A flawed, inconclusive study is headlined, predictably, as an outcome showing that vaping nicotine is beneficial for smoking cessation

by Clark Miller

Published January 26, 2022

The study, originally appearing in JAMA, was summarized here –

Some smokers who said they had no plans to quit ended up doing so after taking up e-cigarettes, government survey data indicated.

Among daily smokers followed for up to 5 years — all reporting at study enrollment that they intended to keep smoking and that they weren’t using e-cigarettes — 28% of those who started daily e-cigarette use then discontinued regular cigarettes (95% CI 15.2%-45.9%), compared with a 5.8% quit rate (95% CI 4.7%-7.2%) for those who never used nicotine vaping products, reported Karin A. Kasza, PhD, of Roswell Park Comprehensive Cancer Center in Buffalo, New York, and colleagues in JAMA Network Open.

. . . 

Notably, however, just 2.4% of the study participants decided to begin using e-cigarettes daily after joining. Another 6.2% used them more irregularly, and that group did not show significantly higher rates of complete smoking discontinuation or nondaily smoking than those who didn’t use vape products.

So, while the study shows that e-cigarettes might help with smoking cessation, it’s also further evidence that the vast majority of smokers who say they plan to continue smoking do exactly that.

. . . 

Kasza and colleagues focused on PATH participants who were daily smokers and who were not using e-cigarettes at all when they joined the study. A total of 1,600 participants qualified for inclusion, who contributed 2,489 serial data points overall. PATH was designed to be representative of the overall population by age and other major demographic features. Responses were weighted to reflect population norms as of 2013-2014 to account for losses to follow-up and uneven response rates over time.

Participants completed virtual interviews by computer in four successive waves ending in November 2019. By that time, 908 of the original 1,600 were lost to follow-up.

 . . .

Since it was not a randomized trial and participants decided on their own whether or not to begin using e-cigarettes, the potential for unmeasured confounding was significant. Also, the authors noted, they did not examine changes in “quit intentions” as time went on and whether such changes were associated with actual quit rates for smoking. The study relied entirely on participants’ self-reports of smoking habits and e-cigarette use. Finally, Kasza and colleagues did not determine how many participants who said they quit smoking later resumed, or quit again after initial relapse.

is representative of the many headlines of mass media pieces messaging the outcome of this study, overtaking for a day or so the Google search “vaping”, confidently and comfortably joining in social assertion of the known outcome, in social use of confirmation.  

Discussion of study limitations in the original publication is somewhat more helpful than in the MEDPAGE TODAY summary. 


Limitations of our study include the lack of ability to evaluate whether quit intentions changed after uptake of e-cigarettes, and we did not assess whether any changes in quit intentions mediated the association between e-cigarette uptake and cigarette discontinuation; thus, future work is important to understand the causal mechanisms underlying our findings. Further, the collection of qualitative data can be useful to informing possible processes that may contribute to discontinuing smoking among this group of smokers. We also note that there may be self-selection differences between those who subsequently used e-cigarettes and those who did not, which were not assessed here. Another limitation is that we had relatively small sample sizes, although weighting ensured the sample was representative of the US population. We also did not assess long-term patterns of subsequent relapse and requitting. The e-cigarette marketplace has also changed since our study period of 2014 through 2019.

The point that “and we did not assess whether any changes in quit intentions mediated the association between e-cigarette uptake and cigarette discontinuation”

deserves some thought, because it poses, along with additional challenges to internal validity for this study, serious limitations on interpretation of results. Subjects would have been cued or “invited” in the language of Motivational Interviewing, to consider their use of tobacco by smoking simply by participating in the study, and each time they were reminded of that by questions related to smoking habits. We know that the most effective path to change in substance use is to simply support autonomous contemplation of change, and it is not possible for this study to support the universally messaged spin on outcomes versus an alternative: that invited repeatedly through participation to consider their use of cigarettes and pros and cons of continued use, a significant portion of subjects became motivated to attempt to stop. About 6 percent of those successfully stopped without continued use of any nicotine delivery, ending nicotine dependence. A much smaller proportion, about 2.4 percent of participants, may likely have also become motivated to stop and initiated use of nicotine by vaping, most likely affected by their understanding that vaping can be beneficial for smoking cessation

For those individuals who stopped use of cigarettes, available evidence points strongly to that change being in spite of use of nicotine by vaping. 

