The effectiveness of using e-cigarettes for quitting smoking compared to other cessation methods among adults in the United Kingdom

Does Self-Reported smoking cessation fatigue predict making quit attempts and sustained abstinence among adults who smoke Regularly?

BACKGROUND

Quitting smoking is difficult and many people who smoke experience cessation fatigue (CF) as a result of multiple failed attempts. This study examined the association of CF with making and sustaining a smoking quit attempt.

METHODS

Data analysed were 4,139 adults (aged 18 years or older) who smoked daily or weekly and participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Surveys (ITC 4CV) conducted in Australia, Canada, England, and the US. CF was assessed at baseline using a single question: "To what extent are you tired of trying to quit smoking?" with response options: "Not at all tired"; "Slightly tired"; "Moderately tired"; "Very tired"; or "Extremely tired". We used binary logistic regression models to test the hypothesis that baseline CF would predict lower odds of both making a quit attempt and sustaining abstinence for a month or longer at follow-up adjusted for socio-demographic and smoking/vaping-related covariates.

RESULTS

Persons who currently smoked and reported at least some CF were more likely to make a quit attempt, but less likely to sustain abstinence for at least one month, than those who reported no CF. These associations were independent of socio-demographic variables, and they did not differ by country.

CONCLUSION

Contrary to expectation, CF was positively associated with making a quit attempt and non-linearly associated with lower rates of sustained abstinence at follow-up. While these findings should be replicated, they suggest that people with CF may benefit from targeted support to remain abstinent after a quit attempt.

Exploring the Rise of E-cigarette Use Among Male Adolescents in Al-Ahsa, Saudi Arabia: Prevalence, Patterns, and Influencing Factors

BACKGROUND

The rising prevalence of electronic cigarette (E-cigarette) use among adolescents is a major public health concern. This study investigates the prevalence of E-cigarette use among male adolescents in Al-Ahsa, Saudi Arabia, and explores associated factors.

METHODOLOGY

A cross-sectional study was conducted from December 2022 to April 2023, involving 476 male students aged 12 to 19. Data were collected through structured questionnaires, covering sociodemographic information, E-cigarette usage patterns, reasons for use, sources of acquisition, awareness of nicotine content, and perceptions of harm. Statistical analysis was performed using SPSS 25 (IBM Corp., Armonk, NY), with significance set at p < 0.05.

RESULTS

The study revealed a prevalence of 17.4% E-cigarette use among participants, with 12.6% using E-cigarettes exclusively and 4.8% concurrently with traditional tobacco cigarettes. Key findings included initiation as early as age eight, sustained and frequent use, and motivations including peer influence (61.4%), curiosity (31.3%), and flavored options (26.5%). Online platforms (34.9%) and shopping malls (28.9%) were the primary sources of E-cigarette acquisition. Most participants were aware of the nicotine content (84.3%) and believed E-cigarettes were harmful (86.7%). Importantly, 69.9% expressed intentions to quit, with 44.6% planning to do so within 30 days. Significant associations were found between E-cigarette use, education level, and having friends who smoke.

CONCLUSION

This study highlights the prevalence of E-cigarette use among male adolescents in Al-Ahsa, Saudi Arabia, and identifies peer influence, curiosity, and appealing flavors as driving factors. Targeted prevention and intervention programs, along with regulatory efforts to restrict access, are urgently needed to address this growing public health issue. Increasing awareness of E-cigarette risks and providing cessation support are vital steps towards mitigating E-cigarette use among Saudi male adolescents.

Switching away from smoking at 12 months among adult JUUL users varying in recent history of quit attempts made with and without smoking cessation medication

