GETTING BEHIND THE SCIENCE OF VAPING
Some of you may have questions regarding the science relating to electronic nicotine products – how they operate, what they contain, how they compare to cigarettes and a host of other issues.
To answers these questions, we’ll be presenting a selection of articles, typically from peer-reviewed scientific journals, regarding electronic nicotine products and the science of vaping.
Some authors believe these products have the ability to substantially reduce the toll of death and disease from combustion cigarettes and save millions of lives, while others caution that they carry unknown health risks. We believe that a consideration of all viewpoints is valuable and essential to understanding the science of vaping, both to us as a company and to you as a consumer.
Table of Contents
Looking for a specific article? Click any of the links below to jump directly to it.
The Truth About Electronic Nicotine Delivery Systems
This is a December 2015 position paper by the Truth Initiative on ENDS. With respect to Health and Safety, the paper states: “ENDS are substantially less harmful than the inhaled smoke from combustible tobacco (i.e., cigarettes). Long-term monitoring of health effects, addictiveness and toxicity is necessary to determine their absolute harm compared with no use of any products and their relative harm compared with other nicotine delivery products (e.g., nicotine replacement therapies) and other tobacco products (both non-combustible and combustible products).” With respect to cigarette smoking cessation with ENDS, the paper states: “Current research suggests that ENDS can promote cessation of cigarettes, increase quit attempts, reduce symptoms of nicotine withdrawal, prevent relapse and potentially serve as a pathway to cessation of cigarettes. Further high-quality, randomized controlled trials and more rigorous observational studies are important to confirm findings from the research published to date.”
Research Brief: Quit Method Used by US Adult Cigarette Smokers, 2014-2016
In this Research Brief, published by the Centers for Disease Control, the authors reported that substituting some cigarettes with e-cigarettes was used as a quit method by a greater percentage of U.S. adult cigarette smokers than the nicotine patch, nicotine gum or other cessation aids approved by the FDA. The study was based on the results of a nationally representative longitudinal online survey of nearly 16,000 U.S. smokers. More specifically, the authors reported the following: “Overall, 74.7% of adult current cigarette smokers used multiple quit methods during their most recent quit attempt (Table 1). Giv- ing up cigarettes all at once (65.3%) and gradually cutting back on cigarettes (62.0%) were the most commonly used methods to try to quit, followed by substituting some cigarettes with e-cigarettes (35.3%), using a nicotine patch or gum (25.4%), switching completely from cigarettes to e-cigarettes (24.7%), and switching from “regular” cigarettes to “mild” cigarettes (20.4%). Quit methods used less often were getting help from a doctor or other health professional (15.2%), using smoking cessation medications approved by the US Food and Drug Administration (FDA) (12.2%), and getting help from a website (7.1%) or a telephone quitline (5.4%).”
Are e-cigs a healthy way to quit smoking?
A recent article published in the WSJ, presents both sides of the ongoing e-cig debate.
Jed E. Rose of the Duke center for Smoking Cessation at Duke university, says e-cigs appear to be less risky than Tobacco Cigarettes, and are an effective way to quit smoking. In opposition, Pamela Ling, at the Center for Tobacco Control Research and Education at the University of California, says there are better and safer ways to quit smoking.
1,3-Propanediol Inhalation Study
This study (conducted at the Haskell Laboratory for Health and Environmental Sciences) was used to determine the potential effects of 1,3-Propanediol following repeated inhalation exposure to rats. The rats were exposed to 1,3-Propanediol for 6hr/day, 5 days/wk for 2 weeks. Responses were observed and measured daily, analyses were conducted after the last exposure session and then again to half of the group following an 18 day non-exposure period. Clinical pathology and tissue pathology examinations in the 1,3-propanediol exposed rats were similar to those in the unexposed controls. In summary, 1,3-Propanediol does not appear to pose a significant hazard via inhalation of either the vapor or a vapor/aerosol mixture.
E-cigs and smoking cessation - a review and meta-analysis
A recent meta- analysis published in the Lancet Respiratory Medicine Journal, looks at the odds of smoking cessation among smokers who use e-cigs, compared with those who don't. According to the authors, including long-time electronic cigarette opponent Dr. Stanton Glantz, their findings showed that those who used e-cigs in their attempts to quit smoking were less successful than those who didn’t.
Read the full summary here
Cancer UK refutes the analysis, by asking; if the use of e-cigs caused fewer smokers to quit, the quit rate in England would have decreased as use of e-cigs has increased – however the data suggests otherwise. The rebuttal goes on to outline various shortcomings of the analysis.
Taking a deeper look behind the headlines. Do they reveal the full e-cig story?
