In Reply

Letters to the Editor The Effectiveness of E-Cigarettes for Smoking Cessation A Comparison With Nicotine Replacement Therapy and No Use of Evidence-Based Cessation Aids in the German Population by Prof. Dr. Daniel Kotz, PhD MSc MPH, Sarah Jackson, PhD, Prof. Jamie Brown, PhD, and PD Dr. rer. nat. Sabrina Kastaun, Dipl.-Psych. in issue 17/2022

The proportion of smokers in the population of Germany is high, and this proportion has grown again in recent months, to 32.9% (www.debra-study.info). Only 15% of these people attempt to stop smoking every year, and only a small proportion of such attempts is supported by methods that are currently recommended in medical guidelines, such as individual or group counseling (1.2%), nicotine replacement therapy (7.6%), or pharmacotherapy with varenicline or bupropion (<0.5% each) (1). On this background new methods are helpful that motivate people to make a quit attempt, support such an attempt effectively, and that are actually used. The most popular smoking cessation method currently used in Germany is the e-cigarette: 10.2% of quit attempts are aided in this way (1). The effectiveness of e-cigarettes is supported by evidence from randomized controlled trials (2) and now also from our population-based study (3). E-cigarettes are not risk-free, but much less harmful to health than tobacco (4). They should not be used by non-smokers, especially young people. In view of 127 000 tobacco-related deaths in Germany every year, however, it would be a wasted opportunity not to use e-cigarettes as a method of tobacco cessation. Many smokers in Germany are motivated to stop smoking with the support of e-cigarettes, for whom other methods are out of the question. We therefore think it is ethically justifiable if physicians in such cases recommend e-cigarettes to support tobacco cessation while considering possible risks and providing information about these. Patients can then be informed about the correct use of e-cigarettes, including cessation of e-cigarette consumption after successfully giving up tobacco.

DOI: 10.3238/arztebl.m2022.0265

On behalf of the authors
Prof. Dr. Daniel Kotz, PhD MSc MPH
Institut für Allgemeinmedizin (ifam)
Schwerpunkt Suchtforschung und klinische Epidemiologie
Centre for Health and Society (chs)
Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf

Conflict of interest statement
The author declares that no conflict of interest exists.

References

1. Kotz D, Batra A, Kastaun S: Smoking cessation attempts and common strategies employed—a Germany-wide representative survey conducted in 19 waves from 2016 to 2019 (The DEBRA Study) and analyzed by socioeconomic status. Dtsch Arztebl Int 2020; 117: 7–13

2. Hartmann-Boyce J, McRobbie H, Butler AR, et al.: Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2021; 9: CD010216

3. Kotz D, Jackson S, Brown J, Kastaun S: The effectiveness of e-cigarettes for smoking cessation—a comparison with nicotine replacement therapy and no use of evidence-based cessation aids in the German population. Dtsch Arztebl Int 2022; 119: 297–301

4. National Academies of Sciences, Engineering, and Medicine: Public health consequences of e-cigarettes. Washington, DC: The National Academies Press 2018. https://doi.org/10.17226/24952