A Mass General expert explains what has and has not been proven to improve the odds of successfully quitting.

People often ask Mass General tobacco researcher Nancy Rigotti, MD, whether electronic cigarettes will help them quit. Potentially these battery-operated devices are less harmful than cigarettes because they heat a liquid vapor containing nicotine rather than burning tobacco with its numerous cancer-causing ingredients.

“We don’t yet know if e-cigarettes can help people quit smoking or even fully understand what their risks and benefits are,” says Dr. Rigotti, director of Mass General’s Tobacco Research and Treatment Center. “But for adults having a hard time quitting, e-cigarettes have the theoretical potential to join the array of already approved methods to quit tobacco.”

Nancy Rigotti, MD
Nancy Rigotti, MD

Part of the problem is that e-cigarettes are not yet regulated by a U.S. government agency. The Food and Drug Administration is trying to extend its jurisdiction over cigarettes to include e-cigarettes. That would allow the FDA to enforce age restrictions and rigorously review the claims of e-cigarette makers.

“The biggest concern about e-cigarettes is their attractiveness to kids,” Dr. Rigotti says. She points out that they are often advertised as increasing sex appeal and are sold with many flavors, including sweet ones like bubble gum that appeal to the young.

“Our worry is that kids will try these products, become addicted to nicotine, and then move on to become cigarette smokers as adults,” she says. One action that might help prevent this is a new Massachusetts law that prohibits the sale of e-cigarettes statewide to anyone below the age of 18.

Progress in Reducing Smoking

The message about tobacco, however, couldn’t be clearer. “Tobacco kills about half of all regular smokers,” Dr. Rigotti says.

These days, only about 18 percent of all U.S. adult smoke cigarettes. That’s down from nearly half 50 years ago. But that still leaves close to 42 million adults and more than 3.5 million middle and high school students who are smokers.

The good news is that there are an array of related aids and behavioral supports backed by scientific evidence.

People want to quit, but get discouraged if they’re not successful. Dr. Rigotti says smokers who want to quit need to break the addition of nicotine and break the habit of smoking.

The good news is that there are an array of related aids and behavioral supports backed by scientific evidence.

Currently, there are five FDA-approved types of nicotine replacement products: nicotine patches, gum, lozenges, inhalers and a nasal spray. Also available are two prescription drugs, varenicline (Chantix) and bupropion (Zyban).

Many people feel nicotine replacement products haven’t worked for them. “But what we now know is that we weren’t originally using them in the most effective ways,” Dr. Rigotti says. She suggests using a patch along with one of the other products that can be taken in response to cravings—the lozenges, inhaler or gum.

“That combination significantly increases the odds of successfully quitting,” she says.

Building a National Model

Counseling helps break the powerful habit of smoking. This can be done one-to-one with a counselor, in group support sessions or by telephone calls.

“Quitting smoking is a marathon, not a sprint. It is never too late to quit.”

Dr. Rigotti and her colleagues are building a national model for addressing smoking in hospitalized patients. No smoking is allowed in hospitals, making hospitalization a good time to quit. At Mass General, smokers who are admitted are automatically offered assistance at the bedside to help them quit. Recently her team tested a new program to help smokers stay quit after they return home. They leave the hospital with a stop-smoking medication in hand and receive a series of automated telephone calls offering continued support for several months.

“Our post-discharge program increased quit rates by 70 percent compared to regular care, which is just advising smokers to quit,” Dr. Rigotti says.

The results of the effort were reported last year in the Journal of the American Medical Association. “We hope soon to be able to offer the post-discharge program to all smokers hospitalized at Mass General,” Dr. Rigotti says. “We want them to leave the hospital with the tools needed to live a healthier tobacco free life.”

Her message to smokers: “Quitting smoking is a marathon, not a sprint. It is never too late to quit.”

For more information about Mass General’s Tobacco Research and Treatment Center and how you can support it, please contact us.

See also: Strategies to Quit Smoking