David Cohen, M.D.·Published 8 November 2013·8 min read
Key points
Electronic cigarette users followed over a year reduced or quit using tobacco cigarettes in large numbers and were less prone to resume smoking, at least in the short term.
E-cigarettes are battery operated nicotine inhalers that consist of a rechargeable lithium battery, a cartridge called a cartomizer and an LED that lights up at the end when you puff on the e-cigarette to simulate the burn of a tobacco cigarette.
Because they preserve the hand-to-mouth ritual of smoking, Kiklas said e-cigarettes might help transform a smoker's harmful tobacco habits to a potentially less harmful e-smoking habit.
Most participants (72%) were former smokers, and 76% were using e-cigarettes daily.
Electronic cigarette users followed over a year reduced or quit using tobacco cigarettes in large numbers and were less prone to resume smoking, at least in the short term.
Experts continue to debate whether or not "e-cigs" are smoking-cessation tools or just leisure products. The electronic vaporizers use cartridges of liquid nicotine to deliver a flavored nicotine-laced vapor without the byproducts of burning tobacco in traditional cigarettes.
"Our results may not be generalizable to all vapers," Jean-Francois Etter said, using the slang for vaporizer users. "We had a majority of ex-smokers at baseline whereas in the general population, most vapers are current smokers," he told Reuters Health.
Etter led the study at the Institute of Social and Preventive Medicine at the University of Geneva in Switzerland. The results were published in Addictive Behaviors.
A few small studies have found that e-cigarettes seemed to help smokers quit using tobacco or at least to smoke fewer traditional cigarettes. But there have been no long-term studies of how people actually use e-cigarettes, so experts are still unsure.
The researchers posted a questionnaire on a French stop-smoking website and asked sites selling e-cigs to link to the questionnaire. Most "vapers" buy their e-cigs online.
What are e-cigarettes?
E-cigarettes are battery operated nicotine inhalers that consist of a rechargeable lithium battery, a cartridge called a cartomizer and an LED that lights up at the end when you puff on the e-cigarette to simulate the burn of a tobacco cigarette. The cartomizer is filled with an e-liquid that typically contains the chemical propylene glycol along with nicotine, flavoring and other additives.
The device works much like a miniature version of the smoke machines that operate behind rock bands. When you "vape" - that's the term for puffing on an e-cig - a heating element boils the e-liquid until it produces a vapor. A device creates the same amount of vapor no matter how hard you puff until the battery or e-liquid runs down.
The e-cig users recruited answered a baseline questionnaire, another one a month later and a third one year later. Questions covered e-cigarette use, tobacco use and the date of quitting tobacco, if one applied.
Of more than 1000 original recruits, 367 responded to all three surveys.
For those who had quit smoking already and were using e-cigarettes instead, six percent had relapsed to tobacco after one month. That number was stable after one year.
Of those who were smoking and using e-cigarettes when the study began, 22 percent had quit smoking tobacco after a month and 46 percent had quit after a year. That group averaged 11.3 tobacco cigarettes daily at the beginning of the study and six cigarettes per day after one month.
Written and revised by
David Cohen, M.D.
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The electronic cigarette was introduced to the U.S. market in 2007 and offers the nicotine-addicted an alternative to smoking tobacco. Most "e-cigs" are similar enough in appearance to be mistaken for regular cigarettes, but one look inside and you'll see the main difference: E-cigarettes don't contain tobacco. Instead, there's a mechanism that heats up liquid nicotine, which turns into a vapor that smokers inhale and exhale. Manufacturers and satisfied customers say that this nicotine vapor offers many advantages over traditional cigarette smoke. But regulatory agencies and some health experts aren't sure. They're asking questions about the possible side effects of inhaling nicotine vapor, as well as other health risks e-cigarettes may pose - both to users and to the public. Those calling for tight regulations on e-cigarettes claim that these devices should be deemed illegal until the proper research trials have been conducted to prove that they're safe.
Because they contain no tobacco, e-cigarettes aren't subject to U.S. tobacco laws, which means they can be purchased without proof of age, especially online. This raises concerns that e-cigs may be particularly appealing to kids and may encourage nicotine addiction among young people. And while manufacturers of the e-cigarette claim that it's the cigarette you can "smoke" anywhere, regulatory agencies around the world are taking a close look at these gadgets and instituting a range of restrictions on their use.
Proponents of the e-cigarette say they feel better using the device than they did when they were smoking tobacco cigarettes, and that because the e-cigarette is reusable, it saves them money. Some praise the e-cig for helping them quit smoking. But is the e-cigarette as safe as its users - including celebrities like Katherine Heigl - believe? Is it a healthier option, or a riskier choice? And what does the FDA have to do with it? Before you consider taking up the e-cigarette habit, read on to get the facts.
This was just an exploratory study and will need confirmation from follow-up studies, Etter said.
"This suggests that e-cigs may help them quit, but our results need to be interpreted with caution, because of the dropout rate at follow-up and the fact that our sample is not representative of all vapers," he said.
