If basking young mate down the pub about FAPE in hands, one, they probably say.
No one agrees if it's safer on nuts, so you might as well smoke anyway.
Now, what Jemmy needs is a Cochrane review, all the facts have been checked at least twice.
They find there's a lot that the experts agree on.
I'd give you. Hi, everyone.
My name's Nicola Linson. I'm Jamie Hertzman.
And this is the second episode of our podcast series.
Let's Talk E-cigarettes, which is a companion to our living systematic review of e-cigarettes for quitting smoking.
This review. We search the e-cigarettes literature every month and find out what's new.
And we'll be summarising what we find here in this podcast. So thank you to everyone who listened to our first episode of the podcast.
We've had some really great feedback. Also, we are well aware that there is still plenty of room for improvement.
And I think that's a good point for me to say. Thank you to everyone on Twitter for your kind of efforts to try and crowdfund me a microphone.
Unfortunately, I have an unreliable authority that the issue is not actually with my microphone, but with my surroundings.
So I had been recording for me there, my kitchen or my garage.
Right now I am in my garage, which is a concrete block, essentially,
because my three and five year old and are in the house, which would probably make sound quality even worse.
But what I'm trying this time, and hopefully I sound a bit better, is I'm literally recording from under a blanket.
So Nicola is looking at me covered by a huge pink fleecy blanket, which might improve the sound and certainly at least makes this feel a bit comedic.
So our latest search was at the beginning of this month, at the beginning of January.
And this time around, we found six new papers.
One of those was linked to a study we'd already included, and another one is an ongoing study in the ongoing study.
We don't have that much detail on it.
So we don't know at this stage whether or not it will be included, but we'll look at any papers that eventually come out of it to cheque.
So those remaining four papers were for completely new studies.
And we're just about to take you on a whirlwind tour of those in our next section.
In a nutshell, so the first new study we found was a paper where the lead author was Florian QAI,
then from the Waterford Institute of Technology in Ireland and was published in the harm reduction journals in 2020.
He was a very small study of twenty three people who were recruited and Irish
supported temporary accommodation service for people experiencing homelessness.
This was a non-random I study and all participants had to be currently smoking at the beginning of the study.
All participants were given an e-cigarettes called the Injera T 22 E and to 10 millilitre nicotine liquids,
which were available in a variety of strengths and flavours.
The outcomes of interest to us in this study were carbon monoxide levels and side effects, which were measured at weeks one for eight and 12.
Of the study, there was a high dropout rate of 20 percent, which meant that actually only nine participants completed the intervention.
The participants had high levels of addiction and smoked a relatively high number of cigarettes per day.
Approximately 25.
Mean carbon monoxide measurements decreased from 21 parts per million to 16 parts per million, which was a 35 percent reduction in CO2 levels.
This decrease was not statistically significant.
However, that is not surprising as this study was underpowered due to the very low number of people that completed it.
Six of the nine participants reported the following side effects coughing, runny nose, bleeding nose,
slight sweating, dizziness, increased phlegm and a burning sensation at the back of the throat.
However, all of these would be considered relatively minor in a randomised controlled trial.
This study was funded by Knowledge Action Change,
which is a private company funded by the Foundation for a Smoke Free World, which is linked to the tobacco industry.
My second paper was published in the journal.
AIDS Cat in 2020 and was led by Jessica Yingst from the Penn State University College of Medicine in the US.
It also recruited a population of people who smoked. So in this case, that was people living with HIV and AIDS.
This study recruited 17 people, so it was also small and implemented across safer design.
Over three weeks, there were two types of e-cigarettes used.
One was the blue psychologic device with a 24 milligram per millilitre nicotine concentration,
and the other was the ego button operated device with a 36 milligram per millilitre nicotine concentration.
Both used tobacco flavoured liquids. Participants were randomly split into two groups, and each group use one of these cigarette types for a week.
After that first week, they all had a week where they stopped using e-cigarettes.
And then in the final week of the study, they used the cigarette that they hadn't used previously.
Again, this study looked at carbon monoxide levels and compared these between the two different types of e-cigarettes that we used.
They found that CO2 or carbon monoxide significantly reduced using based products,
but there was no significant difference between the two product type stuff. Great to hear about those, McLoud, particularly, I think.
Nice to see more and more work being done in some of these harder to reach populations.
So people familiar with our existing review will know that there is a study in there as well.
