Let's talk e-cigarettes

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Harry Tattan-Birch. In the September episode Jamie Hartmann-Boyce interviews Harry Tattan-Birch from the Department of Behavioural Science and Health, University College London. Harry Tattan-Birch talks about their team's recent randomised controlled trial examining whether, in adults receiving behavioural support, offering e-cigarettes together with varenicline helps more people stop smoking cigarettes than varenicline alone. Tentative evidence suggests that offering e-cigarettes alongside varenicline to people receiving behavioural support may be more effective for smoking cessation than varenicline alone. https://doi.org/10.1093/ntr/ntac149 Harry Tattan-Birch also discusses his research into heated tobacco products.

This work was funded by the Oxford University Public Policy Challenge Fund and Cancer Research UK.

Jamie and Nicola also bring us up to date with the literature search conducted between July and September 1st 2022. The July, August and September searches found 6 new studies. We will include the studies we have found in future updates of the Cochrane review.

For more information on the full Cochrane review updated in September 2021 see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage: https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Dr Francesca Pesola. In the June episode Jamie Hartmann-Boyce talks with Francesca Pesola from the Wolfson Institute of Population Health Queen Mary University of London. Dr Francesca Pesola talks to Associate Professor Jamie Hartmann-Boyce about the results from the trial comparing e-cigarettes to nicotine patches for smoking cessation in pregnant women. Professor Tim Coleman discussed this study in the May 2021 podcast and the results have now been published in Nature Medicine, Hajek et al 2022 (DOI: 10.1038/s41591-022-01808-0).

Dr Pesola outlines the need to identify smoking cessation aids to help women quit during pregnancy. Dr Pesola discusses the results of their randomised control trial of 1,140 participants comparing refillable e-cigarettes with nicotine patches. In this trial pregnant women who smoke were randomized to e-cigarettes or nicotine patches. Dr Pesola reports that the unadjusted analysis of the primary outcome of validated quit rates at the end of pregnancy were not found to be significantly different between the e-cigarette and nicotine patch arms. However, Dr Pesola explains that some people in the study used non-allocated products, for example people in the nicotine patch group were also found to be using e-cigarettes. This meant that if they then quit there was uncertainty as to whether the quitting behaviour was due to the nicotine patches or to the e-cigarettes. The study team had anticipated this behaviour and pre-specified that they would exclude people who were abstinent and who had used non-allocated products. Dr Pesola reports that after doing this e-cigarettes were found to be more effective than patches. The safety profile was similar for both study products, however, low birthweight (

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Neal Benowitz. In this episode Associate Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Professor Neal Benowitz. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches.

In the May episode Jamie Hartmann-Boyce talks with Neal Benowitz, Emeritus Professor at the University of California San Francisco, Professor Benowitz practices medicine, cardiology and clinical pharmacology and has a particular interest in tobacco as a major risk factor for cardiovascular disease.

Professor Neal Benowitz talks to Associate Professor Jamie Hartmann-Boyce about the toxicological data from studies of e-cigarettes. He stresses the importance of comparing e-cigarette use to combustible cigarette use, as the exposure to biomarkers that we can measure is much lower in people who vape than in people who use combustible cigarettes. Professor Benowitz points out that many e-cigarette users have been long-term combustible cigarette users so it is difficult to separate out the effects of each. He highlights the need for longitudinal studies among people who have only used e-cigarettes and have not used combustible cigarettes. Professor Benowitz also discusses the need to look at the different types of e-cigarettes, there are many different products and toxicity will vary between the different e-cigarette devices.

Jamie and Nicola discuss recent work comparing biomarkers of harm. Exclusive e-cigarette use was associated with lower levels of biomarkers of harm than exclusive use of combustible tobacco, or use of a combination of combustible tobacco. This work was funded by the Oxford University Public Policy Challenge Fund and Cancer Research UK.

Jamie and Nicola also bring us up to date with the literature search conducted on May 1st 2022. The May search found 2 new studies, 3 new ongoing studies and 2 records linked to previously identified studies. We will include the studies we have found in future updates of the Cochrane review.