Some smokers switch away from smoking using e-cigarettes, but guidelines recommend trying approved medications first. We analyzed switching in adult smokers using JUUL by their recent history of quit attempts and use of smoking cessation medications. Participants were 8511 adult (21+) established smokers (at baseline), in which 50.3% are daily smokers, in a longitudinal observational study who completed a survey 12 months after first purchasing a JUUL Starter Kit. At baseline, participants reported attempts to quit smoking in the prior year and use of pharmacotherapy (nicotine replacement therapy [NRT] or prescription medication) in their most recent attempt. The outcomes were switching (self-reported no past-30-day smoking) and 50%+ reductions in cigarette consumption. Multivariable analyses were adjusted for baseline covariates. Two thirds of the participants had made a quit attempt in the year before purchasing JUUL. Overall, 59% [58%, 60%] had switched at 12 months. Switching was more likely in those who had used NRT and who attempted quitting without medication versus those who used prescription medications or made no quit attempt. In adjusted multivariable analyses, only making a past-year quit attempt (vs. not) was associated with higher odds of switching (OR = 1.15 [1.04, 1.28]). Over 60% of dual users reduced cigarette consumption by ≥50%. These associations were largely similar in daily smokers. Twelve months after purchasing JUUL, almost all smokers reported either switching or reducing their smoking by 50%+, including those who had recently failed to quit smoking with approved pharmacotherapies. E-cigarettes provide an alternative route to abstinence from smoking for smokers with a history of cessation and cessation treatment failure.

Use of Vaping as a Smoking Cessation Aid: A Review of Clinical Trials

Purpose

Smoking is a global public health concern, with a significant negative impact on human health and healthcare spending. Vaping, or the use of electronic cigarettes (e-cigarettes), has emerged as a popular alternative to traditional nicotine replacement therapies (NRTs) for smoking cessation. While considered less harmful than combustible cigarettes, the long-term health effects of e-cigarettes (vaping) are unknown. Therefore, this study aimed to identify and provide a comprehensive overview of the performance of vaping in clinical trials.

Patients and Methods

A search was conducted in the ClinicalTrials.gov database on April 14th, 2023, using the search term "smoking cessation, e-cigarettes, NRTs, and vaping". Inclusion and exclusion criteria were defined to identify relevant clinical trials. Randomized controlled trials (RCTs) and non-randomized clinical trials that evaluated vaping as a therapeutic approach to smoking cessation were included.

Results

A total of 87 clinical trials were identified, of which only seven were related to smoking cessation through vaping as a form of treatment. The primary endpoint was the effect of vaping as smoking cessation, and the secondary endpoints were patients' abstinence rate, withdrawal symptoms, and adverse events of e-cigarettes. Most of the trials used e-cigarettes as an intervention, with some trials including a combination of e-cigarettes and other NRTs. The trials lasted from 4 weeks to 12 months. The overall results of the trials indicated that vaping was effective in helping smokers to quit. It was also associated with a lower risk of adverse events than combustible cigarettes.

Conclusion

Vaping appears to be an effective method for smoking cessation, and it is associated with a lower risk of adverse events than combustible cigarettes.

An examination of quitting smoking as a reason for vaping by the type of nicotine vaping device used most often among adults who smoke and vape: Findings from the Canada, England and the United States 2020 ITC Smoking and Vaping Survey

Several nicotine vaping product (NVP) device types are available to consumers, and many people who smoke report vaping to help them quit. This study included data from the Wave 3 (2020) ITC Smoking and Vaping Survey in the US, Canada, and England and included 2324 adults who were smoking cigarettes and vaping at least weekly. Device types currently used most often (disposables, cartridges/pods, or tank systems) were assessed using weighted descriptive statistics. Multivariable regression analyses were used to compare differences between respondents who reported vaping to quit smoking ('yes' vs. 'no/don't know') by device type, overall and by country. Overall, 71.3% of respondents reported vaping to help them quit smoking, with no country differences (p = 0.12). Those using tanks (78.7%, p < 0.001) and cartridges/pods (69.5%, p = 0.02) were more likely to report this reason for vaping than those using disposables (59.3%); respondents using tanks were also more likely than those using cartridges/pods (p = 0.001) to report this reason. By country, respondents in England using cartridges/pods or tanks (vs. disposables) were more likely to report vaping to quit smoking (with no difference between cartridges/pods and tanks). In Canada, respondents using tanks were more likely to report vaping to quit smoking than those using cartridges/pods or disposables (no difference between disposables and cartridges/pods). No significant differences by device type were found in the US. In conclusion, most adult respondents who smoked and vaped reported using either cartridges/pods or tanks, which were associated with greater odds of vaping for the purpose of quitting smoking versus disposables, with some country variations.

