Courtney, Ryan J and Howard, Bridget C and Barker, Daniel and Petrie, Dennis and Borland, Ron and Shakeshaft, Anthony and Gartner, Coral and Mendelsohn, Colin and Boland, Veronica C and Henderson, Alexandra and Richmond, Robyn L and Tutka, Piotr and Naughton, Felix and Hall, Wayne and Zwar, Nicholas and Farrell, Michael and Mattick, Richard P and McRobbie, Hayden (2025) Vaporized nicotine products for smoking cessation among people experiencing social disadvantage: a randomized clinical trial. Annals of Internal Medicine, Early online, https://doi.org/10.7326/annals-24-03531.
External website: https://www.acpjournals.org/doi/10.7326/ANNALS-24-...
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]; < 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.
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