Dear Sian, [ https://www.hifa.org/dgroups-rss/tobacco-93-q5-what-are-pros-and-cons-va... ]
Thank you very much for this very complete summary that you have presented, with which I agree in "almost" everything, except the observation on the subject of the use of electronic cigarettes for smoking cessation, and I want to explain myself well about it.
There would appear to be evidence that e-cigarette use as part of research studies (in a controlled environment) would effectively aid smoking cessation. If that is confirmed, it would be very good news.
My concern (or at least one of them) is that the evidence in the "real world" (that is, in uncontrolled or OTC use) would not confirm the effectiveness that is mentioned. To this end, I cite the study published by Ruifeng Chen and colleagues at UCSD in Tobacco Control 2022 (“Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Cohort Study, 2017-19.”) The authors sum up their findings: “In this analysis of the most recent PATH Study data, smokers who reported using e-cigarettes to help them in their most recent cigarette quit attempt were less, not more, likely than other quit attempters to achieve either successful cigarette cessation or to become tobacco and e-cigarette free".
The justification for e-cigarette use is that they theoretically are a less dangerous replacement for cigarettes.
The mentioned study shows that adults are not using e-cigarettes to quit (what the FDA and tobacco companies call “switching completely”).
Furthermore, e-cigarettes would not work as well for smoking and tobacco cessation in the real world as FDA-approved medications or even quitting “cold turkey” without any aids.
In addition, another Systematic Review and Meta-analysis by Kim et al, that was published in Am J Health Behav.TM 2022;46(4):358-375, also casts doubt on the claim that e-cigarettes are effective in helping to quit smoking because it concludes that:
- No RCTs were identified, which would have provided the highest level of evidence
- The 2 meta-analyses conducted to investigate quit attempts showed contradicting results
- When restricting the analysis to prospective data evaluating odds of quit attempts at 6-12 month follow-up, no significant association was found
In their conclusions, the authors highlight that: The results of the meta-analyses emphasize temporality in the association between e-cigarette use and cigarette smoking quit attempts. Numerous methodological limitations, including inadequate definitions of e-cigarette use and non-adjustment for confounding variables, limit the confidence in conclusions that can be drawn on the causal association between e-cigarette use and cigarette smoking quit attempts.
Another point of concern is "dual" consumption (e-Cig and cigarettes). According to Osibogun's study (longitudinal transition outcomes among adult dual users of e-cigarettes and cigarettes with the intention to quit in the United States: Path Study (2013-2018). Prev. A Real-World Scenario, dual e-cigarette and cigarette use May Hinder Rather Than Facilitate Smoking Cessation Among those interested in quitting. This Needs Consideration When Assessing the Population Impact of E-Cigarettes and Their Role in Harm Reduction.
If we add to this the fact that the tobacco industry itself is promoting the use of electronic cigarettes... and they are not doing it to make people stop smoking! Because no company wants to do something to stop making money but rather to maintain or increase its profits.
All of that really leaves me in serious doubt as to whether the e-cigarette solution is a "real solution" or a "Trojan horse".
I strongly hope that we can find more effective and accessible aids that will help the majority of smokers to quit. But for now, I will continue to support and try to use the tools for which there is sufficient evidence of its effectiveness in cessation, and continue to fight against the systematic obstacles that are placed for accessing and using them properly.
I hope you can understand my point of view.
Best regards,
Eduardo
Dr. Eduardo Bianco
Director, International Policy Education
Email: ebianco@nextgenu.org
Web: NextGenU.org
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master’s in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Bianco’s research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. He is a member of the HIFA working group on substance use disorders. https://www.hifa.org/support/members/eduardo Email: ebianco AT nextgenu.org