A randomized controlled trial conducted by Queen Mary University of London has revealed that e-cigarettes help people stop smoking even when specialist behavioral support is absent. Published in NEJM Evidence, the study resolves longstanding questions regarding whether vaping devices function independently or rely on concurrent clinical counselling to achieve results.
The trial evaluated 1,170 adult participants across three randomly allocated intervention groups: automated National Health Service (NHS) supportive emails, an e-cigarette starter pack alone, and an e-cigarette starter pack combined with five telephone counselling sessions. Researchers verified cessation using carbon monoxide breath tests to eliminate self-reporting bias.
Comparing Cessation Rates Across Trial Groups
At six months, 11.3% of participants given only e-cigarettes successfully quit smoking, compared with 6.4% of those receiving automated NHS messages. Participants with vapes were 76% more likely to quit without any human support. Adding telephone sessions doubled the cessation rate to 21.1%.
| Intervention Arm | 6-Month Validated Quit Rate | 12-Month Validated Quit Rate |
|---|---|---|
| Automated NHS Messages | 6.4% | 5.4% |
| E-Cigarette Alone | 11.3% | 9.0% |
| E-Cigarette + Telephone Support | 21.1% | 16.8% |
These disparities persisted at the 12-month follow-up. Lead author Dr. Katie Myers Smith noted that while counselling provides measurable benefits, it is not an absolute prerequisite: “Smokers do not necessarily need specialist counselling to benefit from e-cigarettes, but that when counselling is available it can make a difference.”
Self-Treatment and Clinical Implications
The trial exposed a critical trend among the control group: more than two-thirds of participants who successfully quit via automated messaging had purchased e-cigarettes outside the trial. When researchers excluded these self-treating individuals, the message-only quit rate plummeted to 2.7%.
Most quitters continued vaping at 12 months. While acknowledging that vaping is not entirely risk-free, researchers emphasized that it carries a fraction of combustible smoking’s health hazards while preventing weight gain and relapse.
Senior author Professor Peter Hajek stated that clinicians can recommend e-cigarettes with confidence, noting that patients should use them as long as needed to avoid relapse. Collaborator Professor Hayden McRobbie added that while support services remain valuable, programs like the UK government’s “Swap to Stop” initiative correctly recognize that access to vaping products should not require mandatory counselling attendance.
