
E-Cigarettes, as Used, Aren’t Helping Smokers Quit, Study Shows - sundaeofshock
https://www.ucsf.edu/news/2016/01/401311/e-cigarettes-used-arent-helping-smokers-quit-study-shows
======
stegosaurus
'Quitting' seems like an arbitrarily high bar to set.

Bob is a 20-a-day smoker. Bob takes up e-cigarettes and subsequently ceases
smoking other than the odd one here and there (social events, ran out of
e-liquid, etc).

If e-cigarettes are healthier than conventional equivalents, then that alone
seems like a huge improvement to me.

Replace all instances of 'conventional cigarette' with 'chocolate bar', and
'e-cigarette' with 'apple'. Perhaps eating apples doesn't result in quitting
chocolate, but if it reduces consumption, that's great!

~~~
Shivetya
While the health issues are unresolved at this time many insurance policies
consider them the same as smoking with regards to penalties and such.

the only solution to smoking is to quit

Thank you for the down votes, smoking is not equivalent to abstinence

~~~
sneak
> the only solution to smoking is to quit

That's like saying the only solution to teen pregnancy is total abstinence.

We already know how that one works out.

~~~
rm_-rf_slash
It's clear the above poster's argument regarded insurance. Call e-cigs a
metaphorical condom or whatever but you aren't paying premiums for your risk
of becoming pregnant just because you have sex.

------
philh
The full text is available for free.
[http://www.thelancet.com/journals/lanres/article/PIIS2213-26...](http://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2815%2900521-4/fulltext)

You need to log in, I used
[http://bugmenot.com/view/thelancet.com](http://bugmenot.com/view/thelancet.com)

Having a quick skim, here's what I currently guess is going on. It's a meta-
analysis, and most of the studies it looks at include smokers who aren't
trying to quit. The effect remains (but weaker) when they restrict to studies
of smokers who are interested in quitting. But "interested in quitting"
doesn't necessarily mean they were actually trying to quit.

So my guess is Simpson's paradox: for people who try to quit, e-cigs help them
quit; for people not trying, e-cigs make approximately no difference; but
people trying to quit are less likely to use e-cigs, and so people using
e-cigs look like they're less likely to quit.

Reading the paper more thoroughly might be able to falsify this guess.

("Quit" here means "quit cigarettes". Someone who stops smoking cigarettes,
but continues smoking e-cigs, is considered to have quit.)

~~~
leshow
thank you for taking a look at the actual research and breaking down issues in
the meta study methodology

------
tomca32
I find this hard to believe. I was a smoker for a decade and I quit smoking
last year only because of vapes (e-cigs).

Didn't even plan to quit smoking but I was concerned about my health so I
decided to try vapes for a while. The cool thing about it is that you can
control your nicotine dose, so every month I lowered it a bit. The difference
was small enough that my body didn't feel it.

After a couple of months I got to 0-nicotine vape. Did that for a month and by
that point my body was not addicted to it any more. Then I just stopped vaping
altogether. Not because I wanted to but because my body didn't need it anymore
and I couldn't care less about it.

The whole process was pretty easy. At no point did I struggle to quit. I just
did what my body felt like. I'm pretty sure the story would have been totally
different without e-cigs.

~~~
FilterSweep
I have started quitting this exact same way. I'm not as far along as you are,
but I have dropped to 3mg (from 18) which is the next dosage up from 0.

I don't believe this article because of the massive tobacco lobby working
valiantly to combat the rise of new companies in the vaping sector. the FDA is
coming close to a ban on vape products all together for this same reason.

~~~
cmaggard
If you feel like you can't make the jump straight to 0 yet, some places make
1.5mg liquid.

------
Nursie
>> While they are promoted as a way to quit traditional cigarettes, they also
are promoted as a way to get nicotine in environments where traditional
cigarettes are prohibited

>> The studies included smokers who both were and were not interested in
quitting, and included people as young as 15 years old.

This is key - if there is a group who are using them only because they provide
a way of getting nicotine into your system where it is otherwise not allowed,
then it seems likely to me that this group would be more committed to smoking
than average, which may go some way to explaining these results.

Personally I found the e-cig very useful when quitting, but I used it
nicotine-free because the law in Australia bars e-liquids with nicotine from
being sold. You can import legally but by the time my imported e-liquid
arrived I'd kicked the nicotine addiction anyway.

Having seen people get _very_ attached to their e-cigs with nicotine, I reckon
I got it right.

