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E-cigarettes: an evidence update 48 Observational and natural history studies are therefore important. Only one population- based survey has examined the effectiveness of EC used during quit attempts. A large cross-sectional study of 5,863 English smokers who attempted to quit in the past year without using professional support [29] found that those who used EC on their last quit attempt were more likely to quit than those who used over the counter NRT – (the most common help sought by smokers after EC, see Figure 14), or no quit aid, controlling for factors related to quitting. This study was, however, unable to explore prospective predictors of quitting, including pre-quit nicotine dependence. Still, this study offers some of the best evidence to date on the effectiveness of EC for use in quit attempts. Other recent population studies [16, 44, 45] have also examined the association between EC use and quitting. However, because these studies (1) included smokers who were already using EC at baseline, and (2) d id not examine the use of EC during a specific quit attempt, we discuss them below in the section on use of EC while smoking. Pilot studies Polosa et al., 2014 [46] conducted a six-month pilot study of tank-type EC users with no control group among 72 smokers who did not want to quit (smokers were enrolled after rejecting participation in smoking cessation program at a hospital). At six months, they found significant 50% and 80% reductions in cigarette consumption, and a quit rate of 36% [46]. Another study by Polosa et al., 2014 [47] followed 71 vape shop customers (seven different shops) after their first visit to the shop. The first visit included instructions on how to use EC and encouragement to use their EC of choice to reduce their smoking, along with a telephone number they could call for help. At six and twelve months after their initial visit they found that the smokers reported significant 50% and 80% reductions in cigarettes per day at six and twelve months, and that at six and twelve months, 42.2% and 40.8% had quit smoking. E-cigarettes and stop smoking services Some English stop smoking services and practitioners support the use of EC in quit attempts [48], and provide behavioural support for EC users trying to quit smoking. The most recent monitoring data from the stop smoking services show the self-reported success rates for different medications and nicotine -containing products used (Figure 15). Data are not given by validated success rates but overall, 69% of those who self - report stopping smoking are carbon-monoxide validated [49]. Hence, there are limitations with these data as they are self-reported success rates and it is possible that they may vary by treatment used. Additionally, the data are not adjusted for other factors, such as dependence, known to influence success rates, and it is likely that they emanate from a limited number of services who record unlicensed nicotine-containing products and who might therefore be more supportive of their use. Nevertheless, the