Guiney et als paper on the Barriers to successful cessation among young late-onset smokers1 walked right past the elephant bellowing amidst their results. The small study surveyed 111 current smokers who were mostly non-Mori, non-Pacific. Mean age was 22.5 among the sample who had become established smokers after they turned 18 years old. A high proportion reported quitting behaviour in the previous 12 months, with nearly half intending to attempt quitting again in their imminent future. Electronic cigarettes were the second intended quit aid (50%) after quitting without any support (73%). The internet (46%) and nicotine replacement therapy (45%) were similarly favoured.The authors lamented the young peoples preferences as unfortunate because using no support is the least effective quitting method , and there is no consistent evidence that the young peoples preferred quit aid, e-cigarettes and/or the internet, are effective at improving quit success . The authors recommended the need to increase young peoples use of cessation aids (excluding electronic cigarettes or internet). They said there needs to be targeted services that appeal to, and are effective for, this group. However, because their sample had mostly low dependency levels and they concluded from the literature that nicotine replacement therapy (NRT) is not very effective for people with low dependency, they recommended that targeted services should focus on non-chemical (ie, social and behavioural) reinforcers of smoking. For example, providing young adults with practical strategies to deal with social pressure to smoke in certain contexts. Quitting without support is not unusual for young adults.2 Use of cessation support is related to the perceived level of addiction and ability to quit, as well as negative views towards stop-smoking medicines.3 This group had high confidence in their ability to quit and so perhaps it is not surprising that they believed that they could do it on their own.Electronic cigarettes, internet-based cessation support and possibly additionally NRT (as survey participants could select multiple intended cessation aids) appealed to at least half of the sample. There is growing evidence that both electronic cigarettes4,5 and internet programmes6,7 can help people to stop smoking. The internet could also have scored as highly as e-cigarettes because, in New Zealand, nicotine for use in electronic cigarettes is only legally available via the internet from overseas suppliers (or purchased in person overseas).Polosa et al8 tested the provision of personalised advice to cut down and quit delivered by vape shop staff and found high and stable success rates. If young New Zealand adults, or any smokers, want to use electronic cigarettes in their next quit attempt, we should be ready with good information about how to vape instead of smoking, and we should be providing them with easier local access to nicotine to maximise their chance of sustained smoking cessation. This advice is being given by some stop smoking services in the UK, where an exodus of smokers to vaping has occurred: 400,000 in the previous year, taking the total number of vapers to 2.6 million.9We acknowledge that the international debate on vaping is highly conflicted, making it difficult for researchers, academics, doctors, healthcare workers and the general public to know whether to recommend new cessation technologies and products or ignore them. Young adults are not ignoring whats new and perhaps they have calculated the risk: 6 million deaths a year globally caused by smoking tobacco versus likely harm from vaping, estimated to be 95% safer.10 Whilst the Ministry of Healths website advice on the use of e-cigarettes currently says that health professionals should promote approved cessation medication for assisting people who want to quit, they should not dismiss the use of e-cigarettes by people who want to use them to support their efforts to become smokefree. The evidence base for these alternative, yet popular, approaches to stopping smoking is changing quickly. We need to catch up on the latest evidence, the products and social media strategies so that we can better meet the cessation needs of all people who smoke.

Guiney et als paper on the Barriers to successful cessation among young late-onset smokers1 walked right past the elephant bellowing amidst their results. The small study surveyed 111 current smokers who were mostly non-Mori, non-Pacific. Mean age was 22.5 among the sample who had become established smokers after they turned 18 years old. A high proportion reported quitting behaviour in the previous 12 months, with nearly half intending to attempt quitting again in their imminent future. Electronic cigarettes were the second intended quit aid (50%) after quitting without any support (73%). The internet (46%) and nicotine replacement therapy (45%) were similarly favoured.The authors lamented the young peoples preferences as unfortunate because using no support is the least effective quitting method , and there is no consistent evidence that the young peoples preferred quit aid, e-cigarettes and/or the internet, are effective at improving quit success . The authors recommended the need to increase young peoples use of cessation aids (excluding electronic cigarettes or internet). They said there needs to be targeted services that appeal to, and are effective for, this group. However, because their sample had mostly low dependency levels and they concluded from the literature that nicotine replacement therapy (NRT) is not very effective for people with low dependency, they recommended that targeted services should focus on non-chemical (ie, social and behavioural) reinforcers of smoking. For example, providing young adults with practical strategies to deal with social pressure to smoke in certain contexts. Quitting without support is not unusual for young adults.2 Use of cessation support is related to the perceived level of addiction and ability to quit, as well as negative views towards stop-smoking medicines.3 This group had high confidence in their ability to quit and so perhaps it is not surprising that they believed that they could do it on their own.Electronic cigarettes, internet-based cessation support and possibly additionally NRT (as survey participants could select multiple intended cessation aids) appealed to at least half of the sample. There is growing evidence that both electronic cigarettes4,5 and internet programmes6,7 can help people to stop smoking. The internet could also have scored as highly as e-cigarettes because, in New Zealand, nicotine for use in electronic cigarettes is only legally available via the internet from overseas suppliers (or purchased in person overseas).Polosa et al8 tested the provision of personalised advice to cut down and quit delivered by vape shop staff and found high and stable success rates. If young New Zealand adults, or any smokers, want to use electronic cigarettes in their next quit attempt, we should be ready with good information about how to vape instead of smoking, and we should be providing them with easier local access to nicotine to maximise their chance of sustained smoking cessation. This advice is being given by some stop smoking services in the UK, where an exodus of smokers to vaping has occurred: 400,000 in the previous year, taking the total number of vapers to 2.6 million.9We acknowledge that the international debate on vaping is highly conflicted, making it difficult for researchers, academics, doctors, healthcare workers and the general public to know whether to recommend new cessation technologies and products or ignore them. Young adults are not ignoring whats new and perhaps they have calculated the risk: 6 million deaths a year globally caused by smoking tobacco versus likely harm from vaping, estimated to be 95% safer.10 Whilst the Ministry of Healths website advice on the use of e-cigarettes currently says that health professionals should promote approved cessation medication for assisting people who want to quit, they should not dismiss the use of e-cigarettes by people who want to use them to support their efforts to become smokefree. The evidence base for these alternative, yet popular, approaches to stopping smoking is changing quickly. We need to catch up on the latest evidence, the products and social media strategies so that we can better meet the cessation needs of all people who smoke.