"Electronic cigarettes were almost twice as effective as the" standard "combination of nicotine replacement products," said lead researcher Peter Hajek of Queen Mary University in London in a statement.

"Health professionals have been reluctant to recommend their [e-cigarette] use due to the lack of clear evidence of randomized controlled trials. This is now likely to change. "

But US researchers recommend caution, saying the results of the study are neither conclusive nor easy to generalize. They also highlight the unknown long-term health effects of electronic cigarette vapors, as well as the dangers of possibly promoting the use of these cigarettes in adolescents.

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The results of the study have already been widely adopted by British experts, many of whom agree that e-cigarettes should be included in adult tobacco control efforts.

"This study should reassure policymakers and health professionals – primarily beyond the UK – who have been hesitant to recommend the use of e-cigarettes for quitting, due to the lack of of high quality evidence in clinical trials, "said Jamie Brown. , who is the Deputy Director of the Tobacco and Alcohol Research Group at University College London.

"We need to help as many people as possible to give themselves the best chance of success by using aids such as electronic cigarettes every time they try to quit," said Paul Aveyard. , professor of behavioral medicine at Oxford University, a response to the study.

But US researchers and policymakers are not convinced.

FDA does not protect children from electronic cigarettes, according to the American Lung Association

"The US Food and Drug Administration has found no effective and safe electronic cigarette to help smokers quit," said Jennifer Hobbs Folkenroth, Senior Director of American Lung Tobacco. Association. "We only support methods approved and regulated by the FDA."

Belinda Borrelli, a smoking cessation researcher, who wrote a editorial published in conjunction with the study, raises concerns about the possible long-term effects of electronic cigarette use on the health of adults and the In the United States, more and more children are becoming addicted to the electronic cigarette.
Scott Gottlieb, FDA Commissioner, recently announced a crackdown on what he called an "epidemic" of electronic cigarette use in teens.
"Electronic cigarettes contain volatile organic compounds, carcinogenic chemicals and aromas related to lung diseases," said Borelli, director of Behavioral Science Research Center at Boston University. "Let's not say that e-cigarettes are a magic pill to help people quit without having all the information."

Long-term randomized study

The multi-center trial involved nearly 900 British smokers randomly assigned to two groups. One person has received a traditional nicotine substitute of their choice, such as patches, gum, lozenges, sprays, inhalers or a combination of products for three months. The other group received a starter kit for the electronic cigarette and was encouraged to buy future supplies, choosing their preference for the strengths and flavors of electronic juice.

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Both groups received individual behavioral counseling each week for four weeks and were biochemically tested at the end of the year to make sure they had stopped smoking.

The results showed that the one-year abstinence rate was 18% (79 individuals) in the electronic cigarette group compared to about 10% (44 individuals) in the traditional nicotine replacement group. E-cigs users were more likely not to smoke traditional cigarettes, to have less cough and phlegm at the end of the year, and to have lower cravings than those using replacement and other forms of nicotine replacement.

"This study is of paramount importance," said Robert West, professor of health psychology and director of tobacco studies at University College London. "This clearly indicates that e-cigarettes are probably more effective than products such as nicotine gum and patches."

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However, of the 79 people who used the electronic cigarette to quit at the end of the year, 63 still used the electronic cigarette. In comparison, of the 44 people who stopped smoking using patches, chewing gum and other types of traditional nicotine substitutes, only four still used these products at the end of this year.

Critics say these results are not particularly positive. "Switching to e-cigarettes does not mean quitting," said Folkenroth of the American Lung Association. "Quitting means really ending nicotine addiction, which is very difficult."

First randomized study using "modern" e-cigs

Previous research on the use of electronic cigarettes as aids to smoking cessation in adults was inconclusive. Many were observers and did not objectively measure the success of a smoker to quit smoking. Others used older first-generation electronic cigarettes, which did not replace nicotine delivery.

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Today, more than 400 electronic cigarette brands are small, unobtrusive and easier to use than the old ones. They also come in hundreds of flavors and are much more powerful in delivering nicotine to relieve the smoker's cravings. In fact, researchers fear that e-cigarettes are no longer loaded with nicotine than traditional cigarettes.

For example, a Juul capsule – a nicotine-rich liquid cartridge that users connect to the dominant e-cig brand – contains same amount of nicotine like a complete package of cigarettes.

One of the highlights of the British study, said senior researcher Hajek, was that she was the first to use and test "the effectiveness of modern electronic cigarettes to help people." smokers to quit. "

Borrelli acknowledges that the study had many strengths: "They checked the results of smoking by biochemistry. They did a rigorous analysis of the data, they had long-term results. They let people choose their e-liquid, they let people choose their nicotine replacement therapy. in the real world. "

However, it is unclear whether these findings would apply to other electronic cigarette devices, or outside the context of a well-controlled, behavior-free study, said Scott Weaver, a smoking cessation researcher and professor. assistant at Georgia State University.

It is also unclear whether the results "would generalize to other populations of smokers, especially American smokers," Weaver said.

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Trying to compare the US and UK smoking cessation results is like "comparing apples and oranges," Folkenroth said. 2018 letter to the Congress of the American Medical Association and several other medical organizations explicitly stating that "claims in the UK do not really apply to the US market".

The letter from the medical organizations mentioned the stricter regulatory environment for tobacco in Europe, "including advertising restrictions and health warnings for e-cigarettes", which are not fully in place in the United States. United. In addition, the letter indicated that research had not yet proven the ability of electronic cigarettes to help smokers quit smoking.

The worrying increase in electronic cigarette consumption among young Americans – more than 3.6 million college and high school students currently vape. The UK is not near the number of teenage users. In fact, the American Lung Association estimates that less than 6% of British kids use e-cigs, compared to more than 20% in the United States.
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Add to that the fact that it has been shown that young people who use electronic cigarettes are more likely to start smoking traditional cigarettes, sometimes with electronic cigarettes.

"There is concern that the adolescent brain is no longer vulnerable to the addictive effects of nicotine," said Adam Leventhal, director of the laboratory of health, emotion and addictions at the University of Southern California.

"Circuits underlying pleasure and the pursuit of new and enjoyable experiences are growing much faster than those that promote decision-making, impulse control, and rational thinking."

Tips for quitting

In the United States, experts do not recommend the use of electronic cigarettes to adults who are trying to undo them.

FDA does not protect children from electronic cigarettes, according to the American Lung Association

The American Lung Association focuses instead on seven FDA-approved drugs: the nicotine patch, gum, lozenge, inhaler, nasal spray, varenicline (known as Chantix) and bupropion (known as Wellbutrin), said Folkenroth, "who, in addition to behavioral counseling and therapy services, give a boost and are the most effective at helping people quit smoking. "

According to the Georgia State University of Georgia State, people who have successfully tried using approved methods "might find that latest-generation electronic cigarettes, especially when they are used daily with a plan to stop of smoking and a weekly and personalized behavioral advice, can improve their efficiency. " chances to give up successfully. "

The behavioral therapy, emphasizes Folkenroth, must also last much longer than the four weeks planned in the British test. This should be weekly, one-to-one and last well beyond the date of termination to avoid setbacks.

Overall, US experts call for caution until new research clarifies the long-term effects of electronic cigarettes on the human body and the spirit of dependence.

"We have arrived here in the fight against smoking with proven methods that build on years of research on their benefits and long-term side effects," Borrelli said. "Could we now start regressing with electronic cigarettes and renormalizing the addiction?"

Michael Nedelman and Roni Selig from CNN contributed to this report.