Electronic Cigarette Industry Trade Association
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By Tom Pruen
A recent publication from Canada proposes that “The implications of these findings are that concurrent use of e-cigarettes during a quit attempt utilizing cost-free evidence-based treatment (nicotine replacement therapy plus behavioural counselling) does not confer any added benefit and may hamper successful quitting.”
Everybody’s favourite e-cig opponent, Stan Glantz, described it as “a well-done study”
There are, however, a couple of ‘tiny’ issues.
To draw broad useful conclusions, you need:
1) a sample that is representative of the population. Instead, the sample here were:
“Participants were self-or practitioner-referred to participate in the treatment program. Study participants were enrolled in the STOP program (Smoking Treatment for Ontario Patients) a smoking cessation program that provides behavioural counseling and NRT at no cost to smokers who want to quit. Eligible participants had to be cigarette smokers and residents of the province of Ontario. At the time of enrollment participants could be: cigarette smokers; dual users (cigarettes and other tobacco or e-cigarettes); or struggling with a recent quit attempt and in need of support.”
Since the STOP program is in Ontario, this sample probably isn’t even representative of Canadians.
Even more problematically, excluded from this sample are anyone who has already successfully quit with ecigs, and anyone (and it’s the vast majority of smokers) who didn’t enrol in the STOP program.
This is nothing like a representative sample.
2) To gather data about the intervention you are examining.
The data presented for the vaping contingent includes age and socioeconomic data and the reason for use of an e-cig:
“E-cigarette use was assessed at follow-up with two questions: 1) In the past 3 months, did you puff on an electronic cigarette, also known as an e-cigarette (please include any e-cigarette, with or without nicotine); and 2) If YES, did you use e-cigarettes to help you quit or reduce your smoking or to remain smoke free?”
Oddly, however, no data was even gathered for type of e-cig used, the frequency of use, or even if nicotine was used. As a result, a smoker who tried a nicotine free e-cig only once, for a single puff, with a vague idea that it might help them quit is classed an e-cig user.
The data gathered on the intervention is pretty much worthless.
3) Be undertaken in a region with similar conditions to those you which to extend the interpretation to.
Nicotine containing e-cigs are illegal in Canada. While there isn’t much enforcement, this is going to strongly prejudice people’s views about the product, and increase the probability that they used nicotine free products. Since no effort was made to gather any data about nicotine use, we can only speculate about the size of these effects. They would seem likely to be significant, however.
If we compare this with the results from the UK, which allows the use of nicotine, and in a similar self-selecting sample (Smoking Cessation Service users), the results are rather different:
(Beyond the legal and cultural differences, the fact that service users were supported and encouraged in the use of e-cigs may well have been a large part of the difference in successful switching.)
This study does tell us something – it tells us that Ontarians who enrol in the STOP program are unlikely to be helped to quit if they have a puff on an e-cig. This is not a terribly useful observation.
It tells us nothing about the effect on other populations, if nicotine use increases effectiveness (but we can safely assume that it will), or if frequency of use may have an effect (although, again, it seems certain that it will).
This study is only well conducted in the sense that it supports certain existing views in the tobacco control sphere. It does not provide any useful new information about the use of e-cigs as a harm reduction tool, or as a quit aid. It’s junk.
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