The Impact of the COVID-19 Pandemic on Smoking, Vaping, and Smoking Cessation Services in the United Kingdom: A Qualitative Study

BACKGROUND

Existing evidence suggests that while the coronavirus disease 2019 (COVID-19) pandemic triggered quit attempts among many smokers, it led some to smoke more and others to relapse back to smoking. These diverse effects have the potential to have a long-term impact on individuals' smoking and vaping behaviors.

AIMS AND METHODS

This study explored the effect of COVID-19 on smokers and vapers, vape shops (VS), and stop smoking services (SSS). A total of 39 semi-structured interviews were conducted with stop-smoking practitioners, tobacco control leads, smokers and/or vapers, and vape shop owners. Interviews were transcribed verbatim and analyzed thematically.

RESULTS

Four themes were identified: Lockdown as a barrier to becoming or remaining smoke-free; COVID as a catalyst for quitting and remaining smoke-free; changes in vaping and challenges for vapers and VS; and changes and challenges for stop smoking support. Fear of COVID resulting in severe health implications for smokers facilitated behavior change; however, the boredom and monotony of lockdown and associated stress created difficulties in remaining a smoke free. Results showed that the enforced switch from face-to-face to the remote provision of SSS was beneficial for improving engagement, particularly for vulnerable groups such as pregnant women. Stop smoking professionals and vapers disagreed with the forced closure of VS because it created unnecessary difficulties for vapers to access supplies.

CONCLUSIONS

COVID-19 was both a barrier and facilitator for smoking cessation. Remote provision of SSS implemented due to lockdown was beneficial for hard-to-reach groups; services should look to incorporate these changes into day-to-day practice.

IMPLICATIONS

This study is one of the first to explore how the COVID-19 pandemic directly affected smokers, vapers, SSS, tobacco control leads, and VS. It provides evidence for the continued use of the remote provision of smoking cessation services to increase engagement among hard-to-reach groups and provides information on how pandemics can be a catalyst for health behavior change. This study is unique in that it incorporates the views of different stakeholders.

Prospective association between e-cigarette use frequency patterns and cigarette smoking abstinence among adult cigarette smokers in the United States

AIMS

To estimate the association of longitudinal patterns of e-cigarette use with cigarette smoking abstinence, after accounting for time-dependent confounding and selection bias.

DESIGN

Secondary analysis of longitudinal national cohort data. Using marginal structural models and four waves of the population assessment of tobacco and health (wave 1, 2013-14; wave 2, 2014-15; wave 3, 2015-16; wave 4, 2016-18), we estimated the association of vaping frequency across waves 2 and 3 with 12-month sustained cigarette smoking abstinence at wave 4, adjusting for time-dependent confounders at waves 1 and 2 and selection bias due to drop-out with inverse probability of treatment and censoring weights.

SETTING

United States.

PARTICIPANTS/CASES

A total of 5699 adults (18+ years) who smoked cigarettes and did not vape at wave 1.

MEASUREMENTS

The exposure was vaping frequency at waves 2 and 3 (non-use, non-daily use, daily use), representing nine possible combinations of vaping frequency across two waves. Non-use at both waves was the exposure reference group. The primary outcome was sustained 12-month cigarette smoking abstinence at wave 4.

FINDINGS

Among 5699 adults who smoked cigarettes at wave 1, a total of 560 (9.8%) reported smoking abstinence at wave 4. Compared with nonuse at both waves, daily vaping at both waves [risk ratio (RR) = 3.82, 95% confidence interval (CI) = 2.59-5.64] and non-use at wave 2 followed by daily vaping at wave 3 (RR = 2.50, 95% CI = 1.66-3.77) were positively associated with smoking abstinence; non-daily vaping at both waves was inversely associated with smoking abstinence (RR = 0.28, 95% CI = 0.11-0.75). Results persisted after accounting for misclassification of e-cigarette use and cigarette smoking abstinence and after restricting to participants with plans to quit smoking.

