If basking young mate down the pub about FAPE in hands, what they probably say, no one agrees.
If it's safe on 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'd give you a different by. Hi, undeclared Linson, and I'm Jamie Herman Boyce.
Welcome to February's edition of Let's Talk E-cigarettes.
For those of you who haven't tuned in before, 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 process is called a living systematic review.
In each podcast episode, we start by going through the studies we found that month and then go into more detail about one of these.
So we'll start by describing what we found in our search on the 1st of February.
In a nutshell, so January was obviously a quiet month for the publication of e-cigarettes research.
We didn't find any studies that we weren't already aware of. However, we did find one paper linked to a study already included in our Cochrane Review.
And we were provided with new data from one of the studies that we had previously listed as ongoing.
This study is the massive study led by Dr Actioner Bag from the University of Oxford and looks at
providing e-cigarettes to people with chronic illness who are not motivated to quit in primary care.
Next stop, Jamie speaks to Actioner about her study in this month's Deep Dive.
So I am here with Rotch now, which is brilliant. I'm under my blanket once again, feeling very silly.
So to start off Bruch now, could you tell us a bit about yourself and what got you into doing research on e-cigarettes?
So I'm a psychologist by background and currently a university research lecturer in the Primary Care Health Sciences Department at Oxford University.
And it was my first job about 14 years ago now that led me into research and smoking cessation before e-cigarettes were even on the scene.
And the project that I worked on was a community outreach intervention that was
designed to promote the stocks making services to Bangladeshi impact Sony men.
Given the high prevalence in these populations, and that was my first experience of working on a randomised control trial.
And from then on, I started developing and working on clinical trials of my own with a keen interest in addictions,
making sation and behaviour change research.
But it was back in 2015 when e-cigarettes research was starting to gain traction and there was a lot of interest in them,
but not many clinical trials that I started to think about what could be done in primary care.
So fortunately for me, I'm based in the same department as the Cochrane Tobacco Addiction Group,
and I had the opportunity to work on the first systematic review update on e-cigarettes, which helped me think about my research.
I think that's rather fortunate for us, too, because you have been a major asset to our systematic review team.
So you're here to tell us about your new study, which I know the results aren't published yet.
So it's all preliminary, but we are very excited because we've had this study listed as an ongoing study in our review.
So can you tell us a little bit about how you set it up, how it was designed and what you what you tried to find out?
Sure. So this study is called the Mask Trial, which is an acronym for Management of Smoking and Primary Care.
And it was a randomised controlled trial funded by the National Institute for Health Research, which looked at the feasibility,
acceptability and effectiveness of doctors and nurses offering brief advice about e-cigarettes
and any cigarette starter pack to hardcore smokers with smoking related chronic disease.
And we were interested in seeing if people were willing to try and a grant to reduce their smoking and eventually quits.
And we recruited 325 people from general practises in the UK and we had practises invite patients to the study and people were told that the study
involved looking at the practitioner and how they talk to them about their smoking and that they may be offered some form of help and advice.
So we purposefully recruited smokers who weren't interested in quitting anytime soon so that they could look at whether e-cigarettes could be
used as a harm reduction approach and before delivering the intervention or jeepneys in this is hard to complete our online training programme,
which lasted around 45 minutes, and we carried out a lot of user testing before rolling it out.
And the training covered things like how to deliver advice and motivate patients to take up the offer of any cigarettes.
And they're encouraged to describe the offer positively.
Stablish evidence based e-cigarettes emphasise switching from smoking and answer the patient's health concerns about vaping.
And so participants who are interested in taking part had a baseline visit at the practise to cheque for eligibility.
And then they were booked in for an annual review appointment with their GP or nurse.
Now, people with chronic diseases in the UK have a routine appointment with their doctor
or nurse to review their medications and their condition at least once every year.
And the topic of smoking is often brought up for those that smoke.
And it was at this consultation where the practitioner offered stunned care, smoking cessation, advice, support to all participants.
