Vaporized nicotine products may be effective for smoking cessation among people with social disadvantage

1.  In this randomized controlled trial, vaporized nicotine products were associated with higher rates of smoking abstinence compared with nicotine gum and lozenges among people with low socioeconomic status.

2. The group which received vaporized nicotine products reported fewer adverse events and higher treatment adherence.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Despite positive trends in smoking cessation in higher-income countries, smoking rates remain high among socioeconomically disadvantaged groups. Studies have suggested that vaporized nicotine products (VNPs) may lead to higher rates of smoking cessation compared with nicotine replacement therapy (NRT). This study aimed to evaluate the relative effectiveness of VNPs and NRT on smoking cessation among low socioeconomic status (SES) groups. After half a year, more than one-quarter of VNP users achieved verified continuous abstinence compared with less than one-tenth of NRT users. Subgroup analyses by age, sex, nicotine dependence, and mental illness showed greater effectiveness of VNP compared to NRT in achieving smoking cessation. Self-reported adverse effects were lower in the VNP group compared with the NRT group, but there was no significant difference in the occurrence of serious adverse effects. More NRT users stopped adhering to treatment by the second check-in call compared with VNP users; the most common reasons for stopping NRT were related to distaste for the treatment and side-effects, while the most common reasons for stopping VNP were unrelated medical conditions and life stressors. At the final follow-up, the majority of VNP users continued to use their allocated treatment compared with less than one-third of NRT users. The generalizability of this study was limited by a lack of blinding, potentially different perceptions of VNP versus NRT, and potential underestimation of continued use. Nevertheless, this study suggested that VNP may be an effective choice for smoking cessation among socially disadvantaged groups.

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Relevant Reading: Electronic cigarettes for smoking cessation

In-Depth [randomized controlled trial]: This study aimed to compare the effectiveness of VNPs and NRT in achieving smoking cessation among low SES individuals. A total of 1045 participants were randomly assigned to receive VNPs or NRT in a 1:1 ratio. The primary outcome was continuous smoking abstinence for 6 months assessed at 7-month follow-up; continuous smoking abstinence was defined as self-report of having smoked ≤5 tobacco cigarettes over a 6-month period and verified with a CO level of ≤5 ppm. The study population had a median age of 50 years, was 67% female, and smoked a median of 20 cigarettes a day. Among the participants, 82.9% completed the 7-month follow-up. Continuous abstinence after 6 months was achieved in 28.4% of VNP participants and 9.6% of NRT participants, yielding an estimated risk difference of 18.7% (95% credible interval [CrI], 14.1% to 23.3%). Quit rates were similar between participants with and without recent diagnosis or treatment of mental illness in both treatment groups (26% vs. 30% for VNP and 9% vs. 10% for NRT, respectively). Self-reported abstinence outcomes at all time points showed that VNP was more effective than NRT.  Users of VNPs also reported fewer adverse events (355 events reported by 237 participants) compared with NRT users (442 events reported by 278 participants); the incidence rate ratio was 0.75 (95% confidence interval, 0.65 to 0.88). An estimated 11.5% fewer participants experienced adverse events in the VNP group (posterior risk difference, -11.5% [95% CrI, -17.6% to -5.3%]). The most frequent adverse events were COVID-19, cough, headache, and nausea; cough and headache occurred more frequently among VNP users and nausea more frequently among NRT users. At the 7-month follow-up, 253 (56.3%) VNP users and 129 (30.9%) NRT users reported continued treatment use. Overall, this study suggested that VNP may be more effective than NRT in aiding smoking cessation in a low SES population.

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