Research Library
Published Year: 2024. Publication Type: Journal Article
Publication Title: New England Journal of Medicine.
Electronic Nicotine-Delivery Systems for Smoking Cessation
Authors: Reto Auer, M.D., Anna Schoeni, Ph.D., Jean-Paul Humair, M.D., M.P.H, Isabelle Jacot-Sadowski, M.D., Ivan Berlin, M.D., Ph.D., Mirah J. Stuber, M.D., Moa Lina Haller, M.D., Rodrigo Casagrande Tango, M.D., M.P.H., Anja Frei, Ph.D., Alexandra Strassmann, Ph.D., Philip Bruggmann, M.D., Florent Baty, Ph.D., Martin Brutsche, M.D., Ph.D., Kali Tal, Ph.D., Stéphanie Baggio, Ph.D., Julian Jakob, M.D., Nicolas Sambiagio, Ph.D., Nancy B. Hopf, Ph.D., Martin Feller, M.D., Nicolas Rodondi, M.D., Aurélie Berthet, Ph.D.
ISBN/ISSN: 0028-4793, 1533-4406. DOI: 10.1056/NEJMoa2308815.
Website/Url: http://www.nejm.org/doi/10.1056/NEJMoa2308815
Abstract:
Background
Electronic nicotine-delivery systems — also called e-cigarettes — are used by some tobacco smokers to assist with quitting. Evidence regarding the efficacy and safety of these systems is needed.
Methods
In this open-label, controlled trial, we randomly assigned adults who were smoking at least five tobacco cigarettes per day and who wanted to set a quit date to an intervention group, which received free e-cigarettes and e-liquids, standard-of-care smoking-cessation counseling, and optional (not free) nicotine-replacement therapy, or to a control group, which received standard counseling and a voucher, which they could use for any purpose, including nicotine-replacement therapy. The primary outcome was biochemically validated, continuous abstinence from smoking at 6 months. Secondary outcomes included participant-reported abstinence from tobacco and from any nicotine (including smoking, e-cigarettes, and nicotine-replacement therapy) at 6 months, respiratory symptoms, and serious adverse events.
Results
A total of 1246 participants underwent randomization; 622 participants were assigned to the intervention group, and 624 to the control group. The percentage of participants with validated continuous abstinence from tobacco smoking was 28.9% in the intervention group and 16.3% in the control group (relative risk, 1.77; 95% confidence interval, 1.43 to 2.20). The percentage of participants who abstained from smoking in the 7 days before the 6-month visit was 59.6% in the intervention group and 38.5% in the control group, but the percentage who abstained from any nicotine use was 20.1% in the intervention group and 33.7% in the control group. Serious adverse events occurred in 25 participants (4.0%) in the intervention group and in 31 (5.0%) in the control group; adverse events occurred in 272 participants (43.7%) and 229 participants (36.7%), respectively.
Conclusions
The addition of e-cigarettes to standard smoking-cessation counseling resulted in greater abstinence from tobacco use among smokers than smoking-cessation counseling alone. (Funded by the Swiss National Science Foundation and others; ESTxENDS ClinicalTrials.gov number, NCT03589989. opens in new tab.)
Tag: Cessation, Comparison, Adverse Effects
Key: FKMHA3CQ
Published Year: 2024. Publication Type: Journal Article
Publication Title: JAMA Network Open.
Trends in Harm Perceptions of E-Cigarettes vs Cigarettes Among Adults Who Smoke in England, 2014-2023
Authors: Sarah E Jackson, Harry Tattan-Birch, Katherine East, Sharon Cox, Lion Shahab, Jamie Brown
ISBN/ISSN: 2574-3805. DOI: 10.1001/jamanetworkopen.2024.0582.
Website/Url: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815561
Abstract:
Importance
Electronic cigarettes (e-cigarettes) are less harmful to users than combustible cigarettes. However, public health and media reporting have often overstated the potential risks of e-cigarettes, and inaccurate perceptions of the harms of vaping relative to smoking are pervasive.
Objective
To examine time trends in harm perceptions of e-cigarettes compared with combustible cigarettes among adults who smoke.
Design, Setting, and Participants
This nationally representative monthly cross-sectional survey study was conducted from November 2014 to June 2023 in England. Participants were adults who currently smoke.
