‘Relapse Study Asks Wrong Question’

A recent study suggesting that vaping doesn’t prevent smokers from relapsing to cigarettes is flawed because it asks the wrong question, according to Cameron English of the American Council on Science and Health.

For the study, “Effectiveness of E-Cigarettes as Aids for Smoking Cessation,” researchers analyzed data on 3,578 previous-year smokers who had recently attempted to quit and 1,323 recent former smokers from the Population Assessment of Tobacco and Health (PATH) Study between 2017–2019. Participants self-reported their use of e-cigarettes or other products to quit cigarettes. The researchers then investigated who among the study participants had abstained from smoking or any tobacco products in 2019. They concluded that sales increases in high-nicotine cigarettes in 2017 did not improve successful quitting or prevent relapse.

English contends that the significance of the study is limited because of the way it defines “relapse.” To determine how many smokers returned to cigarettes, the authors asked study participants whether they had smoked a cigarette in the past 12 months, “even one or two puffs/times.”

“Using this metric, an individual who has almost entirely quit smoking, save for ‘even one or two puffs’ of a cigarette, and someone who has gone back to smoking a pack a day would be counted as having relapsed,” English writes.

“This definition ignores the fact that many smokers gradually switch from combustible cigarettes to their electronic counterparts. This is known as ‘dual use,’ and properly designed epidemiological studies (even those based on PATH data) and clinical trials try to account for this behavioral shift, correctly noting that replacing even some cigarette smoking with vaping is desirable because vaping is the far safer option.”

Additional high-quality research would be helpful, but “preventing relapse” is an all but useless outcome, according to English. “Unless the researchers evaluate how e-cigarettes are used in the real world, the only thing their next paper will confirm is that asking the wrong question inevitably leads to the wrong answer, he writes.