(--edit-- As I was using no-nic liquid, when the addiction passed and I didn't
need the crutch any more, I just naturally slowed and then stopped the e-cig
use without even thinking about it, after about 4 months IIRC)

------
fenesiistvan
Who said that it should help quit smoking? ...except the marketing from some
e-cig sellers anybody already knows or should know that it will not help to
quit or helps only a bit.

However I am on e-cig for 3 years now and as I feel, it is much better for
health then regular cigarettes.

~~~
oconnor663
Yeah the title is poorly worded. It looks like they're asking whether e-cigs
help people quit smoking regular cigarettes, not whether they help people quit
smoking entirely.

------
lawl
I don't know, just anecdotal evidence of course, but I stopped smoking around
3 month ago and started vaping. I don't even _want_ to smoke cigarettes
anymore. They taste disgusting if you haven't smoked one in over a month (I
ran out of liquid and tried one again, threw it away after 3 puffs, rather
dealing with not having a nicotine fix for 3 hours).

While YMMV I highly doubt that e-cigarettes cause people to not quit smoking.
I bet this is because of how the participants were selected. I don't know,
people trying e-cigs have tried quitting before/smoked for longer/whatever
thus skewing the statistics.

------
eknkc
Used to smoke 2 packs a day, got some e cigarettes and haven't smoked for 6
months. It's not even hard to do, handles nicotine addiction just fine.

I know I still inhale some shady stuff and nicotine but I feel much better,
have more energy, lung capacity and a fun hobby. It's best not to smoke/vape
anything but switching to this feels like quitting to me.

------
contingencies
"Popcorn lung or bust!" I finally quit smoking after about 20 attempts last
year, after having smoked about 10 years, 1-2 packs a day, 3 on occasion. I'd
tried everything. Patches, gum, e-cigarettes, etc. The e-cigs didn't help me
at all... in fact they extended the very same problematic habits (fingers
wanting something to do while I had a drink in the other hand, primarily). Gum
was good for situations where lack of nicotine was removing my capacity to
concentrate. What finally worked was taking a month away from any familiar
drinking/smoking environment and any work commitments. I would recommend
quitting your job, changing your environment and just going cold for a month
or two to successfully quit smoking. Don't rely on products, they're just
feeding the same addition. Most people who successfully quit apparently fail
to quit a lot of times (8-12?), though not as many as me. So I'm something of
an expert. ;)

~~~
solutionyogi
I am really happy that you are able to quit. Nicotine as an addiction is very
difficult to break and one should try every approach and see what works best
for them. For those for whom 'quit your job and move somewhere' is not an
option, I strongly feel that e-cig provides an alternate which is worth
trying. Even if you can't quit it fully, vaping definitely is a better
alternative than smoking.

------
panglott
Am not surprised. As smoking has become more costly (with anti-secondhand-
smoke regulations) and socially unacceptable, many smokers have found means to
quit, and surely many used vaping for this. But it seems to me that a large
proportion of the people who took up vaping were hardcore smokers who want a
more licit habit. And so they're frequently going on about how vaping is
totally harmless, it has absolutely no secondhand consumption issue (all very
dubious). If vapers were formerly the most hardcore smokers, it's not
surprising that vapers would be less likely to quit. Although it is still
probably a good thing, from a harm reduction viewpoint.

Vaping for smoking cessation needs more than some anecdata. It needs
controlled trials where vaping is compared against placebos and other
cessation methods, like Chantix. but I'm afraid that the vaping industry is
nearly as interested in promoting disinformation as the tobacco industry was.

~~~
collyw
According to this study normal smoking has virtually no secondhand consumption
issue, unless you live with a smoker for 30 years.

[http://jnci.oxfordjournals.org/content/early/2013/12/05/jnci...](http://jnci.oxfordjournals.org/content/early/2013/12/05/jnci.djt365.full)

~~~
panglott
That is not at all what that article says. From your link:

“Passive smoking has many downstream health effects—asthma, upper respiratory
infections, other pulmonary diseases, cardiovascular disease—but only
borderline increased risk of lung cancer,” said Patel.

...So does secondhand smoke cause lung cancer or not? “We can’t say it’s not a
risk factor,” said Wang. ...“It’s hard to say anything conclusive with such
small numbers,” said Wakelee.

...Moreover, of the nearly 40,000 nonsmokers in the WHI-OS, only about 4,000
reported no exposure to cigarette smoke. “That means almost everybody had
passive-smoking exposure,” said Wakelee, “so it’s very hard to say that that
exposure is causing the problem—it’s hard to tease out a difference.

