E-Cigarettes and Smoking Cessation

E-Cigarettes and Smoking Cessation

A new study has found that e-cigarettes are comparable to nicotine patches in terms of helping patients quit smoking, and preliminary data show that e-cigarettes seem to be just as safe as nicotine patches.1

E-cigarettes differ from traditional cigarettes in that e-cigarettes do not contain tobacco. Instead, e-cigarettes contain liquid nicotine, which is turned into a vapor and inhaled.

The myriad harms of smoking are well-established. As reminded by The American College of Obstetricians and Gynecologists (ACOG), ob/gyns are in a unique position to offer smoking cessation counseling to patients. In a committee opinion, ACOG advised that brief behavioral counseling paired with smoking cessation aids can help patients quit smoking—or at least get them thinking about it.2

ACOG also reminds clinicians that smoking cessation counseling is reimbursable. Most health care plans consider 3 to 10 minutes of counseling intermediate and more than 10 minutes of counseling intensive and reimburse accordingly.

The use of e-cigarettes as a smoking-cessation tool is controversial, mainly because the long-term effects of the toxins found in nicotine vapor are unknown. In addition, e-cigarettes are not regulated by the FDA. More research is needed to establish what role, if any, e-cigarettes should play in tobacco control and to better understand their benefits and harms. The available evidence, however limited, is promising.

In this new study, 292 people received a 13-week supply of commercially available e-cigarettes, with each containing about 16 mg of nicotine; 292 people received a 13-week supply of nicotine patches, and 73 people received placebo (nicotine-free) e-cigarettes. After the initial 13 weeks, a 3-month follow-up ensued.

At 6 months, 5.7% of participants were completely abstinent from smoking. The e-cigarette group had the highest proportion of abstainers (7.3% vs 5.8% and 4.1% for the nicotine-patch group and placebo group, respectively), although the differences between study groups were not significant.

Of those unable to quit after 6 months, 57% of those in the e-cigarette group reduced their daily consumption of cigarettes by at least half, compared with 41% in the nicotine patch group. A third of participants in the e-cigarette groups (both nicotine and placebo) were still using the devices at 6 months. In the nicotine-patch group, only 8% of participants were still using the patches at 6 months.

There were no differences in adverse health events overall or in serious adverse events between study groups. This finding suggests that the safety of e-cigarettes is similar to that of nicotine patches, explained the study authors.

Considering that safety data for e-cigarettes is scarce and that the devices are unregulated, it would be best not to recommend e-cigarettes. If patients ask, however, study data is available.

Pertinent Points:
- E-cigarettes, with or without nicotine, are a modestly effective tool to help smokers quit.
- The profile of e-cigarettes in terms of achievement of smoking abstinence is similar to that of nicotine patches.
- More research is needed to establish the overall health benefits and harms of e-cigarettes and their role in tobacco control.


1. Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 9 September 2013. doi:10.1016/S0140-6736(13)61842-5.
2. American College of Obstetricians and Gynecologists. Committee opinion no. 503: tobacco use and women’s health. Obstet Gynecol. 2011;118:746-750.
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