Dr Jackson Responds

Posted 9th August 2019 by Dave Cross
Dr Sarah Jackson, Senior Research Associate at University College London, was lead author on a paper titled “Moderators of real‐world effectiveness of smoking cessation aids: a population study”. The study was published in Addiction Journal, which received a letter stating that continuing to use nicotine meant the smokers were not “abstinent”. Dr Jackson has responded.

The study found that vapers were 95% more likely to be able to quit than people not vaping, compared to only a third of smokers finding success with NRT.  They concluded: “It is the first study to evaluate the extent to which treatment efficacy is moderated by level of cigarette addiction and social grade in a real-world setting, providing useful insight that could enable treatment providers to tailor advice on which cessation aids may be most likely to help the user to achieve abstinence.”

Calling the study “robust”, Dr Leonie Brose of King's College London said: “This is in line with what has already been found in randomised controlled trials and extends these findings to adult smokers in the real world. While success rates were similar for varenicline and vaping, vaping is much more popular among smokers trying to quit smoking and thus helped more smokers quit.”

Martin Dockrell, tobacco control lead at Public Health England, celebrated the findings: “This is yet more evidence, adding to a major recent UK trial, that vaping offers some of the most effective help for smokers to quit smoking, especially when combined with expert support. All we need for an e-cigarette to be available on prescription is for one to be licensed as a medicine.”

But the paper was not received with glee by all, some commenting that vaping did not equate to cessation as vapers are still “addicted” to nicotine.

Dr Jackson responded: “In a recent study in Addiction Journal we found e‐cigarettes to be associated with the highest odds of success in quitting smoking. But how good really are they as a quitting aid if users continue to be dependent on nicotine?

In a letter to the editor, the issue was raised that smokers who quit with ecigs are not necessarily abstinent, but rather ‘smoke free, but dependent on nicotine’. The author asked for more data on product use past the point of cessation.

In our study, we defined our outcome as abstinence from smoking, rather than abstinence from nicotine as it’s the inhalation of toxins in tobacco smoke that is the key health risk. Nicotine, while highly addictive, does not carry the same risks.”

When we looked at long term product use, we found smokers who quit with ecigs were more likely than those who quit with NRT to still be using their chosen product at the time of the survey (i.e. up to 1y after they had successfully quit).”

However, this extended nicotine use should be weighed up against the likelihood of the smoker quitting via other means. If vaping helps those who would not otherwise have quit to do so, this is preferable even if it results in long-term ecig use and nicotine exposure.”

Overall, with ecigs found both to be an effective method of quitting and one of the most popular quitting aids out there, their potential to reduce smoking prevalence is substantial.”

Resources:

  • “Moderators of real‐world effectiveness of smoking cessation aids: a population study” by Jackson, Kotz, West and Brown – [link]


 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker