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Smoke & mirrors or harm reduction breakthrough? A compilation of verdicts on electronic cigarettes

Last week the United States Government banned sales of e-cigarettes and cigars to anyone under age 18. The day before, California Democratic Governor Jerry Brown went much further, signing into law a package of tough anti-smoking bills that also regulate electronic cigarettes.

Under the new California laws, the legal age for purchasing tobacco products will rise from 18 to 21 and also ban the sale of e-cigarette or vaping products to anyone under the age of 21. As this Reuters story details, electronic cigarettes will be regulated like traditional ones, banned in any place, such as in restaurants, workplaces and public areas, that tobacco smoking is prohibited. More information about the changes here.

It’s another step in a growing public health divide that is particularly sharp between the United Kingdom and United States over whether e-cigarettes represent a breakthrough in cutting back cigarette smoking or a new vehicle to addict consumers to nicotine. See Quit Victoria’s position.

Croakey thanks Stan Shatenstein, editor and publisher of Smoking & Tobacco Abstracts & News, an electronic bulletin devoted to smoking and health issues, for permission to cross-publish from his news bulletin this compilation of recent research and comments on e-cigs and tobacco control.

[divide style=”dots” width=”medium”]

From Stan Shatenstein:

“Patterns of use and health impacts of electronic and tobacco cigarettes must continue to be monitored closely, and remedial measures applied promptly to deal with any changes or trends that seem counterproductive to health. It is also important that health professionals communicate the risks and benefits of electronic and tobacco cigarettes to smokers, both in practice and through the academic and popular media, objectively and dispassionately, to redress the growing misconception among smokers that these products are similarly harmful. E-cigarettes and other non-tobacco nicotine products offer the potential radically to reduce harm from smoking in our society. This is an opportunity that should be managed and taken.” [Britton J, Arnott D, McNeill A, Hopkinson N, Nicotine without smoke—putting electronic cigarettes in context, British Medical Journal]

“Tobacco companies make their money by selling tobacco, and the industry’s recent programme of investment and acquisitions in e-cigarettes perhaps indicates recognition that these products represent a disruptive technology that should be harnessed to protect the core business of selling tobacco, exploited to expand tobacco markets or developed as an opportunity to make nicotine products attractive to non-smokers. There is little likelihood that the industry sees e-cigarettes as a route out of the tobacco business, but it is highly likely that e-cigarettes will be exploited to enhance claims of corporate social responsibility, and to undermine implementation of Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. There is no firewall between a ‘good’ tobacco industry that is marketing harm-reduction products in the UK and a ‘bad’ one that promotes smoking, or undermines tobacco control activities, in low- and middle-income countries.” [Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction, RCP]

“The Nicotine Without Smoke report concluded that e-cigarettes were not a gateway to smoking, did not help normalise it and could act as a way out of the deadly habit… The RCP [Royal College of Physicians] did not dismiss the possibility of harm from long-term use of e-cigarettes, but said it was likely to be substantially smaller than that from the carcinogens, carbon monoxide and other toxins that come with tobacco… The report said it remained to be seen whether the new EU rules would help or hinder the use of e-cigarettes in the battle against smoking. Some measures should help raise standards, the authors say in their BMJ article, but limits on nicotine content might diminish e-cigarettes’ effectiveness as smoking substitutes while health warnings might discourage their use.” [James Meikle. Doctors warn of big tobacco firms entering e-cigarette market, The Guardian]

“‘These guys, in my view, are going off a cliff,’ said Stanton A. Glantz, a professor of medicine at the University of California who has been outspoken in his criticism of e-cigarettes. ‘They are taking England into a series of policies that five years from now they all will really regret. They are turning England into this giant experiment on behalf of the tobacco industry.’ But some American public health experts applauded the report… ‘This is two countries taking pretty much diametrically opposed positions,’ said Kenneth E. Warner, a professor of public health at the University of Michigan School of Public Health. ‘One is focused exclusively on the hypothetical risks, none of which have been established. The other is focusing on potential benefits.'” [Sabrina Tavernise. Smokers Urged to Switch to E-Cigarettes by British Medical Group, NY Times]

“Combined with research demonstrating wide product variability between e-cigarette brands and evidence of non-compliance by various brands with current UK and European Union safety legislations, it would perhaps be prudent for Public Health England not to advocate e-cigarette use in smoking cessation, and that the UK National Health Service refrain from prescribing e-cigarettes unless there is new, more rigorous evidence demonstrating their efficacy in smoking cessation and until more stringent regulations on e-cigarettes are implemented. Until then the focus should be on the use of smoking cessation with therapies and services that are evidence-based, since an outright ban on tobacco smoking is not foreseeable.” [Ta Y, Bhowmik A, José RJ. E-cigarettes and smoking cessation, Lancet Resp Med]

“First, we found that while all tobacco products are habitual, e-cigarettes are the most habitual product. Such a result raises concerns about the possibility of strong nicotine addiction for e-cigarettes, though e-cigarettes are frequently advertised as a better alternative to smoking. Second, there is a public health concern that e-cigarettes may complement cigarettes in the long run by serving as a gateway to cigarette smoking. We found that e-cigarettes did not substitute or complement cigarettes in the short or in the long run. Combined with the first finding, our results imply that e-cigarettes may lead people to nicotine addiction but not necessarily to cigarette smoking.” [Zheng Y, Zhen C, Nonnemaker J, Dench D. Advertising, Habit Formation, and U.S. Tobacco Product Demand, American Journal of Agricultural Economics]

“The findings from this nationally representative study of US middle and high school students found that e-cigarette advertisement exposure was associated with e-cigarette use, and greater exposure was associated with higher odds of use. Given that youth use of tobacco in any form is unsafe, comprehensive tobacco prevention and control strategies, including efforts to reduce youth exposure to advertising, are critical to prevent use of all tobacco products among youth.” [Singh T et al. Exposure to Advertisements and Electronic Cigarette Use Among US Middle and High School Students, Pediatrics]

“The results of this systematic review lead us to conclude that evidence for the effectiveness of e-cigarettes as a cessation aid is inconclusive. There is too much uncontrolled variation to allow for any general conclusion to be made. Studies are only beginning to account for important variables related to the product (e-cigarette device, fluid, nicotine content, nicotine delivery), characteristics of users (cigarette use profile, quitting history, health status, demographics), and patterns of use (frequency, duration, time period, inhalation). The study of e-cigarettes as cessation aids is still in its infancy, and at present there are simply too few  well-designed studies to establish a strong body of evidence.” [Malas M et al. Electronic Cigarettes for Smoking Cessation: A Systematic Review, Nicotine & Tobacco Research]

Stan Shatenstein is editor and publisher of Smoking & Tobacco Abstracts & News, an electronic bulletin devoted to smoking and health issues. Based in Montreal, Canada, he is a 2012 recipient of the American Cancer Society’s Luther L. Terry award for Outstanding Community Service in the field of tobacco control.

Image captured from an e-cigarette online advertisement

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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
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#ANROWS2016
#ATSISPEP
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#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
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#OTCC2017
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#VMIACConf17
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