And standard care does vary across practises, but it typically involves the GP or the nurse asking the patient about their smoking status.
Advising on the best way to quit and then offering a referral to the local stops, making services or procedure or a prescription for pharmacotherapy.
The patient was randomised by the GP or nurse only if the patient rejected the offer of standard care.
And so half of the patients recruited in the trial were allocated to a control group
who received nothing beyond standard care advice that they had already been given.
And the other half of patients were given brief advice about e-cigarettes,
which included an emphasis on the benefits of switching and reducing the amount of cigarettes they smoked,
together with an offer of a free e-cigarettes starter pack,
which contained three different liquids to start them off of two different nicotine strengths.
A patient support booklet that we developed for the study,
which showed them how to use that e-cigarettes and had a list of vape shops where they could purchase refills and parts and so on.
So they took away their kit and resources in a nice tote bag, which they received.
And they had a telephone call from someone who was trained and experienced and vaping within the first week of taking away that e-cigarettes.
And they were on hand to provide support on any technical aspects of the East,
e-cigarettes and participants had the opportunity to cool the experience vapour for up to two months afterwards.
Awesome. So, Rachna, what are the things that really strikes me about your study?
There's so many unique things about it, but I think you're focussed on what's considered a commonly a really hard to reach group.
So it's people with smoking related illnesses and it's people who turn down standard care as well.
So they don't want to go. They don't want to be referred to standard smoking cessation Carol.
I saw some men on Twitter the other day that was like when we talk about hard to reach groups,
we're actually talking about easy to ignore groups, which I thought was a really interesting way to put it.
So if you could just tell me a little bit more why this group.
Right there must have been easier groups to test your intervention in. Why did you go for this group of people?
Yeah. I mean, smokers with chronic diseases often continue to smoke despite advice to stop from their doctor.
And, you know, for example, nearly one in five people with heart disease smoke at the point of when they're told that they have heart disease.
And then more than half of those continue to smoke for at least a year after, despite being given advice to stop by their practitioner.
And for people with existing conditions, continuing to smoke worsens their health.
But we know that stopping smoking can improve it. So there are a really important group for a candidate for stopping smoking.
But they've often tried and failed to stop through traditional methods.
And e-cigarettes offer obviously offer an alternative method for that.
And there's evidence that people have been able to stop smoking unintentionally where they wouldn't have done so.
I'm from trying any cigarette. So it seemed intuitive to offer this to smokers with chronic diseases.
Fantastic. And can you tell us a little bit more so I know some of our listeners will be from England
and know exactly what we mean when we talk about seeing the GP and a primary care setting.
But for insula international listeners, what does that mean?
Does everyone see a GP in England? How does primary care work?
What usually happens around smoking? I know you spoke about this a little bit at the beginning.
And I suppose also, does anything go on with e-cigarettes and primary care?
Normally at the moment, as is e-cigarettes, I mean, jeepneys are talking to patients about,
say, primary care is the first points of care for health care advice or treatment in the UK.
And it can cover general practises, pharmacies or dental practises.
And and I mentioned that people with smoking related illness,
they see their GP or nurse at least once a year for an annual review of their chronic condition.
And the practises are, in fact,
encouraged through a pay for performance scheme known as the Quality and Outcomes Framework to provide quality care for people with chronic illnesses.
And so cheapies are incentivised for recording key indicators,
including the proportion of people that they advise and refer to the stocks making services.
So an annual review consultation.
There's a prompt on the GP computer screen to talk about smoking in terms of whether jeepneys in England suggest people try e-cigarettes.
They're currently unable to prescribe e-cigarettes as there is no medically licenced e-cigarettes currently available in the UK.
But many UK health authorities, including Public Health England and the Royal College of General Practitioners,
they've all said the GP should offer advice to smokers about e-cigarettes as a means for stopping smoking.
But we found from our qualitative work and the work of others that many are
confused about what information to provide and that they want more training.
