Tag: cessation

Study: Vapers Now More Likely to Quit Cigarettes

Photo: Pcess609
Smokers who switch to e-cigarettes are now more likely to stop smoking regular cigarettes, according to a new paper published by Oxford University Press in Nicotine & Tobacco Research. In the past, smokers who began vaping mostly continued smoking.
Electronic nicotine delivery systems first emerged on the U.S. market in 2007. The first e-cigarettes resembled conventional cigarettes (in appearance) and used fixed low-voltage batteries. Beginning in 2016, manufacturers introduced e-liquids containing nicotine salt formulations. These new e-cigarettes became widely available. These nicotine salts are lower in pH than freebase formulations, which allow manufacturers to increase nicotine concentration while avoiding harshness and bitterness.
Past population-level research provided conflicting findings on whether vaping helps people who smoke combustible cigarettes to quit smoking. Some research suggests improved cigarette quitting-related outcomes with e-cigarette use, while other research suggests the opposite. Inconsistent findings may be due to differences in the samples and measures considered, differences in the analytic approaches of researchers used, the rapidly changing product environment, or policy contexts.

While our study doesn’t give the answers as to why vaping is associated with cigarette quitting in the population today when it wasn’t associated with quitting years ago, design changes leading to e-cigarettes that deliver nicotine more effectively should be investigated.
Karin Kasza, assistant professor of oncology, Department of Health Behavior at Roswell Park Comprehensive Cancer Center
The researchers here examined differences in real-world trends in population-level cigarette discontinuation rates from 2013 to 2021, comparing U.S. adults who smoked combustible cigarettes and used e-cigarettes with U.S. adults who smoked combustible cigarettes and did not use e-cigarettes.
Using data from among adults (ages 21+) in the Population Assessment of Tobacco and Health (PATH) Study, a national longitudinal study of tobacco use from people from all over the United States, the researchers found that between 2013 and 2016, rates of discontinuing cigarette smoking among adults in the U.S. population were statistically indistinguishable between those who used e-cigarettes and those who did not. Cigarette discontinuation rates were 15.5 percent for those who used e-cigarettes and 15.6 percent for those who did not.
But the quit rates changed in subsequent years; the researchers here found that between 2018 and 2021 only 20 percent of smokers who did not use e-cigarettes stopped smoking combustible cigarettes, but some 30.9 percent of smokers who used e-cigarettes stopped smoking combustible cigarettes.
The paper notes that the full study period spanned a time in the United States when the e-cigarette marketplace was expanding; salt-based nicotine formulations gained market share in 2016 and vaping products became available with increased nicotine yields over time. This was also a period in which state and federal governments restricted tobacco in various ways, including increasing the tobacco-purchase age to 21 and restricting flavored e-cigarettes.
“Our findings here suggest that the times have changed when it comes to vaping and smoking cessation for adults in the U.S.,” said study first author, Karin Kasza, an assistant professor of oncology in the Department of Health Behavior at Roswell Park Comprehensive Cancer Center in Buffalo, New York, in a statement.
“While our study doesn’t give the answers as to why vaping is associated with cigarette quitting in the population today when it wasn’t associated with quitting years ago, design changes leading to e-cigarettes that deliver nicotine more effectively should be investigated. This work underscores the importance of using the most recent data to inform public health decisions.”
April 3, 2024
Another Study Finds Vape More Effective Than NRTs

