3 ms·

I submitted this partly to see how people would explain away the result. 4.78 RR for smoking one year after vaping for non-smokers is pretty huge. That’s defin

I submitted this partly to see how people would explain away the result. 4.78 RR for smoking one year after vaping for non-smokers is pretty huge. That’s definitely a clinically significant result. Smoking itself is the highest OR for lung cancer and therefore mortality of any behavior (in the 60s for Americans), and using cigarettes really dooms you to that outcome. Nicotine patches, as transdermal delivery, don’t get people as high as Juul does, and that’s the likely reason you don’t observe either recreational use of them nor people becoming smokers from using them.

dionidium 8y ago
You've used some jargon here that I don't understand, so I'm probably just missing it, but I don't see where any of this addresses the claim that, "Smoked a cigarette in the last 12 months" is a strikingly low bar.
- doctorpangloss 8y ago
  On the one hand, I don't want to condescend. Relative risk and odds ratio are best explained on Wikipedia. If you want to get advice on smoking cessation, ask a doctor. There have been no clinical trials for Juul or any e-cigarette product. No doctor following the letter of what they're supposed to be doing is going to recommend an e-cigarette product to a person seeking smoking cessation. The strikingly low bar thing... People here defend Juul like people defended Theranos. Nobody wants to accept that the Juul guys are liars. Not yet anyway. If e-cigarette companies had a study, much like Theranos, they'd publish it. They'd compare it to nicotine patches. They just don't. There's no secret, it's really just an agglomeration of personal experiences and unfortunate but real stories quitting addiction masquerading as a positive public health development. This study shows pretty unequivocally that vaping can't possibly just substitute for cigarette smoking. If it did, we'd observe zero cigarette smokers in the vaping-only population. Correlation versus causation, whatever logic puzzles commenters invoke, it just distracts from both the evidence presented here and the total lack of a rigorous trial from e-cigarette sellers.
  - agency 8y ago
    > This study shows pretty unequivocally that vaping can't possibly just substitute for cigarette smoking. If it did, we'd observe zero cigarette smokers in the vaping-only population. What an absolutely insane claim.
  - thomasfedb 8y ago
    > There have been no clinical trials for Juul or any e-cigarette product. Rubbish. Just 10 seconds on PubMed found me this: Rahman et al. E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis. PLoS One. 2015. https://www.ncbi.nlm.nih.gov/pubmed/25822251 https://www.ncbi.nlm.nih.gov/pubmed/25822251 "Six studies were included involving 7,551 participants. … Use of e-cigarettes is associated with smoking cessation and reduction." > No doctor following the letter of what they're supposed to be doing is going to recommend an e-cigarette product to a person seeking smoking cessation. Also rubbish. Even if there were no studies, absence of data of effect is different from data of absence of effect. There are good reasons to believe (even pre-hoc) that vaping is safer than cigarettes. As a student doctor and I would happily council a patient to consider vaping instead of smoking as a harm minimisation intervention.
  - NeedMoreTea 8y ago
    > If e-cigarette companies had a study, much like Theranos, they'd publish it Will this do? "In a nutshell, best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether." From the extensive Public Health England study: https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review https://www.gov.uk/government/news/e-cigarettes-around-95-le... E-cigarettes are now available on prescription in the UK as one of the smoking cessation aids available to doctors. No idea about Juul, they're not in the UK yet.
  - pandaman 8y ago
    E-cigarettes companies are in business of selling product, not doing research for once. Another thing you might be missing is that the only reason you can buy vape products with pocket change unlike the "researched" things like patches, gum etc. is that they do not sell them as any kind of medical treatment. If they tried to claim anything to that effect they would have been dealing with FDA and doing whatever expensive procedures FDA demands and their product would be as expensive as patches etc and they would have been out of business since their $100 per 10 ml "researched" juice would not stand a chance against the same compound but not researched and sold at $20/100ml. So, even if they had a study they would not publish it if they had any sense. As for people you suspect being uninformed and defending a fraudulent business, all I can see people who actually quit smoking saying they did it through vaping. We don't know if they are just unique rare cases but, on the other hand, you rarely see people claiming this with patches and gum. Most mentions of these in relation to quitting smoking I've seen were "I tried patches/gum, they did not work". I am lazy to look up research but from what I remember, patches and gum are amazingly inefficient in any prolonged smoking cessation. So pushing patches might appear more similar to shilling for Theranos than you might have suspected.
stan_rogers 8y ago
What these studies show is that kids who are likely to try smoking are also more likely to try vaping. That's it. That's the whole thing. It's correlation, and doesn't speak in any way to anything like a "gateway drug" phenomenon - and that has also been recognised in studies that bother to consider the possibility.
- 013a 8y ago
  Oh, right, yeah. Because this line totally isn't directly from the paper's conclusion: > These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth.
  - stan_rogers 8y ago
    I'll see that study and raise you the UVic cohort study that found the opposite[0], among others if you're willing to look. The "growing body of evidence" is all about correlations in interview studies. [0]http://www.uvic.ca/research/centres/carbc/assets/docs/report-clearing-the-air-review-exec-summary.pdf http://www.uvic.ca/research/centres/carbc/assets/docs/report...
    - minikites 8y ago
      That link just goes to their homepage.
  - pochamago 8y ago
    That line honestly just makes it sound like they already knew what their opinion was before doing the study
rileyphone 8y ago
The easy social explanation for this is that people who vape are more likely to be around smoking anyways, and thus are far more likely to bum a cig off someone in a party than your average 19 year old. The only clinical result you can pull from this is 'people who vape are more likely to smoke >1 cigarette a year', and the fact that they couldn't produce a more significant result with any sort of correlation tells you the paucity of the data.
girvo 8y ago
From personal experience, the gum and the sprays definitely do get you a “buzz”.