And people experiencing homelessness led by Lynn Dawkins and colleagues. That's, again,
a relatively small pilot study in and I think I speak for Nicole and I when I say we really
hope to be seeing more research and bigger studies in these populations moving forward.
So the third paper we found was a bit different.
It was published in the journal Addictive Behaviours and was led by Dr Jenny Oscar Haas at West Virginia University.
It was supported through state funds, all federal and university funding.
And it was a pilot study, which means it was conducted really to help inform the design of a potential larger study or studies.
Because in this case, what the authors were particularly interested in this paper was whether the method they were using to collect data worked well.
That's obviously not something that our review is interested in,
but we are including the study because it did look at carbon monoxide as well, which is an outcome we're interested in.
So in this study, 60 adults who smoked were assigned to either use only their brand of cigarettes or to a
second generation a cigarette to use as they liked and were followed up over four weeks.
The e-cigarettes in question was a Kanger mini protein, too, and they used a nicotine concentration of 18 milligrams per millilitre.
They could choose between three flavour options. And as I said before, they did measure carbon monoxide levels.
Now, it was in a relatively small group of participants, and the authors didn't formally test for a difference between the groups.
But the levels of carbon monoxide appear to have been lower in the E cigarette group than in the cigarette group.
And as I said earlier, there, a force that is the fourth one is from Kim Pulvers and her team published in JAMA Network.
Open funding for this came from the National Institutes for Health.
As I said, this trial was led by Dr. Kim Pulvers and she's based at the California State University, San Marcos.
The senior author for this was Professor Giles Ahluwalia at Brown University in the US.
And I was really excited to get the opportunity to speak to him about this.
And so you'll hear more about this new study in our next section, which is our deep dive.
And I think it's fair to say Nicole and I were also critically excited.
As I've said before, we got pretty excited about e-cigarettes research generally. But here this was one we really wanted to cover and our deep dive,
partly because it's one of the few to look at newer generation e-cigarettes devices and also
because it looks at non-white populations in the US who are historically under researched.
Now to my own mortification and just to set the scene. This interview also took place under a blanket.
So first off, all that jazz tell you about his history and how he got into harm reduction research.
So I've been working in this field of nicotine addiction and tobacco for about 30 years,
and my focus for that time has been on marginalised and underserved populations.
And I do a variety of different approaches to working on this.
But basically clinical trials, but additional to that, qualitative research and some epidemiology work.
And traditionally pharmacotherapy to help smokers quit smoking as well as behavioural approaches.
In fact, when e-cigarettes began to come on the scene, I essentially ignored them.
And I did not sort of move in that direction at all.
And in fact, as well, I focussed and stayed on the course of quitting and thought of abstinence only, if you will.
And I didn't have sort of believe in this concept, so to speak, of harm reduction.
While I used seatbelts and didn't leap to big a slice of a cake.
In terms of tobacco. I was not thinking about harm reduction in the way that I probably should.
And in fact, was a little bit rigid about it.
And then something maybe tipped off in me when I just began to realise that, you know, this may be something of interest.
So we did some pilot work together. Dr. Kim Pulvers, Dr. Nikki Nolan and myself, collaborators across the country at different institutions.
And we began to get excited about what we were finding. The pilot work suggested that people could switch and get off combustibles because,
in fact, it's combustibles that were the worst and the most deadly.
This led to us doing a randomised trial. And to some extent I've become a convert.
I've become very interested in the concept of harm reduction.
I accepted for some of the other aspects of medicine and healthcare in diabetes and obesity and nutrition and in substance use alcohol,
opioids, seat belts, helmet laws. It's just sort of everywhere.
We all practise harm reduction every day.
And so I find it fascinating when people who generally accept all these things are not accepting it in the field of tobacco and nicotine research.
So if you will, to some extent, I'm a convert. So in terms of harm reduction, there's actually no one agreed definition for what that means.
But broadly speaking, what people tend to mean when they talk about harm reduction are a range of policies,
usually in public health, that are designed to lessen the negative impact associated with various behaviours.
So as John's mentioned, in the case of seat belts, the behaviour that we're lessening the negative impact of is driving.
One of the most well-known harm reduction policies in addiction research is methadone treatment for people addicted to heroin.
It's really interesting, Jamie, that a very well accepted harm reduction policies like you just mentioned, like seatbelts and wearing bicycle helmets.
