Electronic cigarettes help smokers who want to escape from tobacco, but a new study shows they also help smokers who had not previous intention of quitting. In an interesting interview, Professor Jonathan Foulds explains to Associate Professor Jamie Hartmann-Boyce how he got into tobacco harm reduction research and what he discovered in his latest piece of work.
Jonathan Foulds is a Professor of Public Health Sciences at Penn State College of Medicine. The Scot has been there for around 12 years, having moved on from Rutgers School of Public Health in New Jersey. Truth told, Professor Foulds is one of the world’s longest serving tobacco researchers, having begun studying it in London in 1989 alongside other renown academics such as Mike Russell, Martin Jarvis, and Ann McNeill.
Foulds’ work began by looking at nicotine replacement therapies. In fact, he ran the first trial in the UK studying nicotine patches. Jonathan got interested in tobacco harm reduction when he was asked to give a talk on smokeless tobacco to a World Health Organisation event. Some leading academics got pretty upset about what he had to say.
Professor Jonathan Foulds: “I said what seemed to be obvious, that smokeless tobacco is much less harmful than smoking because it doesn’t cause respiratory disease, it doesn’t cause lung cancer. I though [what I said] seemed like common sense but clearly, it’s not a widely accepted concept.”
From there he produced a paper looking at the role snus played in improving the public health in Sweden. “That was also very controversial. I was very taken back at the idea that [replacing tobacco with a reduced harm product] could be a bad thing.” Then e-cigarettes came onto the scene.
Initially, Professor Foulds didn’t pay them much attention. Back in 2007, nicotine delivery was so poor he believed they would be nothing more than a prop to play with while someone went through cold turkey.
“But these products have developed,” he said, and explained how he conducted an investigation designed to develop methods to be used to assess e-cigs being used by smokers who weren’t trying to quit for future studies.
The trial wasn’t designed to measure if vapes helped people quit, but he hoped that this would be something they could observe happening. So, the criteria for recruitment to the trial was that the subjects had to be smokers with no intention of quitting who would consider vaping just to reduce their use of cigarettes.
The subjects were split into four groups:
·High nicotine vape (36mg/ml)
·Low nicotine vape (8mg/ml)
·A placebo vape (0mg/ml)
·Or a plastic tube they could suck on when wanting to smoke
The groups were told to use their products to half the number of cigarettes they smoked. Then, after a month, to half that number again and see how long they could continue at that level. For example, 20 cigarettes to 10, then 10 to 5, and remain at just 5 cigarettes per day.
“They were never told to quit.”
The findings were striking.
“What we found was, with a smoking cessation trial you get people to have a quit date at the beginning, and a lot quit on their quit date, then it’s downhill from there.
“In this trial, they didn’t quit at the beginning – partly because they were told not to – but over time the quit rate in the high nicotine group increased. By the end of the trial, it was 11% in the high nicotine group and 4% in the low nicotine group.”
Interestingly, 3% of smokers quit using the plastic tube but just 0.8% quit using a nicotine-free placebo.
Professor Foulds was surprised by the low nicotine vapes result because users can self-titrate – meaning they can vape more to get the amount of nicotine they need. Theoretically then, low nic vapes should work just as well, but he explains that he has since discovered people new to using e-cigarettes get roughly half the amount of nicotine from them that more experienced vapers managed.
His team checked back in with the subjects six months after the trial had finished. They found that the quit rates in the groups using nicotine vapes was still going up, people were still quitting thanks to ecigs despite them never having had an intention to do so.