Thursday, October 28, 2021

E-Cigarette Opponents Torture PATH “One-Puff” Relapse Data to Deny E-Cigarettes’ Cessation Impact


You may have seen headlines like this from CNN: “Using e-cigarettes to prevent smoking relapse doesn’t work well, study finds,” with quotes from the study’s lead author, Dr. John Pierce of the University of California San Diego. 

The research, which appeared in the journal JAMA Network Open (here), relied on data from the FDA’s Population Assessment of Tobacco and Health (PATH) Survey, which for five years has followed smokers and other tobacco users. 

Dr. Pierce generated news coverage largely by making a number of hyperbolic claims: 

“This is the first study to report on whether cigarette smokers can switch to e-cigarettes without relapsing to cigarette smoking…[Smokers] who switched to e-cigarettes (or indeed another form of tobacco) were 8.5 percentage points more likely to relapse to cigarettes…If switching to e-cigarettes was a viable way to quit cigarette smoking, then those who switched to e-cigarettes should have much lower relapse rates to cigarette smoking. We found no evidence of this.”

I have worked extensively with the PATH data.  Two years ago, I found that the authors of one study knowingly included vapers who had heart attacks 10 years before picking up an e-cigarette.  That article was retracted by the journal editors. 

In the new JAMA Network Open report, the authors took a different approach to mischaracterize the facts.  They teased and tortured PATH survey data, which collected information on thousands of factors, to fit their pre-conceived narrative about e-cigarettes and smoking relapse.

Pierce and colleagues focused on 13,000 participants who were adult established smokers the first year they participated in the PATH survey.  Pierce then identified 1,228 (9.4%) who became former smokers one year later (Year 1); at that time, 459 were using e-cigarettes and/or other tobacco products, while 769 were not.  A year after that (Year 2), the researchers used this question to determine who had smoked: “In the past 12 months, have you smoked a cigarette even 1 or 2 puffs?”

That’s right, at Year 2 Pierce counted anyone who even took 1 or 2 puffs on a cigarette as a failure.  Using this yardstick, about 50% of former smokers who weren’t using a tobacco product at Year 1 were still totally cigarette-free at Year 2, compared with 42% of those who had been using e-cigarettes or tobacco at Year 1. 

But here is a fact from Pierce’s study that they did not promote: Former smokers who were using e-cigarettes at Year 1 were “more likely to requit and be abstinent for 3 months at [Year 2] (17.0% vs. 10.4%).”

Adding the results for complete and 3-month abstinence, there was virtually no difference between e-cigarette users (42% + 17%) and non-users (50% + 10%). 

This brings up another issue with Pierce’s media statements.  He said that smokers “who switched to e-cigarettes should have much lower relapse rates to cigarette smoking.”  That ignores the fact that 769 former smokers in his study used no tobacco at Year 1, while 459 different former smokers used e-cigarettes/tobacco.  Both produced complete and 3-month abstinence rates that are similar, and both added to the former smoker pool.  It doesn’t matter how they got there. 

Throughout the article and in his public comments, Pierce referenced smokers “who switched to e-cigarettes.”  That is misleading.  PATH collects information on aids that former smokers used to quit.  (My group published a study on this here.)  The only information Pierce et al. reported was whether former smokers at Year 1 were using or not using e-cigarettes/tobacco.  By ignoring the quitting information, they undercut the positive results for e-cigarettes and distorted the public health message.

Finally, most people know that some former smokers, including those who used e-cigarettes, return to smoking.  Given the drumbeat of misleading negative statements about e-cigarettes – they’re toxic, they enslave children, and now, “E-cigarettes don't help smokers stay off combustible cigs” – it is a small wonder that anyone quits smoking and stays smoke-free with vapor.



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