But in the field of tobacco research, people seem to be more split on how they feel about that.
And do you think this could be dependent on how people and researchers view the addiction and that they're perceived in the main harm,
maybe being from the addiction itself? And if that were the case, they might view switching one addiction for another,
say, in the form of nicotine treatment, like an aisle, tea or e-cigarettes.
They may see that as unacceptable, whereas maybe people who are research is in harm reduction see that as an acceptable
alternative because we hope that it's basically reducing the harm from smoking.
And certainly in the case of MLT, we have a lot of long term evidence to say that that is much safer smoking.
And now we're accumulating more evidence that obviously suggests that e-cigarettes are less harmful than smoking as well.
And so, yes, to some people, that's certainly a suitable alternative.
I think is a really interesting point.
I think there's probably a multitude of complex reasons why there might be slightly more hesitancy to embrace harm reduction in this area.
And of course, you just mentioned nicotine replacement therapy.
And in some ways, we might even think of nicotine replacement therapy as a harm reduction tool, but it's not often spoken about in that way.
I think one of the challenges here, of course,
is the troubled history of the tobacco industry and their potential role in e-cigarettes, research and and harm reduction methods.
But I think you're absolutely right that another element of it is just when we think about tobacco addiction,
what do we think the fundamental problem is? How do we frame it is the fundamental problem of addiction,
in which case switchin one addiction with another doesn't necessarily seem the most
intuitive solution or is the fundamental problem the harms caused by that addiction?
Right. And I think you and I probably both fall fall more into that latter paradigm of thinking.
The fundamental problem is. The harms. And I think that actually brings us nicely onto to the next thing James talked about,
which is why he was talking about some of the harm he's seen and why he is is really motivated to address that.
But it's profound, if I think about it. I'm I'm a physician. I'm trained in medicine policy and epidemiology and public health.
And so I think about things at the population level. But I also think about things at the individual level.
I'll never forget a patient I had when I was a resident at North Carolina Chapel Hill in the late 80s who had late stage COPD,
very late stage, so much so that when they had to sleep at night, they couldn't sleep in a bed because when you lie flat, you're suffocated.
So they would sleep in a reclining chair, but not reclining it and not sit facing forward to get ready for this sit, facing backwards,
leaning over the head of the chair, because that's the only way they could sort of breathe without feeling suffocated.
So I think for those that work in this area who don't practise health care.
Thank you for working in this area. But sometimes what they don't appreciate fully is the individual level situation.
Wow. I find that really. I do know.
Not really affecting example. And it is a good reminder, I think, of why we work in this field, certainly why I work in this field.
It resonates with me because a big reason why I'm interested in this area is through
observing a very close family member of mine quit smoking when I was a child.
And I remember it quite vividly, mainly because of how difficult I could see that they were finding it and.
Therefore, it just became something that I wanted to do, that I wanted to help people to to give up smoking because I'd seen how difficult it was.
And so often, I think in this field, if you're working on a trial or something like that,
the participants ask you whether you've been a smoker yourself.
And I completely understand why they might do that. But I think it's important for people to know that just because we may not have smoked ourselves,
it doesn't mean that we don't have a huge amount of empathy for people who do.
And for me, that's solely, you know, why I have an interest in this field.
And obviously examples that like that justice just give only reinforce the reasons why and why I wanted to do this.
So I think that's a really powerful example. I agree. I think it's it's incredibly powerful and.
And just like you, I sometimes get asked if I have ever smoked as well, and I never have.
And also completely understand the question.
And for me, the reason, I suppose, that I first got involved in tobacco research was actually back as an undergraduate in university when I,
I was getting really interested in public health and not interest for me came
from a place where I have lived with a long term condition since a young age.
I have type one diabetes. I got as a child and realised pretty quickly that there, having been a long term illness, is absolutely rubbish.
I wouldn't wish it on anyone. And got really interested in it.
Kind of, I suppose, acknowledging that no one wants to have an illness and trying to do what we can do to help people try and prevent those.
And for me, I suppose one of my really illuminating moments further on down the line and what got me hooked, I suppose,
on on a cigarette research is that when e-cigarettes were first coming out and we had, I suppose,
a growing body of evidence, really, that they were they looked significantly less harmful than cigarettes.
I was at a family dinner and and a family member who was very much addicted to smoking said to me,
oh, I considered switching to e-cigarettes, but I heard on the radio various scientists disagreed.