Main Outcomes and Measures
Participants were asked whether they thought e-cigarettes were less harmful, equally harmful, or more harmful than cigarettes, or did not know, with the proportion responding less harmful (vs all other responses) as the primary outcome. Logistic regression was used to test associations between survey wave and participants’ perceptions of the harms of e-cigarettes.
Results
Data were collected from 28 393 adults who smoke (mean [SD] age, 43.5 [17.3] years; 13 253 [46.7%] women). In November 2014, 44.4% (95% CI, 42.0%-46.8%) thought e-cigarettes were less harmful than cigarettes, 30.3% (95% CI, 28.2%-32.6%) thought e-cigarettes were equally harmful, 10.8% (95% CI, 9.4%-12.3%) thought they were more harmful, and 14.5% (95% CI, 12.9%-16.4%) did not know. However, by June 2023, the proportion who thought e-cigarettes were less harmful had decreased by 40% (prevalence ratio, 0.60; 95% CI, 0.55-0.66), and the proportion who thought e-cigarettes were more harmful had more than doubled (prevalence ratio, 2.16; 95% CI, 1.84-2.54). Changes over time were nonlinear: late 2019 saw a sharp decline in the proportion who thought e-cigarettes were less harmful and increases in the proportions who thought they were equally or more harmful. These changes were short-lived, returning to pre-2019 levels by the end of 2020. However, perceptions worsened again from 2021 up to the end of the study period: the proportion who thought e-cigarettes were more harmful increased to a new high, and the proportion who thought e-cigarettes were less harmful decreased to levels comparable to those in late 2019. As a result, in June 2023, the perception that e-cigarettes were equally as harmful as cigarettes was the most commonly held view among adults who smoke (33.7%; 95% CI, 31.4%-36.1%), with roughly similar proportions perceiving e-cigarettes to be less (26.7%; 95% CI, 24.6%-28.9%) and more (23.3%; 95% CI, 21.1%-25.7%) harmful.
Conclusions and Relevance
This survey study of adults who smoke in England found that harm perceptions of e-cigarettes have worsened substantially over the last decade, such that most adults who smoked in 2023 believed e-cigarettes to be at least as harmful as cigarettes. The timing of the 2 most notable changes in harm perceptions coincided with the e-cigarette, or vaping product, use-associated lung injury outbreak in 2019 and the recent increase in youth vaping in England since 2021.
Tag: Perceptions, Population, Communication
Key: EAVKRSR5
Published Year: 2024. Publication Type: Journal Article
Publication Title: Emergency Medicine Journal.
Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial
Authors: Ian Pope, Lucy V Clark, Allan Clark, Emma Ward, Pippa Belderson, Susan Stirling, Steve Parrott, Jinshuo Li, Tim Coats, Linda Bauld, Richard Holland, Sarah Gentry, Sanjay Agrawal, Benjamin Michael Bloom, Adrian A Boyle, Alasdair J Gray, M Geraint Morris, Jonathan Livingstone-Banks, Caitlin Notley
ISBN/ISSN: . DOI: 10.1136/emermed-2023-213824.
Website/Url: http://emj.bmj.com/content/early/2024/03/01/emermed-2023-213824.abstract
Abstract:
Background
Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED-based smoking cessation intervention can help people to quit smoking.
Methods
In this multicentre, parallel-group, randomised controlled superiority trial conducted between January and August 2022, adults who smoked daily and attended one of six UK EDs were randomised to intervention (brief advice, e-cigarette starter kit and referral to stop smoking services) or control (written information on stop smoking services). The primary outcome was biochemically validated abstinence at 6 months.
Results
An intention-to-treat analysis included 972 of 1443 people screened for inclusion (484 in the intervention group, 488 in the control group). Of 975 participants randomised, 3 were subsequently excluded, 17 withdrew and 287 were lost to follow-up. The 6-month biochemically-verified abstinence rate was 7.2% in the intervention group and 4.1% in the control group (relative risk 1.76; 95% CI 1.03 to 3.01; p=0.038). Self-reported 7-day abstinence at 6 months was 23.3% in the intervention group and 12.9% in the control group (relative risk 1.80; 95% CI 1.36 to 2.38; p<0.001). No serious adverse events related to taking part in the trial were reported.
Conclusions
An opportunistic smoking cessation intervention comprising brief advice, an e-cigarette starter kit and referral to stop smoking services is effective for sustained smoking abstinence with few reported adverse events.Trial registration number NCT04854616.Data are available upon reasonable request. The protocol, consent form, statistical analysis plan, medical ethics committee approvals, training materials and other relevant study materials are available online at https://osf.io/8hbne/. Deidentified participant data will be made publicly available within 3 months at the above address.
