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Nearly 1 in 10 people quits smoking after trying electronic cigarettes, suggesting a potential alternative to government-approved tobacco-cessation tools such as nicotine patches and lozenges, according to a new study.
The research published Monday in the peer-reviewed journal PLOS One could heighten debate over how to regulate a small but fast-growing rival to traditional cigarettes.
Regular cigarettes are widely viewed as more harmful than e-cigarettes because they release toxins through combustion. By contrast, e-cigarettes rely on battery power to heat nicotine-laced liquid and convert it into vapor. But the science remains incomplete.
The U.S. Food and Drug Administration says it plans to regulate e-cigarettes, adding that more study is needed about their safety and whether they help smokers kick the habit. European Union health ministers called Friday to regulate e-cigarettes as medicinal products, which would subject them to extensive health testing.
In the new study, the first large, lengthy clinical trial of e-cigarettes, Italian researchers at the University of Catania in Italy tracked 300 local smokers who agreed to try e-cigarettes between 2010 and 2012. They found 8.7% weren't smoking traditional cigarettes after 12 months. Quit rates ranged from 4% for those who were given e-cigs without nicotine, an addictive agent in cigarettes, to 13% for those given e-cigs with the highest dose of nicotine.
The results follow online surveys indicating e-cigarettes can help cut smoking rates. A survey published earlier this year by the U.K.'s University of East London and involving 1,347 e-cigarette users in 33 countries said 74% reported not smoking for at least a few weeks and 70% reported a reduced urge to smoke.
The Catania study showed a lower quit rate than reported in existing medical treatments such as nicotine nasal spray or patches. A U.S. government survey in 2008 of more than 80 clinical trials showed smoking abstinence rates typically topping 20% nine months after participants began using such approved medication.
Based on the Catania study, "the jury is still out'' on the effectiveness of e-cigarettes as quitting tools, said David Abrams, who heads research at Legacy, a Washington, D.C., anti-tobacco organization. More study is required, he added.
But researchers at the University of Catania noted that unlike clinical trials involving government-approved medication that employ people who want to quit smoking, participants in the e-cigarette trial initially said they had no intention to quit smoking. The study also employed an early version of an e-cigarette that has since been replaced with better-performing versions. Without those factors, cessation rates would have been much higher, they argue.
Michael Siegel, a professor at Boston University's School of Public Health who wasn't involved in the study, said the Catania study indicates e-cigarettes "are at least as good'' as FDA-approved smoking-cessation products. He argues the 12-month quit rate for approved products outside of clinical trial settings is only around 10%. Mr. Siegel said he hasn't received any money from the e-cigarette industry.
The researchers also highlighted the 4% quit rate involving e-cigs without nicotine, indicating the simple act of mimicking smoking with such devices can help wean users from combustible cigarettes.
"The act of smoking is not a disease, it's a behavior,'' said Riccardo Polosa, a professor at the University of Catania and study leader. "Anything that mimics the act of smoking, even without nicotine, is helpful.''
The Catania study was funded by the nonprofit Italian Anti-Smoking League and an e-cigarette company provided free supplies for 12 weeks. Mr. Polosa said he receives money from the e-cigarette industry as a consultant, but that no e-cigarette company was involved in the study's design or analysis.
Legacy has received funding from pharmaceutical companies that make smoking cessation medication.
The study found that 73.1% of the participants who were no longer smoking after 12 months also had stopped using e-cigs, suggesting they had completely freed themselves from their broader puffing habit.
A 2010 survey by the Centers for Disease Control and Prevention found that 52.4% of American smokers had made at least one quit attempt in the previous 12 months, but only 6.2% of smokers overall succeeded in quitting. Of those who tried to quit, 30% used medication and 5.9% used counseling.
A study published last year by researchers at the Harvard School of Public Health and University of Massachusetts Boston found that users of over-the-counter medication such as nicotine patches were just as likely to relapse over several years as smokers who went "cold turkey.''
How e-cigarettes match up against medication could become clearer in September, when the University of Auckland in New Zealand plans to present the results of another large clinical trial involving 657 people. That study will compare quit rates among users of e-cigarettes with users of nicotine patches.
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