And some someone said that e-cigarettes have been worse for you than smoking. So I'm just gonna keep on smoking.
And and I really felt at that moment that we were doing something wrong.
As scientists in this area. So I think it's it's a privilege to work on this and we need to keep working on it, basically.
So on that note, I am going to let Jazz talk to us a bit about the reason why we contacted him in the first place,
which is that we wanted to hear about his really exciting new study with regards to our clinical trial.
So with the pilot data, we said we need to do a randomised trial.
We got some NIH funding, albeit a small grant, and we randomised in a two to one ratio so that we could get more experience with the e-cigarettes.
So we enrolled about 180 participants in total with a two to one randomisation scheme joule five percent compared to smoke your own, as usual.
And we enrolled people who were interested in switching to e-cigarettes in the United States.
We can't study as an outcome variable cessation. In essence, when you're switching the switch, a goal is to come off the combustible.
But stay on the e-cigarettes if you want to. I mean, to some extent, we're encouraging that.
That's sort of the approach. Well, the short term study, six weeks and the primary outcome was the study and A-L.
This is a potent pulmonary carcinogen. And that was the outcome of interest.
Obviously, we measured other things, including carbon monoxide or respiratory symptoms, score that's been validated,
curtaining pulmonary function tests, some basic ones, as well as systolic and diastolic pressure.
Great. Well, it's really interesting to hear about some of the the methods of the study.
And what kind of struck me with that is that the e-cigarettes that they use, Joule, is something that we don't really hear a lot about in the UK.
And. Obviously just mentioned that they used it at quite a high dosage.
And again, I don't think that dosage is used commonly in the case.
Do you know anything more about that, Jane? So that's absolutely right, Nick.
I mean, I think in the U.S., jewel is really, really commonly used.
And I suppose those of us working on a cigarette research in the U.K. kind of
watched and waited to some extent to see if that was going to happen here.
And it hasn't Jewel hasn't taken off here in the same way as it has in the U.S.
There probably are a whole host of reasons for that, not least of which are are advertising regulations, but also, as just touched upon in the states,
jaw's available and e-cigarettes generally are available at a higher nicotine
concentration than they are here in the U.K. and indeed throughout Europe.
Because the reason we have a cap on the amount of nicotine that's an e-cigarettes comes from the European Union's Tobacco Products Directive,
which basically limits the amount of nicotine, any cigarettes does something that's less than, I suppose,
the most common dose you'd have via duel in the U.S. and less than the dose that's tested in the study at face value.
I think that seems, you know, a really sensible thing to do to limit the amount of nicotine in e-cigarettes,
et cetera, especially if you're concerned about youth uptake.
But there is, of course, a flip side to that which which there's more and more research into.
And I suppose it touches back again to the fact that nicotine itself is not what the harmful thing is in cigarettes,
nor is it the harmful thing in e-cigarettes.
So jazz did actually go on and chat a little bit more about this nicotine dose issues, all that you listened to him explain it and a bit more detail.
Yes. So with our pilot data, we found through an open label trial single arm that looked like people could switch.
We used your five percent. So in the United States, five percent nicotine is the dose that's available.
And. Let me just say right now that that's the right percentage.
In fact, that should be the floor, not the ceiling. And I know in the UK that that dose is not available, if you will.
It's three percent.
And that's, you know, that's concerning to me because, you know, we don't if we think about therapeutics, we don't say to someone, oh,
use a seven milligram nicotine patch or a 40 milligram because over twenty one is too much or it's dangerous or anything like that.
In fact, the pharmacokinetics show that all those doses are too low for the average smoker.
So sometimes we use double nicotine patches. Likewise, here's a product.
And let me keep saying during this podcast that this is a product that is not safe.
That's not we're not trying to it this is not we're not trying to get a therapeutic indication, at least in my state, or at least right now.
It's not a safe product. It's a harm reduction product.
So the goal is to have the nicotine level in the product high and then to minimise the use of the product, if you will.
Right. Because if it's a lower nicotine strength, then you're going to use it to extract more nicotine.
You're going to use more of it.
And then you get, if you will, to so-called bad things, whatever they might be, heavy metals, Crowley and and things like that.
So another thing I know is, Jamie, when Jess was talking about the outcomes that they measured in their study was that they didn't actually
mention or seem to measure smoking cessation or the number of people who managed to quit smoking.
