Let's talk e-cigarettes

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Dr Ailsa Butler. Assistant Professor Jamie Hartmann-Boyce and Dr Nicola Lindson talk with Dr Ailsa Butler from the Centre for Evidence Based Medicine, University of Oxford and co-author of the Cochrane review of e-cigarettes for smoking cessation. They discuss the findings of their recent work on the longer term use of e-cigarettes when provided as a tool to stop smoking. In the studies eligible for the review, just over half of people given nicotine e-cigarettes at study start were found to be still using e-cigarettes at six or more months follow up. Of successful quitters, 70% were found to still be using e-cigarettes at six months or more. The longer-term use of nicotine e-cigarettes may reflect their success as a quit smoking aid by preventing relapse to smoking. A key question about long-term e-cigarette use in people who have quit combustible cigarettes is whether it prevents or facilitates relapse or has no effect on relapse. This work was funded by Cancer Research UK and Oxford University's Public Policy Challenge Grant. Jamie and Nicola also bring us up to date with the literature search conducted on March 1st 2022. The search found 1 record linked to a study already identified as ongoing. We will include the studies we have found in future updates of the Cochrane review.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Billie Bonevski. In this episode Assistant Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Professor Billie Bonevski. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. In the February episode Dr Nicola Lindson talks with Professor Billie Bonevski, Professor of Public Health, Flinders University, South Australia. Professor Billie Bonevski discusses her Team's QuiENDS pilot trial of electronic cigarettes for smoking cessation among people in alcohol and other drug treatment. Professor Bonevski discusses e-cigarettes as a harm reduction tool and as part of a solution to high levels of smoking and very low or non-existent rates of quitting seen in this group. The study looks at people using e-cigarettes to quit abruptly or to reducing more gradually. Going forward work has started on the follow up Harmony Trial. Jamie and Nicola also bring us up to date with the literature search conducted on February 1st 2022. The February search found 2 ongoing studies and 2 records linked to a studies already included the review. We will include the studies we have found in future updates of the Cochrane review.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Billie Bonevski. In this episode Assistant Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Professor Billie Bonevski. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. In the February episode Dr Nicola Lindson talks with Professor Billie Bonevski, Professor of Public Health, Flinders University, South Australia. Professor Billie Bonevski discusses her Team's QuiENDS pilot trial of electronic cigarettes for smoking cessation among people in alcohol and other drug treatment. Professor Bonevski discusses e-cigarettes as a harm reduction tool and as part of a solution to high levels of smoking and very low or non-existent rates of quitting seen in this group. The study looks at people using e-cigarettes to quit abruptly or to reducing more gradually. Going forward work has started on the follow up Harmony Trial. Jamie and Nicola also bring us up to date with the literature search conducted on February 1st 2022. The February search found 2 ongoing studies and 2 records linked to a studies already included the review. We will include the studies we have found in future updates of the Cochrane review.

