additionally, research from Brunel University London found that if 50% of current smokers made the switch to vaping it would save the NHS £518 million on average per year.

Weighing in on the findings, Deborah Arnott, Chief Executive of Action on Smoking and Health, expressed that stop smoking services should be more widely utilising e-cigarettes for patients, saying:

“E-cigarettes are the best option for smokers wanting help to quit. Not only are they as effective as varenicline and cytisine, but more to the point, they’re widely available and cheap,” “The government has promised 1 million free vapes to smoking cessation services and while the scheme’s not yet up and running, there’s no need for stop smoking services to wait.”

E-cigarettes as effective as smoking cessation pharmacotherapies
Cochrane reviews are a systematic analysis of all eligible data, evidence, and research, in this case focusing on the efficacy and safety of different smoking cessation tools available to adult smokers.

This particular review compared e-cigarettes with the pharmacological options varenicline and cytisine, analysing 319 trials published between April 2012 and April 2022, which included data from over 150,000 participants.

It identified that there is no clear difference in the effectiveness of e-cigarettes compared with that of the smoking cessation medicines, as well as being no clear difference in their health risks. Analysis revealed that 10–19% of people were likely to quit smoking using an e-cigarette, 12–16% using varenicline and 10–18% using cytisine. Meaning that e-cigarettes, a widely available and cost-effective option, are just as effective as an aid to quitting smoking as the medicines which are only available on prescription.

A previous Cochrane review found that vaping is twice as effective during a quit smoking attempt as nicotine replacement therapies (NRTs) like nicotine patches and gum, which we covered in our blog post ‘E-cigarettes proven to be twice as effective as other NRTs’.

What are smoking cessation pharmacotherapies?
Smoking cessation pharmacotherapies refer to medications which are prescribed to assist the patient with a stop smoking attempt. Both of these medications work by reducing nicotine cravings as well as reducing the rewarding feeling of smoking.

Cystine is not currently used in the UK, but is widely used in many European countries and is involved in trials in the US and Australia. However, varenicline, more commonly known as Champix, was available on prescription in the UK until recently. It is currently unavailable having been withdrawn as a precaution due to an impurity found in the medicine, and it is not known if or when it will become available again.

A study from King’s College London found that...
On Tuesday 10th of March, No Smoking Day 2021, King’s College London published a new study into e-cigarettes. It identified the ‘clear benefit’ of daily e-cigarette use in helping smokers quit.

Daily e-cigarette use shows ‘clear benefit’ in helping smokers quit
The study, published in the journal Addiction, involved the use of five waves of data collected between 2012 and 2017. Researchers analysed how effective e-cigarettes are at aiding abstinence from smoking for at least a month.

During the study, which was funded by Cancer Research UK, researchers analysed the online data of more than 1155 participants. These included smokers, ex-smokers who had quit within one year of the survey, and e-cigarette users.

They found that vapers who are using a refillable e-cigarette daily are over five times more likely to kick the habit after one month, compared to not using any quitting aids. Similarly, those who use a disposable or prefilled pod style e-cigarette are three times more likely to quit for a month compared to those who do not use an aid.

E-cigarettes have been available for over a decade, but evidence on their effectiveness for smoking abstinence is still limited. Unfortunately, many of the studies carried out so far have failed to include important factors like frequency of use and the type of e-cigarette. This has resulted in inconsistent findings.

There is a lot of first hand evidence that e-cigarettes are more effective than other NRTs and medications. This includes from users, who have previously struggled to quit using other methods, and stop smoking clinic workers who report e-cigarettes, in combination with support, as the most effective tool.

This study found that daily use of an e-cigarette was more effective than other methods, including NRTs and medications like Bupropion and Varenicline. This suggests that possibly it is time to consider moving away from other methods that are offered by the NHS, in favour of a more effective solution.

Dr Máirtín McDermott, Research Fellow at King’s College London’s National Addiction Centre, and lead author of the study, stated;

“Our results show that when used daily, e-cigarettes help people to quit smoking, compared to no help at all. These findings are in line with previous research, showing that e-cigarettes are a more effective aid for quitting than nicotine replacement therapy and prescribed medication.”