And that seems to be a little bit strange in a study of this type,
that they wouldn't look at the number of people who actually ended up stopping using combustible cigarettes.
Did you speak to him anymore about that, Jamie? Yeah. So, Niccola, absolutely.
For us and the UK, that does seem strange.
We think of the big trials here, which, of course, have measured smoking cessation, which is the ultimate aim.
I was also really puzzled about the situation in the US and trying to wrap my head around it.
So I did ask us to elaborate. And again, I'll let him explain the situation to you.
And the reason we can't study cessation is outcome the United States.
The best I understand that is, is that the FDA has different arms to it, if you will.
One is a device unit. Another is a medicinal therapeutics unit.
And in order to have. In order to study this for cessation, then you have to have a therapeutic indications, so you have to go through Ceder.
The Centre for Drug Evaluation and get it approved as a medicinal product,
as a therapeutic indication, the way nicotine patch, nicotine gum, veranda, clean perper undoes.
And you could also take it through the device category. But that probably wouldn't make much sense.
Sort of like a implantable defibrillator or something along those lines.
As such, it goes to the Centre for Tobacco Products. As a tobacco products, so is Sig's.
Interesting enough in the United States or categories categorised as a tobacco product?
I actually don't think they should be. But that's how they're categorised.
So because they didn't measure cessation in this study, Necla, their primary outcome was changes in measure of exposure.
And what they found is that at week six, the cigarette group had significantly greater reductions in an NHL carbon monoxide respiratory systems.
And the number of cigarettes smoked in the past seven days amongst those people who are still smoking.
And that is compared to the control group. There didn't seem to be any big change in Kotin in levels,
which is a measure of how much nicotine you're taking in and lung function and blood pressure remained unchanged and didn't differ between the group.
So essentially, those were the main findings in terms of their primary outcomes of what they set out to measure.
But actually, when I was talking to Johns about this, he was also really excited about some of their other results.
So we're now going to play a clip where he's explaining some of the other things they found in terms of their secondary outcomes.
So the primary study, of course, in a randomised trial is to compare the two different arms, the cigarette group, to the smoke your own.
And in our paper, which was published in JAMA Network Open, that's, of course, the primary finding that we report.
But in addition, we do report in the paper the secondary analysis, which, of course, break randomisation, but are more intriguing, if you will.
And very interesting, which is that if you take all the people who are in the arm of getting the e-cigarettes at the end of six weeks,
they can be in one of four buckets, one bucket, which many people might view as the ideal bucket.
And in fact, I would too, as well, is that they quit cigarettes and they quit e-cigarettes, that they just sort of no longer want anything.
In our study. We had zero people in that bucket, and that's fine.
That's expected. The other bucket, if you will, maybe the ideal outcome in a harm reduction study is,
is that you are only using e-cigarettes and you're completely off combustibles.
And for us, that was about 25 percent plus or minus the second bucket,
which most people view as a failure or as a no different than going back to cigarettes is a very common bucket.
It's the dual users. And for us, that was about fifty five percent plus or minus who are doing using.
Come back to that. And second, the third bucket. Is a bucket where you're going back fully to combustible cigarettes.
And that was about 25 percent as well.
Plus or minus.
So that's a very interesting analysis because it suggests that if you get the cigarette and you're followed over time and you can switch,
which about a quarter of them could. That's quite good news.
Interesting enough. We also followed people we have the funding for up to six months.
We didn't see them in person. And we did phone follow follow up.
So there's no biochemical verification. But we have self report and the data gets more interesting.
The number who successfully quit to e-cigarettes goes up.
The people who actually quit both products. We actually had about seven, eight percent quit both products.
And if you combine that those two numbers. That's a number that, if you will, are off combustibles.
You're going above one third of the group.
So another notable part of this study that we haven't touched on yet is that it's conducted in African-American and Latin text populations.
And I asked Johns to talk a bit more about that as well. You know, things have histories to them.
Not to get too dramatic, but slavery, civil rights, immigrants, immigrants who don't enter in so called legally and so on, so forth.
And as such, folks are marginalised. And then unfortunately, there's a correlation between socioeconomic status and being an underrepresented,
historically under marginalised minority and such.
You get further marginalised. So what happens is traditionally and you look at sort of pharmaceutical trials that lead to medications,
they're basically white participants, White Middle-Class Participants in this country.