But that completely makes sense.
So I suppose the moment we've all been waiting for and obviously with all the caveats around the fact this hasn't been peer reviewed yet,
for the most part. So these are preliminary findings. But can you tell us what you found?
And I suppose what you think the most interesting or most surprising things are about the findings from your study?
We were able to follow up 96 percent of participants at two months and 90 percent of participants eight months.
That's amazing. First of all, that is not what you usually see in smoking cessation research.
So well done. It was a surprise to us. One of our objectives was to look at smokers uptake in use of e-cigarettes.
And we found that 90 percent of people accepted the offer of an exit ramp from their GP or mass, with only 16 people rejecting the offer.
And we found that 68 son was still using that cigarette daily or at least weekly at.
Two months and also two months,
we found that those who were offered an a cigarette in the intervention group were three times more likely
to reduce their smoking by at least half the amount that they smoked compared with a control group.
So this was around 20 percent in the intervention grade compared to six percent in the control.
There was no difference between groups and smoking reduction at eight months with
five percent versus two percent in the intervention group compared to the control,
only few participants stopped smoking at two months.
With more people achieving abstinence in the intervention group with two verses, one son in the control.
But the numbers were too small for overall for any difference between groups.
And this was similar.
At eight months, with four percent stopping smoking in the intervention and two percent in the control in terms of acceptability.
Eighty nine percent of people in the intervention group found the advice given by their GP or nurse appropriate, and 85 percent found it helpful.
And so we found overall that a practitioner led brief intervention was both feasible and acceptable to deliver in primary care,
and uptake of the offer of any cigarette was high amongst smokers who were initially unwilling to try.
Other cessation treatments. And I think that's the most surprising results.
That 90 percent of people who had initially refused standard smoking cessation support
were willing to try an alternative approach and take up the offer of any cigarette.
I think this demonstrates that people need choices and that they are open to trying new approaches when it is offered to them.
Amazing. I mean, that is so interesting to hear about.
And I think really, I don't know reflects how important it is to be able to offer these things.
And I know that that in other countries there are so many different regulations that might mean
physicians are not talking to their patients about other ways to potentially transition off of smoking.
And I think, you know, we know that most people who successfully quit have had to try lots of different methods before getting there.
Some people do quit the first time they try. But that is the minority.
And I just I really hope I suppose as a field, both in research and practise, we keep exploring ways,
ways to reach out to people who have, you know, who aren't keen to engage in in traditional treatments.
Probably a lot of the time because they haven't worked for them previously.
So I think that gives us a lot of, I suppose, food for thought about next steps and what what kind of.
If it was up to you, what research would you like to be seeing done fall this study and what do you think the best next steps would be?
So we found that Apsley rates of abstinence were low.
And so a larger trial is needed to determine whether this approach can, in fact, lead to more people quitting in the long term.
Our qualitative research that we conducted alongside the trial was particularly
interesting where we interviewed practitioners and patients from the trial.
And although the training for practitioners covered concepts like harm reduction,
many of the tepees and nurses struggled to engage with harm reduction and were more
comfortable and familiar with recommending e-cigarettes as a short term step to quitting.
Doctors tend to rely on this concept of do no harm when it comes to treating
patients and say harm reduction is something that's that jars with this idea.
And so I think there's definitely opportunities there for further training of practitioners,
both and in terms of harm reduction and in terms of e-cigarettes, because we found that even with evidence, training, awareness of, you know,
official sanctions from public health bodies to advise patients on using e-cigarettes offerings,
making that many were still reluctant to recommend e-cigarettes and most maintains, like previously held views about ethics in safety.
It's really interesting.
I think that thing with low absolute numbers is so then we see across loads of smoking cessation research where we know that we would be dubious.
I probably wouldn't trust the data if I was looking at a smoking cessation study and the majority of people quit smoking.
