A charity is concerned that negative headlines about e-cigarettes may put people who want to quit smoking off one of the most effective ways of reducing nicotine intake. Cancer Research UK suggests that although e-cigarettes are a recent phenomenon and that there needs to be more studies on the effects on the human body, there can be no doubt that they are safer to use than cigarettes.
Concerns with e-cigarettes have included that they contain similar chemicals to cigarettes, that the variety of flavours could make them more appealing to teenagers or never smokers or that they have caused a reduction in the use of nicotine replacement products, as use of these products have fallen. The World Health Organisation published a report in September which recommends strictly regulating and monitoring the products. This means that smokers in many countries will be unable to access e-cigarettes and will continue to use tobacco products instead. The US recently published a review by the Surgeon General which saw e-cigarettes as a public health concern. It stated that e-cigarettes were the most often used form of tobacco among young people and that any form of nicotine use was not recommended for younger people and pregnant women. The report recommended heavy regulation of e-cigarettes. However it did not compare vaping and smoking risks and the conclusions found about nicotine would also apply to nicotine replacement therapy which is permitted for use by pregnant women and young smokers. The report also did not clarify that e-cigarettes are not tobacco products.
A range of studies are concluding that e-cigarettes are still much healthier than smoking. A report was published from the Royal College of Physicians which suggests that long-term e-cigarette vapour inhalation was likely to cause no more than 5% of the harm caused by smoking cigarettes. UK health organisations have suggested that e-cigarettes should be promoted as tools to help smokers quit alongside more conventional nicotine replacement products. They admit that e-cigarettes are not made to medicine standards and need some regulation to reduce adverse effects, however they do not recommend that the regulation should limit the use of e-cigarettes by smokers trying to quit. They also suggest that there is no evidence to suggest that e-cigarettes are encouraging young people to take up smoking.
One of the most recent studies, published in the BMJ, examined the association between the use of e-cigarettes, the success of quit attempts, the use of stop smoking services and the use of nicotine replacement therapy in England, using time series analysis of surveys from the Smoking Toolkit Study. It had been suggested that e-cigarettes could be responsible for a fall in the use of nicotine replacement therapy. The study suggested that while there was a drop in the use of replacement products, the possibility of it being caused by an increase of use in e-cigarettes was not clear. It did note, however that there had been a fall in tobacco mass media campaigns run by the government. The study results were also affected by a change in the age that people were able to buy tobacco rising from 16 to 18 in 2007, the change of stop smoking services commissioning from central to local government and the introduction of a smoking ban in 2007. The study also found that over 18,000 smokers were able to give up the habit with the help of e-cigarettes.
Although e-cigarettes are not perfect, the balance of evidence would seem to be tipping towards them in that they are effective in helping smokers to give up tobacco products. More research is needed to discover the risks that they offer, but although some of these remain unknown, the likelihood is that they will remain the lesser of two evils when compared to tobacco.
Beard, E., et al., Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends, 2016, BMJ
Royal College of Physicians Report Update, Nicotine without smoke: Tobacco harm reduction, 2016
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