Tuesday 4 January 2022

The awesome power of vaping

I don't post many studies about e-cigarettes and smoking cessation these days. The science was settled years ago, regardless of how much the WHO-Bloomberg spin machine tries to muddy the waters. Nevertheless, it cannot be said too often that vaping is remarkably good at getting people to stop smoking even when they have no intention of quitting. I have personal experience of this and it has been shown empirically in observational studies
It is quite something when you consider how few people manage to stop smoking even when they have a strong desire to do so.

A new study in JAMA Network Open provides some dramatic new evidence of this phenomenon. The researchers found 1,600 smokers in the USA who did not use e-cigarettes and had no intention of giving up smoking. They were followed for five years between 2014 and 2019. By the end of that period, 6.2% of them had stopped smoking, but there was a massive difference between the quit rates of those who had taken up e-cigarettes in the meantime and those who hadn't. 

The odds of cigarette discontinuation were significantly higher among those who used e-cigarettes daily (28.0%; 95% CI, 15.2%-45.9%) compared with those who did not use e-cigarettes at all (5.8%; 95% CI, 4.6-7.2; aOR, 8.11; 95% CI, 3.14-20.97), while the odds of cigarette discontinuation among those who used e-cigarettes nondaily did not statistically differ from those who did not use e-cigarettes at all.
... results showed that those who subsequently used e-cigarettes every day experienced an 8-fold higher odds of cigarette discontinuation compared with those who did not use e-cigarettes at all.

You read that correctly. The smokers who used e-cigarettes were eight times more likely to have stopped smoking after five years than the ones who didn't. 

Studies like this have some major implications. Firstly, vaping obviously works. If it can work for people who don't want to stop smoking, it can certainly work for the large number of smokers who do. 
Secondly, the anti-vaping crusades going on in the USA and elsewhere are extremely counterproductive and the prohibitions on e-cigarette sales in places such as Australia and India are insane. But you already you knew that, I'm sure. 

Thirdly, the UK government should take note. Thanks to Theresa May, it has an arbitrary target of bringing the smoking rate below 5% by 2030 (it is currently about 14%). It has very little chance of achieving this, not least because while groups such as ASH claim that 80% or 90% of smokers want to quit, this is a self-serving lie. In fact, the proportion of smokers who say they want to quit has been falling for years. In the most recent ONS survey, only 53% of smokers expressed a desire to quit.

In other words, even if every smoker who wants to quit manages to do so - a highly improbable outcome - the 5% target will not be met. There is no hope of getting near this target unless ways are found to make people quit 'accidentally' by giving them a more attractive substitute. 

This is particularly relevant because, as the authors of the study say... 

Smokers with no plans to ever quit smoking tend to smoke more cigarettes per day and have lower educational attainment and household income compared with their counterparts who do plan to quit...

This is as true in Britain as it is in the USA. These are the 'hard to reach' people who are patronised or ignored by 'public health professionals'. 

It should also be remembered that a third of smokers in Britain have still never tried an e-cigarette. Many of those who have tried vaping but have not made the switch might be tempted if the products were improved through technological innovation or better regulation, or if a more concerted attempt was made to counter the tidal wave of misinformation about the risks of vaping. For those who do not like vaping, newer products such as heated tobacco and nicotine pouches might be more to their liking. 

There are plenty of options and plenty of scope for constructive action. I don't think the government should have a target for smoking prevalence at all. If people enjoy smoking and don't want to quit, then they should be left alone. They are adults and this is supposed to be a free society. But if, as this study suggests, there is significant latent demand for vaping as a substitute for smoking, it is pretty obvious where the government should be focusing its attention.

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