Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

Jamie Brown, Emma Beard, Daniel Kotz, Susan Michie and Robert West

Accepted manuscript online by Addiction: 20 MAY 2014 10:15PM EST | DOI: 10.1111/add.12623


Background And Aims

Electronic cigarettes (e-cigarettes) are rapidly increasing in popularity. Two randomised controlled trials have suggested that e-cigarettes can aid smoking cessation but there are many factors that could influence their real-world effectiveness. This study aimed to assess, using an established methodology, the effectiveness of e-cigarettes when used to aid smoking cessation compared with nicotine replacement therapy (NRT) bought over-the-counter and with unaided quitting in the general population.

Design And Setting

A large cross-sectional survey of a representative sample of the English population.


The study included 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e-cigarette only (n=464), NRT bought over-the-counter only (n=1922) or no aid in their most recent quit attempt (n=3477).


The primary outcome was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including nicotine dependence.


E-cigarette users were more likely to report abstinence than either those who used NRT bought over-the-counter (odds ratio 2.23, 95% confidence interval 1.70 to 2.93, 20.0% vs. 10.1%) or no aid (odds ratio 1.38, 95% confidence interval 1.08 to 1.76, 20.0% vs. 15.4%). The adjusted odds of non-smoking in users of e-cigarettes were 1.63 (95% confidence interval 1.17 to 2.27) times higher compared with users of NRT bought over-the-counter and 1.61 (95% confidence interval 1.19 to 2.18) times higher compared with those using no aid.


Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.

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