ASH’s annual “Use of e-cigarettes among adults in Great Britain” survey for 2023 found that…
Action on Smoking and Health (ASH) released their annual ‘Use of e-cigarettes among adults in Great Britain’ survey for 2023, and it identified that an alarming number of smokers incorrectly believe that vaping is as harmful as smoking, if not more so.

This has prompted them to produce a myth busting brief to help tackle the misconceptions that may be preventing smokers from making the switch to vaping as a way to quit smoking.

Four in ten smokers wrongly believe vaping is as or more harmful than smoking
The latest ASH annual survey has revealed that four out of every ten smokers in Britain incorrectly believe that vaping is as risky or even more risky than smoking cigarettes, which equates to 39% of smokers. This is thought to be one of the main reasons that 1.8 million (27%) of current smokers have never tried vaping, despite that fact that there is an abundance of research finding vaping to be substantially less harmful than smoking, and an extremely effective quitting aid.

Additionally, it was discovered that 2.9 million smokers have tried vaping but stopped and returned to smoking cigarettes, with 44% of this group also having incorrect beliefs about the safety of vaping.

This information has led to concern that these misconceptions around the safety of vaping could threaten the success of the recently announced Government ‘swap to stop’ scheme. This initiative will see one million smokers provided with e-cigarettes as a way to help them quit smoking as a step towards the Government’s aim for England to be smoke-free by 2030.

Speaking on these findings, Hazel Cheeseman, Deputy Chief Executive of ASH said:

“The Government has backed a vaping strategy as its path to reduce rates of smoking, but this approach will be undermined if smokers don’t try vapes due to safety fears or stop vaping too soon and revert to smoking. The Government must act quickly to improve public understanding that vaping poses a fraction of the risk of smoking.”

Some of the most common vaping myths
To help address the issue of misinformation that was so apparent in the survey, ASH have released a myth busting brief which highlights the many misconceptions around e-cigarettes, including examples of misleading headlines from the media, and provides evidence based rebuttals.

This document has been developed with the country’s leading experts on smoking and vaping and provides evidence on the following topics:

·Vaping is NOT more harmful than smoking
·Vaping is NOT more addictive than smoking
·Vaping is NOT a proven gateway into smoking
·Nicotine DOES NOT damage young people’s brain development

The brief is intended to not only combat misinformation, but to be used as an aid for responsibly reporting information about vaping, and reducing the repetition of such information as conventional wisdom, the overstating of evidence, and instances of opinions being presented as facts.

Vaping is NOT more harmful than smoking
As stated by Chief Medical Officer Professor Sir Chris Whitty:

“The key points about vaping (e-cigarettes) can be easily summarised. If you smoke, vaping is much safer; if you don’t smoke, don’t vape.”

The most obvious evidence to back up this fact is that over 75,000 people die every year from smoking in the UK, in comparison to the fact that in the last twelve years only five fatalities linked to vaping products have been reported to the Medicines and Healthcare products Regulatory Agency (MHRA).

E-cigarette products in the UK are strictly regulated, and these regulations prohibit the use of any ingredients which pose a risk to human health both in heated or unheated form. These regulations have helped the UK become a leading example of how e-cigarettes can be utilised as a crucial aid for helping smokers to quit smoking, and enabled healthcare authorities to endorse vaping as a quitting tool.

Vaping is NOT more addictive than smoking
The brief reveals that two thirds of those who try one cigarette will go on to become regular smokers. Traditional cigarettes actually carry the highest risk of addiction when it comes to nicotine delivery, and for those who manage to quit smoking it takes on average 30 attempts.

As with nicotine replacement products like patches and gum, e-cigarettes are an alternative nicotine source designed to help manage nicotine cravings during an attempt to quit smoking. While this may continue the users addiction to nicotine, which is also true of nicotine replacement therapies (NRTs), it greatly reduces their risk of returning to smoking traditional cigarettes and is a much safer alternative.

