One of Santé publique France’s missions is to help identify effective interventions to assist smokers in quitting, as smoking is the leading cause of preventable death in France, with 73,000 deaths in 2013.

The question that arises is: Is the e-cigarette an effective tool for smoking cessation? The answer to this question remains controversial to this day: on the one hand, the two randomized controlled trials published to date show that e-cigarettes can be effective in helping people quit smoking; on the other hand, cohort studies in the general population are more cautious regarding their effectiveness.

In this context, this study is the first to provide findings on the role of e-cigarettes among French smokers. Our objective was to assess whether regular e-cigarette use among daily smokers was associated with smoking cessation six months later. The study described in this article is an observational study examining the outcomes of smokers in real-world conditions, and not strictly speaking an efficacy study. We therefore surveyed more than 2,000 smokers aged 15 to 85 at six-month intervals in September 2014 and March 2015, selected to be representative of the French smoking population using the quota sampling method.

Smokers who vaped regularly (vape-smokers) were compared to exclusive smokers (who did not vape). The smokers’ socioeconomic profiles and tobacco use characteristics were taken into account in the statistical analyses.

At 6 months, the three main findings of this study are:

• More vape-smokers than exclusive smokers had cut their daily cigarette consumption in half or more: 26% versus 11%.

• More vape-smokers than exclusive smokers attempted to quit smoking for at least 7 days during the past month: 23% versus 11%.

• Regarding smoking cessation for at least 7 days over a 6-month period, there was no significant difference between vapers and exclusive smokers.

In conclusion, this study shows that regular e-cigarette use is associated with reduced tobacco consumption and more frequent quit attempts, but does not provide evidence of its effectiveness as a smoking cessation aid.

This study focuses on smokers from the general population monitored in real-world conditions. This context differs from clinical trials, where smokers are closely monitored and where e-cigarettes are provided free of charge and may be perceived as the tool that will finally enable them to quit smoking, which can influence smokers’ behavior. Furthermore, the originality of our study lies in its focus on smokers who vape regularly, excluding occasional vapers.

Like any scientific study, it also has limitations that should be noted: the follow-up period is relatively short, and the sample of vape-smokers is small. Finally, the fact of having become a vape-smoker may reflect an initial desire to quit smoking, which ultimately results in more frequent quit attempts.

The study’s findings are consistent with the recommendations issued by the High Council for Public Health in February 2016. Based on these recommendations, Santé publique France’s messages and guidelines regarding the role of e-cigarettes in smoking cessation remain relevant today. The statement on Santé publique France’s “Tabac info service” website states: “E-cigarettes can be an aid to quitting or reducing tobacco use. […] However, complete cessation should remain your goal, as even light smoking carries significant health risks. […] When used exclusively, e-cigarettes are much less dangerous than traditional cigarettes because vapers do not inhale the toxic substances found in tobacco.”

Santé publique France will continue to monitor trends in e-cigarette use in France through its Health Barometer surveys. These data, along with research findings, will help advance the discussion on the role of e-cigarettes in smoking cessation.