An analysis of population trends in England demonstrated that use of electronic cigarettes (e-cigarettes) improves the rate of successful quit attempts, but results in less use of prescription nicotine-replacement therapy products, according to a study published in the BMJ.1

Concerns have been raised about the use of e-cigarettes, including that the increase in their use along with a decrease in the use of licensed treatments and smoking cessation behavioral programs could be undermining quit attempts. This study sought to determine if there was an association between changes in e-cigarette use at a population level and changes in quit attempts and use of licensed smoking cessation treatments.

Using data from the Smoking Toolkit Study and the English national health service (NHS) stop smoking services, researchers conducted a time series analysis of trends in use of e-cigarettes, nicotine-replacement therapy (NRT), and smoking cessation programs. The Smoking Toolkit Study is a series of computer-assisted surveys of representative samples of the English population age 16 years and older; this study has been collecting data since November 2006.

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Statistics on the use of NHS stop smoking services were obtained from the NHS Information Centre, including a quarterly number of persons who set a quit date at stop smoking services.

Participants in the Smoking Toolkit Study who reported smoking every day or less often were asked to select from a list of nicotine products, including e-cigarettes, in response to 3 questions: Which products do you use to reduce the amount smoked? Do you use any of these products in situations where you cannot smoke? Are any of these products being used to quit, smoke less, or for any other reason? Additional data collected were number of quit attempts made in the last 12 months, length of most recent quit attempt, and what nicotine products or services were used in the attempt.

The Smoking Toolkit Study provided data on 170,490 persons age 16 and older, of which 41,301 were past year smokers and 37,765 were current smokers. During the period covered in this study, 8,029,012 smokers set a quit date with their stop smoking service.

Analysis results show smokers’ success rate for quit attempts increased by 0.098% for every 1% increase in use of e-cigarettes. Success rates also increased by 0.058% for every 1% increase in use of e-cigarettes in a recent quit attempt. No clear association was seen between e-cigarette use and rate of quit attempts, use of NRT products purchased over the counter, use of NRT on prescription, or use of support programs.

The researchers conclude that increased e-cigarette use in England has not made a noticeable impact on attempts to quit smoking, but is associated with an increase in success of quit attempts. However, their use is associated with less use of prescription NRT products, but not use of other quitting support.


1. Beard E, West R, Michie S, Brown J. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. BMJ. 2016;354:14645. doi: 10.1136/bmj.14645. [Epub ahead of print]