Trial Finds Posted Vape Kits Outperform Support Emails, With Calls Nearly Doubling Quit Odds
A British randomised controlled trial published in NEJM Evidence has found that a simple vape kit sent by post helps more daily smokers quit than automated support emails, and that adding a few telephone calls can almost double the chances of success.
The trial, led by researchers at Queen Mary University of London's Wolfson Institute of Population Health and funded by the National Institute for Health and Care Research (NIHR), set out to answer a question that large earlier trials had left open: how vaping performs against behavioural support alone or no support at all, since most trials to date paired vaping with multi-session counselling.
The researchers recruited 1,170 adults who smoked daily and wanted to quit. Participants smoked an average of 19 cigarettes a day, were 48 years old on average, and most had already tried stop-smoking treatments. They were randomly assigned to three groups: a battery and tank kit with two 10 ml bottles of e-liquid at 18 mg/ml, five spare coils and a buying guide, expected to last around two weeks; automated support emails; or the kit plus structured telephone support.
The primary outcome was continuous abstinence at six months, validated by measuring carbon monoxide in exhaled breath, with participants lost to follow-up counted as still smoking.
At six months, participants given a vape alone were 1.76 times more likely to have quit than those in the email group. Adding telephone support increased these chances a further 1.87-fold compared with vaping alone. At one year, the effect of the support held, but the difference between vaping alone and emails was no longer statistically significant.
The email group appears to have been heavily contaminated by vaping: nearly a quarter of its participants were vaping at six months, and 68% of those in that group who had quit were using an e-cigarette. Excluding participants in the email group who vaped, the authors say, the group's quit rate would fall to 2.7%, four times lower than with vaping alone.
Among participants who did not quit, vaping still reduced consumption: at six months, participants smoked an average of 6.4 fewer cigarettes a day in the email group, 8.2 fewer with vaping alone and 9.6 fewer with vaping plus support.
The authors found the telephone support mainly encouraged participants to use their vape early in the quit attempt — at four weeks, 74.2% of supported participants were still vaping versus 63.8% in the vape-only group — rather than making vaping itself more effective. The six-month quit rate in the vape-plus-support group was 21.1%, below the 35.4% of a 2019 trial that offered four weeks of face-to-face support, but the gap narrowed at one year (16.8% versus 18.0%), suggesting the advantage of face-to-face support fades over time.
The authors acknowledge limitations: carbon monoxide measures only detect smoking over the past 24 hours; the 2.7% figure for the email group comes from excluding vapers, which may overestimate the gap; the flavoured e-liquids provided may not apply to countries that ban flavours; and participants reassured by the trial setting may have taken up vaping more readily than ordinary smokers, since 52% of UK smokers still believe vaping is as harmful as, or more harmful than, smoking.
[Reference]
- Queen Mary University of London press release — https://www.qmul.ac.uk/wiph/news/latest-news/items/e-cigarettes-help-smokers-quit-even-without-specialist-support.php
- News-Medical coverage — https://www.news-medical.net/news/20261027/E-cigarettes-help-smokers-quit-even-without-behavioral-support-sessions.aspx