People who smoke switched entirely to using safer heated tobacco products when provided with them, found an important new study—even if they had no intention of quitting cigarettes, or had experienced past challenges in doing so.
The first-of-its kind study, known as CEASEFIRE, enrolled 220 participants. On average, they were 41 years old and smoked about a pack a day. They averaged two previous attempts to quit smoking.
The participants were randomized into two groups: one given a refillable vape, and one given a heated tobacco product—a device that heats sticks of tobacco to produce vapor, without the combustion that produces smoke. Researchers sought to compare effectiveness and tolerability between the two harm reduction options.
High rates of quitting and staying off of cigarettes were observed in both groups, described as “remarkable” by one of the researchers.
Understanding the critical role of flavors in making the switch, they also gave participants a choice of three different flavors. In addition, motivational counseling was offered throughout the 12-week study.
High rates of quitting and staying off of cigarettes were observed in both groups, at 39.1 percent for those using the heated tobacco product (IQOS 2.4 Plus) and 30.8 percent for the vape (JustFog Q16). These rates were described as “remarkable” by one of the researchers.
The results are encouraging for both combustion-free devices—the difference between the two rates was not deemed significant—and it’s notable that more than 95 percent of participants completed the study.
“Data confirm the effectiveness and tolerability of e-cigarettes and the health potential of heated tobacco products for smokers not intending to quit,” said principal investigator Maria Signorelli.
Some participants became healthier even during the short study period. “We observed an improvement in exercise tolerance in participants compared to the initial levels,” said Pasquale Caponnetto, another of the researchers. “Many patients from the first month declared that they have more breath and feel less fatigue in small but important daily activities such as climbing stairs or doing household chores.”
In Italy, where the research was conducted, heated tobacco products have been available for years at tabaccheria (tobacco shops), and are sold alongside cigarettes in vending machines. Japan, where the products are also widely available, has seen an unprecedented decline in cigarette sales in just a few years. This is tobacco harm reduction in action.
In 2020, the Food and Drug Administration authorized IQOS to be marketed as having “reduced exposure” to harmful chemicals compared with cigarettes. But a patent dispute has delayed rollout in the United States.
Different things work for different people, and both vapes and heated tobacco products are essential tools to bring down smoking rates.
“Comparing the Effectiveness, Tolerability, and Acceptability of Heated Tobacco Products and Refillable Electronic Cigarettes for Cigarette Substitution (CEASEFIRE): Randomized Controlled Trial” was conducted by researchers in the Department of Clinical and Experimental Medicine at the University of Catania and the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR).
Unfortunately, people with mental health diagnoses or histories of problematic drug use other than tobacco were excluded from this study. These are two groups with some of the highest rates of smoking, smoking-related illnesses and premature deaths. It’s crucial to include them in safer nicotine product research.
The researchers cautioned that longer follow-up studies are needed “to confirm significant and prolonged abstinence from smoking,” and whether the results can be generalized to settings that don’t offer high levels of support.
But the CEASEFIRE study suggests that giving people who smoke and don’t even intend to quit the option of heated tobacco products or vapes is highly effective. Different things work for different people, and both of these are essential tools to bring down smoking rates.
Photograph of vending machine carrying both cigarettes and heated tobacco products in Catania, Italy, by Helen Redmond
The Influence Foundation, which operates Filter, has received grants from Philip Morris International, which manufactures IQOS. Both The Influence Foundation and CoEHAR have received grants from the Foundation for a Smoke-Free World. Filter’s Editorial Independence Policy applies.