Can Vaping Help People Quit Smoking? It’s a Fact

 

Simon Chapman, emeritus professor in public health at the University of Sydney in Australia, is a long-time anti-tobacco activist and frequent contributor to The Conversation, which bills itself as “the world's leading publisher of research-based news and analysis.”  Undercutting that claim is a May 3 article Chapman authored, titled, “Can vaping help people quit smoking?” Chapman predictably answered that “It’s unlikely.”

His vaping analysis in support of that finding is grossly flawed.

Chapman starts with the “Myth of ‘hardened smokers’” -- “die-hard addicts: frequently relapsing smokers who just can’t quit.”  He asserts that their existence is a myth because the “average number of cigarettes smoked per day would be rising.”  That number has, in fact, fallen, but for entirely unrelated reasons, such as the imposition of a range of barriers to smoking, both social and economic, over a period of 20 years.

Chapman follows with a sweeping statement: “In other words, there is no evidence long-term smokers are impervious to the suite of tobacco control policies and campaigns that have driven hundreds of millions of smokers around the world to quit.”

No evidence?  There is definitive evidence: 480,000 dead smokers every year in the U.S.

Next, Chapman says that “Vapes don’t help smokers cut back.”  He’s talking about smokers who also vape, and there may be some truth in that, but the larger reality is that Chapman and his anti-tobacco allies in government and academia have been waging for years a very successful misinformation campaign, convincing smokers that vaping is as, or more dangerous than smoking.

Chapman asks how effective vapes are for smoking cessation, and answers with this: “The most recent Cochrane review of randomised controlled trials compared vaping with nicotine replacement therapy (such as drugs, gums and patches). It found about 82% of people who vape are still smoking when followed up six or more months later.  This was better than those using nicotine replacement therapy: 90% were still smoking.”  That answer is both humorous and revealing.

It’s amusing because I have made the same claim about medicinal nicotine for decades, and I agree that “trials also poorly reflect the ways vapes and nicotine replacement therapy are used in the real world and aren’t representative of all smokers wanting to quit.” (here)  In fact, population success with medicinal nicotine is only 7%.  But his answer is also revealing, since his point that 82% of those vaping are still smoking means that 18% quit with vapes, compared with only 10% relying on nicotine medicines.  Why would anyone deny smokers, who could be facing life-threatening illness, the option to quit by vaping?

Chapman posted his article in support of Australia’s crackdown on access to vaping products. Clearly, that government initiative and his pseudo-scientific analysis are woefully flawed.

 

E-Cigarettes = Nicotine Medicines = Prescription Medicines = Cold Turkey: All Help Some Smokers Quit

 

Thirty-six co-authors, peer review, and they still got it wrong.

Dr. John Pierce and 35 colleagues have published a study in the journal PLoS One analyzing data from FDA Population Assessment of Tobacco and Health (PATH) surveys.  Their work was touted in a University of California San Diego press release titled, “E-cigarettes Don’t Help Smokers Quit and They May Become Addicted to Vaping.”  But their study actually proved that e-cigarettes are as helpful as medicines promoted by anti-tobacco crusaders.

The study followed participants in all three waves of the PATH – one year apart in 2014, 2015 and 2016.  I will describe how Pierce and colleagues conducted this complicated analysis. 

Pierce et al. selected participants who were smoking every day when they enrolled in PATH Wave 1 (n= 9,021).  They then selected those who had tried to quit smoking “in the past 12 months” between Waves 1 and 2, but who were still smoking daily (n= 2,443).  In other words, those daily smokers had tried, but did not quit, during the year between the first two waves.  Daily smokers who had not tried quitting were excluded.

Pierce divided those 2,443 daily smokers who had failed to quit between Waves 1 and 2 into three groups: those who had tried stop-smoking medicines (a prescription and/or over-the-counter medicinal nicotine, n=442); those who had tried e-cigarettes (n=566, 116 of whom had also used stop-smoking medicines); and those who had used neither (i.e., had gone cold turkey, n=1,435).

