Ecig, an asset to remain abstinent from smoking?

Ecig, an asset to remain abstinent from smoking?

That is the question an Italian team is trying to answer with a cohort survey started more than two years ago. Leaded by Dr Lamberto Manzoli from the University of Chieti, the 14 researchers (9 cited + ISLESE working group) from various institutes and universities confirm that switching completely to e-cigarettes might help smokers remain abstinent from smoking.


Expert epidemiologists from several academic and research centers in Italy carried out a survey of vapers, smokers and dual-users [1]. Their research is the only study directly comparing vapers with smokers of traditional cigarettes in the long run.

Their research is aimed by the lack of data to support health policies and legislation despite e-cigarettes have been introduced on the European market almost 10 years ago.

Italy is characterized by a high fraction of dual-users among vapers, as noticed by Prof. Walter Ricciardi, co-author of the study and President of the ISS, the Italian Institute for Health that recently updated national smoking and e-cigarette use figures.

The scientist is concerned by dual-use of combusted and electronic cigarettes that is considered by some as a long-term pattern for smokers who find it convenient to switch to another mode where smoking forbidden, or a transient state during which the smoker experiments a new mode of nicotine delivery before opting for one or the other.

Should e-cigarettes be considered a formidable tool, a public health threaten, or something in the middle?

This is the ultimate question the team would like to answer by the follow up of this group over the long-term. After 24 months [1], the researchers found:

  • 61.1% of the 229 baseline e-cigarette-only users were still abstinent from tobacco smoking,
  • 23.1% of the 480 baseline tobacco smokers and 26.0% of the 223 baseline dual users achieved tobacco abstinence.
  • dual-users were significantly more likely to reduce the average number of daily cigarettes by 50% or more.

Crowdfunded research, a solution for the sake of scientific independence?

The study was originally planned to be funded, but the sponsor withdrew when the protocol was already approved and the study started, said the authors in a previous report of their work [2]. At that time, after 12 months of survey, they found no serious safety concerns among the “largest sample of e-cigarette users examined so far”. From the results, they concluded that dual-use did not facilitate smoking cessation or reduction. They reported abstinence from tobacco smoking for all vapers, and among a few smokers and dual-users.

After 24 months, the study confirms that switching completely to e-cigarettes might help tobacco smokers remain abstinent from smoking.

While dual-use did not encourage quitting tobacco or e-cigarette use; it however may facilitate the reduction of tobacco cigarette consumption and improve self-rated health.

Controversies remain for dual-use

The researchers discuss dual-use as a transient phase after observing that most dual-users switched to either one or the other within the survey. But at this term of the study, the researcher couldn’t infer any reduced or increased smoking quit rate among dual-users compared to smokers. Further research will probably help elucidate this pattern.

Severe impairment of participants’ health were scarce among exclusive vapers who were more likely than others to report adverse events.

Reproduction of figure 1,
Reproduction of figure 1, Manzoli et al., 2016.

Follow-up for another 36-month period will help achieve the target of collecting data over a total of 5 years, declared the authors who set up a crowdfunded project “E-cigarette long-term efficacy & safety: a study to complete” to fund their research.

A recent message by Lamberto Manzoli confirmed that, thanks to the financial support obtained during the campaign, the study continues.

[1] Manzoli L., Flacco ME., Ferrante M., La Vecchia C, Siliquini R.,  Ricciardi W., Marzuillo C., Villari P., Fiore M., the ISLESE Working Group. 2016. Cohort study of electronic cigarette use: effectiveness and safety at 24 months.Tob Control. doi:10.1136/tobaccocontrol-2015-052822
Published Online First: 6 June 2016

[2] Manzoli L., Flacco ME., Fiore M., La Vecchia C., Marzuillo C., Gualano MR., Liguori G.,  Cicolini G., Capasso L., D’Amario C., Boccia S., Siliquini R., Ricciardi W., Villari P. 2015. Plos One. doi:10.1371/journal.pone.0129443