CLINICAL QUESTION

Is nicotine delivery via vaping more effective than nicotine gum for patients of low socioeconomic status who want to stop smoking?

BOTTOM LINE

In the study, vaping nicotine is more effective than nicotine replacement therapy for smoking cessation in people of low socioeconomic status who smoke, which confirms similar findings in a more general population. (Level of Evidence = 1b−)

SYNOPSIS

The researchers enrolled 1,045 adults who smoked and received government assistance (a surrogate for low socioeconomic status). The participants responded to social media advertising and were willing to attempt to stop smoking. Using concealed allocation, the participants were randomly assigned to receive an 8-week supply of nicotine replacement therapy (4-mg nicotine gum) or a nicotine vaping device (Innokin Endura T18; 18 mg/mL). Participants received minimal behavioral support, which consisted of multiple daily texts for 5 weeks. The dropout rate was 17.9%. Using intention-to-treat analysis, confirmed abstinence at 6 months was 9.6% with nicotine replacement therapy and 28.4% with vaping (number needed to treat = 5; 95% CI, 4.3–7). Self-reported adverse effects were more likely with the gum. A limitation of the study was the use of expired carbon monoxide as the indicator of abstinence, which cannot determine whether abstinence was long term or recent.