March 28, 2018
Nancy Rigotti and colleagues just published a well-done study of the effects of e-cigarette use on smoking cessation among a cohort of smokers who planned to stop smoking after being hospitalized. They randomized smokers into two groups, one that was given an active intervention to help them quit smoking and a control group who just received advice to quit. Smokers were followed prospectively for 6 months to examine successful quitting as a function of whether or not the patients used e-cigarettes as well as the assigned therapy.
Only 10.1% of the smokers who used e-cigarettes had quit smoking after 6 months compared to 26.6% of smokers who did not use e-cigarettes. In other words, smokers who used e-cigarettes while trying to quit had their chances of successfully quitting cut by two thirds.
This is a very strong study because it is done prospectively by a well-respected group. In addition, Rigotti and her colleagues carefully controlled for differences between the e-cigarette users and non-e-cigarette users and made a strong case that their results were very unlikely to be due to some unobserved confounder.
March 27, 2018
Tired of waiting for the FDA to deal with menthol and other flavored tobacco products, last fall the San Francisco Board of Supervisors passed a law ending the sale of all flavored tobacco products, including menthol. While other cities have passed restrictions on flavored tobacco products, the San Francisco law is the most comprehensive. Big tobacco in the person of RJ Reynolds dropped into town and is spending millions to convince voters to reject the law in a referendum election in June.
Why is the industry so hysterical about menthol/flavor bans? There is lots of survey research showing that many menthol smokers say that, without menthol cigarettes, they would just quit altogether.
March 27, 2018
Samir Soneji and his colleagues have just published the best-done model for assessing the effects of e-cigarettes on population health so far (including the one Sara Kalkhoran and I published). Their model accounts for the effects of e-cigarette use on youth and young adult initiation as well as cessation in adult smokers. The model is based on extensive population data on smoking behavior and how it evolves over time as well as the health effects of smoking. Most impressively, they use their baseline data to predict future behavior that was subsequently observed and show that the model is accurate. This is the first time anyone has done such a validation, which is a particular strength of the study.
What they find is that even making very optimistic assumptions about the effects of e-cigarettes on smoking cessation and assuming a 95% reduction in risk associated with e-cigarette use, the availability of e-cigarettes is associated with net population harm (1.5 million years of life lose based on e-cigarette use patterns in 2014).
They found about 80 new smokers for ever one that quit even making the optimistic assumption that smoking cessation increased among e-cigarette users.
March 8, 2018
In 2014 Lauren Dutra and I published “Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study,” showing that e-cigarette use was associated with progression from experimenting with cigarettes (kids who had “smoked a puff” of a cigarette) and established smoking (smoked 100 cigarettes). We got beat up by a lot of e-cigarette enthusiasts because the UCSF press release used the word “gateway,” which they said could only be demonstrated with a longitudinal study that followed kids forward in time. (The criticisms are at Youth experimentation with e-cigarettes: another interpretation of the data [JAMA. 2014]; Youth tobacco use and electronic cigarettes [JAMA Pediatr. 2014]; Tobacco control policy and electronic cigarettes [JAMA Pediatr. 2014]; Youth tobacco use and electronic cigarettes [JAMA Pediatr. 2014]. Our response is at Youth tobacco use and electronic cigarettes—reply [JAMA Pediatr. 2014])
March 7, 2018
Strong evidence for a huge gateway effect for e-cigs in England
Recently researchers from England, led by Ann McNeill and including prominent e-cigarette advocates, published a well-done study showing a huge gateway effect for e-cigarettes leading to cigarette smoking among youth in Great Britain.
The paper, “Association between smoking and electronic cigarette use in a cohort of young people,” published in Journal of Adolescent Health, showed that youth who initiated product use with e-cigarettes had 12 times the odds of smoking cigarettes 4 months later than kids who did not use e-cigarettes.
Two strengths of the study are that it is longitudinal (follows the kids forward in time) and controls for a wide range of other risk factors for smoking, including susceptibility to smoking. The fact that, controlling for susceptibility e-cigarettes have such a huge effect, indicates that (like other studies) e-cigarettes are attracting kids at low risk of initiating nicotine use with conventional cigarettes.