If asking your mate down the pub about Theepan is what they probably say, no one agrees if it's safe or not, 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 give you a different advice. Hi, I'm Nicole Allinson.
And I'm Jamie Harmon. We're both researchers based at the University of Oxford, where we work with the Cochrane Tobacco Addiction Group.
Welcome to this edition of Let's Talk E-cigarettes. This podcast is a companion to a research project being carried out at the University of Oxford,
where every month we search the e-cigarettes research literature to find new studies.
We then use these studies to update our Cochrane systematic review of e-cigarettes for smoking cessation.
This is called a Living Systematic Review. In each episode we start by going through the studies.
We have found that one and then go into more detail about a particular study or topic related to e-cigarettes.
This month we carried out our searches on the first of July 2021 and we identified two papers that are
linked to studies already included in the review and two new included studies that Nicola will now cover.
In a nutshell, the first new study is reported in a paper by Catherine Kimber and colleagues at South Bank University in the UK.
It's a randomised study with two weeks follow up comparing psychologic and tank models of e-cigarettes with different nicotine concentrations.
And the outcomes of interest for our review were change in carbon monoxide levels and adverse effects.
The authors found that carbon monoxide decreased in all groups, but for both carbon monoxide and adverse events,
there were no statistically significant between group differences.
A second news study was by Katmai Smith and colleagues at Queen Mary, University of London,
also in the U.K. It was a randomised controlled trial comparing e-cigarettes with nicotine
replacement as a harm reduction intervention in people who smoked and found quitting difficult.
You'll hear more about this study and its results in this month's deep dive.
This month, Dr. Mark Smith and I couldn't find a time that suited us both, so I sat through some questions and she kindly recorded her answers.
First, I asked her to tell us a bit about herself and how she got into E cigarette research.
Hello, my name is Dr. Katmai Smith and I'm a senior research fellow at Queen Mary University of London.
I've worked for the Health and Lifestyle Research Unit for the past 17 years.
And when I first began, we were doing a lot of research studies into Varenicline, which was a new medication being used to treat smokers at the time.
I was also involved in clinical work treating patients at the local hospital trust,
supporting pregnant smokers, as well as the general public accessing our community.
Stop smoking service. Our clinic is the ideal setup for a researcher as having the experience of engaging with smokers and seeing the things we do in
research in real life really gives a good perspective on what the reality will work and what will help engage participants.
Over the last 10 years. Our focus has turned to e-cigarettes.
We noticed in clinic more and more smokers were telling us they were using them to help them to stop
smoking and often went off the medication and not helped previously and finding really useful.
Since then, we've done several studies, including the first randomised controlled trial,
which is published in 2019 in the New England Journal of Medicine,
which was to compare e-cigarettes versus nicotine replacement therapy study found that one year follow the quit rates with
doubled in the participants assigned to e-cigarettes and showed the clinical relevance e-cigarettes have as a stop smoking aid.
Next, I ask you to tell us a bit about why they chose to use the group they did.
People who had tried to stop smoking before and hadn't been able to do so using kind of traditional quitting AIDS.
Currently, there is a gap in stocks making service policy and how best to help smokers
who have failed in previous quit attempts using conventional cessation aids.
From what we know, almost 80 percent of smokers who access treatment will still be smoking one year later.
This is not for want of trying a desire to stop smoking.
And at the time of applying for this grant, there was very little research being done with e-cigarettes in a treatment context.
But there were strong reason to believe e-cigarettes may have potential to help highly
dependent smokers who had failed to with conventional cessation aids in the past.
So I think what Katie touches on there is really important. We know that there are lots of things that can boost people's chances of quitting,
like nicotine replacement therapy, varenicline and all sorts of behavioural support.
But we also know they don't work for everyone. And that's why when e-cigarettes first came to the market,
there was some enthusiasm that this might be an opportunity for a new treatment option for people to help them quit,
particularly if they tried to quit previously and been unsuccessful.
So I then went on and asked Katie about how she ran this new study.
We recruited a hundred and thirty five participants in total and they recruited from my clinic
as we were able to target those who had not been successful with those in previous attempts.
And we also use social media to advertise the city participants were included, if they were over 18 years of age,
had a history of unsuccessful quitting with a stop smoking medication,
and had no preference to use or not to use either nicotine replacement therapy or any cigarette.
