It doesn’t seem unreasonable to assume that e-cigarettes can help people quit smoking. They offer nicotine in a cleaner form, much like nicotine replacement therapy products, but also replicate the sensation of smoking a cigarette like no other option on the market. So we’re hardly surprised when we see things like a clinical trial comparing e-cigs to patches and finding similar quit-rates. In fact, given that the trials thus far have used first-generation devices (which aren’t as effective at nicotine delivery), it seems very reasonable to assume that new-generation “mods” are actually a little better than patches and gums at helping people quit.
However, if you happen to be a researcher working with Stanton Glantz at the University of California, San Francisco, it doesn’t really matter what’s reasonable, because if you construct your study carefully enough, you can say whatever the hell you like. The newest example is the new study – published as a research letter – in JAMA Internal Medicine, which reaches the conclusion that “our data add to the current evidence that e-cigarettes may not increase rates of smoking cessation.” So how did they come to this conclusion? In a word: unfairly.
Summary
- Researchers surveyed 949 smokers about their consumption habits, and followed up one year later to see if there was a difference in quit rates between those who’d used e-cigs and those who hadn’t.
- Participants were defined as e-cig users if they’d tried an e-cig at any point over the course of the month prior to the baseline survey; out of the sample, there were 88 e-cig “users” and 861 non-users.
- Most of the sample who’d used an e-cig in the previous month at baseline had no intention of quitting in the following year, and the research didn’t take sufficient information to even determine whether or not they used e-cigs in a quit attempt.
- After one year, 13.8 percent of the non e-cig users and 10.2 percent of the e-cig users were abstinent from smoking. There was no statistically significant difference between the quit rates in the groups and it’s unclear whether e-cigs were used to try to quit by either group, but the researchers claim this means e-cigs don’t aid quitting.
- The findings could be more accurately conveyed as: out of a group of smokers primarily not intending to quit in the next six months, there was no significant difference in one year quit rates between those who’d used an e-cigarette once or more in the month before the baseline survey and those who hadn’t. It’s not exciting, but that’s what the research really shows.
What They Did – Longitudinal Analysis of E-Cig Use and Smoking Cessation
The research comes from the Center of Tobacco Control Research and Education at UCSF, the same group who recently claimed that e-cigarettes may encourage smoking among youth, despite no such evidence being presented in the study. The new paper doesn’t bear Stanton Glantz’s name (which would be a dead giveaway that something about the research won’t be quite right), but lead author Rachel Grana and her colleagues have evidently been paying attention to how this misinformation game works.
In the study, 949 smokers were surveyed about their smoking habits in November 2011, and followed up with them one year later to see how they’d gotten on. The method seems straightforward enough, but the problems take root straight away, because only 88 of these smokers had tried e-cigarettes in the month prior to the baseline survey. These were classed as the “e-cigarette users” in the research, but in actual fact, all the researchers know is that they’d used e-cigarettes at least once (albeit recently), as Dr. Michael Siegel points out, not that they were regular or current users.
What They Found – E-Cigarette “Users” Not More Likely to Quit Smoking
The core finding is that at the one year follow-up, 13.8 percent of non e-cigarette users and 10.2 percent of e-cigarette users had quit smoking. This translates to no significant difference between the two groups, meaning that e-cigarette users weren’t more likely to have quit smoking than non e-cigarette users, even after the researchers made adjustments to account for differing levels of tobacco dependence (the e-cigarette users in the study smoked slightly more on average and had a cigarette sooner after waking, indicating a greater level of addiction). From the relatively straightforward findings, the authors conclude that:
“Consistent with the only other longitudinal population-level study with one-year follow-up that we are aware of, we found that e-cigarette use by smokers was not followed by greater rates of quitting or by reduction in cigarette consumption one year later.”
Study author Pamela Ling takes things a little further, talking to Nature, “Advertising suggesting that e-cigarettes are effective for smoking cessation should be prohibited until such claims are supported by scientific evidence.”
What They Really Found
The problems with this research aren’t exactly nuanced or well-hidden, as Carl Philips comments, “Their lies are so obvious that every honest casual observer who reads their papers can spot them.” Firstly, the sample of e-cigarette users was tiny, so there is an obvious statistical issue presented there – a much larger sample would be needed to reliably make any sweeping statements about e-cigs as a whole.
The much bigger problem comes in the form of the definition of e-cigarette user and their reasons for vaping. The researchers took information about the participants’ intentions with regards to quitting smoking in the baseline survey, and this reveals that only 8 percent of the e-cigarette users intended to quit in the next 30 days, and just another 31.8 percent intended to quit at some point in the following six months. In fact, the majority of the e-cigarette “using” participants didn’t intend to quit for at least six months. It must be said that the intention to quit smoking among the e-cigarette users was slightly greater than among the non-users, but in any case it’s clear that most of the e-cigarette users weren’t even trying to stop smoking.
With that information alone, it wouldn’t exactly be fair to say e-cigarettes don’t aid quitting smoking, because most who used them didn’t even want to. However, the much larger issue is that many of them might not have even used e-cigarettes if they did try to quit, because all we know is that they’d tried them in the month before the baseline survey. In other words, the sample could have included a large proportion of smokers who’d just given vaping a try at some point recently, or who perhaps use them to get a dose of nicotine when they can’t smoke a cigarette for whatever reason. With these points combined, the designation of “e-cigarette users” for the group is massively inappropriate, and insinuating they were trying to quit using e-cigarettes is terrifyingly misleading.
So what did they really find? Something like this: there was no significant difference in one-year quit rates between smokers (primarily with no intention of quitting within six months) who’d tried an e-cigarette at least once in the month prior to the baseline survey and those who hadn’t. This might not sound as interesting, but at least it’s an accurate portrayal of the findings of the study. And most people would likely respond with a justified “so what?”
If the researchers wanted to legitimately make claims about e-cigarette users not being more likely to quit, all they would have needed to do would be add some questions about reasons for vaping, how frequently they did so and whether the used e-cigarettes in their quit attempt. If they’d found out about what methods were used in quit attempts in the follow-up, it might have been found that some of the non-e-cig group actually used e-cigarettes to try to quit. Since we only know their e-cig use status at baseline, there is no indication of whether any participants vaped regularly over the following year. It wouldn’t have been difficult to ask these extra few questions – so why didn’t the researchers do so?
Conclusion – Are People Waking Up to These Tricks?
There was some unthinking repetition of the information in the press release from the media, but as Clive Bates points out, there are also rumblings of dissatisfaction with this junk science. Reuters spoke to Michael Siegel, who shared his irritation with the unjustified statements accompanying the research, and even the American Cancer Society criticized the researchers in a statement:
“These limitations severely reduce the ability of the research team to make any meaningful conclusions about their data and call into question the headline in the news release accompanying the study, i.e. “E-cigarettes Not Associated With More Smokers Quitting, Reduced Consumption.” This conclusion simply cannot be justified on the basis of the data collected by the authors.”
It might be a little too optimistic, but perhaps the days of these unjustified conclusions slipping into the media and the public understanding of the issues wholly unchecked are coming to an end. They’ll try something like this again, undoubtedly, but perhaps the further they push it the more the media will be willing just call them out on the lies. Because we should; the implicit assumption that the public is stupid enough to swallow this nonsense should serve as motivation enough to call these people out as the charlatans they are at every opportunity we get.