Effect of Pod e-Cigarettes vs Cigarettes on Carcinogen Exposure Among African American and Latinx Sm
Thursday, November 19, 2020
Posted by: Natalia Gromov
Pulvers
K, Nollen NL, Rice M, et al.
Effect of Pod
e-Cigarettes vs Cigarettes on Carcinogen Exposure Among African American and
Latinx Smokers: A Randomized Clinical Trial.
JAMA Netw Open. 2020;3(11):e2026324. doi:10.1001/jamanetworkopen.2020.26324
Importance
Fourth-generation nicotine salt pod system (NSPS) electronic cigarettes
(e-cigarettes) are the leading class of e-cigarettes. They contain high
nicotine concentrations, which may facilitate switching among smokers, but
could also lead to increased exposure to nicotine and biomarkers of potential
harm. African American and Latinx smokers experience significant
tobacco-related health disparities. The potential of NSPS e-cigarettes to
reduce smoking-related harm among these groups is unknown.
Objective
To compare the harm reduction potential of NSPS e-cigarette vs combustible
cigarettes.
Design, Setting, and
Participants This unblinded randomized clinical trial
compared 6 weeks of e-cigarette use vs cigarettes as usual from to 2018 to 2019
among smokers in the San Diego, California, and Kansas City, Missouri, areas.
Participants included African American and Latinx adult combustible cigarette
smokers who smoked at least 5 cigarettes/d on at least 25 of the past 30 days
for at least 6 months and were interested in switching to e-cigarettes. Data
were analyzed from September 18, 2019, to September 4, 2020.
Interventions
6 weeks of e-cigarette use in a choice of pod flavors (5% nicotine) along with
brief education, training, and action planning to completely switch to
e-cigarettes from combustible cigarettes. The control group smoked combustible
cigarettes as usual.
Main Outcomes and
Measures The primary outcome was reduction in urinary
4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) concentration at week 6.
Secondary outcomes were change in urinary cotinine, expired carbon monoxide
(CO), respiratory symptoms, lung function, blood pressure, past 7-day
consumption of combustible cigarettes, and switching rates (e-cigarette group
only) at weeks 2 and 6.
Results
This study included 186 participants, including 92 African American
participants and 94 Latinx participants. The mean (SD) age was 43.3 (12.5)
years, and 75 (40.3%) were women. Participants smoked a mean (SD) of 12.1 (7.2)
cigarettes/d on 6.8 (0.6) d/wk at baseline. A total of 125 participants were
randomized to the e-cigarette group and 61 were randomized to the control
group. At baseline, median (interquartile range) NNAL was 124 (45-197) pg/mL in
the e-cigarette group and 88 (58-197) pg/mL in the control group. At week 6,
the e-cigarette group had significantly greater reductions in NNAL (relative
risk [RR], 0.36 [95% CI, 0.23-0.54]; P < .001), CO (RR, 0.53 [95% CI,
0.42-0.68]; P < .001), respiratory symptoms (RR, 0.63 [95% CI, 0.47-0.85];
P = .002), and number of cigarettes smoked in the past 7 days among those still
smoking (RR, 0.30 [95% CI, 0.20-0.43]; P < .001) than the control group and
maintained their cotinine levels (RR, 0.80 [95% CI, 0.58-1.10]; P = .17). Lung
function and diastolic and systolic blood pressure remained unchanged and did
not differ between groups. For participants randomized to receive e-cigarettes,
32 participants (28.1%) were exclusively using e-cigarettes at week 6, while 66
participants (57.9%) were dual using and 16 participants (14%) resumed
exclusively using cigarettes.
Conclusions and
Relevance These findings suggest that e-cigarettes may be
an inclusive harm reduction strategy for African American and Latinx smokers.
|
|
Email to a Friend