We excluded participants who were pregnant or currently using any cigarette or stop smoking medications.
Interested participants were invited to a baseline visit where eligibility was confirmed by our research team and informed consent was collected.
Participants were then randomised to either to receive an e-cigarettes or nicotine replacement therapy and instructed on how to obtain their products.
So for the Naziism at the baseline visit,
participants selected an innovative products or product combination from all available nicotine replacement therapies such as nicotine patch,
chewing gum, nasal spray, mouth spray. And they were provided as per our standard practise on a letter of recommendation which allows
them to go to the local pharmacy to get a two week supply of the medication of choice.
Participants paid a prescription charge of eight 60 unless they were exempt and letters of
recommendation were provided for up to eight weeks as per standard practise at the time.
Participants either picked up from the clinic their letter of recommendation,
or they were posted to the participants directly and participants were free to switch to a different NRT product if required in the cigarette arm.
At the baseline visit, participants were shown three different refillable Essig products.
They were indicating to see the smoke and the tech mini with variable voltage and explain the principles of their use by the research team.
They were instructed to obtain one of these if they liked them or could choose another product of their choice,
together with initial samples of liquid with a strengthened flavour of their choice,
either via a voucher for up to 40 pounds,
a local vape shop that had agreed to provide the service or via the suppliers and claim a refund against their receipt of up to 40 pounds.
Participants then paid for further supplies themselves or e-cigarettes, liquid and any parts were paid for by the participant.
They were then encouraged to try liquids of different strength and flavours if their initial purchase did not meet their needs.
Those wishing to stop smoking altogether were asked to set a target quit date around the time of the second visit to the clinic.
Typically a week later, participants were then asked to bring their products along to the second visit to confirm that they
obtained the products to try the product in front of the research team and to rate their experience.
They were then asked to start using the products.
Only after this visit, participants received brief instructions on product use and were advised to use their products,
which is possible instead of smoking. Those opting for smoking cessation also received the standard advice on coping with urges to smoke.
Participants also signed a commitment form.
This was to say that they would only use their allocated product for the first four weeks and after that they were free to do as they pleased.
Participants receive phone calls one and four weeks later to monitor product use and smoking status and to provide brief support.
And this this was provided by our experienced smoking advisors as part of our research team.
At four weeks and six months, participants who reported stopping smoking or reducing cigarette consumption by at least
50 percent compared to baseline were invited to provide a carbon monoxide reading.
Participants receive Tempa for their time and travel at both of these extra visits.
And now for the exciting. But I then asked Katie what they found.
Our study found that validated smoking reduction, which included also people who completely stopped smoking,
was achieved by twenty six point five percent in their cigarette arm and six percent in their nicotine replacement therapy.
Obscure science term definition. In the context of smoking cessation studies,
we use validation to check the when people say they have reduced their smoking or have quit, that this is truly the case.
This is because people may not want to tell the researcher that they have returned to smoking.
We do that by taking a biological measure of the waste products of smoking.
In this case, the researchers measured carbon monoxide in participants, exhaled breath to see if this had reduced it.
Follow up in comparison to the amount exhaled at the start of the study when they were smoking as normal.
Our study was powered on seeing a reduction in smoking is the main finding.
However, even with a hundred and thirty five participants we were able to see sustained,
validated absence raises six months, which were nineteen point one percent versus three percent.
And this was in a population you could reduce rather than quit if they preferred, although not unexpected.
As we know, e-cigarettes have potential to work this way. It's a surprise that rates between the two hours were so significant.
I think it really does go to show that giving a smoker the right tools has a
significant impact on the success of quit attempts and from the results of this study,
even without standard intensive support. Well, those quit rates are Eye-Opening.
Although the study was originally designed to look at how many people reduce smoking,
it's impressive that such a clear difference in quitting emerged.
As I see it, I think one of the strengths of this study is the fact that they allowed people to either attempt to reduce or quit,
which probably reflects the mixture of approaches people take when they use e-cigarettes without support.
I think that's a great point, because one of the interesting things about the study,
and I actually did ask Katie to talk a bit more about why they decided to look at reduction in the first place as discussed,
our focus was on how we bridge the gap for smokers and able to quit with the current best treatments and.
Whether they could benefit from approaches that often offer a means to reduce the harm from smoking without ceasing nicotine use,
that idea is not new. And nicotine replacement therapy has been licenced for a cut down to quit approached for over 10 years.