Nicotine e-cigarettes are more effective quit-smoking products than conventional nicotine-replacement therapies (NRTs), reports University of Massachusetts Amherst, citing the latest Cochrane review.
The review found high certainty evidence that e-cigarettes lead to better chances of quitting smoking than using patches, gums, lozenges or other traditional NRTs.
“In England, quite different from the rest of the world, e-cigarettes have been embraced by public health agencies as a tool to help people reduce the harm from smoking,” said Jamie Hartmann-Boyce, assistant professor of health policy and promotion in the School of Public Health and Health Sciences at the University of Massachusetts Amherst.
“Most of the adults in the U.S. who smoke want to quit, but many find it really difficult to do so,” said Hartmann-Boyce, who conducted research at the University of Oxford in England before joining the University of Massachusetts Amherst earlier this year and is the senior author of the review and a Cochrane editor. “We need a range of evidence-based options for people to use to quit smoking, as some people will try many different ways of quitting before finding one that works for them.”
The review included 88 studies and more than 27,235 participants, with most of the studies taking place in the U.S., the U.K. or Italy.
“We have very clear evidence that, though not risk-free, nicotine e-cigarettes are substantially less harmful than smoking,” Hartmann-Boyce said. “Some people who haven’t had success in the past with other quit aids have found e-cigarettes have helped them.”
For every 100 people using nicotine e-cigarettes to quit smoking, eight to 10 are expected to successfully quit compared to six of 100 people using traditional NRTs and four of 100 trying to quit without support or with only behavioral support, according to the review.
“Not everything is either entirely harmful or beneficial,” Hartmann-Boyce said. “Different things can have different impacts on different populations. Evidence shows that nicotine e-cigarettes can help people quit smoking and that people who don’t smoke shouldn’t use e-cigarettes.”
Hartmann-Boyce compared tobacco smoking versus e-cigarette use to the treatment for substance use disorders involving opioids. “We’re not going to prescribe methadone to people who aren’t addicted to opioids,” she said. “But for people addicted to opioids, we recognize that methadone is a helpful thing.”
In 2021, a study by Queen Mary University of London, published in Addiction, shows that e-cigarettes are more effective in achieving long-term smoking reduction and cessation than NRTs.
The U.S. Food and Drug Administration has not approved any e-cigarettes as medications to help adults quit smoking. “While certain e-cigarettes may help adult smokers transition completely away from, or significantly reduce their use of, more harmful combusted cigarettes, the law’s public health standard balances that potential with the known and substantial risk with regard to youth appeal, uptake and use of these highly addictive products,” said Robert Califf, FDA commissioner.
January 9, 2024
Study Finds Cytisine More Effective than NRTs

Image: molekuul.be
Cytisine, a low-cost, generic stop-smoking aid that has been used in eastern Europe since the 1960s, increases the chances of successful smoking cessation by more than two-fold compared with placebo and may be more effective than nicotine replacement therapy, according to a new study published in Addiction. The cessation tool reportedly has a benign safety profile, with no evidence of serious safety concerns.
Cytisine is a plant-based compound that eases smoking withdrawal symptoms. It was first synthesized in Bulgaria in 1964 as Tabex and later spread to other countries in eastern Europe and Asia, where it is still marketed. In 2017, the Polish pharmaceutical company Aflofarm began selling it as Desmoxan, a prescription-only medicine, and Canada approved it as an over-the-counter natural health product, Cravv.
This study pooled the results of eight randomized controlled trials comparing cytisine with placebo, with nearly 6,000 patients. The combined results showed that cytisine increases the chances of successful smoking cessation by more than twofold compared with placebo.
The study also looked at two randomized controlled trials comparing cytisine with nicotine replacement therapy, with modest results in favor of cytisine, and three trials comparing cytisine with varenicline, without a clear benefit for cytisine.
“Our study adds to the evidence that cytisine is an effective and inexpensive stop-smoking aid,” said lead author Omar De Santi in a statement. “It could be very useful in reducing smoking in low- and middle-income countries where cost-effective smoking cessation drugs are urgently needed.”
Cytisine is currently not licensed or marketed in most countries outside of central and eastern Europe, making it unavailable in most of the world. At the end of January, cytisine pills are due to become available in the U.K., according to National World.
January 5, 2024
US Science Council Cries Foul on Cessation Study
A recent study that found that vaping doesn’t prevent smokers from relapsing to cigarettes has a major flaw, according to Cameron English, writing for the American Council on Science and Health. The results seem to undermine the efficacy of e-cigarettes as smoking-cessation tools—”until you take a closer look at the definition of relapse.”
At first glance, the study seems to undermine the case for e-cigarette use as a smoking cessation tool. But first glances, as we all know, rarely tell the whole story, according to English. A closer look at the paper indicates that its authors improperly assessed how smokers utilize e-cigarettes, thus generating results that don’t reflect reality.
The researchers analyzed data on 3,578 previous-year smokers who had recently attempted to quit and 1,323 recent former smokers from the Population Assessment of Tobacco and Health (PATH) Study between 2017-2019. Participants self-reported their use of e-cigarettes or other products to quit cigarettes. The researchers then investigated who among the study participants had abstained from smoking or any tobacco products in 2019.
Credit: Aleksej
“The significance of this study is limited by the same flaw we found in an earlier paper by two of the same authors: relapse to tobacco use was measured by the question ‘In the past 12 months, have you smoked a cigarette/(used product), even one or two puffs/times?’ Using this metric, an individual who has almost entirely quit smoking, save for “even one or two puffs” of a cigarette, and someone who has gone back to smoking a pack a day would be counted as having relapsed,” English writes.
“This definition ignores the fact that many smokers gradually switch from combustible cigarettes to their electronic counterparts. This is known as ‘dual-use,’ and properly designed epidemiological studies (even those based on PATH data) and clinical trials try to account for this behavioral shift, correctly noting that replacing even some cigarette smoking with vaping is desirable because vaping is the far safer option.”
Additional high-quality research would be very helpful, but “preventing relapse” is an all but useless outcome, states English. “Unless the researchers evaluate how e-cigarettes are used in the real world, the only thing their next paper will confirm is that asking the wrong question inevitably leads to the wrong answer, he writes.

