A Harmless Cigarette?

“The tobacco epidemic is one of the biggest public health threats the world has ever faced.” –World Health Organization

Image courtesy of photopin.com

With the dangerous combination of tobacco and nicotine still universally available in the form of a cigarette, smoking threatens to remain one of the leading causes of preventable deaths for quite some time.

With that said, in 2003 a Chinese pharmacist invented a new type of cigarette that some say has already started (ever so slightly) to take on Big Tobacco.

A tobacco industry analyst was quoted saying, “E-cigarettes are to tobacco what energy drinks were or are to beverages. It is a small category that is growing very fast, embraced by retailers and consumers.”

These smokeless cigs, known as the electronic cigarette or e-cigarette, were marketed in China as an aid for smoking cessation and replacement (e-cigarettes are no longer marketed as smoking cessation tools in most countries). They were introduced in the U.S. in 2007.

The role that e-cigarettes play in encouraging quitting —as well as their safety —has been the source of heated debates in public health circles nationwide. These debates are likely to remain unsettled until more rigorous, peer-reviewed studies are available to present hard evidence one way or the other.

Until then, it’s still important to take a look at the information that’s already out there —as far as I can tell, the e-cigarette is here to stay.

I first came into contact with an electronic cigarette last summer when I was abroad. I saw someone using one, forgot my manners, and eagerly asked him what it was. He explained that it is a battery-operated device that turns a liquefied nicotine solution into a vapor that is delivered to the user’s lungs. The user can select the amount of nicotine that is delivered, and some people even choose to use the device with no nicotine at all.

Oh, and another thing. These cigarettes are 100% tobacco-free. That’s a new one.

Image courtesy of photopin.com

The tobacco and pharmaceutical industries do not manufacture or distribute electronic cigarettes. Instead, small distributors sell them over the internet and in mall kiosks. According to the Centers for Disease Control and Prevention (CDC), about 60% of American adults are aware of the devices, one in five adult cigarette smokers has used an electronic cigarette, and about 6% of all adults (that’s smokers and non-smokers) have tried e-cigarettes.

The head of the CDC’s office on smoking and health, Tim McAfee, noted that increasing awareness and utilization of e-cigarettes highlights the need for government regulation and evaluation.

In 2009, the U.S. Food and Drug Administration (FDA) publicly discouraged the use of electronic cigarettes and tried to stop e-cigarette sales by classifying them as drug delivery devices. These devices would be subject to regulation until their safety could be demonstrated in clinical trials.

In 2010, the drug delivery device classification was challenged in Federal District Court and overruled.

Also in 2010, the FDA took the case back to court, but the appeals court blocked the product from regulation as a medical device, arguing that e-cigarettes would only be subject to drug legislation if they are marketed for therapeutic use—targeted at those trying to quit. (This only speaks to the way in which companies market their e-cigarettes and nothing about whether people are choosing to use them as a smoking cessation aid or their potential effectiveness as a smoking cessation tool).

The FDA currently has been given the okay to regulate e-cigarettes as “tobacco products” and is expected to begin doing so later this year. However, this distinction allows for less control over the product than the agency had hoped.

What the fans say:

Users report buying electronic cigarettes to help quit smoking, to reduce cigarette consumption, and to relieve withdrawal symptoms as a result of smoking restrictions at work or other places. E-cigarettes are thought to address both the nicotine addiction and behavioral components of smoking. They are also free of smoke, tar, ash, and odor (a nice bonus for the public, the user, and the user’s clothes!). So, supporters claim that whether or not there are some risks associated with use of the electronic cigarette, they don’t carry the great harm of traditional cigarettes.

Among other studies that have looked at the effectiveness of the e-cigarette for smoking cessation, a study from the Boston University School of Public Health found that the use of e-cigarettes as a smoking cessation or smoking reduction tool appears promising. Using an online survey of 222 first-time e-cigarette users, Michael Siegal and colleagues looked at the prevalence of smoking abstinence 6 months later. They found that 31% of respondents were not smoking at the 6-month point and of those not smoking, 56.7% were using e-cigarettes, 9.0% were using tobacco-free nicotine products, and 34.3% were not using any kind of nicotine.

What the critics say:

E-cigarettes appear to have fewer toxins than traditional cigarettes, but people still worry about whether the nicotine vapor in e-cigarettes may be harmful or toxic. The long-term health effects of e-cigarettes are still largely unknown, which makes many people uncomfortable with the idea of allowing their promotion, sale, and utilization.

Image courtesy of photopin.com

Critics also note that research is needed to assess how marketing could impact initiation and use of traditional cigarettes, especially among youth. Particularly for e-cigarette brands like NJOY, which really try to emulate the entire experience of smoking, people worry that e-cigarettes could be a gateway to smoking. Available research suggests that this could be the case, but more work still needs to be done in this arena.

