E-cigarettes are nearly twice as effective as nicotine replacement treatments, such as patches and gum, at helping smokers to quit, according to a clinical trial led by Queen Mary University of London.
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.
The debate over the potential harms and benefits of vaping has raged on for years. A study cited by the National Institutes of Health showed that e-cigarettes do generate second-hand exposure to nicotine, but do not generate any second-hand exposure to the toxicants found in combustible tobacco.
Of those e-cigarette users who had stopped smoking after 1 year, 80% were still vaping regularly. "However, particularly in the US, smokers are not, in general, using e-cigarettes under such conditions". Nearly 179,000 youth who have tried cigarettes and more than 43,000 who are now smoking would not be if they had never started vaping, the study found.
Under Florida law, smoking is not allowed inside most businesses and restaurants, and state voters took the first step to eliminate secondhand e-cigarette emissions by approving an amendment a year ago to ban vaping and e-cigarette use indoors. Meanwhile the e-cigarette group showed a larger decline in coughs and sputum production - surprising, as these are respiratory symptoms. Even the success rate using nicotine replacement therapy seen in this study is actually pretty high compared to other studies measuring its effectiveness.
"We know that patients are asking about e-cigarettes and many doctors haven't been sure what to say", said Dr. Nancy Rigotti, a tobacco treatment specialist at Harvard Medical School who was not involved in the study.
Overall, adolescents who used e-cigarettes before trying any other tobacco products were more than four times as likely to be smoking traditional cigarettes within a couple of years compared to those who had never tried any type of vaping device or non-cigarette tobacco products, the study team reports in JAMA Network Open. "There is substantial evidence that they are less harmful than traditional cigarettes, but that doesn't mean they are not harmful".
Prof Hajek said he hoped the results of the study would lead to stop-smoking services offering quitters an e-cigarette starter pack and guidance on how to vape, after which they could pay for their own supplies.
"Something people often don't recognise is how vaping products have become much better substitutes for cigarettes over time".
"We really isolated a very low-risk group of youth, and within that group experimentation with e-cigarettes had a pronounced effect on subsequent cigarette uptake", Stokes said.
And while Gottlieb continues to promote the idea that there's a teen vaping epidemic, the data doesn't bare this out at all.
The delay has come under intense criticism amid an explosion in teenage vaping, driven chiefly by devices like Juul, which resembles a flash drive.
All participants were also tested to see if they were still smoking tobacco cigarettes, and had weekly one-to-one support for at least four weeks.
For one, the United Kingdom has already been pretty welcoming to the idea of e-cigarette use as a cessation tool.
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.
Myers' group is one of several anti-smoking organizations suing the FDA to immediately begin reviewing e-cigarettes.
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