Tag: Cessation, Comparison
Key: VK6HHT6P
Published Year: 2024. Publication Type: Document/Report
Publication Title: E-cigarettes and harm reduction: An evidence review.
E-cigarettes and harm reduction: An evidence review
Authors: Royal College of Physicians
ISBN/ISSN: . DOI: .
Website/Url: https://www.rcplondon.ac.uk/projects/outputs/e-cigarettes-and-harm-reduction-evidence-review
Abstract:
The Royal College of Physicians (RCP) has published a new report that looks at the part e-cigarettes can play in preventing death, disability and inequalities from tobacco use.
The new RCP report, E-cigarettes and harm reduction: An evidence review, looks at several themes, including how e-cigarettes can be used to support more people to make quit attempts while discouraging young people and never-smokers from taking up e-cigarette use. It also examines trends in tobacco and vaping use, the effectiveness of e-cigarettes to treat tobacco addiction, and the differences in health effects of vaping in people who smoke, vape or do neither, the role of the tobacco industry in the rising use of e-cigarettes, and the ethical dilemmas presented by e-cigarettes.
With over 50 recommendations, the report concludes that e-cigarettes remain an important tool to alleviate the burden of tobacco use but that much more can and should be done to reduce their appeal, availability and affordability to people who do not smoke, including children and young people, and reduce environmental harms.
It makes several recommendations for regulations on vaping to protect young people and never smokers from vaping:
Price – raising their price by introducing an excise tax and minimum unit pricing while banning multi-buy purchases but making sure they remain a less expensive option for adults using them to quit smoking.
Promotion – restricting ‘point of sale’ in store promotional materials and product visibility, and restricting promotion on social media.
Purchase – ensuring Trading Standards services are sufficiently resourced to effectively enforce e-cigarette sales legislation and reduce underage sales.
Products – making products less appealing to young people by introducing standardised packaging and flavour descriptors. Require manufacturers to limit the production of toxic substances from vapes, require the Medicines and Healthcare products Regulatory Agency (MHRA) to independently verify product contents, provide advice to consumers on which are the safest products if using them to stop smoking and require manufacturers cover the costs of recycling.
The new report follows several previous RCP publications on e-cigarettes and vaping, including:
Harm reduction in nicotine addiction – a report on alternative nicotine products published in 2007, which covered their regulation and role as alternatives to smoking. The report concluded that there was a role for alternative nicotine products to support people to stop smoking tobacco and that regulation for those products should be formalised.
Nicotine without smoke, which re-examined emerging data on the role of e-cigarettes and alternative nicotine products. The 2016 report concluded that e-cigarettes were an effective aid to quitting smoking but there needed to be regular surveillance to monitor intended and unintended consequences of regulation.
Executive Summary: https://www.rcplondon.ac.uk/file/48803/download
Full Report: https://www.rcplondon.ac.uk/file/48804/download
Tag: Evidence Review, Biomakers, Cessation, Continuum of Risk, Ethics, Population, Public Health, Regulations, Literature Review
Key: 8R3IQUZ5
Published Year: 2024. Publication Type: Journal Article
Publication Title: Tobacco Induced Diseases.
Level and timing of product substitution in a trial of e-cigarettes for smokers not interested in quitting
Authors: Sargent, James D., Stoolmiller, Mike, Santos, Meghan M., Ferron, Joelle C., Brunette, Mary F., Pratt, Sarah I.
ISBN/ISSN: 1617-9625. DOI: 10.18332/tid/189220.
Website/Url: https://www.tobaccoinduceddiseases.org/Level-and-timing-of-product-substitution-in-a-trial-of-e-cigarettes-for-smokers-not,189220,0,2.html
Abstract:
Introduction:
The e-cigarette market is large and diverse. Traditional smoking cessation trials involving a control group and a 6-month observation period are an inefficient methodology for testing the multiple treatment options e-cigarettes provide for harm reduction in cigarette smokers. We determined when product substitution occurred in the e-cigarette provision arm of an e-cigarette substitution trial for cigarette smokers who were not interested in quitting.
Methods:
We conducted a secondary analysis of 120 cigarette smokers with severe mental illness (recruitment 2017–2020) who were given disposable e-cigarettes for 8 weeks and assessed at weeks 0 (t0), 2, 4, 6, and 8. We explored product substitution through visit-to-visit correlations in change in product use, then developed a dual process growth model for cigarette and e-cigarette use to test the association between increases in e-cigarette use and concurrent decreases in cigarettes smoked.