Those hoping for tighter regulation on e-cigarettes claim that these devices should be illegal until proven safe. These individuals and various agencies are not poo-pooing the idea of e-cigarettes. Rather, they will not condone their use until they can be certain that the device’s public health impact is a positive one.

The FDA warns that, “As the safety and efficacy of e-cigarettes have not been fully studied, consumers of e-cigarette products currently have no way of knowing:

whether e-cigarettes are safe for their intended use,

how much nicotine or other potentially harmful chemicals are being inhaled during use, or

“If large numbers of adult smokers become users of both traditional cigarettes and e-cigarettes — rather than using e-cigarettes to quit cigarettes completely — the net public health effect could be quite negative.”

Both sides in the debate believe that e-cigarettes should be studied more, subjected to greater quality-control standards, and banned on sales to minors. It seems that only time and more research will reveal the regulatory fate of the electronic cigarette.

Related

I know quite a few people who use these, some exclusively, some only in places where they cannot smoke cigarettes; none would be under the illusion that they are healthy and most have said they would not see them as the ideal aid to give up nicotine completely – partly because the whole “ritual” of smoking is still there as opposed to nicotine chewing gum or patches, and that of course is what they enjoy about them. One of them, however, has actually given up nicotine altogether (using the e-cigarette with some other flavored solution with no nicotine), another has reduced their nicotine intake considerably and a third, who has no intention of ever giving up nicotine, no longer has a smoker’s cough, is feeling fitter, and clearly looks better – skin, eyes, teeth etc. no longer yellow etc. So, in comparison to cigarettes there certainly does seem to be some benefits, however, further research is essential – are the risks of any types of cancer increased, what are the effects on the digestive tract, lungs etc? A person who wants to smoke has every right to do so, regardless of the risks, if they are not harming anyone else, and if e-cigarettes get rid of the serious problem of passive smoking then they would seem to be the way forward. Arguments that they are attractive to young people are not sufficient, if they were to be banned for that reason alone, then we would also have to immediately ban alcohol, McDonalds and co., fizzy drinks, and sugar. Where does it stop? I do hope that e-cigarettes will be thoroughly researched without bias and that we will all soon know the full story so that sensible regulations can be introduced. However, they should definitely only be available to people over 18.

Thank you for your comment. I don’t personally know anyone who has used electronic cigarettes, so it’s interesting to hear how some of your friends have used them and the result of their use. From doing research for this blog, it seems that e-cigarettes serve different purposes for individual people based on their initial reasons for using it and whether they want to reduce their smoking behaviors or just use the e-cigarette as a supplement for moments when cigarette smoking is not allowed. It is nice to hear that someone you know successfully weaned him or herself off of smoking completely.

I suspect that the fate of e-cigarettes will not come down to their potential attractiveness to young people or the “gateway drug” argument. I think it’s more likely that they will only be removed completely from the market if they are found to be harmful. But you bring up the important contradiction that often happens in public health in which people emphasize one phenomenon (marketing of e-cigarettes) without focusing on others in the same way (marketing of alcohol). However, this is not to say that alcohol and sugary drinks have not had their share of backlash against them. It is most likely to be the case that because e-cigarettes are a relatively new product, those who would like to increase regulation have a greater pull than they would on products that have been around for a long time (McDonald’s and alcohol).

love this part:
“E-cigarettes appear to have fewer toxins than traditional cigarettes, but people still worry about whether the nicotine vapor in e-cigarettes may be harmful or toxic. The long-term health effects of e-cigarettes are still largely unknown, which makes many people uncomfortable with the idea of allowing their promotion, sale, and utilization.”

regular cigarettes are PROVEN dangerous and “they” don’t seem to be “uncomfortable with the idea of allowing their promotion, sale, and utilization.”

I’m glad you brought this up because it’s an important consideration. As I alluded to in my response to Betty, whether or not it is an appropriate or harmful way to treat this issue, I think this is because cigarettes have been sold for so many years and because Big Tobacco manufacturers have so much influence in the United States and abroad. On the other hand, e-cigarettes have only been sold in the U.S. since 2007. So unfortunately, the potentially “harmless” e-cigarettes have taken the recent heat on this.