dionidium 8y ago

You've used some jargon here that I don't understand, so I'm probably just missing it, but I don't see where any of this addresses the claim that, "Smoked a cigarette in the last 12 months" is a strikingly low bar.

doctorpangloss 8y ago
On the one hand, I don't want to condescend. Relative risk and odds ratio are best explained on Wikipedia. If you want to get advice on smoking cessation, ask a doctor. There have been no clinical trials for Juul or any e-cigarette product. No doctor following the letter of what they're supposed to be doing is going to recommend an e-cigarette product to a person seeking smoking cessation. The strikingly low bar thing... People here defend Juul like people defended Theranos. Nobody wants to accept that the Juul guys are liars. Not yet anyway. If e-cigarette companies had a study, much like Theranos, they'd publish it. They'd compare it to nicotine patches. They just don't. There's no secret, it's really just an agglomeration of personal experiences and unfortunate but real stories quitting addiction masquerading as a positive public health development. This study shows pretty unequivocally that vaping can't possibly just substitute for cigarette smoking. If it did, we'd observe zero cigarette smokers in the vaping-only population. Correlation versus causation, whatever logic puzzles commenters invoke, it just distracts from both the evidence presented here and the total lack of a rigorous trial from e-cigarette sellers.
- agency 8y ago
  > This study shows pretty unequivocally that vaping can't possibly just substitute for cigarette smoking. If it did, we'd observe zero cigarette smokers in the vaping-only population. What an absolutely insane claim.
- thomasfedb 8y ago
  > There have been no clinical trials for Juul or any e-cigarette product. Rubbish. Just 10 seconds on PubMed found me this: Rahman et al. E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis. PLoS One. 2015. https://www.ncbi.nlm.nih.gov/pubmed/25822251 https://www.ncbi.nlm.nih.gov/pubmed/25822251 "Six studies were included involving 7,551 participants. … Use of e-cigarettes is associated with smoking cessation and reduction." > No doctor following the letter of what they're supposed to be doing is going to recommend an e-cigarette product to a person seeking smoking cessation. Also rubbish. Even if there were no studies, absence of data of effect is different from data of absence of effect. There are good reasons to believe (even pre-hoc) that vaping is safer than cigarettes. As a student doctor and I would happily council a patient to consider vaping instead of smoking as a harm minimisation intervention.
- NeedMoreTea 8y ago
  > If e-cigarette companies had a study, much like Theranos, they'd publish it Will this do? "In a nutshell, best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether." From the extensive Public Health England study: https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review https://www.gov.uk/government/news/e-cigarettes-around-95-le... E-cigarettes are now available on prescription in the UK as one of the smoking cessation aids available to doctors. No idea about Juul, they're not in the UK yet.
- pandaman 8y ago
  E-cigarettes companies are in business of selling product, not doing research for once. Another thing you might be missing is that the only reason you can buy vape products with pocket change unlike the "researched" things like patches, gum etc. is that they do not sell them as any kind of medical treatment. If they tried to claim anything to that effect they would have been dealing with FDA and doing whatever expensive procedures FDA demands and their product would be as expensive as patches etc and they would have been out of business since their $100 per 10 ml "researched" juice would not stand a chance against the same compound but not researched and sold at $20/100ml. So, even if they had a study they would not publish it if they had any sense. As for people you suspect being uninformed and defending a fraudulent business, all I can see people who actually quit smoking saying they did it through vaping. We don't know if they are just unique rare cases but, on the other hand, you rarely see people claiming this with patches and gum. Most mentions of these in relation to quitting smoking I've seen were "I tried patches/gum, they did not work". I am lazy to look up research but from what I remember, patches and gum are amazingly inefficient in any prolonged smoking cessation. So pushing patches might appear more similar to shilling for Theranos than you might have suspected.

stan_rogers 8y ago

What these studies show is that kids who are likely to try smoking are also more likely to try vaping. That's it. That's the whole thing. It's correlation, and doesn't speak in any way to anything like a "gateway drug" phenomenon - and that has also been recognised in studies that bother to consider the possibility.

013a 8y ago
Oh, right, yeah. Because this line totally isn't directly from the paper's conclusion: > These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth.
- stan_rogers 8y ago
  I'll see that study and raise you the UVic cohort study that found the opposite[0], among others if you're willing to look. The "growing body of evidence" is all about correlations in interview studies. [0]http://www.uvic.ca/research/centres/carbc/assets/docs/report-clearing-the-air-review-exec-summary.pdf http://www.uvic.ca/research/centres/carbc/assets/docs/report...
  - minikites 8y ago
    That link just goes to their homepage.
- pochamago 8y ago
  That line honestly just makes it sound like they already knew what their opinion was before doing the study

rileyphone 8y ago

The easy social explanation for this is that people who vape are more likely to be around smoking anyways, and thus are far more likely to bum a cig off someone in a party than your average 19 year old. The only clinical result you can pull from this is 'people who vape are more likely to smoke >1 cigarette a year', and the fact that they couldn't produce a more significant result with any sort of correlation tells you the paucity of the data.

girvo 8y ago

From personal experience, the gum and the sprays definitely do get you a “buzz”.