CONCLUSIONS

In a US cohort of adult smokers, longitudinal patterns of vaping frequency appear to predict smoking abstinence, even after accounting for several sources of systematic error. Consistent daily vaping is associated with increased chances of cigarette smoking abstinence, while consistent non-daily vaping is associated with decreased chances of smoking abstinence.

Modeling the longitudinal transitions of electronic cigarettes and conventional cigarettes with time-dependent covariates among adolescents

E-cigarettes may help combustible cigarette smokers switch to a less harmful alternative, or may increase the risk of subsequent initiation of cigarettes among non-smokers. Among youth, it is not clear whether both pathways occur equally, or whether one direction is more likely than the other. We used data from a prospective cohort study of youth in Southern California followed twice annually from Fall 2013 (9th grade) to Fall 2015 (11th grade) (N = 1977). A polytomous logistic regression model was used to simultaneously estimate transition rates for initiation of and abstention from e-cigarettes and cigarettes. Use of e-cigarettes was positively associated with initiation of cigarettes (OR = 7.57; 95%CI:[5.32, 10.8]) and negatively associated with cigarette abstention (OR = 0.58; 95%CI:[0.33, 0.99]) in adjusted models; cigarette use was positively associated with e-cigarette initiation (OR = 2.54; 95%CI:[1.45, 4.47]) and negatively associated with e-cigarette abstention (OR = 0.31; 95%CI:[0.17,0.57]). Uni-directional transition from e-cigarettes only to cigarettes only occurred less frequently than expected under independence (OR = 0.33; 95% CI [0.20, 0.55]), whereas simultaneously initiating both products (OR = 9.79; 95%CI:[7.22, 13.3]) and simultaneously abstaining (OR = 2.84; 95%CI:[1.50, 5.37]) were more frequent than expected. E-cigarettes were more strongly associated with subsequent cigarette initiation than the reverse, though both models indicated that use of either product seems to encourage use of the other. Models also indicated that use of either e-cigarettes or cigarettes resulted in reduced abstention of the other product. Findings suggest that prevention efforts for that continue to focus on both e-cigarettes and cigarettes are needed.

Do Current Smokers and Ex-Smokers Who Use Nicotine Vaping Products Daily Versus Weekly Differ on Their Reasons for Vaping? Findings from the 2020 ITC Four Country Smoking and Vaping Survey

This study examined reasons why adults who currently smoke or formerly smoked cigarettes use nicotine vaping products (NVPs) by vaping frequency (daily vs. weekly) stratified by smoking status. This cross-sectional study included 3070 adults from the 2020 ITC Four Country Smoking and Vaping Survey (Australia, Canada, England, United States) who reported using a NVP (vaping) at least weekly and who either currently smoke (n = 2467) or formerly smoked (n = 603). Respondents were asked to select the reason(s) they use NVPs, including to manage their smoking (reduce/quit or remain quit) and/or for reasons unrelated to managing smoking (e.g., to save money, enjoyment, flavours). We found that both current and former smokers endorsed an average of six reasons for vaping, with those vaping daily reporting significantly more reasons than those vaping weekly. Among current smokers, 72.8% reported vaping may help them quit smoking, 13.0% reported vaping to reduce smoking but not to quit, and 14.2% reported vaping only for reasons other than to reduce or quit smoking. The most common reason for vaping among current smokers was to reduce smoking (81.3%). Current smokers vaping daily were significantly more likely than those vaping weekly to report using a NVP to reduce smoking, for enjoyment, to reduce harm to themselves and others, to quit smoking, likeable flavours, and to save money. The most common reason cited for vaping by respondents who formerly smoked was enjoyment, with those who vaped daily more likely than those who vaped weekly to report vaping for enjoyment and to reduce harm to themselves. Nearly all reported vaping to help stay abstinent from smoking (92.3%), with no significant difference by vaping frequency. In conclusion, a majority of respondents reported using NVPs to manage their smoking (reduce/quit smoking or remain quit), particularly those vaping daily. Those who were vaping daily also endorsed a greater number of reasons other than managing smoking relative to those who were vaping weekly.

