E-cigarettes best bet to quit smoking

Faith Castro
February 2, 2019

"This landmark research shows that switching to an e-cigarette can be one of the most effective ways to quit smoking, especially when combined with face-to-face support", Martin Dockrell, head of the Tobacco Control division at Public Health England, said in a statement.

The problem with translating drug research to a consumer product like e-cigarettes is that the strict protocols of a drug trial (all participants use a certain drug at a certain dose and interval) may not translate to products that succeed by offering a wide range of possibilities to users.

Extrapolating their data, the researchers estimated that 820,414 youths had smoked a cigarette over the examined years, with almost 180,000 of those having used e-cigarettes previously.

But in an email exchange with MedPage Today, Berry explained that numerous prior studies may have been subject to methodological limitations because they started with a sample of youth who were never cigarette users, assessed their e-cigarette use at that early time point, and then reviewed their smoking status after a year of follow-up. People who smoke e-cigarettes have a 72 percent higher risk of stroke and a 51 percent higher risk heart attack and angina, according to one recent study.

A total of 8.6% reported e-cigarettes as their first tobacco product, while 5.0% reported using another non-cigarette product first (3.3% reported using cigarettes first). It also was unable to examine how the association of e-cigarette use with cigarette initiation may vary by different products or use behavior patterns.

In the trial, just under 900 participants who were already using UK NHS stop-smoking services were randomly assigned to either a NRT product of their choice, including combination treatments, or an e-cigarette starter pack. However, there's been controversy about the safety of e-cigarettes and a lack of research about how effective they are in helping people to stop smoking. There is no evidence that nicotine use causes health problems, but considerable evidence that many ex-smokers relapse long after they quit cigarettes. Peter Hajek of Queen Mary University of London describes a randomized trial comparing smokers attempting to quit using a vaping product with others using NRT. "There is substantial evidence that they are less harmful than traditional cigarettes, but that doesn't mean they are not harmful".

The report was released on the same day as a separate study by the Harvard T.H. Chan School of Public Health that found common e-cigarette flavors may harm users' lungs.

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Richard Miech from the University of MI, who was not involved in the study, told Reuters, "This is great news for cigarette smokers who want to quit".

For now, Borelli added, "the best way to quit smoking right now is to use FDA-approved evidence-based treatment as a first-line choice". Both groups also participated in "behavioral support" sessions. These devices now often have more nicotine and come in a more convenient form than the first-generation vaping devices.

Myth #1: E-cigarettes give you popcorn lung.

But Jordt noted that newer devices like the Juul pod have only recently arrived in the UK.

Because people had known which treatment they had received - as opposed to being "blinded" as they are in most randomised controlled trials - it was possible participants may have perceived nicotine replacements as an inferior option and put less effort into quitting, the authors said. The other thing it does is show that the magnitude of risk is even higher for those at low risk for using cigarettes. The e-cig users were more likely to report throat and mouth irritation, while the NRT group were more likely to suffer from nausea.

Myers' group is one of several anti-smoking organizations suing the FDA to immediately begin reviewing e-cigarettes.

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