E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis

Richard J Wang, Sudhamayi Bhadriraju, Stanton A Glantz, Richard J Wang, Sudhamayi Bhadriraju, Stanton A Glantz

Abstract

Objectives. To determine the association between e-cigarette use and smoking cessation.Methods. We searched PubMed, Web of Science Core Collection, and EMBASE and computed the association of e-cigarette use with quitting cigarettes using random effects meta-analyses.Results. We identified 64 papers (55 observational studies and 9 randomized clinical trials [RCTs]). In observational studies of all adult smokers (odds ratio [OR] = 0.947; 95% confidence interval [CI] = 0.772, 1.160) and smokers motivated to quit smoking (OR = 0.851; 95% CI = 0.684, 1.057), e-cigarette consumer product use was not associated with quitting. Daily e-cigarette use was associated with more quitting (OR = 1.529; 95% CI = 1.158, 2.019) and less-than-daily use was associated with less quitting (OR = 0.514; 95% CI = 0.402, 0.665). The RCTs that compared quitting among smokers who were provided e-cigarettes to smokers with conventional therapy found e-cigarette use was associated with more quitting (relative risk = 1.555; 95% CI = 1.173, 2.061).Conclusions. As consumer products, in observational studies, e-cigarettes were not associated with increased smoking cessation in the adult population. In RCTs, provision of free e-cigarettes as a therapeutic intervention was associated with increased smoking cessation.Public Health Implications. E-cigarettes should not be approved as consumer products but may warrant consideration as a prescription therapy.

Figures

FIGURE 1—
FIGURE 1—
Association of E-Cigarette Consumer Product Use With Smoking Cessation Among All People Who SmokeBased on Studies as of January 20, 2020 Note. CC = combustible cigarette; CI = confidence interval; EC = e-cigarette; NHIS = National Health Interview Survey; OR = odds ratio; TUS-CPS = Tobacco Use Supplement to the Current Population Survey. Weights are from random effects analysis.
FIGURE 2—
FIGURE 2—
Association of E-Cigarette Consumer Product Use With Smoking Cessation Among People Who Express SomeMotivation to Quit Smoking Based on Studies as of January 20, 2020 Note. CI = confidence interval; EC = e-cigarette; NRT = nicotine replacement therapy; OR = odds ratio. Weights are from random effects analysis.
FIGURE 3—
FIGURE 3—
Association of Daily and Less-Than-Daily E-Cigarette Consumer Product Use With Smoking Cessation AmongPeople Who Smoke Based on Studies as of January 20, 2020 Note. CI = confidence interval; EC = e-cigarette; OR = odds ratio. Weights are from random effects analysis.
FIGURE 4—
FIGURE 4—
Association of Provision of Free E-Cigarettes With Significantly Increased Smoking Cessation in RandomizedClinical Trials of E-Cigarettes as Smoking Cessation Therapy by (a) Relative Risk and (b) Risk Difference Based onStudies as of January 20, 2020 Note. CI = confidence interval; RR = relative risk. Weights are from random effects analysis.

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