Associations Between E-cigarette Use and E-cigarette Flavors With Cigarette Smoking Quit Attempts and Quit Success: Evidence From a U.S. Large, Nationally Representative 2018-2019 Survey

INTRODUCTION

Although many studies have examined the association between e-cigarette use and smoking cessation, fewer have considered the impact of e-cigarette flavors on cessation outcomes. This study extends previous studies by examining the effects of e-cigarette use and e-cigarette flavors on quit attempts and quit success of smoking.

AIMS AND METHODS

We used data from the 2018-2019 Tobacco Use Supplement-Current Population Survey (TUS-CPS) survey. Multivariate logistic regression analyses were used to investigate the associations between flavored e-cigarette use with quit attempts and quit success of smoking among individuals who smoked 12 months ago. Two current e-cigarette use definitions were used in these logistic regression analyses; currently use every day or some days versus 20+ days in the past 30 days.

RESULTS

Compared to those not using e-cigarettes, current every day or someday e-cigarette use with all nontobacco flavors had an adjusted odds ratio (AOR) of 2.9 (95% CI: 2.4 to 3.5) for quit attempts and 1.7 (95% CI: 1.3 to 2.2) for quit success. 20+ days e-cigarette use with flavors had stronger associations with quit attempts (AOR = 4.2, 95% CI: 3.1 to 5.5) and quit success (AOR = 4.0, 95% CI: 2.9 to 5.4). E-cigarette users with nontobacco flavors were more likely to succeed in quitting compared to those exclusively using non-flavored or tobacco-flavored e-cigarettes. Menthol or mint flavor users had slightly higher odds of quit attempts and success than users of other nontobacco flavors.

CONCLUSIONS

E-cigarette use is positively associated with both making smoking quit attempts and quit success. Those using flavored e-cigarettes, particularly menthol or mint, are more likely to quit successfully.

IMPLICATIONS

E-cigarette use is positively associated with both making a quit attempt and quit success, and those using flavored e-cigarettes are more likely to successfully quit smoking, with no statistically significant differences between the use of menthol or mint-flavored e-cigarettes versus the use of other nontobacco flavored products. This suggests that the potential for e-cigarettes to help people who currently smoke quit could be maintained with the availability of menthol or mint-flavored e-cigarettes, even if other nontobacco flavored products, which are associated with e-cigarette use among youth, were removed from the market.

The UK Coronavirus Job Retention Scheme and smoking, alcohol consumption and vaping during the COVID-19 pandemic: evidence from eight longitudinal population surveys

BACKGROUND

Employment disruptions can impact smoking and alcohol consumption. During the COVID-19 pandemic, many countries implemented furlough schemes to prevent job loss. We examine how furlough was associated with smoking, vaping and alcohol consumption in the UK.

METHODS

Data from 27,841 participants in eight UK adult longitudinal surveys were analysed. Participants self-reported employment status and current smoking, current vaping and alcohol consumption (>4 days/week or 5+ drinks per typical occasion) both before and during the early stages of the pandemic (April-July 2020). Risk ratios were estimated within each study using modified Poisson regression, adjusting for a range of potential confounders, including pre-pandemic behaviour. Findings were synthesised using random effects meta-analysis.

RESULTS

Compared to stable employment and after adjustment for pre-pandemic characteristics, furlough was not associated with smoking (ARR = 1.05; 95% CI: 0.95-1.16; I²: 10%), vaping (ARR = 0.89; 95% CI: 0.74-1.08; I²: 0%) or drinking (ARR = 1.03; 95% CI: 0.94-1.13; I²: 48%). There were similar findings for no longer being employed, and stable unemployment, though this varied by sex: stable unemployment was associated with smoking for women (ARR = 1.35; 95% CI: 1.00-1.82; I²: 47%) but not men (0.84; 95% CI: 0.67-1.05; I²: 0%). No longer being employed was associated with vaping among women (ARR = 2.74; 95% CI: 1.59-4.72; I²: 0%) but not men (ARR = 1.25; 95% CI: 0.83-1.87; I²: 0%).

CONCLUSIONS

We found no clear evidence of furlough or unemployment having adverse impacts on smoking, vaping or drinking behaviours during the early stages of the COVID-19 pandemic in the UK. Differences in risk compared to those who remained employed were largely explained by pre-pandemic characteristics.

