UW-CTRI Paper Calls for More Research on Vaping

Dr. Michael Fiore and Dr. Tim Baker
Dr. Michael Fiore and Dr. Tim Baker

UW-CTRI Director of Research Dr. Tim Baker and UW-CTRI Director Dr. Michael Fiore wrote an editorial in JAMA Open Network commenting on three new research studies on vaping, asserting that our knowledge of the topic is still in its infancy. The three new studies published in JAMA Open Network found:

  1. In the first paper by Everard et al based on data from the Population Assessment of Tobacco and Health (PATH) Study, former smokers who took up vaping were at increased risk of relapsing back to smoking, implying that clinicians should warn former smokers about vaping. “Thus, e-cigarette use may precipitate relapse, perhaps via nicotine priming effects,” Baker and Fiore wrote. “However, the authors were careful to draw delimited inferences about the possible effects of e-cigarettes.”
  2. In a second paper by Friedman and Xu, vaping uptake was positively associated with smoking initiation in youth and emerging adults. Yet, vaping uptake was associated with greater likelihood of smoking cessation in adults. While vaping nontobacco flavors was no more associated with youth smoking initiation than was vaping tobacco flavors, it was associated with more adults quitting smoking. “Such results remind us of the dangers of safe assumptions and illustrate the likely complexity of e-cigarette effects,” Fiore and Baker wrote.
  3. In the third paper by Kock et al, researchers examined vaping among former smokers in the English Smoking Toolkit Study. They found that former smokers were likely to try vaping, especially those from low socioeconomic backgrounds, a finding that echoes the first paper.

Baker and Fiore said that they appreciated the nuanced approach of these studies, and the attention to detail. The authors didn’t make sweeping conclusions. While the studies were limited by self-selected samples, the research does expand the body of research on vaping and smoking.

They wrote that there is still a great deal to learn, such as:

  • What will be the fate(s) of people who smoke and vape, especially long-term?
  • How will legal restrictions affect youth vaping?
  • How will youth vaping relate to future harms, including cigarette prevalence?
  • To what degree can vaping help people quit smoking?
  • How do the quit rates produced by vaping compare with the use of effective FDA-approved medications?
  • How will vape products evolve?
  • How does COVID-19 impact vaping?

Much more research is needed. To that end, they outlined a plan to help limit tobacco use, with these proposed action steps:

  1. The FDA should encourage studies in the United States to examine vaping as aids to quit smoking by issuing a blanket investigational new drug certificate for all researchers.
  2. The FDA and National Institutes of Health should launch a funding program for research to evaluate the effectiveness of vaping to quit smoking, encouraging studies that span the translation landscape (from efficacy to real-world use contexts).
  3. Researchers should launch a careful examination of the effect of a flavor ban, including its potential both for benefits and unintended consequences.
  4. The FDA should resume its regulatory plan, authorized by its 2009 legislative language—to reduce the nicotine content of all tobacco products not documented as safe and effective to zero.

Baker TB, Fiore MC. (2020) What We Do Not Know About E-cigarettes Is a Lot. JAMA Network Open. 2020;3(6):e204850.