Research Article: Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach

Date Published: March 5, 2013

Publisher: BioMed Central

Author(s): Amanda M Barbeau, Jennifer Burda, Michael Siegel.


Nicotine is widely recognized as an addictive psychoactive drug. Since most smokers are bio-behaviorally addicted, quitting can be very difficult and is often accompanied by withdrawal symptoms. Research indicates that nicotine replacement therapy (NRT) can double quit rates. However, the success rate for quitting remains low. E-cigarettes (electronic cigarettes) are battery-powered nicotine delivery devices used to inhale doses of vaporized nicotine from a handheld device similar in shape to a cigarette without the harmful chemicals present in tobacco products. Anecdotal evidence strongly suggests that e-cigarettes may be effective in helping smokers quit and preventing relapse, but there have been few published qualitative studies, especially among successful e-cigarette users, to support this evidence.

Qualitative design using focus groups (N = 11); 9 men and 2 women. Focus groups were conducted by posing open-ended questions relating to the use of e-cigarettes, comparison of effectiveness between NRTs and e-cigarettes, barriers to quitting, and reasons for choosing e-cigarettes over other methods.

Five themes emerged that describe users’ perceptions of why e-cigarettes are efficacious in quitting smoking: 1) bio-behavioral feedback, 2) social benefits, 3) hobby elements, 4) personal identity, and 5) distinction between smoking cessation and nicotine cessation. Additionally, subjects reported their experiences with NRTs compared with e-cigarettes, citing negative side effects of NRTs and their ineffectiveness at preventing relapse.

These findings suggest tobacco control practitioners must pay increased attention to the importance of the behavioral and social components of smoking addiction. By addressing these components in addition to nicotine dependence, e-cigarettes appear to help some tobacco smokers transition to a less harmful replacement tool, thereby maintaining cigarette abstinence.

Partial Text

Nicotine is widely recognized as an addictive psychoactive drug [1]. Since most smokers are bio-behaviorally addicted, quitting can be very difficult and is often accompanied by withdrawal symptoms such as anxiety and irritability. Additionally, many smoking cessation products focus on the neuropharmacology of nicotine but fail to address the bio-behavioral component that is heavily ingrained in most addictive practices [2]. As a result, smoking cessation may be unsuccessful, even when there is a strong desire to quit.

Five main themes were identified that explain why e-cigarettes appear, at least anecdotally, to be efficacious in helping tobacco users quit smoking. Table 1 provides an outline of the themes identified and some examples of narratives expressed by focus group participants illustrating those themes. Additionally, focus group members discussed the perceived efficacy of e-cigarettes compared with conventional NRTs (e.g., nicotine patch, nicotine gum).

Results from these focus groups add to the albeit still limited research base regarding e-cigarettes and their usefulness as smoking cessation tools. The information gained provides new insights into the social and group dynamics that may underlie the reasons why NRT has such low observed rates of effectiveness, and why e-cigarettes, at least anecdotally, appear to be more effective for many vapers. Most notably, these include e-cigarettes becoming part of the vaper’s social identity, the recognition of vaping as a hobby, and the ability of these devices to aid in smoking cessation without complete nicotine cessation.

There is anecdotal evidence that e-cigarettes may be useful in helping smokers quit, but little is known about the reasons why these products help smokers achieve cessation or how smokers perceive these products in comparison to other cessation strategies such as traditional NRTs. We conducted focus groups with e-cigarette users to assess their perceptions of the efficacy of these devices in smoking cessation compared with other strategies such as varenicline, nicotine gum, and the nicotine patch. We identified five major themes to explain why e-cigarettes appear to be helpful in aiding cessation, at least for some users. These themes highlight the need for health practitioners and policy makers to give greater consideration to the physical, behavioral, and social aspects of cigarette smoking addiction and not merely to treat smoking addiction as a pharmacologic addiction to nicotine.

The authors declare that they have no competing interests.

All authors participated in the conception of the study and in crafting the research design. AB and JB prepared the IRB protocol, conducted the focus group sessions, and analyzed the focus group transcripts. All authors participated in the review and interpretation of the data, the preparation of the manuscript, and the review of the manuscript for critical content. All authors read and approved the final manuscript.




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