“We don’t want people to conclude that passive smoking has no effect on lung
cancer,” she said. “We think the message is, this analysis doesn’t tell us
what the risk is, or even if there is a risk.”

------
embro
Every two or three months we see this same headline based on the same studies
or have new numbers. We all know that other methods had very low success rate
yet we never see a healine about Nicorette or patches.

A large number of "vapers" have reduce or even stopped smoking, including
myself.

My goal was to stop smoking, goal achieved.

------
snarfy
Define quitting smoking.

Vaping hasn't helped me quit nicotine addiction, but I haven't breathed
cigarette smoke in years.

~~~
ssharp
This may be a really naive question (or I may be falsely inferring that you
want to quit nicotine), but I'm curious:

If you've cut out the behavioral addiction with cigarettes and are now
addicted solely to nicotine, couldn't you slowly ween yourself from nicotine
by gradually using liquids with less and less nicotine until you eventually
end up using liquids without any nicotine?

~~~
eknkc
You can.

Liquids generally have a nicotine rating in mg per ml. I started with 18mg
liquids, then 12, 6 and now 3mg (which is the lowest rating on most brands). I
consume a little more liquid than before but it's probably due to my recent
switch to 3mg from 6mg. As soon as I get used to 3mg, I'm finally gonna get
some nicotine free liquids and start diluting 3mg to 2, 1 and then 0.

Most people don't do this as far as I can tell though.

------
solutionyogi
I was a light smoker (a pack in 3 days) and hated that I was addicted to
cigarettes. I tried nicotine gum and patch to help me quit but it didn't
really work.

Then I realized that I am more addicted to the act of having something in my
hand blowing smoke then nicotine. I have switched to e-cigarettes and have
moved to juice with 3mg nicotine. I feel much better overall and have quit
regular cigarettes.

I haven't looked at all the papers regarding e-cigarette's ill side effects
but based on how my body feels, it is definitely better than regular
cigarettes, no question about it.

------
SlimXero
Smoked 60 a day, from around 2001 til August of 2012. Began using an e-cig in
August of 2009, off and on again until I found what worked for me. Now 1,242
days without a cigarette.

No, it's not for everyone and it won't help everyone quit. But, as it says
right in the article, no business or brand markets it as a smoke cessation
device. Only end users are making those claims. Furthermore, it's not
clarified on the page as to whether or not people who continued vaping were
considered to not have quit smoking.

~~~
zerebubuth
Congratulations! For me, it's 353 days, and I attribute this success to having
vaped for a year prior to that, and being able to gradually reduce the
nicotine levels without reducing the frequency of vaping.

I think it's unfortunate that the conclusion of the paper (that all smokers
are 28% less likely to quit if they also vape) will be confused with the
questions that doctors and policy-makers will be interested in: whether
smokers who want to quit are more or less likely to quit with the aid of
e-cigarettes, and whether smokers who use e-cigarettes are more or less likely
to die of cancer.

It seems like there's a huge, irrational split between pro-smokers and anti-
smokers, and it's a big shame that what really matters might get lost in the
argument: helping people to not die early.

------
nikcub
I'll +1 to the other comments here of people who stopped smoking cigarettes
and took up vaping. I didn't even intend to quit, and I know a lot of other
people in the same situation.

For some people, vaping is just far more pleasant than smoking cigarettes and
they don't look back.

The couple of times I started back up again with cigarettes early on was when
I ran out of e-liquid, since it is heavily regulated (or illegal, as in AU)
and can be difficult to obtain.

I really find this result difficult to believe.

~~~
tombrossman
Same here, I was happy to keep smoking and had no intention of quitting. I
just thought e-cigarettes were a cool new gadget to try, and I liked the idea
that I could now 'smoke' even more places. I fully expected to continue
smoking but over the course of about three months, I just stopped all of it
very gradually. It wasn't the expected outcome at all, but it's nice. Haven't
smoked for at least eight years now, but I tell people (only half joking) that
I would start again if medical science advanced far enough to counter the
health risks.