With the recent influx of media reports that suggest e-cigarettes aren’t any safer than traditional cigarettes, Cancer Research UK does a deeper dive.
Their findings reveal a larger story behind the headlines, which point towards a positive role for e-cigs as a harm reduction tool.
Superior Health Council - Belguim; risk assessment of e-cigarettes
In a lengthy report, Belgium’s Superior Health Council provided its recommendations to the government on electronic cigarettes. The council is the second Western European agency (after Public Health England) to identify a positive role for electronic cigarette use for those who seek to switch from traditional cigarettes.
Among other things, the Belgium Public Health report includes the following:
"Smoking is extremely harmful to human health. The health hazard is caused chiefly by the inhalation of combustion products in tobacco smoke and repeated exposure to these products through addiction to nicotine, further reinforced by psychological habituation to the routines of smoking. It should be noted that the harmful effect of nicotine in itself is relatively limited, and clearly much less than tobacco smoke." Page 5
"Where tobacco smokers are concerned, the aim is to stop smoking, through a (possibly temporary) switch to vaping. If giving up cigarettes (tobacco or e-cigarettes) is not possible in an individual case, or not preferred/desired, then the use of the electronic cigarette is preferable to tobacco smoking." Page 12
The report also advocates including electronic cigarettes in indoor smoking bans and restricting electronic cigarette advertising.
Dragon Slayers - Powering the public health war on vaping
Where we stand now: E-cigarettes
Electronic cigarette use in France in 2014
A recent study looked at the use of e-cigs in France.
The study, based on a telephone survey of 15,635 individuals shows that on the whole e-cigs in France were used by smokers. The findings also suggest that e-cigs could have helped four hundred thousand of French smokers to quit smoking in 2014, at least temporarily.
E-Cigs' Inconvenient Truth: It's Much Safer to Vape
Are we missing out on the chance to save millions of lives?
Rolling Stones' writer, David Amsden, discusses the life saving potential of vaping as a 'harm-reduction' approach to quitting traditional cigarettes.
Amsden looks at the public health debate about electronic cigarettes and vaping, quoting from advocates on both sides of the debate. He probes the shortcomings of some widely publicized negative research, and examines how the emergence of Big Tobacco's Vaping Products has influenced the discussion.
Impacts of electronic cigarettes on individual and public health
Professor Linda Bauld from the University of Stirling in the UK, talks about the potential impacts that e-cigs could have on the health of smokers and the impact of e-cig vapor on bystanders.
She argues, that e-cigs are significantly less harmful than regular cigarettes, and that banning the use of e-cigs in public places could be counter-productive to helping people quit traditional cigarettes.
Study finds e-cigs help some smokers quit cigarettes
People who have recently stopped smoking within the last year, are four times more likely than current smokers to use e-cigs daily, according to a new Rutgers study.
Should we switch from tobacco to e-cigarettes?
Do e-cigarettes have the potential to eradicate smoking related diseases, or will they create unknown problems? BBC Science Journalist Michael Mosley, spearheads the discussion and presents us with some interesting facts.
Watch the BBC's 'Trust Me, I'm A Doctor" segment featuring Professor Peter Hajek here
E-cigarettes: a consumer-led revolution
Olivia Maynard, a tobacco researcher at the University of Bristol, explains her take on a recent public debate on whether e-cigarettes are the key to reducing smoking. She suggests that one of the reasons why they are so popular is because they reflect a consumer-led revolution, with many seeing them as a lifestyle-choice rather than a smoking cessation aid or medicine. She cautions that if strict regulations leads to fewer smokers switching to e-cigarettes, we could be missing a huge public health opportunity.
E-cigarettes: What We Know
Professor Kevin Fenton, the National Director for Health and Wellbeing for Public Health England, writes in the Huffington Post on what we know about e-cigarettes. Professor Fenton addresses some of the most pressing public health questions about these products, including risk comparison with smoking, whether second hand vapor harms bystanders, whether e-cigarettes help smokers leave smoking, and whether e-cigarettes are a route into smoking for youth or other non-smokers. Professor Fenton concludes by writing: “So far the evidence shows that e-cigarettes are far less harmful than smoking and can be effective in helping smokes to quit.”
Readers Respond: E-Cigarettes Help Them Quit Traditional Smokes
When Consumer Reports reported on the USPSTF’s conclusion regarding electronic nicotine products and smoking cessation, it heard from more than 1,300 readers, with most reporting that these products had helped them kick their combustion smoking habit.