In this episode Assistant Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Dr Sharon Cox. This podcast is a companion to the Electronic Cigarettes Cochrane Living Systematic Review. The podcasts shares the evidence from the Cochrane monthly searches. In the January episode Jamie Hartmann-Boyce talks with Dr Sharon Cox, Senior Research Fellow at the Department for Behavioural science and Health from University College London’s Tobacco and Alcohol Research Group. Study trial registry number: ISRCTN18566874 Dr Sharon Cox discusses her team’s multi centred cluster randomised controlled trial based in homeless centres in the UK. In this study people experiencing homelessness who smoke are being offered e-cigarettes or usual care. This trial is funded by NIHR. Centre staff will provide EC arm participants with a tank‐style refillable EC starter kit, a choice of nicotine strength e‐liquids and flavours and an EC fact‐sheet. E‐liquids will be supplied for four weeks at weekly intervals by centre staff. Participants will be given time to try different flavours and nicotine strengths at baseline and be permitted to switch between flavours in accordance with documented vaping practices. Jamie and Nicola also bring us up to date with the literature search conducted on January 1st 2022. The January search found 4 ongoing studies and 1 record linked to a study already in the review. We will include the studies we have found in future updates of the Cochrane review. For more information on the full Cochrane review updated in September 2021 see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage: https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Anne Joseph. In the November 2021 episode Jamie Hartmann-Boyce talks with Professor Anne Joseph from the Department of Medicine, University of Minnesota Medical School, Minneapolis, about her study carried out with a team at the University of Minnesota and study's first author Kolawole Okuyemi, Department of Family and Preventive Medicine, University of Utah, Salt Lake City. DOI:  10.1093/ntr/ntab212 Professor Anne Joseph discusses her team's recent study that compares the effects of e-cigarettes with and without nicotine on patterns of combustible cigarette use and biomarkers of exposure to tobacco toxicants among African American smokers. Professor Joseph outlines that there are many reasons to look at the question of e-cigarette use with and without nicotine among African American smokers. African Americans are disproportionately impacted by tobacco-related diseases, for example lung cancer. This is in spite of different patterns of smoking by African Americans, such as smoking fewer average cigarettes per day but having more difficulty stopping smoking. In real world settings people change their behaviour without support of researchers and clinicians, Professor Joseph's study aimed to replicate this by providing little behavioural support. Participants were given a choice of menthol and non-menthol flavoured e-cigarette cartridges and were asked to use e-cigarettes ad libitum for 6 weeks. The majority of participants (88.6%) selected menthol e-cigarettes. Follow-up assessments were conducted at 2, 6, and 12 weeks post randomisation. Contrary to their hypotheses, they found that nicotine e-cigarettes did not significantly reduce the use of combustible cigarettes compared to non-nicotine e-cigarettes in this cohort of African American smokers. Their findings suggested that e-cigarettes were modestly associated with decreased use of combustible cigarettes among non-treatment seeking smokers, regardless of nicotine content, but without a reduction in tobacco toxicants. Professor Joseph considered that although e-cigarettes have potential to reduce harm if substituted for combusted cigarettes (or if they promoted cessation) because of lower levels of tobacco toxicants, their study suggested that ad libitum use of e-cigarettes among African American smokers, with or without nicotine, resulted in modest smoking reduction but did not change toxicant exposure in a cohort where smoking cessation or reduction was not the goal. The authors considered that their data suggested that testing future harm reduction interventions using e-cigarettes should include more specific behavioural change coaching, including substituting for or completely stopping combusted cigarettes. For more information on the full Cochrane review updated in September 2021 see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage. Jamie and Nicola bring us up to date with the literature search conducted on November 1st. The November search found one new study described in the podcast. The DOI for the new included study (Okuyemi 2021) is 10.1093/ntr/ntab212 . We will include the studies we have found in future updates of the Cochrane review.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Nicholas DeVito. In this episode Jamie Hartmann-Boyce and Nicola Lindson discuss the emerging evidence in e-cigarette research and interview Nicholas DeVito. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. In the October 2021 episode Jamie Hartmann-Boyce talks with Nick DeVito from the Evidence Based DataLab at the University of Oxford. They discuss his recent research which looks at e-cigarette manufacturers' compliance with clinical trial reporting expectations focussing on trials by Juul Labs and how they report their data. Nick's study was published in BMJ Tobacco Control (http://dx.doi.org/10.1136/tobaccocontrol-2020-056221). The discussion covered the importance of whether, where and how research findings are reported or published including publication bias and reporting bias, the selective reporting of outcomes. This interview covers the crucial role of trial registration for research transparency. Nick describes the FDA amendment act, in which studies are registered within 21 days with pre-registered outcomes and a primary completion date and that the results are to be put onto clinicaltrials.gov within a year. Clinicians, public health professionals, and the public cannot make informed choices about the benefits or hazards of e-cigarettes if the results of clinical trials are not completely and transparently reported. This interview highlights that transparency is key and the importance of all evidence being made available. For more information on the September Cochrane review see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage. Jamie and Nicola also bring us up to date with the literature search conducted on October 1st. The October search found one new included study two reports linked to studies already in the review, and one new ongoing (NCT04854616). The DOI for the new included study (Morris 2021) is https://doi.org/10.1007/s11739-021-02813-w. We will include the studies we've found in future updates of the Cochrane review.

