Vaporized Nicotine Products for Smoking Cessation Among People Experiencing Social Disadvantage : A Randomized Clinical Trial.

BACKGROUND

Vaporized nicotine products (VNPs) are more effective than nicotine replacement therapy (NRT) for smoking cessation in general populations, but their effectiveness among low socioeconomic groups is largely unknown.

OBJECTIVE

To examine whether VNPs are more effective than NRT for smoking cessation among people experiencing social disadvantage.

DESIGN

Two-group, open-label, randomized trial with blinded outcome ascertainment. (Australian New Zealand Clinical Trials Registry ACTRN12621000076875).

SETTING

Australia, between March 2021 and December 2022.

PARTICIPANTS

1045 adults who smoked daily, were willing to quit smoking, and were receiving a government pension/allowance (proxy for social disadvantage).

INTERVENTION: Participants were randomly assigned (1:1) to either a free 8-week supply of NRT or VNPs, and all participants received text-message support.

MEASUREMENTS: The primary outcome was 6-month continuous smoking abstinence verified using a carbon monoxide breath test at 7-month follow-up. Analysis included randomly assigned participants in accordance with Russell Standard criteria and the intention-to-treat principle.

RESULTS

Among 1045 randomly assigned participants, 866 (82.9%) completed final follow-up. The verified 6-month continuous abstinence rate was 9.6% (50 of 523) in the NRT group and 28.4% (148 of 522) in the VNP group (posterior risk difference estimate, 18.7% [95% credible interval, 14.1% to 23.3%]; >99% posterior probability that VNP is superior). Self-reported adverse events occurred less frequently in the VNP group (355 events among 237 participants) compared with the NRT group (442 events among 278 participants; incident rate ratio, 0.75 [95% CI, 0.65 to 0.88]; P < 0.001).

LIMITATIONS: Biochemical verification method tested short-term exposure to cigarette smoke.

CONCLUSION

Findings indicate that VNPs were more effective than NRT for smoking cessation in this population. Given the challenges for cessation among these socially disadvantaged populations, VNPs present a promising treatment option for this priority group.

PRIMARY FUNDING SOURCE: Australian National Health and Medical Research Council.