I really enjoyed this blog! I do not smoke personally but being around people who smoke I understand how smoking a traditional cigarette can effect the user and others around them as well.I like how you compared the traditional cigarette to the e-cigarette and how you stated how the FDA feels about the product and how users real about e-cigarettes.It is rare to see people using e-cigarettes where I am located,but with all the advantages compared to the traditional cigarette I don’t see why not.The e-cigarettes are great for quiting smoking as stated in the blog and as I read in other comments,they eliminate most of the toxins such as tobacco,tar and ash.They also give off no smell which in my case is great because I hate the smell and I’m sure the users don’t love having there cloths smell as well.I wouldn’t say e-cigarettes are completely harmless though as the possible effects are still unknown as it is still somewhat of new technology.In a survey of 222 first time e-cigarette users Michael Siegal found that e-cigarettes did help 31% of respondents had stopped smoking at the 6 month point.And of the 31%,56.7% of the non smokers were using e-cigarettes and 31% were not consuming any nicotine at all!To summarize:E-cigarettes are not completely harmless,but the sure are a step up from traditional cigarettes.A question I have now though is:what do people like more about traditional cigarettes that they would switch back from an e-cigarette?In my point of the e-cigarette seems like a smarter and better choice as it eliminates many of the factors that people don’t like about cigarettes.And one last question is:why have these e-cigarettes not really caught in Canada and the United States as much as Europe or Asia?As what I can tell as soon as there is a new electronic product people jump on it and e cigarettes are the way of bringing smoking into this century not that many people want to. #SPX9

Well at least the good thing about this is that it is not as bad as the real cigarettes! The main idea idea of this blog is the company trying to replace the harmful cigarettes with electronic ones! When It said that the e-Cigarettes have few toxins in it than the real cigarettes I was still thinking that either way, cigarettes are still totally bad for you. I have one question and that is, why would you guys create an electric cigarette that reduces smoking when there is nicatine? #spx9

Your blog is very interesting. E-cigarette is good to use to prevent people from smoking tobacco.I was surprised that 60% of American adults are aware of e-cigarette but only 6% of all adults have tried this device. E-cigarette is powered by a battery that turns into a nicotine solution into a vapour that is delivered to the person’s lungs. Therefore, this device is safe to use because it does not contain any toxic chemicals such as arsenic, cadmium, ammonia and more. I have a question, How much does the e-cigarette cost? Does using e-cigarette will have an affect on your body? #SPX9

Your blog is very interesting.i like the fact that you put picture of what the e-cigarette look like. E-cigarette is good to use to prevent people from smoking tobacco.I was surprised that 60% of American adults are aware of e-cigarette but only 6% of all adults have tried this device. E-cigarette is powered by a battery that turns into a nicotine solution into a vapour that is delivered to the person’s lungs. Therefore, this device is safe to use because it does not contain any toxic chemicals such as arsenic, cadmium, ammonia and more. I have a question, How much does the e-cigarette cost? Does using e-cigarette will have an affect on your body? #SPX9

Thanks for reading. The 60% of those who are aware of e-cigarettes is representative of all American adults (including many individuals who do not use nicotine or smoke), so that is probably why the percentage of adults who actually use e-cigarettes is much lower at 6%. Perhaps some people who are aware of e-cigarettes may not know where to get them or do not know enough about them to try using them. As I noted, there is not enough research to conclusively say whether or not using e-cigarettes will have an effect on the body. This seems to be causing much of the debate about whether or not e-cigarettes should be marketed and sold. From my research, it appears that for an e-cigarette starter kit, the price can range from $24.99 all the way up to $199.

Hi. This was a great post to read thank you. I personally now use e cigarettes. For me I simply cannot quit smoking. I have 4 children and of course my partner has begged me to stop and rightly so! I am in the uk and I am so impressed with e cigarettes. I am so proud to be able to tell people that I no longer smoke and instead I now ‘vape’. I am so excited about this that it has prompted me to start my own blog site. I have started reviewing (1 brand only) that I feel is the very best right now (there is a lot of cheap rubbish out there that you need to avoid). You can view my e cigarette review if it may be of interest to here http://www.thathelps.co.uk/2013/03/vapestick-the-new-xl-starter-kit-review/

I hope that my review may help give a bit more information to those actually considering buying one. Thanks for the interesting read

Thank you for writing and publishing this article. It’s discouraging to see the constant misinformed press around e-cigarettes, so when I read pieces like this that are well-researched, well-referenced and not biased to either side, it’s a breath of fresh air. As with most things there are negative and positive aspects to vaping but most media pieces tend to exaggerate either one side or the other. I hope that as time goes on more journalists come to adopt your balanced approach to reporting on electronic cigarettes.

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About Mind The Science Gap

Mind The Science Gap was a Science Communication Training blog that ran between 2012 - 2013.

Each semester, ten Master of Public Health students from the University of Michigan participated in a course on Communicating Science through Social Media. Each student on the course was required to post weekly articles here as they learned how to translate complex science into something a broad audience can understand and appreciate. And in doing so they were evaluated in the most brutal way possible - by the audience they were writing for!