Differences in cigarette smoking quit attempts and cessation between adults who did and did not take up nicotine vaping: Findings from the ITC four country smoking and vaping surveys

INTRODUCTION

There is mixed evidence as to whether nicotine vaping products (NVPs) can help adults who smoke transition away from cigarettes. This study investigated if self-reported attempts to quit smoking and smoking cessation, over a period of either 18 or 24 months, differed between respondents who initiated nicotine vaping versus those who did not. Outcome comparisons were made between those who: (1) initiated vaping vs. those who did not; (2) initiated daily or non-daily vaping vs. those who did not; and (3) initiated daily or non-daily vaping between surveys and continued to vape at follow-up (daily or non-daily) vs. those who did not initiate vaping.

METHODS

This cohort study included 3516 respondents from the ITC Four Country Smoking and Vaping Surveys (Australia, Canada, England, United Sates), recruited at Wave 1 (2016) or 2 (2018) and followed up at Wave 2 (18 months) and/or 3 (2020, 24 months). Adults who smoked daily at baseline and did not have a history of regular vaping were included. Initiation of vaping was defined as beginning to vape at least monthly between surveys. Respondents indicated whether they made an attempt to quit smoking between surveys. Smoking cessation was defined as those who self-reported no longer smoking cigarettes at follow-up.

RESULTS

Relative to those who did not initiate vaping, initiation of any daily vaping between surveys was associated with a greater likelihood of smokers making a cigarette quit attempt (p < 0.001) and quitting smoking (p < 0.001). Among smokers who attempted to quit smoking, initiation of daily vaping was associated with a greater likelihood of being abstinent from smoking at follow-up (p = 0.001). Respondents who initiated vaping between surveys and were vaping daily at follow up were significantly more likely to have attempted to quit smoking (p < 0.001) and to have quit smoking (p < 0.001) than those who did not initiate vaping. Respondents who initiated non-daily vaping did not differ significantly from those who did not initiate vaping on any of the outcome measures.

CONCLUSIONS

Daily NVP use was associated with increased attempts to quit smoking and abstinence from smoking cigarettes. These findings are consistent with the concept that complete cigarette substitution may be more likely to be achieved when smokers vape nicotine daily.

Effect of vaping on past-year smoking cessation success of Australians in 2019-evidence from a national survey

BACKGROUND AND AIMS

Previous analyses of the effect of e-cigarettes on real world smoking cessation success have mainly been based on surveys undertaken in the United States and United Kingdom, where nicotine e-cigarettes can be readily obtained. In Australia, regulations have made obtaining e-cigarettes containing nicotine difficult. The effectiveness of e-cigarette use as a smoking cessation aid in Australia might therefore be lower than survey-based estimates published to date. This study aimed to estimate the effect of using e-cigarettes for a smoking cessation attempt on past-year smoking cessation success in Australia.

DESIGN

Multivariable logistic regression models for past-year smoking cessation success.

SETTING AND PARTICIPANTS

Respondents to the 2019 wave of Australia's National Drug Strategy Household Survey who made a smoking cessation attempt in the 12 months leading up to the survey.

MEASUREMENTS

Past-year smoking cessation success was assumed if a smoking cessation attempt resulted in abstinence of more than a month at the time of the survey.

FINDINGS

In 2019, Australians who attempted to quit smoking using e-cigarettes achieved greater success than smokers attempting to quit without e-cigarettes [adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) = 1.09-2.60]. If people who only tried e-cigarettes once or twice are considered not to have used e-cigarettes, the estimated effect was slightly stronger (aOR = 1.98; 95% CI = 1.27-3.10). Also, the estimated odds ratio was higher among vapers who acquired their e-cigarettes from overseas websites (aOR = 2.24; 95% CI = 1.02-4.93).

CONCLUSIONS

Use of e-cigarettes for a smoking cessation attempt appears to be associated with greater success among Australians who attempted to quit tobacco in 2019 compared with Australians attempting to quit without e-cigarettes, after adjusting for confounding effects.