And so when I got started in 1992, thinking about how I could contribute,
I've always been interested both personally, professionally and even from my religious perspective.
I'm a practising Sikh. Is that social justice, caring for the underserved?
Worrying about marginalised populations is just core to what I do professionally and as a physician.
So I began to study African-Americans and I think, you know, when I was doing that work, you're not going to believe this.
There is really maybe one or two other people in the United States who are doing work in African-Americans or landmarks.
Now, think God through efforts that we started and many others,
that there are now hundreds and there are many people interested in setting these groups.
And, you know, we've learnt things like metabolism being different in African-Americans, nicotine intake being different,
levels of carcinogens being higher per unit, cigarette that Neal Benowitz has done some elegant work on.
It's led to some very concerning and profound findings.
The average number of cigarette smoke being lower in African-Americans, African-Americans and Latin X trying to quit more often,
but especially African-Americans having a harder time quitting and not interested enough.
The prevalence of smoking and then over cigarette smoke per day for Latin X and African-Americans is lower than whites.
But unfortunately, especially for African-Americans, somehow they have greater harm.
But the net population effect is that these two groups are affected more adversely.
And that's sort of a whole nother our dialogue.
So what's really notable that is when just talks about these differences that we're seeing emerge between the different
ethnic groups and say things like he was saying the levels of carcinogens and the differences in metabolism.
And that is something that really seems to be emerging.
And I hope we see a lot more of in future studies, because obviously it's something that's really important to understand.
Yeah, I think it's a great research, you know, is somewhat in its infancy.
But this is an area that that now we really need to do better on and actually probably in health care research overall.
But certainly cigarette research is not an exception. So for me, I think this interview just touched on so many interesting things.
I kind of talked to jazz for hours.
And at the core of all these these things we touched on and arguably at the core value, cigarette research is the issue of harms.
So we're gonna leave you today with some closing remarks from jazz,
talking about how he conceptualises the relative safety of e-cigarettes and how we might operate in this context.
Let's just briefly talk about youth. Let me be let me go on record by saying if you don't use nicotine, don't start.
If you use nicotine or combustible tobacco products or even non-combustible tobacco products, quit if you can't quit.
Try to use harm reduction products, get off combustibles. There's a whole spectrum of risk.
There's no question about it. It would be almost unbelievable, not impossible that e-cigarettes are as or more dangerous than cigarettes.
It's almost unfathomable, especially because we know the ingredients in cigarettes when they're 60 tumour accelerators,
co carcinogens and carcinogens.
And it's a combusted product versus a heated product that lacks essentially all those things that this is going to be more dangerous.
I think what we're going to learn is that e-cigarettes, you know, it's probably not good for your lungs.
That's the bottom line. E-cigarettes that's doing. Subject to the cilia, doing something to the epithelium.
And we need to understand that the concern that people have the lay public or even the scientific world is that,
oh, well, we don't know the long term outcome of e-cigarettes that's going to I can't argue against.
So I'm going to agree. We don't know the long term outcomes. We never will.
Until we have the long term. But if you can use I mean, if you when no.
Does it decrease the onset of COPD or heart attacks? You're going to need cohort or randomised trials, 50 feet, 15 to 20 years.
I can't wait 15 to 20 years. I can't wait for that patient that I saw in 1988 and watch him smother and die.
I need to get him off combustibles. That's it from us. Thank you so much for listening.
And a massive thanks to Jazz for the interview. If you haven't already, please do subscribe to us via iTunes or Spotify.
We very much hope to be bringing you another episode next month.
This is me. But some mention the findings we have can tell us what happened long.
Safer than smoking. Still buying cars. That's why.
Thank you so much for listening to our second episode of Let's Talk E-cigarettes.
You've been listening to Nicola Linson and Jamie Harben Boyce with thanks to our guests this month, Professor Jazz Ahluwalia.
Music is performed by Johnny Berliner.
Thanks also to Jonathan Livingston Banks for running our monthly searches to Elsa Butler for editing this podcast.
And to all our brilliant Cochran co-authors for helping us sift through and interpret the literature.
This podcast was made possible through funding from Cancer Research UK and through core infrastructure
funding to the Cochrane Tobacco Addiction Group from the National Institute for Health Research.
The views expressed are those of the authors and not necessarily those of the
National Institute for Health Research or the Department of Health and Social Care.