Evidence that e-cigs depress quitting cigarettes keeps piling up, this time from Japan

February 21, 2017

Stanton A. Glantz, PhD

Tomoyasu Hirano and colleagues just published “Electronic Cigarette Use and Smoking Abstinence in Japan: A Cross-Sectional Study of Quitting Methods” that adds to the already-strong case that smokers who use e-cigarettes are less, not more, likely to quit smoking.
They conducted a national cross-sectional study of 9055 people in Japan who had tried to quit smoking cigarettes in the last 5 years and found that people who used e-cigarettes were 38% less likely to have stopped smoking than people who didn’t use e-cigarettes.  This finding of about a 1/3 drop in the odds of having quit is consistent with the meta-analysis of the entire available literature – including the few papers that showed increased quitting among e-cigarette users -- we published last year as well as other results published since then.
Here is the abstract:

The benefit of electronic cigarettes (e-cigarettes) in smoking cessation remains controversial. Recently, e-cigarettes have been gaining popularity in Japan, without evidence of efficacy on quitting cigarettes. We conducted an online survey to collect information on tobacco use, difficulties in smoking cessation, socio-demographic factors, and health-related factors in Japan. Among the total participants (n = 9055), 798 eligible persons aged 20–69 years who smoked within the previous five years were analyzed to assess the relationship between the outcome of smoking cessation and quitting methods used, including e-cigarettes, smoking cessation therapy, and unassisted. E-cigarette use was negatively associated with smoking cessation (odds ratio (OR) = 0.632; 95% confidence interval (CI) = 0.414–0.964) after adjusting for gender, age, health-related factors, and other quitting methods. Conversely, smoking cessation therapy (i.e., varenicline) was significantly associated with smoking cessation (OR = 1.885; 95% CI = 1.018–3.492) in the same model. For effective smoking cessation, e-cigarette use appears to have low efficacy among smokers in Japan. Allowing for the fact that this study is limited by its cross-sectional design, follow-up studies are needed to assess the prospective association between e-cigarette use and smoking cessation.

My one quibble with the way the authors summarize their conclusions is their statement that “e-cigarette use appears to have low efficacy in Japan.”  This statement could be read as saying that e-cigarettes help people quit, just not by much.  What the data show is that e-cigs significantly depress quitting.
The full citation is:  Tomoyasu Hirano, Takahiro Tabuchi, Rika Nakahara, Naoki Kunugita, Yumiko Mochizuki-Kobayashi.  Electronic Cigarette Use and Smoking Abstinence in Japan: A Cross-Sectional Study of Quitting Methods. Int. J. Environ. Res. Public Health 2017, 14(2), 202; doi:10.3390/ijerph14020202.  The free full text is available at http://www.mdpi.com/1660-4601/14/2/202/htm

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