Changes in the Patterns and Characteristics of Youth ENDS Use over Time

Research on youth use of electronic nicotine delivery systems (ENDS) has explored the correlates of initiation and use; however, little is known about the factors that predict continued youth use of ENDS. We used an ecological momentary assessment (EMA) burst design to explore both daily variability within adolescents over a two-week observation period and variability over time two years later (2018 and 2020). The contribution of device characteristics, motivations for use, contextual factors, and community factors to daily use occasions were explored. Youth participants (n = 35) at the start of the study were past two-week nicotine vapers, 14 to 17 years old, who resided within 100 miles of Louisville, KY, and reported past two-week ENDS use. Close to a quarter of participants ceased all tobacco use two years later, suggesting that some youth, despite prior regular vaping habits, may have only been experimenting with ENDS. The regular continued use of ENDS was predicted by trying to quit using cigarettes, appealing flavors, and being in locations where cigarette use was prohibited. Except for flavors, these factors did not affect ENDS use in year one. These findings suggest that tobacco policy might target ENDS use by prohibiting all tobacco use, including ENDS, in locations where smoking is already banned.

The Use of Tobacco Industry Vaping Products in the UK and Product Characteristics: A Cross-Sectional Survey

BACKGROUND

Tobacco industry (TI) companies have entered the UK e-cigarette ("vaping") market in recent years. However, their motives and ambitions are unclear. This study explored how popular TI vaping products are and who uses them, and how they differ from independent products.

METHODS

Secondary analysis of data from a longitudinal web-based survey of smokers, ex-smokers, and vapers (n = 3883) in the UK in 2019. The main study sample consisted of daily and nondaily vapers, who were current or ex-cigarette smokers, and had stated the brand of their preferred e-cigarette device (n = 1202). Proportions using TI and independent brands were calculated and regression analysis assessed associations with sociodemographic and smoking/vaping characteristics between vapers of TI and independent products. Chi-square tests were used to analyze differences between TI and independent products.

RESULTS

Overall, 53.4% used TI products. A university education (67.6%; adjOR = 1.54; 95% CI, 1.140-2.088), nondaily vaping (68.2%; adjOR = 1.39; CI, 1.029-1.880), and cigarette dependence (moderate, strong and very strong urges to smoke) were associated with using TI vaping brands. TI products used were less likely to be refillable ("open") than independent brands (60.9% vs. 18.3%, chi-square = 228.98, p < .001), more likely to use nicotine salts (16.7% vs. 8.6%, chi-square = 25.04, p < .001) and tobacco flavors (23.8% vs. 17.9%, chi-square = 12.65, p < .001).

CONCLUSION

TI vaping products were popular in the UK, associations with product and user characteristics suggest that TI products may be less conducive to smoking cessation, although the findings were not always consistent.

IMPLICATIONS

Consequences of regulations need to be carefully considered to ensure that independent producers are not more negatively impacted than tobacco industry producers, and to avoid reducing utility of products for smoking cessation.

How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries

OBJECTIVES

While smoking tobacco remains a substantial cause of harm in Europe, novel products such as electronic cigarettes or e-cigarettes (ECs) and heated tobacco products (HTPs) have entered the market recently. While debate still persists over the role of these novel products, they are now in widespread use. This study aimed to explore the prevalence and methods of attempts to quit EC and HTP.

SETTING

We analysed the 2020 Eurobarometer survey, which collected data in 28 European countries.

PARTICIPANTS

A representative sample of individuals residing in these countries aged ≥15 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Multilevel regression analyses were performed to assess differences in quit attempts and cessation methods among tobacco smokers and exclusive EC/HTP users separately.

RESULTS

51.1% of current tobacco smokers and 27.1% of exclusive EC or HTP users reported having ever made a quit attempt. The majority of former and current smokers (75.8%) who made a quit attempt did so unassisted, with 28.8% reporting at least one attempt using a cessation aid. The most popular cessation aids were nicotine replacement therapy or other medication (13.4%) and ECs (11.3%). 58.8% of exclusive EC or HTP users who had made a quit attempt did so unassisted, with 39.5% reporting the use of a cessation aid.