Let’s consider why that is. 

The complex and poorly described design of this study work against accurate description of sampling protocol and sequential attrition, thus of potential validity problems. Of note: 1) of the 1600 original subjects about 57 percent were “lost to follow-up” and 2) there were 5 sampling points and collection of 2,489 serial data points. That seems to point to a small sample size of follow up data following a report of initiation of vaping. As the authors noted, “We also did not assess long-term patterns of subsequent relapse and requitting”.

In plain language – As far as we know, not any of the subjects reporting cessation of cigarette smoking after starting vaping remained avoidant of cigarette use for more than a short period, as short as a few weeks or a few months. 

And as far as we know, that is, what we actually know based on available research, is that those vapers were much more likely than not to return to use of cigarettes.

We know that because – 

Instead of any adequately designed studies (that excludes this study under discussion) pointing to benefit of use of vaping of nicotine in cessation of use of combustible nicotine cigarettes (“smoking”), available evidence points consistently to no benefit or “gateway effect”

That gateway effect due to adult vaping is evidenced by a recent study using the same data set as the study examined here, but with a sample size much larger (more than 13,600 participants), approaching an order of magnitude greater sample size considering rates of attrition in the current study. 

From the prior study – 

The study’s goal was to see if smokers who had recently stopped smoking and switched to e-cigarettes or another tobacco product would be less likely to go back to smoking traditional cigarettes compared to people who didn’t use another tobacco product.

“Our findings suggest that individuals who quit smoking and switched to e-cigarettes or other tobacco products actually increased their risk of a relapse back to smoking over the next year by 8.5 percentage points compared to those who quit using all tobacco products,” the study’s first author John P. Pierce, Ph.D., Distinguished Professor at the Herbert Wertheim School of Public Health and UC San Diego Moores Cancer Center said in a UC San Diego press release.

Pierce added that evidence showed using e-cigs made it “less likely, not more likely, to stay off of cigarettes.”

Those results were predictable, determined by everything that is known and established about vaping.

Return to use of combustible cigarettes in the study featured here in this post, branded as validating effectiveness of “Vapes in Smoking Cessation” is predictable and was not measured in the longitudinal study, as noted by the authors. 

Predictable based on the research and predictable because vapers remained nicotine dependent, including dependent on the ritual of administration of nicotine by inhalation, unlike individuals who quit cigarettes by ending nicotine dependence along with the associated psychological associations and dependencies. 

Predictable based on epidemiological evidence for a gateway effect over years of rapid increase in prevalence of nicotine vaping and associated increases in cigarette use, after decades of decline. 

Predictable based on newly nicotine dependent young adults by taking up vaping switched to use of combustible cigarettes to deliver the nicotine based on contingencies or availability. 

Predictable because those young adults, often nicotine dependent by initiation by vaping, are, predictably, choosing to smoke cigarettes as driven by factors profoundly important and compelling for them – image, social acceptance, being at the cutting edge of whatever new trend is evident on social media and confers status as rebellious, special, attractive. 

From the recent New York Times piece on vapers switching to cigarettes – 

While some smokers attest to choosing cigs over vapes for health reasons, others say that the choice is a much more classic one, loath as they may be to admit it: It looks and feels cool.
“It’s just a cool thing,” Ms. Frey said. “It sounds lame to say that. I think of hot guys that I’m into, and they’re like, ‘I’m going to step out and have a cigarette.’ It’s kind of sophisticated. Grunge sophisticated.”
And of course, part of that is your online image. “People are posting outside of a cool place, smoking with their friend, outside of cool dive bars,” Ms. Frey said. For her, like many of her generation, this aspect sounds familiar: “Smoking is part of being seen, and I think people want to be seen right now.”

The results were predictable, determined by everything that is known and established about vaping, giving the lie to everything that is “known” about vaping, “known” because it goes without saying, a thread in the lethal matrix of American Truth. 

“Known” as true by virtue of repetition within the warm, intoxicating bath of Groupthink generating the lies that fuel lethal epidemics. 

Score one dunce hat for American Medicine, JAMA, and American Corporate Media. Score tens of thousands of projected deaths for American Groupthink, mass and social media, and the cowardice and  diminished capacity that would spin weak, inconclusive results into a public health message with potentially lethal outcomes, again

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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