For more information on the full Cochrane review updated in September 2021 see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Alex Liber. In the April episode Jamie Hartmann-Boyce talks with Assistant Professor Alex Liber, Department of Oncology at Georgetown University's School of Medicine, Washington DC, USA. Alex Liber discusses his work at the intersection between markets, public policy, and public health. Alex Liber discusses global tobacco control policy research and tax and price policy. He talks about why different countries react differently to policies and to why tobacco control is seen as the battle of politics, business, and health. He discusses the need for comparative regulatory language. Alex discusses the different e-cigarette policies adopted around the world. Turning to flavours Alex tells us about his work with his colleagues at Georgetown and the University of Michigan on the potential effects of a ban on the sale of menthol cigarettes in the United States. He expanded this work to on menthol cigarettes to look at European sales data and to the effect of the European Union's menthol cigarette ban of menthol cigarette sales in Poland. He reports that although the share of menthol cigarettes sales was 30% in Poland, cigarette sales overall did not drop. He explains that tobacco companies were able to convert their menthol cigarette smokers into standard flavour cigarette smokers, via rebranding cigarettes and flavouring cards. Alex is interested in documenting industry responses. Alex also discusses work looking at e-cigarette flavour bans and temporary bans in the US.

Jamie and Nicola also bring us up to date with the literature search conducted on April 1st 2022. The April search found 4 new ongoing studies. We will include the studies we have found in future updates of the Cochrane review.

For more information on the full Cochrane review updated in September 2021 see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Dr Ailsa Butler. Assistant Professor Jamie Hartmann-Boyce and Dr Nicola Lindson talk with Dr Ailsa Butler from the Centre for Evidence Based Medicine, University of Oxford and co-author of the Cochrane review of e-cigarettes for smoking cessation. They discuss the findings of their recent work on the longer term use of e-cigarettes when provided as a tool to stop smoking. In the studies eligible for the review, just over half of people given nicotine e-cigarettes at study start were found to be still using e-cigarettes at six or more months follow up. Of successful quitters, 70% were found to still be using e-cigarettes at six months or more. The longer-term use of nicotine e-cigarettes may reflect their success as a quit smoking aid by preventing relapse to smoking. A key question about long-term e-cigarette use in people who have quit combustible cigarettes is whether it prevents or facilitates relapse or has no effect on relapse. This work was funded by Cancer Research UK and Oxford University's Public Policy Challenge Grant. Jamie and Nicola also bring us up to date with the literature search conducted on March 1st 2022. The search found 1 record linked to a study already identified as ongoing. We will include the studies we have found in future updates of the Cochrane review.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Billie Bonevski. In this episode Assistant Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Professor Billie Bonevski. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches.

In the February episode Dr Nicola Lindson talks with Professor Billie Bonevski, Professor of Public Health, Flinders University, South Australia. Professor Billie Bonevski discusses her Team's QuiENDS pilot trial of electronic cigarettes for smoking cessation among people in alcohol and other drug treatment. Professor Bonevski discusses e-cigarettes as a harm reduction tool and as part of a solution to high levels of smoking and very low or non-existent rates of quitting seen in this group. The study looks at people using e-cigarettes to quit abruptly or to reducing more gradually. Going forward work has started on the follow up Harmony Trial.

Jamie and Nicola also bring us up to date with the literature search conducted on February 1st 2022. The February search found 2 ongoing studies and 2 records linked to a studies already included the review. We will include the studies we have found in future updates of the Cochrane review.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Billie Bonevski. In this episode Assistant Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Professor Billie Bonevski. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches.

In the February episode Dr Nicola Lindson talks with Professor Billie Bonevski, Professor of Public Health, Flinders University, South Australia. Professor Billie Bonevski discusses her Team's QuiENDS pilot trial of electronic cigarettes for smoking cessation among people in alcohol and other drug treatment. Professor Bonevski discusses e-cigarettes as a harm reduction tool and as part of a solution to high levels of smoking and very low or non-existent rates of quitting seen in this group. The study looks at people using e-cigarettes to quit abruptly or to reducing more gradually. Going forward work has started on the follow up Harmony Trial.

Jamie and Nicola also bring us up to date with the literature search conducted on February 1st 2022. The February search found 2 ongoing studies and 2 records linked to a studies already included the review. We will include the studies we have found in future updates of the Cochrane review.

In this episode Assistant Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Dr Sharon Cox. This podcast is a companion to the Electronic Cigarettes Cochrane Li The podcasts shares the evidence from the Cochrane monthly searches.

In the January episode Jamie Hartmann-Boyce talks with Dr Sharon Cox, Senior Research Fellow at the Department for Behavioural science and Health from University College London’s Tobacco and Alcohol Research Group. Study trial registry number: ISRCTN18566874

Dr Sharon Cox discusses her team’s multi centred cluster randomised controlled trial based in homeless centres in the UK. In this study people experiencing homelessness who smoke are being offered e-cigarettes or usual care. This trial is funded by NIHR. Centre staff will provide EC arm participants with a tank‐style refillable EC starter kit, a choice of nicotine strength e‐liquids and flavours and an EC fact‐sheet. E‐liquids will be supplied for four weeks at weekly intervals by centre staff. Participants will be given time to try different flavours and nicotine strengths at baseline and be permitted to switch between flavours in accordance with documented vaping practices.