CONCLUSION

Most EC and HTP users in Europe try to quit unassisted, although more of them report the use of a cessation aid compared with tobacco smokers. Cessation support services should take into consideration the increasing numbers of users of EC and HTP who may be trying to quit.

Smoking cessation aids and strategies: a population-based survey of former and current smokers in Norway

BACKGROUND

In Norway, tobacco consumption is equally divided between combustible (cigarettes) and non-combustible (snus) tobacco. In the process of quitting, people who smoke can choose between several smoking cessation aids and strategies based on what is available on the market or what are recommended as cessation aids. A quit attempt may be planned or unplanned and consist of a gradual decline in consumption or an abrupt quitting. This study explores smoking cessation aids and strategies used at the latest quit attempt among people who have ever smoked. How prevalent is the use of various cessation aids and strategies, and do they correlate with each other? Are there any differences in successful quits depending on the use of a specific cessation aid or strategy?

METHOD

We used repeated cross-sectional representative surveys in Norway for 2017, 2018, 2019 and 2020. The analytic sample consists of people aged 20 years or older who have ever smoked daily, more precisely current daily smokers with at least one quit attempt (n = 476), and former daily smokers who quit in 2012 or later (n = 397). Participants answered questions on cessation aids and strategies used at their last quit attempt. Logistic regression analysis was used to estimate the associations between cessation aids and strategies and sociodemographic and smoking-related variables and successful quit attempts.

RESULTS

Fifty-six percent of people who ever smoked daily reported any use of cessation aids, and nicotine replacement therapy (NRT), snus and e-cigarettes were the most commonly used cessation aids. Snus and web/mobile use was associated with successful quits, while NRT was associated with unsuccessful quit attempts. When exclusive use was separated from the combined use of several aids, only snus was associated with successful quits.

CONCLUSION

Snus use was found to be a "stand-alone" cessation aid, and only weakly associated with the use of other cessation aids. Further investigation of cessation aid preferences is needed, especially among smokers with little or no contact with health services and/or for whom traditional cessation aids have no appeal.

A pragmatic randomised comparative trial of e-cigarettes and other nicotine products for quitting or long-term substitution in smokers

INTRODUCTION

Tobacco harm reduction has potential to improve individual and population health. However, little research exists on low-intensity interventions, such as encouraging longer-term NRT or e-cigarette use. We aimed to determine whether: 1) encouraging use of nicotine products as long-term tobacco substitutes is more effective for smoking abstinence than standard treatment, and 2) offering e-cigarettes is more effective than NRT.

METHODS

An open-label, parallel group randomised trial was conducted in Australia between 2014 and 2015, with 1563 adult daily smokers, randomised to: A) Standard cessation advice and NRT: advice to use NRT short-term B) Quit or substitute advice and NRT: advice to use NRT as a longer-term substitute for smoking if required to maintain smoking cessation or C) Quit or substitute advice and NRT and/or e-cigarettes. Participants were offered an initial supply of products they could then purchase for up to 7 months. The primary outcome was self-reported continuous smoking abstinence at 7 months. Point prevalence, dual use, and cigarette reduction were secondary outcomes.

RESULTS

At 7 months, 2.8% (N=9) of group A (N=324) were abstinent, compared with 1.8% (N=11) in B (N=620) and 1.3% (N=8) in C (N=619) (Adjusted ORs: B vs A 0.66, 95% CI: 0.27-1.63; C vs A 0.46, 95% CI: 0.17-1.21; C vs B 0.69, 95% CI 0.27-1.73). There were no suspected unexpected serious adverse reactions associated with trial products.

CONCLUSION

A free trial of NRT and first generation e-cigarettes and advice on long-term substitution was no better for smoking abstinence than usual care.

IMPLICATIONS

This pragmatic trial allowed the comparison of existing and alternative policy options under semi-realistic conditions, such as product choice and financial cost. All trial arms had low rates of smoking cessation. The findings suggest that providing unflavoured cigalike e-cigarettes without additional support may not increase quitting compared with advice to use standard NRT in a general population of Australians who smoke. More intensive support and education, and/or opportunity to try a range of e-cigarette products, may be required to motivate quit attempts using e-cigarettes.