Results:
Mean age of the participants was 45.9 years, and 42.7% smoked ≥20 cigarettes per day. Almost all product substitution occurred between t0 and t2. For the average smoker (18 cigarettes per day), t2 cigarette frequency decreased by 0.39 (95% CI: -0.56 – -0.22) cigarettes for each additional e-cigarette session. There was effect modification (p=0.033), such that baseline light smokers (<10 cigarettes/day) had no significant decrease in t2 cigarette frequency, regardless of their initial increase in e-cigarette use, while heavy smokers (38 cigarettes/ day) switched products nearly on a one-to-one basis.
Conclusions:
In this study, most product substitution occurred early, and heavier smokers had larger t2 decreases in cigarettes/day with increased e-cigarette use. If confirmed with replication studies, the findings could suggest establishment of a novel outcome for e-cigarette studies – early product substitution – and support the value of short-term comparative effectiveness trials that compare multiple potentially lower harm tobacco products.
Tag: Cessation
Key: BX2QPDLT
Published Year: 2024. Publication Type: Journal Article
Publication Title: Addiction.
Young people’s use of disposable vapes: A qualitative study
Authors: Notley, Caitlin, Ward, Emma, Dawkins, Lynne, Pope, Ian, Varley, Anna
ISBN/ISSN: 0965-2140, 1360-0443. DOI: 10.1111/add.16570.
Website/Url: https://onlinelibrary.wiley.com/doi/10.1111/add.16570
Abstract:
Background and aims
Youth use of disposable vapes has increased markedly in the United Kingdom in recent years, yet little is known about the motivations, experiences and perceptions of young people themselves. This study aimed to explore young people’s experiences and use of disposable vapes.
Methods
This was a qualitative study recruiting young people reporting regularly vaping disposables, collecting data via dyad guided, individual and group interviews. Data analysis was theoretically informed by the Social Ecological Model. Inductive and deductive coding approaches were used, with resolution of coded interpretations by consensus.
Results
Twenty‐nine young people aged 16–20 years participated in qualitative interviews. At the individual level, participants discussed how characteristics of disposable vapes were important to them—particularly price, accessibility and the attractive designs, colours, names and flavours. Young people frequently engaged in both vaping and tobacco smoking, seeing the behaviours as interchangeable dependent on context, and having inaccurate relative harm perceptions of vaping compared with smoking. Experimentation was widespread and many used vapes as a way of managing stress and anxiety. Vaping was positioned as a social behaviour, common among peers. Parental influence on vaping behaviour was minimal, although vaping initiation could be influenced by family vaping norms. Culturally, vaping was a widespread normalized behaviour. Young people were aware of media reports and potential harms, but were less aware of smoking related harms as a consequence.
Conclusions
Disposable vapes appear to be attractive and accessible to young people in the United Kingdom. Vaping is normalized in this population, despite being seen as potentially damaging to health, and vaping and smoking are engaged in interchangeably. Underage sales of vapes are reportedly widespread. Strict regulation, such as banning products or increasing prices, may prompt UK youth to switch from vaping to smoking.
Tag: Youth, Young Adults
Key: ZT2TJREW
Published Year: 2024. Publication Type: Journal Article
Publication Title: Nicotine and Tobacco Research.
The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review
Authors: Travis, Nargiz, Levy, David T, Hartmann-Boyce, Jamie, Meza, Rafael, Ranganathan, Radhika, Oh, Hayoung, Goniewicz, Maciej L, Warner, Kenneth E
ISBN/ISSN: 1469-994X. DOI: 10.1093/ntr/ntae131.
Website/Url: https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntae131/7693924
Abstract:
Introduction
Oral nicotine pouches (ONPs) are a new class of nicotine products. This scoping review summarizes evidence on ONPs and explores their potential public health impact.
Aims and Methods
We conducted a structured literature search for empirical studies across three electronic databases through January 10, 2024. Outcomes included ONP product characteristics, use patterns, beliefs and perceptions, toxicity, and marketing and sales.
