No question in my mind that part of the addiction of smoking is the ritual associated with it. Step outside, fiddle with your hands, deep breathe for ten minutes, be left alone and have some time to relax. Sounds almost like meditation, no? So I’ve asked patients to use e-cigs to help them stop smoking with some success. It’s even better when you have them go to a smoke shop and over time reduce the nicotine in the juice they use, so now you can taper the dose over time, just like you would with nicotine gum.
“No, you succeeded in reducing your risk. And you can do it again, if you are ready to try.”
👍I use a similar motivation when counseling those starting Chantix/Champix aka Canadian
On day 7-10 post starting Rx there is no need to "quit".
1st if the client has a cigarette it can be viewed as failure.
Remedy, my recommendation pick a date (goal orientation) on that day take 5 cigarettes from what ever you smoke.
After 2-3 days remove another 5 (total 10), don't be harsh on yourself If you go find an extra cigarette.
Every day you smoke less is a win!
It is not when you quit (long game) the goal is to quit some day. It's rare I encounter a 1st "quitter". My goal is simply logic, enable the smoker to succeed in increments.
Most, former smokers achieved their goal after several attempts.
Any comparisons of e-cigs with patches re cessation? They also deliver nicotine - but of course don't expose the user to public awareness. And as Jay points out, the ritual is a big part of the addiction.
Readers should know that I consult for Juul Labs so that they can consider that source of bias while reading my observations.
Jeremy has provided a useful and thoughtful summary of the contentious topics of nicotine and vaping, centered around a recent RCT on the use of vaping products to promote cigarette smoking cessation.
Readers may appreciate additional perspectives and updates, as follows:
In his penultimate paragraph, Jeremy rightly notes the centrally important question regarding the net population impact of vaping products. For more reading to inform your thinking on these topics, I offer the following:
• The net population health impact of vaping cannot be known in advance, but we do have tools to inform our judgments about potential futures. The most potent tools are population simulation models which are able to integrate a wide swath of information, from toxicology to behavior. There are a range of models (see here for a review of them https://tobaccocontrol.bmj.com/content/32/5/589) and one that I find particular helpful (that, yes, largely comports with my priors!), is one from some of the parents of this whole discipline in smoking and nicotine research: David Mendez and Ken Warner. They first used these approaches in a 1998 paper (https://doi.org/10.1093/oxfordjournals.aje.a009632), but this 2021 “magic bullet” publication uses these tools to examine 360 different “futures”, based on the varying of six key variables that impact net population impact (eg, how much gateway in to smoking is there? How effective are vaping products at helping people who smoke to stop? How much toxicity do vaping products impose upon those who use them?).
John Fontaine offered up an excerpt from the New York Times on vaping and oral health. This brief letter to the editor provides some perspectives and its references cite relevant sources: https://www.nature.com/articles/s41415-022-4409-1
Smoking is one of the worst things you can do for your oral health. But there is a “widespread misconception” that vaping is safer, Dr. Nguyen said. One reason, she suggested, is that there are fewer studies on the newer habit.
But when you vape, you’re still inhaling nicotine, Dr. Nguyen said, as well as other chemicals. Nicotine has been shown to cause an increase in bacteria and plaque in your mouth, and a 2020 study found that subjects who vaped had less healthy oral microbiomes than people who never smoked.
No question in my mind that part of the addiction of smoking is the ritual associated with it. Step outside, fiddle with your hands, deep breathe for ten minutes, be left alone and have some time to relax. Sounds almost like meditation, no? So I’ve asked patients to use e-cigs to help them stop smoking with some success. It’s even better when you have them go to a smoke shop and over time reduce the nicotine in the juice they use, so now you can taper the dose over time, just like you would with nicotine gum.
Love your take on this. Thanks for the article.
“No, you succeeded in reducing your risk. And you can do it again, if you are ready to try.”
👍I use a similar motivation when counseling those starting Chantix/Champix aka Canadian
On day 7-10 post starting Rx there is no need to "quit".
1st if the client has a cigarette it can be viewed as failure.
Remedy, my recommendation pick a date (goal orientation) on that day take 5 cigarettes from what ever you smoke.
After 2-3 days remove another 5 (total 10), don't be harsh on yourself If you go find an extra cigarette.
Every day you smoke less is a win!
It is not when you quit (long game) the goal is to quit some day. It's rare I encounter a 1st "quitter". My goal is simply logic, enable the smoker to succeed in increments.
Most, former smokers achieved their goal after several attempts.
Any comparisons of e-cigs with patches re cessation? They also deliver nicotine - but of course don't expose the user to public awareness. And as Jay points out, the ritual is a big part of the addiction.
Readers should know that I consult for Juul Labs so that they can consider that source of bias while reading my observations.
Jeremy has provided a useful and thoughtful summary of the contentious topics of nicotine and vaping, centered around a recent RCT on the use of vaping products to promote cigarette smoking cessation.
Readers may appreciate additional perspectives and updates, as follows:
In his penultimate paragraph, Jeremy rightly notes the centrally important question regarding the net population impact of vaping products. For more reading to inform your thinking on these topics, I offer the following:
• A June 2024 commentary from my colleague, Arielle Selya, reviewing the evidence on the “gateway” (on-ramp) hypothesis whereby youth using e-cigarettes are more likely to progress to tobacco smoking: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-024-01034-6
• The net population health impact of vaping cannot be known in advance, but we do have tools to inform our judgments about potential futures. The most potent tools are population simulation models which are able to integrate a wide swath of information, from toxicology to behavior. There are a range of models (see here for a review of them https://tobaccocontrol.bmj.com/content/32/5/589) and one that I find particular helpful (that, yes, largely comports with my priors!), is one from some of the parents of this whole discipline in smoking and nicotine research: David Mendez and Ken Warner. They first used these approaches in a 1998 paper (https://doi.org/10.1093/oxfordjournals.aje.a009632), but this 2021 “magic bullet” publication uses these tools to examine 360 different “futures”, based on the varying of six key variables that impact net population impact (eg, how much gateway in to smoking is there? How effective are vaping products at helping people who smoke to stop? How much toxicity do vaping products impose upon those who use them?).
Finally, in responding to comments from earlier posters, for JL, I suggest the living review on nicotine-containing e-cigarettes for smoking cessation: https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used. It answers the “how does vaping compare to nicotine patches” question, along with a host of other ones, given that it is the collection and synthesis of the available evidence on these questions.
John Fontaine offered up an excerpt from the New York Times on vaping and oral health. This brief letter to the editor provides some perspectives and its references cite relevant sources: https://www.nature.com/articles/s41415-022-4409-1
Taken from the New York Times
21 June 2024
5 Things Dentists Hate
Vaping
Smoking is one of the worst things you can do for your oral health. But there is a “widespread misconception” that vaping is safer, Dr. Nguyen said. One reason, she suggested, is that there are fewer studies on the newer habit.
But when you vape, you’re still inhaling nicotine, Dr. Nguyen said, as well as other chemicals. Nicotine has been shown to cause an increase in bacteria and plaque in your mouth, and a 2020 study found that subjects who vaped had less healthy oral microbiomes than people who never smoked.
This is off subject, but I’m curious about your masking choices post-COVID.