Jamie and Nicola also bring us up to date with the literature search conducted on January 1st 2022. The January search found 4 ongoing studies and 1 record linked to a study already in the review. We will include the studies we have found in future updates of the Cochrane review.

For more information on the full Cochrane review updated in September 2021 see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage:

https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Anne Joseph. In the November 2021 episode Jamie Hartmann-Boyce talks with Professor Anne Joseph from the Department of Medicine, University of Minnesota Medical School, Minneapolis, about her study carried out with a team at the University of Minnesota and study's first author Kolawole Okuyemi, Department of Family and Preventive Medicine, University of Utah, Salt Lake City. DOI:  10.1093/ntr/ntab212

Professor Anne Joseph discusses her team's recent study that compares the effects of e-cigarettes with and without nicotine on patterns of combustible cigarette use and biomarkers of exposure to tobacco toxicants among African American smokers. Professor Joseph outlines that there are many reasons to look at the question of e-cigarette use with and without nicotine among African American smokers. African Americans are disproportionately impacted by tobacco-related diseases, for example lung cancer. This is in spite of different patterns of smoking by African Americans, such as smoking fewer average cigarettes per day but having more difficulty stopping smoking. In real world settings people change their behaviour without support of researchers and clinicians, Professor Joseph's study aimed to replicate this by providing little behavioural support. Participants were given a choice of menthol and non-menthol flavoured e-cigarette cartridges and were asked to use e-cigarettes ad libitum for 6 weeks. The majority of participants (88.6%) selected menthol e-cigarettes. Follow-up assessments were conducted at 2, 6, and 12 weeks post randomisation. Contrary to their hypotheses, they found that nicotine e-cigarettes did not significantly reduce the use of combustible cigarettes compared to non-nicotine e-cigarettes in this cohort of African American smokers. Their findings suggested that e-cigarettes were modestly associated with decreased use of combustible cigarettes among non-treatment seeking smokers, regardless of nicotine content, but without a reduction in tobacco toxicants.

Professor Joseph considered that although e-cigarettes have potential to reduce harm if substituted for combusted cigarettes (or if they promoted cessation) because of lower levels of tobacco toxicants, their study suggested that ad libitum use of e-cigarettes among African American smokers, with or without nicotine, resulted in modest smoking reduction but did not change toxicant exposure in a cohort where smoking cessation or reduction was not the goal. The authors considered that their data suggested that testing future harm reduction interventions using e-cigarettes should include more specific behavioural change coaching, including substituting for or completely stopping combusted cigarettes.

For more information on the full Cochrane review updated in September 2021 see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage.

Jamie and Nicola bring us up to date with the literature search conducted on November 1st. The November search found one new study described in the podcast. The DOI for the new included study (Okuyemi 2021) is 10.1093/ntr/ntab212 . We will include the studies we have found in future updates of the Cochrane review.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Nicholas DeVito. In this episode Jamie Hartmann-Boyce and Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Nicholas DeVito. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches.

In the October 2021 episode Jamie Hartmann-Boyce talks with Nick DeVito from the Evidence Based DataLab at the University of Oxford. They discuss his recent research which looks at e-cigarette manufacturers' compliance with clinical trial reporting expectations focussing on trials by Juul Labs and how they report their data. Nick's study was published in BMJ Tobacco Control (http://dx.doi.org/10.1136/tobaccocontrol-2020-056221). The discussion covered the importance of whether, where and how research findings are reported or published including publication bias and reporting bias, the selective reporting of outcomes. This interview covers the crucial role of trial registration for research transparency. Nick describes the FDA amendment act, in which studies are registered within 21 days with pre-registered outcomes and a primary completion date and that the results are to be put onto clinicaltrials.gov within a year. Clinicians, public health professionals, and the public cannot make informed choices about the benefits or hazards of e-cigarettes if the results of clinical trials are not completely and transparently reported. This interview highlights that transparency is key and the importance of all evidence being made available.

For more information on the September Cochrane review see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage.

Jamie and Nicola also bring us up to date with the literature search conducted on October 1st. The October search found one new included study two reports linked to studies already in the review, and one new ongoing (NCT04854616). The DOI for the new included study (Morris 2021) is https://doi.org/10.1007/s11739-021-02813-w. We will include the studies we've found in future updates of the Cochrane review.