Tuesday, May 26, 2015

New Harvard Study Finds that As Many as 18% of Current E-Cigarette Users May Have Quit Smoking Completely Using E-Cigarettes

According to a new electronic cigarette survey study reported at the 2015 FAMRI meeting, as many as 18% of current electronic cigarette users are ex-smokers who may have quit smoking completely as a result of their e-cigarette use. Such a finding would represent perhaps the strongest evidence to date that not only are e-cigarettes helping smokers quit, but that the magnitude of this effect at a population level is massive and is likely to be associated with profound public health benefits.

The key finding of the Harvard study was that in 2014, 20.7% of current electronic cigarette users were former smokers. The important question, of course, is whether these represent ex-smokers who re-initiated nicotine use with e-cigarettes or whether these represent smokers who quit smoking using e-cigarettes and thus are now identified as former smokers who use e-cigarettes.

To try to tease this out, the researchers ascertained how long ago the respondent had quit smoking. One would assume that if the individual had quit smoking many years ago, then their e-cigarette use probably represents a return to nicotine use (i.e., a bad outcome). On the other hand, for more recent quitters, it is likely that the e-cigarette use represents the results of a successful quit attempt (i.e., a good outcome).

For the purposes of their analysis, the researchers set the differentiation of these two groups at quitting more or less than six years ago. Those who quit more than six years ago are almost certainly ex-smokers who have been enticed to return to nicotine use via e-cigarettes. Those who quit less than six years ago could represent smokers who used e-cigarettes to become former smokers.

Using this breakdown, the researchers reported that only 2.8% of current e-cigarette users represent distant former smokers who were presumably attracted back to nicotine use via e-cigarettes. In contrast, 17.9% of current e-cigarette users represent recent former smokers who could conceivably have quit smoking using e-cigarettes.

These data are consistent with a recent report from the UK which notes that during the past year alone, half a million smokers in the UK switched to e-cigarettes, and that most of these are ex-smokers, suggesting that these are smokers who quit smoking via the use of e-cigarettes.

Based on these findings, Deborah Arnott, Chief Executive of ASH, said:

“The number of ex-smokers who are staying off tobacco by using electronic cigarettes is growing, showing just what value they can have. But the number of people who wrongly believe that vaping is as harmful as smoking is worrying. The growth of this false perception risks discouraging many smokers from using electronic cigarettes to quit and keep them smoking instead which would be bad for their health and the health of those around them.”

The Rest of the Story

While the findings from these two studies are similar, the conclusions drawn were polar opposites. The UK study concluded that it appears many smokers are quitting by switching to electronic cigarettes, meaning that e-cigarettes are undermining cigarette use, de-normalizing smoking, and saving lives.

With similar findings, the Harvard study concluded that one-third of current e-cigarette users are nonsmokers, undermining any benefits of smokers switching to electronic cigarettes.

But there's a huge problem with the Harvard study's conclusion: their conclusion assumes that all of the 20.7% of vapers who are ex-smokers represent former smokers who returned to nicotine use due to e-cigarettes. However, as the study itself acknowledges, many of these ex-smokers could actually be individuals who successfully quit smoking using e-cigarettes and now continue to vape to keep themselves off real cigarettes. In fact, the study estimates that the overwhelming majority of these vapers are recent quitters, rather than distant former smokers, suggesting that it may be more likely than not that this group largely represents smokers who switched to e-cigarettes, thus becoming former smokers. Specifically, only 2.8% of vapers were distant former smokers. A full 17.9% of vapers were recent former smokers.

Thus, as one can easily see, the conclusion of the Harvard study is not consistent with its actual findings and appears to reflect a bias against e-cigarettes. Despite having implemented methods to try to differentiate ex-smokers who returned to nicotine use with e-cigarettes from smokers who quit using e-cigarettes, and despite having found that the overwhelming majority of vapers who were former smokers reported that they were recent quitters, the study nevertheless makes the assumption that all of the ex-smokers were former smokers who were enticed back to nicotine use due to e-cigarettes. This is the only way that the study was able to draw as its ultimate conclusion:

"In conclusion, there has been rapid growth in ever and current electronic cigarette use over the past five years, although growth in current use slowed down from 2013 to 2014. Although smokers are most likely to use these products, almost a third of current users are nonsmokers, undermining potential public health benefits of cigarette smokers possibly switching to electronic cigarettes."

This conclusion doesn't comport with the actual findings of the study. When the study concludes that a third of current e-cigarette users are nonsmokers, it is entirely possible that roughly half of these "nonsmokers" are former smokers who quit smoking successfully using e-cigarettes. Obviously, the difference in these two interpretations is drastic. That the researchers chose to present the findings in a negative way that is not consistent with their own findings seems to indicate a bias against e-cigarettes.

By the way, I fully understand why many anti-tobacco researchers have a strong bias against e-cigarettes. They look like cigarettes and are used like cigarettes. For those of us who have been fighting smoking for our entire careers, it is difficult to condone a behavior that looks just like smoking.

But as some point, we need to be able to put aside our biases and our pre-existing conclusions and objectively examine the actual science. That science does not support the claims that are being made by the major anti-tobacco organizations and health groups and agencies. Unfortunately, the public is not getting an objective view of the evidence because it is being distorted by the ideological biases of the anti-smoking groups.

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