2024 - Session 3 Seminars

In this session, Prof Benjamin Toll will present recently published nationally representative data from the US FDA Population Assessment of Tobacco and Health (PATH) study showing that since 2013 in the key demographic of 18-24 year-olds, rates of combusted cigarette use have been falling and rates of e-cigarette use have been rising, such that now 14.5% use e-cigarettes, compared with only 6.1% who use combustible cigarettes. Moreover, more than half of these young adults who use e-cigarettes have never smoked. This age group of young adults (age 18-24) has historically been important to the tobacco industry as a time when tobacco users often transition to established use and brand loyalty, and these data may forecast a future in which e-cigarettes are the dominant tobacco product in the US. Importantly, we have shown in published papers that over 60% of all e-cigarette users in the US express (in responses reported in Waves 4 and 5 of the PATH study) that they plan to quit vaping. A recent systematic review from our group shows that there are almost no studies of e-cigarette treatment to assist the many e-cigarette users who plan to quit. We will present several pilot clinical trials investigating dual nicotine replacement therapy, high dose dual nicotine replacement therapy, and varenicline tartrate for the treatment of e-cigarette use.

Electronic cigarettes (or e-cigarettes) have been studied as a cessation tool in clinical trials and longitudinal studies. Less well-studied is how e-cigarette use among former smokers affects smoking relapse, a concept that is not well-defined. A recent paper looked at this issue but only used any cigarette smoking in the past 12 months as their smoking relapse measure. We examine how the use of different definitions of relapse might affect findings.

Using longitudinal data from three consecutive waves (waves 1-3 and 2-4) of the Population Assessment of Tobacco and Health (PATH) Study, we found that more than half of recent former smokers relapsed if we define relapse as any cigarette smoking in the past 12 months (Measure I), 40.3% relapsed if we use the definition of any past 30-day smoking (Measure II), and 30.1% relapsed if we use the definition of smoking on >=3 days in the past 30 days (Measure III). Compared with those who remained tobacco-free, recent former smokers who switched to current e-cigarette use or any non-cigarette tobacco use were marginally more likely to relapse using Measure I but showed no increased likelihood of relapse using measures II or III. Recent former smokers who switched to current e-cigarette use may be more likely to slip but reported no difference in the likelihood of cigarette smoking relapse, especially when not defining relapse as any lapse during the 12 months following quitting.

Much of the debate around the potential public health benefits and harms of e-cigarettes focuses on their relationship to smoking. If – at a population level – e-cigarettes lead to more people smoking than would have otherwise, then their net impact on public health will undoubtedly be a negative one. If, however, vaping decreases smoking at a population level, there is the potential for public health benefit. In this talk, I’ll describe the current state of the evidence on the impact of vaping on smoking behaviors, including flagging some potential consequences of vaping restrictions. I’ll touch on topical issues including the theories that vaping may act as a gateway into smoking, and the potential role e-liquid flavors may have on vaping-smoking transitions.

In April 2023 England’s Minister for Public Health announced an ambitious national Swap to Stop scheme through which 1 million smokers will be supported to quit smoking through the use of an E-Cigarette, this presentation will review the evidence and update on progress including highlighting the targeted way the scheme is seeking to reduce health inequalities by serving some of England’s most disadvantaged smokers.

The accumulating evidence now supports a strong conclusion that e-cigarettes are tools that health care clinicians can—and should—use to help adults stop smoking, especially those who cannot quit another way or who want to reduce health harm without quitting.  It is time for the medical community to add e-cigarettes to the tobacco treatment toolbox. The question is no longer “Should we?” but “How and for whom?” should we recommend them?  Doing so will require addressing multiple barriers. Both patients and clinicians misunderstand the relative risk of nicotine vs. combustible tobacco products.  Lack of a medically licensed product or guidance from medical organizations complicates making a specific recommendation for choosing a product or learning how to use it. This session will raise questions and highlight issues that are likely to arise for U.S. clinicians who add e-cigarettes to their tobacco treatment toolkit.

This session will look at the role of e-cigarettes as a harm reduction strategy for high priority individuals, specifically those with high smoking prevalence or with the most immediate risk of particular health harm.

Smoking cessation is the most effective means of slowing the decline of lung function associated with chronic obstructive pulmonary disease (COPD) but while effective smoking cessation treatments are available, they are underutilized and nearly half of people with COPD continue to smoke. In this session, Dr Sherman will present the findings from a recent pilot study that looked to identify barriers and facilitators to the use of and assess the preliminary effectiveness of e-cigarettes as a harm reduction strategy for people with COPD, CAD or PAD who currently smoke. Dr Sherman will incorporate findings from their ongoing studies for people with opioid use disorder, mental health diagnosis and HIV.

Finally, Dr Sherman will talk about the launch of a new Center on vaping for both nicotine and cannabis products.

• Has the controversy over e-cigarettes been a roadblock to advising current smokers about their choices? and, if so, how could this be corrected?
• Does long-term e-cigarette use pose more of a public health challenge than a potential relapse to combustible products?
• Who is responsible for communicating the evidence on the harms of smoking and vaping to clinicians?
• How can e-cigarettes be promoted to optimize smoking cessation in disadvantaged communities?
• Why is harm reduction a recognized tool for many societal issues, but so controversial in tobacco control?
• Are we targeting the right people with the right message?