And several studies have reported that such issues can facilitate a significant reduction in smoke intake,
as well as quitting smoking altogether at a later date. The approach, however, can be costly, as medication may be used for a longer.
The quit rate it generates are often low and usually are only achieved with regular and intensive behavioural support and monitoring,
which is why this approach is seldom used in practise harm reduction approach.
For many years.
The only next step, and we know when using any cigarette that this is a 95 percent reduction in harmful toxins compared with continue spiking.
So it's very likely that there will be a health benefit.
But looking into this is very complex and you have to control the smoke has increased risks of many diseases due to that previous smoking.
And many of the things that are smoking may have developed, may not emerge until later in life, sometimes when they've even stopped smoking.
So if we were to look at health benefits in a group of smokers,
it's important we compare like for like ice smokers with or without e-cigarettes and have a similar smoking period before quitting.
We're currently doing some long term research into this topic now, and it's really a really important area that needs further research to help
fully understand the role of e-cigarettes and cessation and harm reduction.
While I find that fascinating and can't wait to see that research. So next, I ask Katie just to talk a bit more about her experiences,
the support that people might need to quit if they're quitting with e-cigarettes compared to if they're quitting nicotine replacement therapy,
because this is something they discussed briefly in their paper.
Our experience in clinic is that for NRT, participants need clear guidance and support on how to use their products,
but also to understand other aspects of use, such as taste, talking about side effects and strategies for how and when to use the product.
E-cigarettes seem to deliver quickly what a smoker desires, both in terms of nicotine and sensorimotor aspects of smoking.
The VAP, the hit, the flavour,
all of these things kind of combined and seem to work a lot better with e-cigarettes compared with nicotine replacement in practise.
And so this seems to mean participants can pick it up and go with it quite easily, changing products,
using different e-cigarettes, using different eclectically liquids, and they use them when needed without giving them up.
They don't just suddenly stop and and pause. They they look and search and kind of actively keep using the products.
This is not usually the case.
They're not if they don't like it quite often, they will stop it and then it will wait to seek advice before starting something else.
And possibly that is also down to the fact that NRT is not as easy and it can be very expensive to purchase over the counter.
And so there's other factors that play a part with NRT.
But for those reasons, we wanted to explore more the role of this minimal support and goal when using e-cigarettes,
which is what the study was set up to do. So finally, I asked Katie what research she thinks should be done next.
We already mentioned the importance of harm reduction and its impact on smokers, which I think is the priority area for many in in our field.
The other focus to our research now is looking into e-cigarettes with and without support.
We know, although there are fantastic services in the UK to support smokers, however,
we know that only a small percentage of smokers actually access them when they want to quit.
Understanding the role of support with e-cigarettes is imperative to supporting Future Critter's.
It may be the case of simply handing someone in e-cigarettes started back in hospital may be enough to stop attempts or like NRT,
we may need to factor in intensive supports, help smokers quit. We wait and see what future research shows.
Is really interesting to hear about another great study from the group Queen Mary comparing e-cigarettes to NRT.
This is a key comparison for us as an art to the current standard treatment for smoking cessation that is routinely provided.
It's most interesting for us to be able to see how e-cigarettes compare to this,
and this study will have more participants to that analysis in our review, which is great.
Yeah, I always get very excited when we have another study that we can add to one of our main analyses.
So we're looking forward to doing that in a subsequent update.
And with that, that's it for us this month.
We're taking a break next month because our kids are off school and we're going to spend some time off work, but we will be back in September.
Thanks so much for listening and massive thanks once again to Dr Meyer Smith for taking the time to share her thoughts on her study.
Please subscribe on iTunes or Spotify and stay tuned for our next episode.
This may help your community in.
To mention the Fineman's we have can tell us what happened long time.
Even the. Vaping is safer than smoking weed may still cause for concern.
I'm thinking of switching to Ben, doing this for.
Thank you to Jonathan Livingston Banks for running searches to Elsa Butler for producing this podcast and to all of you for tuning in.
Music is written with Johnny Berlinale and performed by Johnny are live in systematic reviews supported by funding from Cancer Research UK.
The Cochrane Tobacco Addiction Group also receives core infrastructure funding from the National Institutes for Health Research.
The views expressed in this podcast are those of Nicola and I and do not represent those of the funders.