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Moffitt Cancer Center study on e-cigarette use may help ‘take a bite’ out of smoking deaths
Moffitt Cancer Center has initiated a nationwide study of individuals who use both conventional and electronic cigarettes.
The study, called Project E-cigarette and Smoking Evaluation (EASE), will follow 2,500 participants to assess their attitudes and behaviors toward cigarettes and e-cigarettes. Study participants will complete surveys every 3 months for 2 years.
Researchers also will evaluate whether a minimal intervention can help these individuals use e-cigarettes to quit smoking.
Thomas H. Brandon, PhD, chair of the department of health outcomes and behavior at Moffitt Cancer Center, spoke with HemOnc Today about the trial, as well as the potential implications the findings may have for cancer prevention and diagnosis.
Question: How did the idea for this study come about?
Answer: E-cigarettes have burst on the scene in the last few years and their popularity has been increasing exponentially. If you ask e-cigarette vapers — which is what they call themselves instead of smokers — why they started vaping, 75% will say that they started in order to quit smoking. So, they are using this as an unofficial, unapproved nicotine replacement therapy — like the nicotine patch or gum, for example. We do not really know how well it works, and most people start vaping while continuing to smoke. There is concern that many of these folks are using both products at the same time. The health benefits of doing this are questionable. This issue of dual users is a big concern. It occurred to us that, for the most part, these are folks who are looking to quit smoking. If we have this identifiable group of smokers who want to quit, maybe it would not take that much to nudge them a little further and give them some help to quit smoking by using e-cigarettes to their advantage. That is, maybe we could help them achieve their original goal of quitting smoking by vaping. It turned out that, around the same time that vaping was becoming popular, we were completing a study that showed a great deal of success with our self-help smoking cessation intervention. This intervention consists of a series of booklets that people get over the course of 18 months that are designed to give fairly comprehensive but easy-to-digest advice about how to quit smoking. Our idea was to see if we could capitalize upon the exponential rise in e-cigarette use to reduce the prevalence of smoking and, thereby, smoking-related mortality and morbidity.
Q: What is the anticipated timeline of the study?
A: The grant began in April 2015. We spent the first year developing the intervention. We held focus groups and meetings with e-cigarette users, and we consulted experts as well as our own research on how to modify our existing smoking-cessation intervention for use by dual users. The clinical trial started in July. We are recruiting a sample of 2,500 dual users throughout the country. Accrual will continue through July 2017. The study will end in 2020.
Q: What is the study designed to determine?
A: One arm of the study is surveillance only, so we are just monitoring these folks. We are simply trying to see what happens naturally among dual users. When we originally wrote this grant, there was very little information on this population. Then, for our intervention arms, we are going to give participants a couple different versions of self-help materials. We want to test if these self-help interventions are effective for helping dual users stop their tobacco smoking and maybe eventually give up their vaping, as well. We also are looking at factors that may influence this change, including sex, level of nicotine dependence, type of e-cigarettes used and so on. This information may help us better focus an intervention in the future.
Q: What are the potential implications regarding cancer prevention and diagnosis?
A: Tobacco smoking is the leading preventable cause of cancer mortality. Traditional tobacco control approaches have greatly reduced smoking in the past several decades. Then e-cigarettes exploded on the market, and there are still many unknowns and concerns about these products. However, they may also have the potential to help millions of smokers finally quit smoking. In fact, within the past year, some evidence has started to emerge that suggests they can indeed help smokers quit. However, we still do not know the size of this effect. If a minimal intervention — such as sending booklets through the mail or internet — can boost this effect, there is the potential to improve population-wide cessation and ultimately reduce the burden of smoking-related cancers and other diseases. This is our ultimate goal.
Q: How excited are you about the study's ultimate potential?
A: Very excited. Smoking is expected to kill about 1 billion people in this century. I certainly would like to take a bite out of that, and I think this is one way that we can potentially do so.
Q: Is there anything else that you would like to mention ?
A: E-cigarettes are very controversial. In fact, there are legitimate questions about how they will ultimately affect public health on a population level. Will they be a net-good or a net-bad? Not surprisingly, there are people — both tobacco control advocates and pro-vaping advocates, including some scientists on both sides — who have staked out extreme positions about e-cigarettes. Unfortunately, this has become an emotional issue for some, and they sometimes make statements that outpace the science. On one side, some vaping advocates make the claim that e-cigarettes are completely safe and that any regulation represents a blow to public health. On the other side, some tobacco control proponents falsely imply that vaping is as dangerous as smoking, and that we know that vaping is reversing decades of tobacco control. As a psychologist, I understand why tobacco use is so emotion-laden. After all, it is responsible for a half-million deaths per year in the United States and an estimated 5 million worldwide. We have been fooled by the tobacco industry before with ultra-light and filtered cigarettes. On the other hand, we have to take a rational and reasoned perspective on each new change in the tobacco environment. I urge oncologists to take both extreme positions with a grain of salt. I am cautiously optimistic that e-cigarettes will be a net-gain for public health. But, I have an open mind, and this is why we do the research. – by Jennifer Southall
For more information:
Thomas Brandon, PhD, can be reached at Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612; email: thomas.brandon@moffitt.org.
Disclosure: Brandon received study medication from Pfizer for unrelated studies.