Oxford University Updates Vape Evidence

Oxford University’s Dr Nicola Lindson and the University of Massachusetts’ Professor Jamie Hartmann-Boyce have spoken about the emerging evidence surrounding the relative safety and effectiveness of vaping as a tobacco harm reduction tool. Eve Taylor, a research assistant with the Nicotine Research Group at King’s College London has offered her insight too.

Dr Lindson and Professor Hartmann-Boyce provide frequent updates on vape-related academic research. The distilled overview is very useful because the volume of projects linked to ecig research has increased to an incredible level. The pair’s updates originate from the Cochrane Database of Systematic Reviews, a project they are both involved with.

What is the Cochrane Systematic Review?
The reviews have been going on since the project was set up by Professors Hayden McRobbie, Chris Bullen, and Peter Hajek in 2016. The objective is to “examine the safety, tolerability and effectiveness of using electronic cigarettes to help people who smoke tobacco achieve long‐term smoking abstinence.”
It does this by looking at all the relevant published research and then pairing it down to include only the most reliable studies – randomised controlled trials (RCTs) and randomised cross‐over trials.
With each new update, the academics involved in the Cochrane Tobacco Addiction Group add the latest findings they discover to past data so that they can produce the most reliable of recommendations for public health bodies and politicians to use in their policy making decisions.

Best of all, the Cochrane Systematic Review is produced in a plain English format so that non-specialists can access the information. The information is also important to smokers and vapers so they can have confidence in the claims being made that ecigs work as a tool to help smokers quit using tobacco and that vaping is substantially safer than smoking.

What does the latest study cover?
The authors of Cochrane’s report say: “We were interested in finding out how many people stopped smoking for at least six months and how many people had unwanted effects, reported on after at least one week of use.”
The latest review now covers 78 studies conducted by university researchers and includes data obtained from 22,052 adults. The size of this sample means that there is a high level of confidence in the team’s findings and conclusions.

The Cochrane systematic review only focusses on studies that compare vapes with NRT products like patches and gum, medication products like varenicline, vapes that don’t contain nicotine, different types of vape devices, behavioural support through counselling or other forms of advice, and people trying to quit without any support.

What have they found?
The latest iteration has found four new studies and a linked paper that will be included in future updates.
The first will look at how ecigs may help smokers suffering from COPD (chronic obstructive pulmonary disease), to be conducted by a team at the University of Birmingham. In total, it will recruit 1,250 participants to the project and will produce some exciting findings by comparing the use of NRT products with vapes.

The second study will take place in Pakistan and use 438 participants to compare NRT products with vapes to see which best helps smokers to quit.
The third is going to compare vapes with nicotine pouches, a first study of its kind. This Yale University project will focus on the flavours and strengths of the products to see which work best for smokers. The Cochrane team say they won’t be including the findings from a quitting perspective but will be considering adding the results to what we know about relative safety.

The final project is going to put smokers onto a course of NRT products. At the end of the trial period, all of those who failed to quit smoking will be put into one of two cohorts that receive either vaping products or nicotine pouches to see if these help.
“It’s awesome and exciting to see more studies in the pipeline,” says Professor Hartmann-Boyce.

What the Cochrane Living Systematic Review concludes so far
The team state:

·People are more likely to stop smoking for at least six months using nicotine containing vapes than with nicotine replacement products like patches, gum, and sprays.
·Nicotine containing vapes work better at helping people to stop smoking than going cold turkey or only getting behavioural support from local quit centres.
·Nicotine containing vapes work at least twice as well as nicotine replacement products – and nicotine free vapes work as well as nicotine replacement products.
·Non‐serious unwanted effects were more common in vapes compared to nicotine replacement therapy. These would include things like short term sore throats or headaches as people get used to their devices. The team say, “These effects reduced over time as people continued using nicotine e‐cigarettes.”
The Cochrane Tobacco Addiction Group states: “There is now high‐certainty evidence that [a vape] with nicotine increases quit rates at six months or longer compared to nicotine replacement products.”

On the related subject of packaging
Professor Hartmann-Boyce and Dr Lindson spoke to Eve Taylor, someone who has gained experience in the area from working with the International Tobacco Control Project and the UK Health Security Agency’s ecig evidence updates.
There has been a long journey to transform tobacco packaging and now there are strict rules as to what information must be included, what can’t be included and the colour. Some are arguing that the same restrictions should be applied to vape products.
Eve says: “It’s been found that with each of these steps that they’ve reduced the appeal of cigarettes to young people but also made them less viable to adults as well.”

Vapes must conform to packaging restrictions at the moment. They must contain:

·A warning label about nicotine
·Information about nicotine level
·Information about other ingredients
·Manufacturer details
There is also a ban on making health claims or things like the vape products are “revitalising”.
With a range of options to changing vape packaging available, Eve has looked at how they might impact youth and adult use. She claims that plain packs disincentivise young people from buying vapes, but it makes “little difference” to vaping and smoking adults. The concern here is that this is one study and so confidence in the results is low.

With the push from certain quarters to implement plain packaging as a response to the government’s recent consultation process, it is hoped that they wait for more concrete evidence before deciding and risk endangering the success vaping has had in reducing the UK’s smoking rate.