------
jheriko
but what about the health benefits? isn't that the real bottom line we care
about? not something arbitrary and meaningless like whether people completely
stop smoking? isn't reducing smoking a good thing too?

it does need some regulating though. the volume of nicotine in the default
over the shelf vaping kit... you never get anywhere near to consuming as much
as that smoking 20 a day of the strongest brands.

~~~
bencoder
> the volume of nicotine in the default over the shelf vaping kit...

I did the calculation myself and was shocked at how much nicotine was in the
liquids, but after looking into it, I believe the nicotine absorption rate
from vaping is much lower than from traditional cigarettes[0]:

> Compared to smoking one tobacco cigarette, the EC devices and liquid used in
> this study delivered one-third to one-fourth the amount of nicotine after 5
> minutes of use. New-generation EC devices were more efficient in nicotine
> delivery, but still delivered nicotine much slower compared to tobacco
> cigarettes. The use of 18 mg/ml nicotine-concentration liquid probably
> compromises ECs' effectiveness as smoking substitutes; this study supports
> the need for higher levels of nicotine-containing liquids (approximately 50
> mg/ml) in order to deliver nicotine more effectively and approach the
> nicotine-delivery profile of tobacco cigarettes.

[0][http://www.nature.com/articles/srep04133](http://www.nature.com/articles/srep04133)

------
oldmanjay
It isn't clear to me how useful this study is. There is no indication that the
people found "less likely" to quit even intended to do so in the first place.
The story seems to make the assumption that anyone vaping is doing so as a
cessation technique but that certainly is not true in my anecdotal experience.

Since this came from the UCSF Center for Tobacco Control Research and
Education, it's pretty easy to assume a senseless agenda behind the whole
thing.

I will say, as someone who shuns nicotine after a decades-long addiction, I
find vapers far more pleasant than smokers. If people are switching with no
intent to quit, that's still a big win in my eyes. Particularly since I don't
see it as my job to regulate what people put into themselves.

------
mori
If it's like smoking, but safe, then who cares if less quit?

The projected amount of damage done by means of people hurt by not quitting
ecigs needs to be higher than the projected amount of damage done by means of
people not switching to ecigs for this to be alarming.

~~~
panglott
Why are vapers so convinced that vaping is "safe"? The supposed "safety" of
e-cigs mostly looks like industry marketing to people desperate to preserve
their habit.

~~~
solutionyogi
I vape and I don't know if vaping is safe or not. But here's what I do know.
From seeing how my body reacts to it, I think vaping is a better alternative
than cigarettes to get nicotine. I am a full advocate for further research in
to vaping and identifying the exact side effects.

~~~
panglott
It would be implausible for vaping to not be less harmful than smoking. And
harm reduction is good! But that's a far cry from "vaping is 'safe'".

------
zamalek
You can't quit if you don't really want to. E-cigs aren't a get out of jail
free card and cannot replace willpower. It is a quitting _aid._ Like all
quitting aids _you_ will still have a job to do - it just takes a little less
effort.

I am certain that I would have still quit on my final and successful attempt,
regardless of the e-cig. _I_ wanted to quit, instead of others wanting me to
quit. It was merely a less harrowing experience.

Anecdotally e-cigs are not absolutely healthy, my lungs actually felt
unhealthy after using one for a long time - something that I never felt with
normal cigarettes. They are a tool and not a solution.

------
hakanderyal
I was smoking 40-50 cigarettes per day before I met with vaping(smoking
e-cigarette) 3 years ago.

In the last three years, I only consumed around 50 traditional cigarettes.
Compared to 49.275 that I would have smoked if I haven't switched to vaping,
that's a big win.

OTOH, will I quit vaping? I don't know, and don't care for now.

EDIT: For anyone looking for information about e-cigarettes,
[https://www.e-cigarette-forum.com/forum/](https://www.e-cigarette-
forum.com/forum/) was a big help for me. (Not affiliated)

------
amykhar
They helped my husband quit. He did it gradually over a period of two years,
using a re-fillable e-cigarette. Every few months we would buy a few bottles
of the vapor juice, stepping down the nicotine concentration each time. At the
end, he used nicotine free vapor juice for quite some time. He didn't give up
the e-cigarette until it finally quit working about three years ago.

I don't think using the disposable ones with the fixed nicotine content would
have allowed him to quit. It was the very gradual dosage decreases that did it
for him.

~~~
rm_-rf_slash
That's a very good point. Even if a smoker cuts down on volume and smokes less
of each cigarette than before, the first puff will always carry the same blast
of nicotine.

E-cigs also give you something to do that takes up roughly the same amount of
time as regular smokes, which is probably one of the biggest behavioral
barriers to longtime smokers.

------
x5n1
I don't understand. Why is everyone against nicotine all the sudden. These
puritans need to mind their own business. Nicotine by itself hardly does
anything to anyone.

~~~
moron4hire
Uh, it's actually extremely poisonous.

------
tdkl
One addiction replaces the other.

The catch is to replace smoking with something better.