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In the short-term, e-cigs appear not to carry any health risks of their own, he said. But researchers still don't know the long-term health effects of inhaling the common solvent glycol and food flavoring over many years.
The biggest factor in being able to trust your products is by choosing your company wisely, and paying attention to how much information they give you. Integrity goes very far in today’s day and age. Here is a look at some of the most common myths regarding electronic cigarettes that have spread around, along with factual information clarifying these misleading claims.
Myth #1: E-cigarettes will soon be illegal.
Fact: Perhaps in some places, but not in the U.S. Some places have tried to ban them, but as e-cigarettes become more mainstream and accepted, this is unlikely to happen.
Myth #2: E-cigarettes are bad for you because nicotine is bad for you. Therefore, they are not much different than tobacco smoke.
Fact: This is just plain wrong. While nicotine is very addictive, studies have shown its effects on the body to be minimal. The problem with traditional cigarettes is the additives, smoke and chemicals, not so much the nicotine.
Myth #3: E-cigarettes are dangerous because no one really knows what’s in them.
Fact: Not the case when you are dealing with a reputable company. Any legit e-cigarette brand will disclose ingredients, so you truly do know what’s in them. And if you do your research on every ingredient, you’ll definitely know what you’re inhaling.
E-cigarettes don't need to be 100 percent safe, he said, they only need to be significantly safer than tobacco cigarettes because they are primarily used by cigarette smokers. Of the three studies that have investigated e-cig users, none of the daily vapers were non-smokers.
Even though the evidence is still thin, Etter believes smokers should use e-cigarettes as quit-smoking aids, and doctors should recommend them. But the products should not be treated as medical devices or drugs, even though they may have therapeutic benefit for patients, he said.
"Internet surveys are more likely to attract people who had a positive experience with e-cigarettes," professor Peter Hajek said. "The study is nevertheless innovative in that it did not just ask for a one-off information as a number of previous studies did, but it followed the e-cigarette users up to see what happens to their e-cig use and to their smoking one year later," he said.
Do e-cigarettes help tobacco smokers quit?
Because they preserve the hand-to-mouth ritual of smoking, Kiklas said e-cigarettes might help transform a smoker's harmful tobacco habits to a potentially less harmful e-smoking habit. As of yet, though, little evidence exists to support this theory.
In a first of its kind study published last week in the medical journal Lancet, researchers compared e-cigarettes to nicotine patches and other smoking cessation methods and found them statistically comparable in helping smokers quit over a six-month period. For this reason, Glynn said he viewed the devices as promising though probably no magic bullet. For now, FDA regulations forbid e-cigarette marketers from touting their devices as a way to kick the habit.
Experts like Erika Seward, the assistant vice president of national advocacy for the American Lung Association, said many of her worries center on e-cigarettes being a gateway to smoking, given that many popular brands come in flavors and colors that seem designed to appeal to a younger generation of smokers.
"We're concerned about the potential for kids to start a lifetime of nicotine use by starting with e-cigarettes," she said.
Though the National Association of Attorneys General today called on the FDA to immediately regulate the sale and advertising of electronic cigarettes, there were no federal age restrictions to prevent kids from obtaining e-cigarettes. Most e-cigarette companies voluntarily do not sell to minors yet vaping among young people is on the rise.
A Centers for Disease Control and Prevention study found nearly 1.8 million young people had tried e-cigarettes and the number of U.S. middle and high school students e-smokers doubled between 2011 and 2012.
Hajek is director of the Tobacco Dependence Research Unit at Barts and The London School of Medicine and Dentistry in London, UK. He was not involved in this study.
The new study adds to the evidence that e-cigarettes can help smokers quit or cut down, he said.
"There are two products competing for smokers' business," Hajek said. "One kills half the users, the other one is at least an order of magnitude safer," he said. "It makes little sense to try to cripple the safer one so the deadly one maintains the market monopoly."
A longitudinal study of electronic cigarette users
Results
Most participants (72%) were former smokers, and 76% were using e-cigarettes daily. At baseline, current users had been using e-cigarettes for 3 months, took 150 puffs/day on their e-cigarette and used refill liquids containing 16 mg/ml of nicotine, on average. Almost all the daily vapers at baseline were still vaping daily after one month (98%) and one year (89%). Of those who had been vaping daily for less than one month at baseline, 93% were still vaping daily after one month, and 81% after one year. In daily vapers, the number of puffs/day on e-cigarettes remained unchanged between baseline and one year. Among former smokers who were vaping daily at baseline, 6% had relapsed to smoking after one month and also 6% after one year. Among dual users (smokers who were vaping daily at baseline), 22% had stopped smoking after one month and 46% after one year. In dual users who were still smoking at follow-up, cigarette consumption decreased by 5.3 cig/day after one month (from 11.3 to 6.0 cig./day, p = 0.006), but remained unchanged between baseline and 1-year follow-up.
Conclusions
E-cigarettes may contribute to relapse prevention in former smokers and smoking cessation in current smokers.
Jean-François Etter, Chris Bullen
Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, Switzerland National Institute for Health Innovation, School of Population Health, University of Auckland, New Zealand
Medication effective in helping smokers quit gradually
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