E-cigarettes much better for quit smoking

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Those who used e-cigarettes to quit smoking succeeded at almost double the rate of those using methods like nicotine patches and gum, according to a report in the New England Journal of Medicine.

The researchers analyzed data from three waves of the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013-2016) in their effort to evaluate the association between prior e-cigarette use and use of other non-cigarette tobacco products with later cigarette initiation over a roughly 2-year period. And among participants who had issues with coughing and phlegm before the trial began, significantly fewer in the vaping group had those symptoms after a year. That study, Hajek et al. note, "used cartridge e-cigarettes with low nicotine delivery and no face-to-face contact". The journal was apparently so embarrassed about the positive results that it commissioned not one but two accompanying editorials slamming e-cigarettes, one offering questionable advice to doctors (insist smokers try and fail with NRT first; use low nicotine vaping products), and the other advocating for a vaping flavor ban.

The e-cigarette group were nearly twice as successful, with an abstinence rate of 18%. That was a reversal of a hands-off approach to e-cigarettes Gottlieb took in 2017 that was followed by a 75 percent rise between 2017 and 2018 in use of e-cigarettes by children and teens.

However, some experts have said e-cigarettes, while safer than normal cigarettes, are not harm-free, and their long-term effects are not yet known.

Some research has previously suggested e-cigarettes might help smokers cut back or quit altogether, but other studies have raised concerns about their use among teenagers.

Philip Morris International Inc., whose sister company Altria Inc.is seeking FDA approval to sell its "heat-not-burn" IQOS tobacco device, said a balance must be struck between seeking to prevent teens from using nicotine products and helping to move adult smokers away from cigarettes.

"Although a large number of smokers report that they have quit smoking successfully with the help of e-cigarettes, health professionals have been reluctant to recommend their use because of the lack of clear evidence from randomised controlled trials".

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According to the study, after one year, 18 percent of e-cigarette users had stopped smoking while only 9.9 percent of participants were able to quit with the other cessation products. To objectively measure their progress, they also had their breathing levels of carbon monoxide (a common toxin in cigarette smoke that lingers in exhaled air) monitored.

Both treatment groups also received weekly behavioural support for at least four weeks.

The researchers didn't test e-cigarettes against new drugs such as Pfizer's Chantix, which has shown higher rates of success than older nicotine-based treatments. These devices now often have more nicotine and come in a more convenient form than the first-generation vaping devices.

"You may be more likely to be offered a cigarette, and you may be more exposed to tobacco industry marketing", Stokes said.

"If you have a method of helping people with smoking cessation that is both more effective and less costly, that should be of great interest to anyone providing health services", said Kenneth Warner, a retired University of MI public health professor who was not involved in the study. People who said they had stopped smoking after 1 year were asked to attend for a carbon monoxide screen to confirm their claim.

Because of the nature of the treatments, it wasn't possible to disguise from people whether they were using e-cigarettes or NRT products. In addition, some flavorings of e-cigs have been shown to be harmful.

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