Let's talk e-cigarettes

Jamie Hartmann-Boyce and Nicola Lindson discuss the September 2021 update of their Cochrane living review of electronic cigarettes for smoking cessation, their response to a paper by Pisinger et al 2020 and emerging evidence in e- In this episode Jamie Hartmann-Boyce and Nicola Lindson discuss the emerging evidence in e-cigarette research and two recent publications by the group: the September 2021 update to the Cochrane living review of electronic cigarettes for smoking cessation; and a response to a paper by Pisinger et al 2020. This podcast is a companion to our Cochrane living systematic Review and shares the evidence from monthly searches and review findings.

Jamie and Nicola discuss the team's response to a paper by Pisinger and Vestbo 2020, and underline that the aim of the Cochrane process is to always focus on the evidence (DOI: 10.1183/13993003.02117-2021 or link).

They then outline the findings of the September update to the review which includes five new studies that have been added since the April 2021 version and includes search findings up to 1st May 2021. Overall the review includes 61 studies representing 16,759 participants. The main findings remain the same and some new comparisons have been included. There is still moderate certainty that nicotine containing e-cigarettes help more people to quit at 6 months or longer compared to e-cigarettes without nicotine or than NRT (nicotine replacement therapy). Uncertainty also still exists around nicotine containing e-cigarettes compared to no intervention (e.g. continued smoking). This reflects that the quality of the evidence is considered very low according to Cochrane standards. There is moderate certainty evidence that neither nicotine e-cigarettes nor non-nicotine e-cigarettes result in higher numbers of adverse or serious adverse effects.

Turning to new comparisons this update includes a study of a pod device (Russell et al), the findings were consistent with the other included studies that showed that more people quit at 6 months or longer using EC than with NRT. This update also includes a study comparing nicotine salt to free-base nicotine e-cigarettes; no clear differences were found between the two. We also included studies that provided 'dual users' (people who already use EC and tobacco cigarettes) with advice on how to use their EC to quit smoking; in one study there was no usable data in a second larger study (Martinez) there was a marginally better quit rate, however there was no clear evidence of benefit.

In response to feedback, for the first time in this update, data is included on the proportion of participants still using e-cigarettes or quitting aids) at six months or longer. Data from two studies comparing nicotine EC with NRT were notably different, with one finding no difference in the proportion of participants still using study product at longest follow-up, and the other finding significantly higher levels of EC use than NRT. There was no evidence for a difference in the proportion of people still using EC at longest follow-up in two studies comparing nicotine EC with non-nicotine EC. For all other studies the majority of participants that had been given nicotine EC at the start of the study were still using EC at 6 months or longer. Jamie and Nicola discuss the different ways that this result could be interpreted. It will be important to collect more information on this outcome.

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 August 1st and September 1st. The August search found one linked study by Rubenstein et al 2021 (doi: 10.1016/j.addbeh.2021.107037) and two new ongoing studies (El-Khoury et al 2021 (doi: 10.1136/bmjopen-2021-048859); and NCT04708106 2021). No new studies were found in the September 1st search. We will include the studies we've found in future updates of the Cochrane review.

 

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research. Dr Katie Myers Smith discusses findings from her recent study. Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and Dr Katie Myers Smith responds to questions on her recent research. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches.

In the July episode Dr Katie Myers Smith from Queen Mary University of London talks about her team's recent study looking at e-cigarettes versus nicotine replacement therapy (NRT) as a harm reduction intervention for people who smoke and who find quitting difficult. Their randomised controlled study compared e-cigarettes with NRT in 135 people who smoked and who were previously unable to stop smoking with conventional treatments. Dr Myers Smith's study found that in people who smoked and were unable to quit using conventional methods, e-cigarettes were more effective than NRT in facilitating validated long-term smoking reduction and smoking cessation, when limited other support was provided.

We will include the results in our Cochrane review. For more information on the study see Myers Smith et al 2021, Addiction, June 2021, DOI: 10.1111/add.15628 .

Our July 2021 literature search identified two new included studies (Myers Smith et al 2021, DOI: 10.1111/add.15628 ; Kimber et al 2021 DOI: 10.1016/j.addbeh.2021.106909 ) and two reports linked to studies already in the review (Leavens et al 2021, DOI: 10.1111/add.15597 linked to Pulvers 2020; Jones et al 2021, DOI: 10.1097/ADM.0000000000000881 linked to Klonizakis 2017).

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

In the June episode Jamie Hartmann-Boyce talks with Professor Thomas Brandon from the University of South Florida and the Moffitt Cancer Center on his team's new study published in Lancet Public Health. This study is a randomised control trial and investigates the effect of tailored advice to dual users of combustible and electronic cigarettes on how to use their electronic cigarette to quit combustible cigarettes. This targeted self-help intervention with high potential for dissemination could be efficacious in promoting smoking cessation among dual users of combustible cigarettes and e-cigarettes. We will include the results in our Cochrane review. For more information on the study see: Martinez 2021 (https://www.thelancet.com/pdfs/journals/lanpub/PIIS2468-2667(20)30307-8.pdf).

Our June 1st literature search found one new protocol by Elling et al 2021 (doi: 10.2196/27088) and two linked studies (NCT01188239 linked to Caponnetto 2013a and a dissertation by Guttentag linked to Tseng 2016 (doi: 10.1093/ntr/ntw017).