The article notes reported concerns regarding electronic cigarettes and, while acknowledging the “compelling” reports from readers, concludes by recommending that "people who smoke conventional cigarettes ask their doctors to recommend a counselor who specializes in smoking cessation to help them choose safe and effective methods for kicking the habit.”
Click here to read the article and share your personal story.
The USPSTF's recommendation
This past month the U.S. Preventive Services Task Force, an independent, volunteer panel of national experts in prevention and evidence-based medicine, released its recommendations with respect to tobacco smoking cessation. With respect to the use of electronic nicotine products for smoking cessation, the USPSTF concluded that there was “insufficient evidence to recommend for or against its use for smoking cessation.”
Click here to read the full recommendation.
E-Cigarettes: a savior for smokers, a lurking global danger … or both?
Dr. Joanna Cohen, director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health and recently a voting member on the Food and Drug Administration's Tobacco Products Scientific Advisory Committee, writes on the continuing debate over the safety of electronic cigarettes. Her conclusion: “If you’re a cigarette smoker, all available research shows that e-cigarettes are a safer alternative. If you don't smoke e-cigarettes or tobacco products, don’t start. Although e-cigarettes might ultimately prove to be the lesser of two evils, additional research could uncover dangers unknown today."
A Public Health Expert’s Perspective on the Gateway Controversy
In this article, Dr. Kozlowski carefully dissects recent journal articles discussing a potential “gateway” phenomenon between electronic cigarette use and combustion cigarette initiation. Dr. Kozlowski challenges the methodology of both studies and their conclusions that there is such a gateway effect.
E-Cigarette hysteria is hazardous to your health
In this article that appears in the New York Post, Dr. Richard Carmona explains how emerging data on e-cigarettes should be carefully considered against the e-cigarette hysteria that we are more often exposed to. Dr. Carmona, outlines the emerging trends, which show an overall decline in smokers in the US, since the inception of the first e-cig in 2007. He argues the importance of looking at the science, data and reports to inform us on how we can continue to obsolete traditional smoking with advancing new technologies.
To Help Smokers Quit, Make Them Vapers
In this opinion piece that appeared in the Los Angeles Times, Berkeley Law Professor Stephen Sugarman argues that the government should adopt three complementary policies that will encourage rather than discourage e-cigarette use, nudging many more Americans to leave smoking and eventually save "millions of lives." Professor Sugarman advocates a reduction of the nicotine level in combustion cigarettes to make them less appealing, enact a new $2-a-pack cigarette tax to reduce demand, and make insurance that is available under the Affordable Care Act cover e-cigarettes so as to further reduce their price as compared to traditional cigarettes.
The real challenge is to make e-cigarettes accessible for poor smokers
In a letter to the editor published in The Lancet, Clive Bates argues that more public health gains from electronic cigarettes could be achieved for lower income smokers if there were "clear statements by trusted bodies affirming that vaping is likely to have at least a 95% lower risk of serious disease than smoking; if there were greater availability of high quality, easily accessible guidance on how to get started; with assistance with the upfront investment necessary to access more effective vaping products; and with creation of a supportive policy environment. Public health Professor Lucie Kalousova, in a response, acknowledges that the measures advocated by Clive Bates could make electronic cigarettes a more promising instrument of harm reduction, but only if they (a) help current smokers make the switch without encouraging uptake from non-smokers and (b) if they do not dissuade from complete cessation those smokers who would have fully quit in the absence of electronic cigarettes.
E-cigarettes: Helping smokers quit, or fueling a new addiction?
In this lead story, CNN quotes a number of experts about some of the hot button issues relating to electronic cigarettes. Two points of view are presented with respect to rising experimentation among adolescents – Tim McAfee of the CDC warns of potential harm to the developing adolescent brain, and Professor Francois Etter who believes the youth experimentation should be monitored but argues that the role of these products in reducing global tobacco consumption is more important. Professor Linda Bauld argues that electronic cigarettes are 60% more effective then going cold turkey or buying nicotine replacement therapy over the counter for those who want to leave combustion smoking.
Study Finds that Switching to Electronic Cigarettes Reduces Toxicant Exposure, Even for Dual Users
A study of 40 adults found that beginning one week after switching, those who switched experienced a decrease in levels of carbon monoxide and acrolein. Individuals who had fully switched to electronic cigarettes experienced greater decreases for both toxicants but both the complete switchers and the dual users experienced significant decreases. The authors cautioned that the study only measured these two toxicants, that the study length was only four weeks, and that study participants were only individuals who wanted to stop smoking.
Click here to read the abstract.