Jamie Hartmann-Boyce and Nicola Lindson discuss the September 2021 update of their Cochrane living review of electronic cigarettes for smoking cessation, their response to a paper by Pisinger et al 2020 and emerging evidence in e-cigarette research. In this episode Jamie Hartmann-Boyce and Nicola Lindson discuss the emerging evidence in e-cigarette research and two recent publications by the group: the September 2021 update to the Cochrane living review of electronic cigarettes for smoking cessation; and a response to a paper by Pisinger et al 2020. This podcast is a companion to our Cochrane living systematic Review and shares the evidence from monthly searches and review findings. Jamie and Nicola discuss the team's response to a paper by Pisinger and Vestbo 2020, and underline that the aim of the Cochrane process is to always focus on the evidence (DOI: 10.1183/13993003.02117-2021 or link). They then outline the findings of the September update to the review which includes five new studies that have been added since the April 2021 version and includes search findings up to 1st May 2021. Overall the review includes 61 studies representing 16,759 participants. The main findings remain the same and some new comparisons have been included. There is still moderate certainty that nicotine containing e-cigarettes help more people to quit at 6 months or longer compared to e-cigarettes without nicotine or than NRT (nicotine replacement therapy). Uncertainty also still exists around nicotine containing e-cigarettes compared to no intervention (e.g. continued smoking). This reflects that the quality of the evidence is considered very low according to Cochrane standards. There is moderate certainty evidence that neither nicotine e-cigarettes nor non-nicotine e-cigarettes result in higher numbers of adverse or serious adverse effects. Turning to new comparisons this update includes a study of a pod device (Russell et al), the findings were consistent with the other included studies that showed that more people quit at 6 months or longer using EC than with NRT. This update also includes a study comparing nicotine salt to free-base nicotine e-cigarettes; no clear differences were found between the two. We also included studies that provided 'dual users' (people who already use EC and tobacco cigarettes) with advice on how to use their EC to quit smoking; in one study there was no usable data in a second larger study (Martinez) there was a marginally better quit rate, however there was no clear evidence of benefit. In response to feedback, for the first time in this update, data is included on the proportion of participants still using e-cigarettes or quitting aids) at six months or longer. Data from two studies comparing nicotine EC with NRT were notably different, with one finding no difference in the proportion of participants still using study product at longest follow-up, and the other finding significantly higher levels of EC use than NRT. There was no evidence for a difference in the proportion of people still using EC at longest follow-up in two studies comparing nicotine EC with non-nicotine EC. For all other studies the majority of participants that had been given nicotine EC at the start of the study were still using EC at 6 months or longer. Jamie and Nicola discuss the different ways that this result could be interpreted. It will be important to collect more information on this outcome. For more information on the September Cochrane review see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage. Jamie and Nicola also bring us up to date with the literature search conducted on August 1st and September 1st. The August search found one linked study by Rubenstein et al 2021 (doi: 10.1016/j.addbeh.2021.107037) and two new ongoing studies (El-Khoury et al 2021 (doi: 10.1136/bmjopen-2021-048859); and NCT04708106 2021). No new studies were found in the September 1st search. We will include the studies we've found in future updates of the Cochrane review.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research. Dr Katie Myers Smith discusses findings from her recent study. Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and Dr Katie Myers Smith responds to questions on her recent research. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. In the July episode Dr Katie Myers Smith from Queen Mary University of London talks about her team's recent study looking at e-cigarettes versus nicotine replacement therapy (NRT) as a harm reduction intervention for people who smoke and who find quitting difficult. Their randomised controlled study compared e-cigarettes with NRT in 135 people who smoked and who were previously unable to stop smoking with conventional treatments. Dr Myers Smith's study found that in people who smoked and were unable to quit using conventional methods, e-cigarettes were more effective than NRT in facilitating validated long-term smoking reduction and smoking cessation, when limited other support was provided. We will include the results in our Cochrane review. For more information on the study see Myers Smith et al 2021, Addiction, June 2021, DOI: 10.1111/add.15628 . Our July 2021 literature search identified two new included studies (Myers Smith et al 2021, DOI: 10.1111/add.15628 ; Kimber et al 2021 DOI: 10.1016/j.addbeh.2021.106909 ) and two reports linked to studies already in the review (Leavens et al 2021, DOI: 10.1111/add.15597 linked to Pulvers 2020; Jones et al 2021, DOI: 10.1097/ADM.0000000000000881 linked to Klonizakis 2017).

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Thomas Brandon Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Thomas Brandon. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. In the June episode Jamie Hartmann-Boyce talks with Professor Thomas Brandon from the University of South Florida and the Moffitt Cancer Center on his team's new study published in Lancet Public Health. This study is a randomised control trial and investigates the effect of tailored advice to dual users of combustible and electronic cigarettes on how to use their electronic cigarette to quit combustible cigarettes. This targeted self-help intervention with high potential for dissemination could be efficacious in promoting smoking cessation among dual users of combustible cigarettes and e-cigarettes. We will include the results in our Cochrane review. For more information on the study see: Martinez 2021 (https://www.thelancet.com/pdfs/journals/lanpub/PIIS2468-2667(20)30307-8.pdf). Our June 1st literature search found one new protocol by Elling et al 2021 (doi: 10.2196/27088) and two linked studies (NCT01188239 linked to Caponnetto 2013a and a dissertation by Guttentag linked to Tseng 2016 (doi: 10.1093/ntr/ntw017).

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Tim Coleman. Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Professor Tim Coleman. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. In the May episode Jamie Hartmann-Boyce talks with Professor Tim Coleman from the University of Nottingham's Faculty of Medicine and Health Sciences. Professor and GP Tim Coleman discusses a study he is carrying out with colleagues from Queen Mary University of London which looks at helping pregnant women who smoke tobacco cigarettes quit smoking. This trial of 1140 pregnant women compares usual care of behavioural support plus nicotine patches to behavioural support plus e-cigarettes in women willing to receive help to stop smoking. This multi-centre randomised control trial is taking place in the UK and we will include the results in our Cochrane review when these become available. For more information on the study see: https://fundingawards.nihr.ac.uk/award/15/57/85 Our May literature search found four new ongoing studies which may be relevant to our review when they are completed.