After the three groups of smokers had failed between Waves 1 and 2, Pierce compared them at Wave 3 (one year after Wave 2) with respect to three outcomes: abstinent from cigarettes for 12+ months; abstinent from cigarettes for 30+ days; and abstinent from all tobacco. 

The researchers found that the first two outcomes for all groups were similar: “Twelve-month cigarette abstinence was ~10% and comparable across all methods used to quit… There was no net risk difference in 30+ days cigarette abstinence at W[ave]3 between the e-cigarette group and either the no e-cigarette control, the no [cold turkey group] or the [medicine group].”     

While the authors apparently approved their press release headline – “E-cigarettes Don’t Help Smokers Quit” – they failed to note that e-cigarettes had helped people quit as often as medicinal nicotine, other medicines or going cold turkey.  In fact, all of the quit aids helped some smokers.  The headline should have read: “E-cigarettes, Nicotine Medicines, Prescription Medicines and Cold Turkey All Help Some Smokers Quit.”

Another red flag with this study is that it focused only on 2,443 “daily smokers” at Wave 1 who had tried to quit between Waves 1 and 2, but were also daily smokers at Wave 2 and additionally had information at Wave 3.  That number represents a remarkably narrow subset of all daily smokers at Wave 1 (about 27% of the 9,021 daily smokers at Wave 1).

Even more important, the authors completely ignored former smokers at both Waves 1 and 2 who had already used e-cigarettes (and other aids) to quit in the year before.  The Wave 1 former smokers were documented by my research group in a 2017 research study.  It is entirely inappropriate for Pierce et al. to issue a press release claiming that “E-cigarettes don’t help smokers quit” when they produced results only for a select population of daily smokers who remained daily smokers after trying to quit. 

While Pierce et al. narrowly defined their study groups, another study of PATH Waves 1 to 3 has produced diametrically opposite results.  Investigators at New York University, Ohio State, Georgetown and Columbia, led by Allison Glasser, coauthored a study that concluded: “…consistent and frequent e-cigarette use and increasing use over time, as well as flavors and device type, are associated with smoking cessation among adult smokers.”  They also found that “flavors may play a facilitating role in cigarette smoking cessation among adults. Use of a rechargeable device consistently…was also associated with a higher likelihood of smoking cessation within the past year when compared with use of disposable devices, although this effect was only found among daily smokers.”

The Pierce study and its PR spin underscore the importance of critical analysis and fact-checking of all research reports, even when “co-written” by dozens of authors and ostensibly peer reviewed.

 

  

More Proof from FDA Population Data Showing E-Cigarettes As Popular Quit-Smoking Aids

While the number of American vapers declined over the last three years (as I reported here), e-cigarettes were still far more popular quit-smoking aids than medicinal nicotine or other drugs, according to researchers at the University of California San Diego (here).

Tarik Benmarhnia and colleagues used information from Waves 1 and 2 of the FDA-funded Population Assessment of Tobacco and Health (PATH) Study to evaluate “the influence of [e-cigarettes] and pharmaceutical cessation aids [varenicline, bupropion and nicotine medicines, NRT] on persistent abstinence (≥30 days) from cigarettes, and reduced cigarette consumption” during the period 2013 to 2015.  They concluded:

“Our results indicate that [e-cigarettes] are a more popular choice than approved pharmaceutical products as a smoking cessation aid among US quit attempters, over three quarters of whom were daily smokers.  In the future, as [vapor] products continue to evolve to make nicotine delivery more similar to that obtained from a cigarette, it is possible that they may play a bigger role in assisting smokers to quit combustible tobacco.”

This study confirms my research group’s earlier analysis of Wave 1 PATH data: E-cigarettes are among the most commonly used quit aids for American smokers, and they are the only aid more likely to make one a former smoker (i.e., a successful quitter) than trying to quit cold-turkey (here).