Smoking remains a leading cause of preventable disease and death globally. While there have been significant strides in smoking cessation efforts, a notable gap persists in addressing the needs of people who smoke (PWS) but do not intend to quit. This blog delves into the potential of Electronic Nicotine Delivery Systems (ENDS) as an innovative approach to support this overlooked group. 

The Challenge with Traditional Smoking Cessation 

Conventional smoking cessation strategies follow three main steps: motivating individuals to quit, improving the success of quit attempts, and maintaining abstinence to avoid relapses. Despite various individual, health system, and population-level strategies promoting smoking cessation, many efforts tend to focus on individuals already motivated to quit. This focus often excludes those who do not plan to quit smoking, resulting in a lack of applicable strategies for this group. 

The Potential of ENDS 

ENDS offer an alternative to traditional nicotine delivery methods by aerosolizing nicotine-containing liquids instead of burning tobacco. As described on Using E-Cigarettes to Stop Smoking, a United Kingdom National Health Service resource page, “E-cigarettes do not produce tar or carbon monoxide, two of the most harmful elements in tobacco smoke.” Public Health England states, “The current best estimate is that e-cigarettes are around 95% less harmful than smoking.” 

High-certainty evidence suggests that ENDS can significantly increase smoking cessation rates compared to nicotine replacement therapy (NRT). A study published in Cochrane Database of Systemic Reviews, examined 88 previous studies that included 27,235 participants they found. The study found, “High certainty evidence that e-cigarettes, which allow users to “vape” nicotine instead of smoke it, lead to better chances of quitting smoking than patches, gums, lozenges or other traditional NRT.”  

One distinguishing factor of ENDS is their broader reach as a consumer product, appealing even to those not planning to quit smoking. Studies have shown that ENDS can lead to unexpected changes in smoking habits, with some users quitting smoking without intending to. 

Research Insights 

Research by Kasza et al. highlights that daily ENDS users, who initially did not plan to quit, were six times more likely to reconsider their smoking plans. This shift, although not always aligning with immediate cessation plans, marks progress for those previously unmotivated to quit. 

Further studies indicate that providing ENDS to unmotivated PWS results in a substantial reduction in cigarette consumption and dependence. This reduction not only benefits current smokers but also increases the likelihood of complete switching to ENDS in the future. 

User Experience and Quality of Life 

ENDS have shown a significant association with smoking discontinuation and improved quality of life, even among those not motivated to quit smoking. Qualitative studies reveal that user experiences such as convenience, flavor variety, perceived lesser harm, and efficient nicotine delivery contribute to the appeal of ENDS. These factors may facilitate complete switching from cigarettes to ENDS, particularly with daily use. 

Harm Reduction and Public Health 

While complete smoking cessation remains the gold standard for health improvement, ENDS present a harm reduction opportunity for PWS who are not ready to quit. Nicotine, though not responsible for the major health consequences of smoking like cancer or heart disease, still warrants further research regarding its long-term effects when delivered through ENDS. Additionally, concurrent use of cigarettes and ENDS poses potential risks, but the transition towards exclusive ENDS use offers significant benefits. 

Conclusion 

For the majority of PWS not planning to quit soon, ENDS provide a viable alternative, facilitating substantial smoking reduction and potential cessation. These benefits underscore the importance of addressing misperceptions about the relative harm of ENDS compared to cigarettes. 

Countries like the United Kingdom demonstrate the success of institutional support for tobacco harm reduction, leading to accelerated declines in smoking. Integrating ENDS into broader tobacco control measures can help reach a diverse range of smokers, including those previously overlooked. 

Final Thoughts 

ENDS offer a promising solution to meet PWS where they are, providing an unanticipated pathway towards smoking cessation. By resolving controversies and educating about the relative harm of ENDS, we can harness their potential to make significant public health strides. 

To see the full study click here.