Additionally, another way in which e-cigarettes are regulated in the UK is that nicotine-containing e-liquids are limited to a maximum of 20 mg/ml of nicotine. While some countries like the US do not have such restrictions and strengths as high as 50 mg/ml are widely available, UK law ensures that e-liquids can contain enough nicotine to help ex-smokers manage their cravings and remain smoke free, without being excessive.

Vaping is NOT a proven gateway into smoking
As the use of e-cigarettes has increased in the UK, the smoking rates have continued to decline, and are actually at an all time low. If e-cigarettes were in fact a gateway into smoking we would expect the opposite to be true, for smoking rates to stop dropping and even to start increasing, which is simply not the case.

In fact, the data suggests that vaping is a gateway out of smoking traditional cigarettes, which is something we have delved into in our blog posts ‘E-cigarettes are not a gateway into smoking’ and ‘Debunking the ‘gateway theory’’.

Nicotine DOES NOT damage young people’s brain development
The use of e-cigarettes by young people is something that has been closely monitored for many years, especially in the wake of the large uptake of youth vaping that was seen in the US some years ago. However, youth vaping in the UK has remained relatively  low, thanks to the strict regulations that are in place.

A common misconception is that nicotine can be damaging to a young person's brain development, when in fact nicotine replacement therapy is on the World Health Organization (WHO) list of essential medicines due to its efficacy, safety, and cost effectiveness. NRT products are licensed by the MHRA in the UK not just for the use of adults, but also from the age of 12 and for pregnant women, for smoking cessation.

Systematic reviews have found that the evidence on the effects of both nicotine containing and nicotine-free e-cigarettes on developing children and adolescents is insufficient or unavailable.

In fact, nearly 90% of lifetime smokers in the UK first started smoking between the ages of 10 and 20, and a Scottish study following a group of children from the age of 11 until they were 70 found that smoking did not have an effect on cognitive function. Therefore, if adolescent smoking does not damage cognitive function, it is implausible to suggest that adolescent use of e-cigarettes would.

That is not to say that this is not something we must remain vigilant on, and combatting youth vaping will always be a high priority. However, it is important that this does not come at the cost of making them inaccessible to adult smokers who could use them to quit smoking traditional cigarettes.

Professor Ann McNeill, King’s College London, author of Government commissioned review on the harms from vaping and contributor to the ASH myth buster, commented:

“Anxiety over youth vaping is obscuring the fact that switching from smoking to vaping will be much better for an individual’s health. It is wrong to say we have no idea what the future risks from vaping will be. On the contrary levels of exposure to cancer causing and other toxicants are drastically lower in people who vape compared with those who smoke, which indicates that any risks to health are likely to be a fraction of those posed by smoking.

“We must not be complacent about youth vaping and further regulation is needed, but so too is work to ensure many more adults stop smoking and vaping is an effective means of doing that.”

This brief for tackling vaping myths could prove to be a vital tool in helping to educate smokers on the facts around the safety of e-cigarettes relative to smoking traditional cigarettes, and could go a long way towards reassuring them that making the switch from smoking to vaping is one of the best decisions they could make for their current and future health.

The spread of accurately reported facts and evidence about vaping could also have a great impact on the success of initiatives like the ‘swap to stop’ campaign, and bring us that much closer to the goal of England being smoke-free by 2030.

A study from the American National Library of Medicine (February 2023) found that…
A study from the American National Library of Medicine has concluded that not only can e-cigarettes help smokers quit, but they can do so without increasing the users nicotine dependence.

Vape users report significantly lower dependence
The study was conducted by researchers at the Centre for Research on Tobacco and Health at the Pennsylvania State University and involved 520 participants who were interested in reducing their cigarette intake but with no plans of quitting smoking altogether.

As part of the six month study participants randomly received an e-cigarette that delivered either 36, 8, or 0 mg/ml of nicotine, or a cigarette substitute that did not contain tobacco, to be used in an effort to reduce their cigarette consumption.

After six months all participants using an e-cigarette reported significant decreases in cigarette consumption, especially those using the 36 mg/ml nicotine strength.