Vapes containing nicotine are a more effective quit-smoking aid than nicotine lozenges and gum among adults experiencing social disadvantage, who typically have a harder time quitting than others, according to results from a landmark clinical trial.
Australia has one of the lowest smoking rates globally – currently, 8.8% of adults are daily smokers – however, socially disadvantaged people smoke at a rate three times higher than their more advantaged peers.
While these individuals are just as motivated to quit smoking, they find it harder to quit and, as a result, suffer the most from the health and social impacts caused by tobacco.
But new research from the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, published in the Annals of Internal Medicine, demonstrates that vaping is an effective quit-smoking aid for this priority group.
“Vapes are not a magic cure, but they are a promising treatment option that leads to higher quit rates than nicotine gum or lozenges for those experiencing social disadvantage,” said Associate Professor Ryan Courtney, lead researcher and Head of the Tobacco Research Group at NDARC.
“For some smokers, they have tried every treatment option, and additional approaches are needed to lift quit rates.”
As part of the clinical trial, A/Prof Courtney’s team recruited more than 1000 adults who smoked daily, were willing to make a quit attempt, and were receiving a government pension or allowance (which acted as an indicator for social disadvantage).
Participants were randomly allocated to an 8-week supply of either two vaping devices and flavoured e-liquids (tobacco, mint or fruit), or NRT in the form of lozenges or gum.
After six months, continuous verified quit rates were higher in the vaping group at 28.4% compared to just 9.6% in the NRT group.
“Even after accounting for individual differences within a socially disadvantaged sample, our analysis found quit rates were superior for the vaping group compared to NRT irrespective of age, gender, nicotine dependence and recent diagnosis or treatment for mental health disorder,” said A/Prof Courtney.
The design of the study, which aimed to mimic the real world by giving participants a choice of vaping device and flavour, was a key component to its success.
“We believe treatment choice in the vaping group with the option of two different device types and three e-liquid flavours, paired with an encouraging and non-judgemental text messaging program supported people to quit smoking and contributed to high abstinence rates,” said A/Prof Courtney.
“Vapes, in addition to delivering nicotine, provide some of the sensory and behavioural aspects that people miss when they quit smoking.
“Cost of living pressures and the price of cigarettes may also be part of the reason why vapes help people in our community on a fixed income to quit smoking.”
Professor Nicholas Zwar, Chair of the Expert Advisory Group for the Royal Australian College of General Practitioners Smoking Cessation Guidelines, said this study is further evidence that nicotine vaping is an effective smoking cessation aid and should be considered in people who have not been able to quit successfully with approved therapies such as NRT.
“This study is also important as it used nicotine pod devices, which are the most widely prescribed in Australia due to their low risk of accidental or intentional poisoning,” said Professor Zwar, who was a co-author on the study.
However, despite the treatment success, the study found new challenges on the horizon for peak health bodies and health professionals supporting smokers to quit when using vapes.
For those who had successfully quit smoking cigarettes, 58% continued to vape their allocated study-supplied product at the end of follow-up.
“The trial findings consolidate our understanding of vaping products role in smoking cessation, and the research findings illustrate that for some who have managed to quit, they may need support to stay vape-free in the longer term,” said A/Prof Courtney.
“People who switch from smoking to vaping should ultimately aim to stop vaping too once they feel confident that they won’t relapse back to smoking, as the long-term health effects of vaping itself are unknown.
“It’s never too late to quit and vaping products are a further tool in the tobacco treatment toolbox, but more work is needed to support general practitioners, pharmacists and Quitlines when providing patient care regarding vapes.”
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Contact details:
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