Reply to: "Nicotine or tobacco abstinence?"

Long-Term Effectiveness of a Quitline for Smoking Cessation: Results of a Randomized Controlled Trial

INTRODUCTION

Smoking remains a significant global public health issue, leading to numerous preventable deaths and disabilities annually. Telephone counselling is a recommended intervention for smoking cessation, offering accessible support to a wide range of people who smoke. This study aimed to evaluate the long-term effectiveness of the German quitline for smoking cessation.

METHODS

A parallel-group, two-arm, superiority, randomized controlled trial was conducted between October 2021 and November 2023. People who smoked daily and were willing to quit received either up to six telephone counselling calls (intervention group) or a self-help brochure (control group). Seven-day point prevalence abstinence from cigarettes and tobacco at 12 months and prolonged cigarette and tobacco abstinence from 3 to 12 months after the start of the intervention were assessed. Further, the use of additional cessation aids was assessed.

RESULTS

A total of n = 905 participants were randomized (intention-to-treat sample). The intervention group (n = 477) exhibited higher rates of prolonged cigarette abstinence (31.7% vs. 17.8%) and prolonged tobacco abstinence (30.8% vs. 15.2%) compared to the control group (n = 428) at 12-month follow-up with corresponding odds ratios of 2.2 (95% CI [1.6, 3.0]) and 2.5 (95% CI [1.8, 3.5]). Seven-day point-prevalence cigarette abstinence was not statistically significant (OR = 1.3, 95% CI [1.0, 1.7]). E-cigarettes were the most commonly used additional cessation aid (46.0%), followed by electronic media (31.0%) and nicotine replacement therapy (26.2%).

CONCLUSIONS

Telephone counselling provided by the national German quitline for smoking cessation demonstrates effectiveness in promoting long-term abstinence from cigarettes and tobacco. Increased awareness and use of the quitline could promote cessation rates in Germany. Given the rising popularity of novel nicotine consumer products, counselling protocols should incorporate information on their risks and potential as cessation tools.

Oral Nicotine Gum Discussions on Twitter: Content Analysis

BACKGROUND

Oral nicotine gum such as LUCY, which comes in colorful packaging, mimicking traditional chewing gum, is becoming popular. Many brands of gum have not been approved by the FDA for smoking cessation. This study examined public discourse about, including sentiment toward, oral nicotine gum on Twitter.

METHODS

We used Twitter's Streaming Application Programming Interface to collect data from January 1, 2021, to December 21, 2021, using "nicotine gum" and/or "#nicotinegum" search terms (N = 19 171 unique tweets were collected). We used an inductive approach to become familiar with the data, generated a codebook, and conducted a content analysis on (n = 2152) tweets.

RESULTS

Cessation (n = 716, 33.3%), personal experience (n = 370, 17.2%), and addiction to gum (n = 135, 6.3%) were the most prevalent themes. Cessation tweets primarily discussed cigarette smoking cessation (n = 418, 58.4% of cessation tweets) and successful cessation experiences (n = 155, 21.6%). Other identified themes pertained to using nicotine gum for cognitive enhancement or catching a "buzz" (n = 102, 4.7%), marketing (n = 98, 4.6%), using nicotine gum with other substances (n = 90, 4.2%), and adverse effects (n = 63, 2.9%). Sentiment analysis results revealed that 675 (44.2%) tweets were categorized as neutral, 605 (39.6%) tweets were classified as positive, and 248 tweets (16.2%) were negative.

CONCLUSIONS

About one-third of tweets in our corpus mentioned nicotine gum in the context of smoking cessation. Most nicotine gum-related posts conveyed positive and neutral sentiments. Future studies should consider adding novel nicotine gum-specific search terms as well as exploring other social media platforms to gain more insights about these products.

IMPLICATIONS

Our findings suggest that Twitter has the potential to track and facilitate conversations between those seeking cigarette cessation advice and those who have successfully quit tobacco by using nicotine gum. Monitoring of promotional content from nicotine gum companies is needed to ensure these products are not appealing to youth and nonusers of tobacco.

[Electronic cigarettes: harm reduction or harm prolongation?]

This paper deals with the question of whether electronic cigarettes (e-cigarettes) can minimize the proven harm of smoking tobacco or may lead to a long-term harm. While the British Royal College of Physicians recommends smokers to use e-cigarettes as a substitute for tobacco products, the German Society for Pneumology and Respiratory Medicine advises smokers against using e-cigarettes. The harm reduction strategy is based on three hypotheses. Hypothesis 1: It is assumed that e-cigarettes cause less damage to health than tobacco cigarettes. Hypothesis 2: It is postulated that smokers are motivated to switch from conventional cigarettes to e-cigarettes. Hypothesis 3: It is assumed that e-cigarettes are an effective means for quitting smoking with few side effects. Although the long-term health consequences of e-cigarette use remain unknown, there is increasing evidence that e-cigarettes are toxic, harmful to cardiovascular system, respiratory health and potentially carcinogenic. Population-representative epidemiological surveys have shown that three-quarters of all current e-cigarette users in Germany smoke tobacco at the same time. In a few randomized clinical trials, e-cigarettes showed higher success rates compared to nicotine replacement products. As over-the-counter consumer products, a large number of studies have found no advantage for e-cigarettes under real conditions. In addition, e-cigarettes prolong nicotine dependence compared to nicotine replacement products. According to the current state of knowledge, the hypotheses behind the harm minimization strategy using e-cigarettes must be regarded as refuted. It therefore appears ethically problematic when doctors recommend e-cigarettes to their patients as a substitute for smoking.