Results
Sixty-two studies were included, 17 were industry-funded. Most studies were from the United States. While large variations across studies were observed in ONP youth prevalence estimates, nationally representative U.S. studies find current use at 1.5% and lifetime use below 2.5% through 2023. Between 35% and 42% of U.S. adolescents and young adults have heard of ONPs, and 9-21% of tobacco-naïve youth were susceptible to trying them. U.S. adult-use estimates varied widely (0.8%–3% current; 3%–16% lifetime use) and were limited to populations with a history of tobacco use. The chemical composition of ONPs suggests fewer harmful/potentially harmful compounds at lower levels than cigarettes and smokeless tobacco (SLT), except formaldehyde. Industry-funded studies find substantially less cytotoxicity compared to cigarettes and suggest that higher nicotine-strength ONPs can deliver nicotine at levels comparable to or higher than SLT or cigarettes, although with slower nicotine release than cigarettes. Evidence on the cytotoxicity of ONPs relative to SLT is mixed.
Conclusions
ONPs appear to be less toxic than cigarettes and deliver comparable nicotine, presenting an alternative for combustible product users, although key data are mainly available from industry-funded studies. Data from independent research is critically needed. Industry marketing of ONPs may encourage initiation in youth and situational and dual use in adults.
Implications
The review provides an initial assessment of the potential role of ONPs in harm reduction and aims to determine unintended consequences of their use (youth uptake and dual-use) and identify populations that disproportionately use the product. This information is essential for tobacco regulatory bodies in determining the net public health impact of nicotine pouches.
Tag: Nicotine Pouches, Public Health
Key: 8P5YKILR
Published Year: 2024. Publication Type: Journal Article
Publication Title: Addiction.
Nicotine strength of e‐liquids used by adult vapers in Great Britain: A population survey 2016 to 2024
Authors: Jackson, Sarah E., Cox, Sharon, Bauld, Linda, Arnott, Deborah, Shahab, Lion, Brown, Jamie
ISBN/ISSN: 0965-2140, 1360-0443. DOI: 10.1111/add.16576.
Website/Url: https://onlinelibrary.wiley.com/doi/10.1111/add.16576
Abstract:
Background and aims
In March 2024, the UK government announced plans to introduce a Vaping Products Duty that will tax e‐liquids based on their nicotine strength. This study examined trends in the nicotine strength of e‐liquids used by adult vapers and differences in those currently used across relevant subgroups.
Design
Nationally‐representative, cross‐sectional household survey, July 2016 to January 2024.
Setting Great Britain.
Participants 7981 adult vapers.
Measurements Participants were asked whether the e‐cigarette they mainly use contains nicotine (yes/no) and the e‐liquid strength (no nicotine, >0–≤ 6, 7–11, 12–19 or ≥20 mg/ml). We also collected information on the main device type used (disposable/refillable/pod), age, gender, occupational social grade, history of ≥1 mental health conditions, smoking status and (among past‐year smokers) level of cigarette addiction.
Findings
The proportion of vapers in England using high‐strength (≥20 mg/ml) e‐liquids increased from an average of 3.8% (95% confidence interval [CI] = 2.9–5.0) up to June 2021 to 32.5% (CI = 27.9–37.4) in January 2024 (the vast majority of whom [93.3% in January 2024] reported using exactly 20 mg/ml; the legal limit). This rise was most pronounced among those using disposable e‐cigarettes, those aged 18‐24 years and all smoking statuses (including never smokers) except long‐term (≥1y) ex‐smokers. Of those surveyed in 2022–2024 in Great Britain, overall, 89.5% (CI = 88.1–90.8) said they usually used e‐cigarettes containing nicotine, 8.7% (CI = 7.5–10.0) used nicotine‐free e‐cigarettes, and 1.8% (CI = 1.2–2.4) were unsure. The proportion using ≥20 mg/ml was higher among those mainly using disposable (47.9%) compared with pod (16.3%) or refillable (11.5%) devices; never smokers (36.0%), current smokers (28.8%) or recent (<1y) ex‐smokers (27.4%), compared with long‐term ex‐smokers (13.9%); and younger (16–24y; 44.2%) compared with older (≥25y; range 9.4–25.1%) age groups. There were no notable differences across other subgroups of interest.
Conclusions
Use of high‐strength nicotine e‐liquids in England appears to have increased sharply in recent years. Most adult vapers in Great Britain appear to use e‐cigarettes that contain nicotine but different subgroups use different strengths: nicotine strengths tend to be higher among those who mainly use disposable devices and those aged 16–24y, and lower among long‐term ex‐smokers.
Tag: Nicotine, Population, Trends
Key: X4AV5QH9