Effectiveness of e-cigarettes for smoking cessation in the German population - a comparison with nicotine replacement therapy and no use of evidence-based support (DEBRA study)

Our primary aim was to assess – in the German population – the effectiveness of e-cigarettes (ECs, with or without nicotine), nicotine replacement therapy (NRT), and no use of evidence-based support in helping smokers quit smoking.

Cross-sectional analysis of data from a representative survey of the German population (age 14-96 years) collected in 2016-2021, with adjustment for potential confounders. We included all current and recent ex-smokers (quit tobacco <12 months) who had made ≥1 quit attempt in the past 12 months (n=2740). They were asked about use of cessation aids in their most recent quit attempt and reported their current smoking status.

Overall, 239 respondents had used ECs in their most recent quit attempt, 168 had used NRT, and 2333 had tried to quit unaided. The unadjusted abstinence rates in those who started their quit attempt more than 6 months ago were 15.6%, 13.8%, and 20.2%, respectively. After adjustment for potential confounders, smokers who had tried to quit with ECs had 1.78 higher odds of abstinence (95%CI=1.09-2.92, p=.02) compared with the unaided group, and 1.46 (95%CI=0.68-3.13, p=.34, Bayes Factor=1.26) compared with the NRT group. Odds of abstinence were 2.34 times higher (95%CI=1.21-4.53, p=.01) in the subgroup using ECs with nicotine and 1.48 times higher (95%CI=0.68-3.26, p=.33) in the subgroup using ECs without nicotine, compared with the unaided group.

In Germany, use of ECs in an attempt to quit tobacco is associated with a higher rate of successful cessation than attempting to quit unaided.