I think how are they measuring smoking cessation here? And I think the thing I always try and think about when we convey those results,
that absolutely more research is needed to see if the difference between groups was present or not.
But even if you're doubling quit rates from, let's say, two to four percent, if that's a real doubling,
if you had one hundred people and two to further people quit because they were given me cigarette,
you might be saving one life through that, which is is incredibly important.
We think about her harmful smoking is and how meaningful it is to quit.
So that is excellent. I really love your qualitative work on this, too.
And so I'm looking forward to not only seeing the quantitative numbers published, but also looking more into the qualitative work.
One final question for you. Is that another thing that I think is kind of unique about your study?
Was this almost I don't know what you'd call it. I'm going to call it a buddy system, but you might disagree.
Having people on hand who'd used e-cigarettes before to support people who are trying to use them.
And I wondered if you, I suppose, had any feedback about that,
either from the participant who was had that support or the people who were getting involved as buddies and how that worked.
Yet we know that people appreciate is having that initial telephone call from someone who who was experiencing these cigarette use.
And, you know, often it was the case that, you know,
some of these patients had never tried in a cigarette before and even though we provided a a beginners start.
It's patients who tend to be older, who have never used a cigarette, were were less familiar and sort of the technical aspects of of cigarette use.
And so they they found that having having this kind of this experienced vapour.
Who who called them up and could offer that advice was was really important.
And some of them in the interviews had actually said that, you know,
they would appreciate kind of group support while they're using e-cigarettes in terms of the patients getting in contact with the experienced vapour.
After the initial call, we didn't find that many people took up that opportunity.
And and again, I think some of the patients sent that if they had that that face to face support, it might have been different and they might.
That's so interesting. Yeah. Yeah. And telephonist makes sense.
Well, thank you so much. Such an interesting study. Great to hear about it.
Yeah. And as you work with me, I am sure I will have more chats with you about this study in the future, which I look forward to.
Thanks much. It was really great to hear from Russia.
And it was a very interesting slant to look at people who weren't interested in quitting at the start of the study.
The fact that despite that 90 percent of people accepted these cigarettes is pretty eye opening.
Another of the things that stood out for me is what Russians said about jeepneys.
Uncertainty about offering e-cigarettes as a treatment and an obvious barrier is the fact that they weren't able to prescribe them.
Absolutely. And we also know that there are barriers just in terms of how comfortable health care providers are when talking about e-cigarettes,
let alone recommending them to their patients. So in a survey done by Cancer Research UK, which was published at the end of 2019,
they found that approximately half of the health care providers surveyed said that if a patient had stopped
smoking and they'd done that using e-cigarettes and they'd stop smoking for at least three months,
they'd advise that patient not to use e-cigarettes in the long term. But that kind of makes sense.
We know that there is lots of uncertainty about long term effects of e-cigarettes,
but we do have loads of data on nicotine replacement therapy, which is considered both safe and effective.
However, in the same survey, when asked about nicotine replacement, a similar proportion of health care providers.
So that's around 50 percent. So they would advise people against using that long term if they'd used it to stop smoking.
And that actually fits in nicely with a study we recently made aware of in the US.
The study by Steinberg and colleagues was published last year in the Journal of General Internal Medicine.
It looked at nicotine risk misperception amongst US physicians, and the majority, approximately 80 percent,
strongly agreed that nicotine directly contributes to the development of cardiovascular disease, COPD and cancer.
For the record, this isn't correct. It's tobacco that causes the increased risk of these diseases in people who smoke, not nicotine.
So we still have worked to be done. And the good news is we intend to keep at it.
So please subscribe to this podcast on iTunes or Spotify and join us next month for the next instalment of Let's Talk E-cigarettes.
So that's it from us this month. Thank you so much for listening. And a massive thanks to ratchet up for this interview.
Smidgens B C, this may help you.
Yeah. But some mention the findings we have can tell us what whatever happened long term,
even though we know vape in is safer than smoking, we may still find.
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 Berliner and I 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.