Patterns of e-Cigarette Use and Smoking Cessation Outcomes: Secondary Analysis of a Large Randomised Controlled Trial to Inform Clinical Advice

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but confidence intervals exclude null

• Effect Size: Tobacco flavour users had 44% lower cessation rate (RR=0.56); dual users 4.45 times more likely to quit at week 4

• Primary Outcome: Smoking cessation rates at 1 year varied by e-cigarette use patterns

• Nnt Or Sensitivity: Dual users had RR=2.37-4.56 for achieving 50% smoke reduction depending on timepoint

• Confidence Interval: Tobacco flavour RR 95% CI 0.35-0.89; dual use cessation RR 95% CI 1.96-10.10

Clinical Application

Recommendations easily implementable in clinical practice - flavour advice, expectation setting, dual use counselling Relevant to Australian practice where e-cigarettes require prescription. TGA regulations allow therapeutic e-cigarettes. Aligns with RACGP smoking cessation guidelines supporting evidence-based cessation aids Adult smokers seeking cessation assistance, particularly those considering e-cigarettes

Abstract

INTRODUCTION: Limited data exist on how to use e-cigarettes (EC) to optimize smoking cessation. METHODS: We examined associations between patterns of EC use and outcomes at 1 year in a large trial (N = 886) comparing nicotine replacement therapy (NRT) and EC. RESULTS: Use of tobacco flavor was limited and associated with a lower smoking cessation rate compared to other flavors (relative risk; RR = 0.56, 95% CI = 0.35 to 0.89). EC users reduced nicotine strength over time. Abstainers using EC reported lower urges to smoke than abstainers using NRT at both weeks 1 (b = -0.25, 95% CI = -0.45 to -0.04) and 4 (b = -0.37, 95% CI = -0.58 to -0.16). Participants using both cigarettes and EC (dual users) at week 1 were more likely to stop smoking at week 4 than exclusive smokers (RR = 4.45, 95% CI = 1.96 to 10.10). Dual users at 4 weeks and 6 months were also more likely to achieve validated 50% reduction in smoke intake at 1 year (RR = 2.37, 95% CI = 1.36 to 4.11 and RR = 4.56, 95% CI = 2.71 to 7.66, respectively). CONCLUSIONS: Non-tobacco flavors were preferred and may be also more effective. Urges to smoke were lower in EC users than in users of NRT. Dual use was associated with a reduction in smoking and quitting smoking later on. IMPLICATIONS: Clinicians advising smokers wanting to use EC as a quitting aid can consider recommending non-tobacco flavors; explaining that EC reduce urges to smoke more than combination NRT; and reassuring those worried about dual use that such use is associated with reduced smoking and a higher chance of stopping smoking altogether later on.

References

1. 1.Pesola, F., Myers Smith, K., Przulj, D., Ladmore, D., Phillips-Waller, A., McRobbie, H., & Hajek, P. (2026). Patterns of e-Cigarette Use and Smoking Cessation Outcomes: Secondary Analysis of a Large Randomised Controlled Trial to Inform Clinical Advice. Nicotine & Tobacco Research. https://doi.org/10.1093/ntr/ntaf240