The question of whether e-cigarettes can help people quit smoking is hotly debated. Studies looking at the effectiveness of the devices as cessation aids have been unclear, but at best, they suggest that they work about as well as nicotine patches.
The uncertainty surrounding use of e-cigarettes, also known as vaping, did not stop a government body in the United Kingdom from concluding in a new report that e-cigarettes could help people quit smoking.
The report, published by Public Health England, stated that e-cigarettes are 95% safer than normal cigarettes, and that the “public health opportunities” of these devices should be maximized. The authors of the report recommended that a range of prescription-based e-cigarette options be available, as there are for nicotine replacement therapies.
“I agree with the UK, which is that they are going to medically license e-cigarettes and make them available in the context of smoking cessation aids, as opposed to in this country, (where) they are advertised in every way except for cessation,” said Michael P. Eriksen, dean of the Georgia State University School of Public Health.
“But I think (the report) is overstating the evidence that e-cigarettes are a miracle for cessation,” Eriksen said. The devices do appear to help people quit about as much as nicotine replacement therapies do, yet most smokers are still not successful at quitting, he said.
For those who use e-cigarettes as a cessation aid, the goal is for them to switch entirely to the products and then to eventually give them up, too. “That would be a major public health accomplishment,” Eriksen said.
Many people are so-called dual smokers, using both tobacco and electronic cigarettes, and it is unclear whether they eventually phase out the former. Because of the level of nicotine in e-cigarettes, quitting could be just as tough as giving up the regular kind, said Dr. Jason Jerry, an addiction specialist at Cleveland Clinic.
Although e-cigarettes are probably safer than tobacco cigarettes, the estimate of 95% is probably too high, Eriksen said. That number is based on the opinion of experts, not scientific studies, and could make ex-smokers think they can start vaping, he added.
Instead of e-cigarettes, Jerry advises patients try nicotine replacement therapy. The level of nicotine in those therapies is known and regulated by the U.S. Food and Drug Administration, whereas the level can vary among vaping products, he said. There are also health concerns with the propylene glycol, a main ingredient in many e-cigarettes, flavoring and additives.
“E-cigarettes are probably less detrimental to our health than tobacco cigarettes, but there is still a lot we don’t know,” Jerry said.
If e-cigarettes did become licensed in the United Kingdom, it could make them safer because there would be more regulation of the ingredients, Eriksen said. The upside for companies would be that they could then make claims about their product being a smoking cessation aid. To date no e-cigarettes have been licensed in the United Kingdom, although the new report encourages licensing.
There are no federal regulations on e-cigarettes in the United States. “Everyone is waiting on the FDA,” Eriksen said. The Obama administration has requested the authority to regulate the products like regular cigarettes.
“The UK and European Union are farther ahead … and the U.S. could follow what they’ve done,” Eriksen said. The EU regulations include a ban on advertising e-cigarettes and a requirement that products have health labels.
Many states in the United States have rules about where people can vape and rules that prevent the sale of e-cigarettes to minors. There is concern “whether this is a much more appealing product to adolescents with all the bubble gum and other flavors,” Jerry said.
A Centers for Disease Control and Prevention report found the use of e-cigarettes among high school students tripled from 4.5% in 2013 to 13% in 2014. In that time, use grew among middle schoolers from 1% to 4%.