February 19, 2022
England Paves Way for E-Cig Prescriptions

Photo: goodmanphoto
Doctors in England may soon be prescribing e-cigarettes to help people stop smoking tobacco, according to a news story published by the Department of Health Social Care and the Office for Health Improvement and Disparities. The Medicines and Healthcare products Regulatory Agency (MHRA) is publishing updated guidance that paves the way for medicinally licensed e-cigarette products to be prescribed for smoking cessation.
Manufacturers can approach the MHRA to submit their products to go through the same regulatory approvals process as other medicines available on the health service.
This could mean England becomes the first country in the world to prescribe e-cigarettes licensed as a medical product.
If a product receives MHRA approval, clinicians could then decide on a case-by-case basis whether it would be appropriate to prescribe an e-cigarette to NHS patients to help them quit smoking. It remains the case that non-smokers and children are strongly advised against using e-cigarettes.

This country continues to be a global leader on healthcare, whether it’s our Covid-19 vaccine rollout saving lives or our innovative public health measures reducing people’s risk of serious illness.
Sajid Javid, Health and Social Care Secretary
If a product receives MHRA approval, clinicians could then decide on a case-by-case basis whether it would be appropriate to prescribe an e-cigarette to NHS patients to help them quit smoking. It remains the case that non-smokers and children are strongly advised against using e-cigarettes.
E-cigarettes contain nicotine and are not risk free, but expert reviews from the U.K. and U.S. have been clear that the regulated e-cigarettes are less harmful than smoking. A medicinally licensed e-cigarette would have to pass even more rigorous safety checks.
Smoking remains the leading preventable cause of premature death and while rates are at record low levels in the U.K., there are still around 6.1 million smokers in England. There are also stark differences in rates across the country, with smoking rates in Blackpool (23.4 percent) and Kingston upon Hull (22.2 percent) poles apart from rates in wealthier areas such as Richmond upon Thames (8 percent).
E-cigarettes were the most popular aid used by smokers trying to quit in England in 2020, according to the Department of Health and Social Care. E-cigarettes have been shown to be highly effective in supporting those trying to quit, with 27.2 percent of smokers using them compared with 18.2 percent using nicotine replacement therapy products such as patches and gum.
Some of the highest success rates of those trying to quit smoking are among people using an e-cigarette to kick their addiction alongside local Stop Smoking services, with up to 68 percent successfully quitting in 2020 -2021.

We fully welcome the news that the NHS in England is exploring opportunities to prescribe vaping products to help people quit smoking.
Doug Mutter, director, VPZ
“This country continues to be a global leader on healthcare, whether it’s our Covid-19 vaccine rollout saving lives or our innovative public health measures reducing people’s risk of serious illness,” said Health and Social Care Secretary Sajid Javid.
“Opening the door to a licensed e-cigarette prescribed on the NHS has the potential to tackle the stark disparities in smoking rates across the country, helping people stop smoking wherever they live and whatever their background.”
Vapor industry representative welcomed the prospect of e-cigarettes on prescription.
“We fully welcome the news that the NHS in England is exploring opportunities to prescribe vaping products to help people quit smoking,” said Doug Mutter, director of VPZ, the U.K.’s largest vaping retailer with 157 stores throughout the country.
“The pandemic has triggered an increase in smoking rates and the public health problem has been compounded by funding cuts for NHS stop smoking services and local support groups.
“However this progressive and innovative approach being considered by the NHS in England has the potential to reverse this damage and bring new momentum to our ambitions of becoming a smoke free nation by 2030.”

The government deserves huge praise for taking this bold decision to look more closely at the use of vaping when it comes to smoking cessation and for taking an evidence-based, science-led approach.
John Dunne, director-general, UKVIA
“The government deserves huge praise for taking this bold decision to look more closely at the use of vaping when it comes to smoking cessation and for taking an evidence-based, science-led approach rather than the nonsensical anti-vaping, anti-harm reduction stance of some countries,” said John Dunne, Director General of the U.K. Vaping Industry Association.
“This announcement by the Department for Health is just the latest in a long line of breakthroughs for those of us who for years have advocated vaping as the best and most effective method for people looking to quit smoking.”
October 29, 2021