November 2021 with guest Professor Anne Joseph

In the November 2021 episode Jamie Hartmann-Boyce talks with Professor Anne Joseph from the Department of Medicine, University of Minnesota Medical School, Minneapolis, about her study carried out with a team at the University of Minnesota and study's first author Kolawole Okuyemi, Department of Family and Preventive Medicine, University of Utah, Salt Lake City. DOI:  10.1093/ntr/ntab212

Professor Anne Joseph discusses her team's recent study that compares the effects of e-cigarettes with and without nicotine on patterns of combustible cigarette use and biomarkers of exposure to tobacco toxicants among African American smokers. Professor Joseph outlines that there are many reasons to look at the question of e-cigarette use with and without nicotine among African American smokers. African Americans are disproportionately impacted by tobacco-related diseases, for example lung cancer. This is in spite of different patterns of smoking by African Americans, such as smoking fewer average cigarettes per day but having more difficulty stopping smoking. In real world settings people change their behaviour without support of researchers and clinicians, Professor Joseph's study aimed to replicate this by providing little behavioural support. Participants were given a choice of menthol and non-menthol flavoured e-cigarette cartridges and were asked to use e-cigarettes ad libitum for 6 weeks. The majority of participants (88.6%) selected menthol e-cigarettes. Follow-up assessments were conducted at 2, 6, and 12 weeks post randomisation. Contrary to their hypotheses, they found that nicotine e-cigarettes did not significantly reduce the use of combustible cigarettes compared to non-nicotine e-cigarettes in this cohort of African American smokers. Their findings suggested that e-cigarettes were modestly associated with decreased use of combustible cigarettes among non-treatment seeking smokers, regardless of nicotine content, but without a reduction in tobacco toxicants.

Professor Joseph considered that although e-cigarettes have potential to reduce harm if substituted for combusted cigarettes (or if they promoted cessation) because of lower levels of tobacco toxicants, their study suggested that ad libitum use of e-cigarettes among African American smokers, with or without nicotine, resulted in modest smoking reduction but did not change toxicant exposure in a cohort where smoking cessation or reduction was not the goal. The authors considered that their data suggested that testing future harm reduction interventions using e-cigarettes should include more specific behavioural change coaching, including substituting for or completely stopping combusted cigarettes.

For more information on the full Cochrane review updated in September 2021 see: https://doi.org/10.1002/14651858.CD010216.pub6 or our webpage.

Jamie and Nicola bring us up to date with the literature search conducted on November 1st. The November search found one new study described in the podcast. The DOI for the new included study (Okuyemi 2021) is 10.1093/ntr/ntab212 . We will include the studies we have found in future updates of the Cochrane review.