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Tim Coleman. Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Tim Coleman. 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 Professor Tim Coleman from the University of Nottingham's Faculty of Medicine and Health Sciences. Professor and GP Tim Coleman discusses a study he is carrying out with colleagues from Queen Mary University of London which looks at helping pregnant women who smoke tobacco cigarettes quit smoking. This trial of 1140 pregnant women compares usual care of behavioural support plus nicotine patches to behavioural support plus e-cigarettes in women willing to receive help to stop smoking. This multi-centre randomised control trial is taking place in the UK and we will include the results in our Cochrane review when these become available. For more information on the study see: https://fundingawards.nihr.ac.uk/award/15/57/85

Our May literature search found four new ongoing studies which may be relevant to our review when they are completed.

Jamie Hartmann-Boyce and Nicola Lindson discuss the April 2021 update to their Cochrane living review of electronic cigarettes for smoking cessation and respond to questions from listeners. Jamie Hartmann-Boyce and Nicola Lindson discuss the April 2021 update to the Cochrane living review of electronic cigarettes for smoking cessation. This podcast is a companion to this Cochrane Review and shares the evidence from monthly searches and review findings.

In this episode Jamie Hartmann-Boyce and Nicola Lindson discuss the latest update to the review and respond to questions covering subjects, such as risk of bias, design of randomised control trials (RCTs), second hand vapour and sustainable cessation, put to them by listeners. This update includes six new studies that have been added since the 2020 version of the review and we are pleased to see the first inclusion of an RCT studying e-cigarette pod devices. There is still moderate certainty that nicotine containing e-cigarettes help more people to quit at 6 months or longer compared to e-cigarettes without nicotine or than NRT (nicotine replacement therapy). Uncertainty still exists around nicotine containing e-cigarettes compared to no intervention (eg continued smoking). This reflects that the quality of the evidence is considered very low according to Cochrane standards. In this update the low certainty evidence for no difference in adverse and serious adverse effects between nicotine e-cigarettes and non-nicotine e-cigarettes has been upgraded to moderate certainty evidence.

Jamie and Nicola also bring us up to date with the literature search conducted on April 1st, which found one linked and two new ongoing studies. doi: 10.3390/ijerph18020430 ; ANZCTR - Registration ; https://doi.org/10.1093/ehjci/ehaa946.2359

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

In the March episode Jamie Hartmann-Boyce interviews Professor Caitlin Notley from the Addiction Research Group at the University of East Anglia. The interview covers her qualitative research that centres on electronic cigarettes as a harm reduction tool, smoking cessation and relapse prevention in vulnerable populations. Professor Notley also discusses relapse prevention in pregnant and post-partum women and the role of social identity.

As well as our usual searches, in March we searched conference abstracts from the annual meeting of the Society for Research on Nicotine and Tobacco (SRNT). We identified four new included studies, five new ongoing studies and five papers linked to studies already included in the review. The four new studies identified are summarised in the ‘in a nutshell’ section of the podcast. They are all reported as conference abstracts; three of which were identified from the SRNT 2021 abstract book (SYM2A, SYM2B, PH‐353; https://www.srnt.org/page/2021_Meeting). The fourth was found in a systematic review identified through our search and is available here: http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1091.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Dr Rachna Begh. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. In this episode Jamie Hartmann-Boyce and Nicola Lindson interview Dr Rachna Begh about the findings from her ongoing UK Management of Smoking in Primary Care, MaSC, study. This randomised controlled study explores the feasibility, acceptability effectiveness of general practitioner and nurse promotion of e-cigarettes versus standard care for smoking reduction and abstinence in people who smoke and who have smoking-related chronic diseases who are unwilling to stop smoking.

Jamie & Nicola review 4 new studies & interview Prof Jasjit Ahluwalia. In this episode Jamie Hartmann-Boyce and Nicola Lindson interview Professor Jasjit Ahluwalia about his team’s recent study on the effect of pod e-cigarettes vs cigarettes on carcinogen exposure among African American and Latinx smokers (Pulvers, 2020, see links to all studies in short description above). They also talk through three other studies: Schiebein et al, an exploratory non-randomized study of an e-cigarette intervention with people accessing a homeless supported temporary accommodation service; Orga-Hess et al’s study which tested a method for evaluating the effects of e-cigarettes on quit-related motivation and behaviour; and a study by Yingst et al which explored the acceptability of electronic nicotine delivery systems (ENDS) among HIV positive smokers.

Studies discussed:

Pulvers 2020: 10.1001/jamanetworkopen.2020.26324

Ozga-Hess 2019: 10.1016/j.addbeh.2019.106105

Scheibein 2020: 10.1186/s12954-020-00406-y

Yingst 2020: 10.1080/09540121.2019.1687

Jamie Hartmann-Boyce and Nicola Lindson discuss their Cochrane Review and emerging evidence. Links to studies discussed:

Czoli et al: 10.1093/ntr/nty174 https://dx.doi.org/10.1093/ntr/nty174

Bonevski et al: 10.1093/ntr/ntaa143 https://dx.doi.org/10.1093/ntr/ntaa143

Eisenberg et al: 10.1001/jama.2020.18889 https://dx.doi.org/10.1001/jama.2020.18889