Dr. Farsalinos Responds to Lancet Editorial
An editorial in Lancet criticized Public Health England for relying in its 111-page report on a study regarding electronic cigarette safety that had 12 co-authors, asserting that the study was methodologically weak and that one of the 12 authors had consulted for an electronic cigarette company while another had consulted with manufacturers of smoking cessation products. In his response, Dr. Farsalinos writes that the safety study, authored by some of the most active researchers in tobacco smoking, was properly based on evidence. In addition, he strongly rejects the Lancet's bias argument, saying among other things it is insulting to the 10 authors who are not accused of bias, yet whom the Lancet would have the public believe were misled by the two authors singled out for a bias charge.
Effects of Electronic Cigarette Vapor, Combustion Smoke, and Air on the Human Airway
This article reports the results of laboratory testing designed to test the potential irritant effects of electronic cigarette vapor on the human airway. The authors exposed reconstructed, three-dimensional, human airway tissue in a laboratory setting to three different test conditions: (a) six hours of exposure to electronic cigarette vapor from two different NJOY King products, (b) to six hours of exposure to smoke from a traditional cigarette, and (c) to 6 hours of exposure to untreated air. As expected, exposure to the untreated air did not affect the human cells, while the 6 hour exposure to traditional cigarette smoke caused near-complete cell death. The exposure to electronic cigarette vapor showed no irritant effects on the reconstructed human airway and, indeed, the authors observed no statistical difference between the results of exposure to electronic cigarette vapor and to untreated air.
Policy Statement and Detailed Report on Electronic Cigarettes from Public Health England (an Agency of England’s Department of Health)
This policy statement and detailed report, from Public Health England, an agency of England’s Department of Health, contains a number of widely-reported pronouncements regarding electronic cigarettes. Among other things, the authors write that electronic cigarettes are “around 95% less harmful to health than smoking.” They also declare that “when supported by a smoking cessation service, [they] help most smokers to quit tobacco altogether.” They caution that “[continued] vigilance and research in this area are needed.”
Click here to read the full Policy Statement.
Policy Statement on Electronic Cigarettes from the World Health Organization
In this Report, the World Health Organization notes the divide in the public health community between those who welcome electronic cigarettes as a “pathway to the reduction of tobacco smoking” versus those who “characterize them as products that could undermine efforts to denormalize tobacco use.” While observing that “it is very likely that average ENDS use produces lower exposures to toxicants that combustible products” the report finds that the “evidence is sufficient to caution children and adolescents, pregnant women, and women of reproductive age about ENDS use because of the potential for fetal and adolescent nicotine exposure to have long-term consequences for brain development.” With respect to use as a potential cessation aid, the Report states that: “Smokers should first be encouraged to quit smoking and nicotine addiction using a combination of already approved treatments. However, at the individual level, experts suggest that in some smokers who have failed treatment, have been intolerant to it or who refuse to use conventional smoking cessation medication, the use of appropriately- regulated ENDS may have a role to play in supporting attempts to quit.” The Report concludes by advocating a strict regulatory regime for these products.
Laboratory Testing of Exposure of Mice to Electronic Cigarette Vapor
This study reported the results of an animal toxicology study in which mice were exposed to electronic cigarette vapor at the rate of 3 hours per day (separated into two 1.5 hour sessions), infected, and then tested for possible impairment to anti-microbial defenses. The study found impairment of such defenses.
Critique of Methodology Employed in Mice Exposure Laboratory Study
This was a critique of the mice toxicology study that is the subject of the previous article. The authors of this critique argued that the study exposed the mice to grossly excessive amounts of vapor, stating that it was “more than ten times the nicotine exposure of a typical cigarette smoker” or the equivalent of smoking 200 cigarettes per day. To achieve the levels of exposure described in the study, a user would need to “practically take an e-cig puff with each breath.”
Review of Scientific Literature Regarding Electronic Cigarettes
This is a survey of scientific articles concerning electronic cigarettes. The study authors are Peter Hajek, Jean-François Etter, Neal Benowitz, Thomas Eissenberg and Hayden McRobbie. It was published in June 2014.
The survey summarizes findings on a broad range of scientific issues pertaining to electronic cigarettes. With respect to toxicant levels, the article states that electronic cigarettes “can contain some of the toxicants present in tobacco smoke, but at levels which are much lower.” With respect to long term health effects, the article notes that these “are unknown but compared with cigarettes, EC [electronic cigarettes] are likely to be much less, if at all, harmful to users or bystanders.” With respect to possible use by smokers desiring to leave smoking, the article states that “health-care professionals (HCP) should support smokers unable or unwilling to stop tobacco use who wish to switch to EC to reduce harm from smoking.” They also caution that health care providers “should emphasize the importance of stopping using cigarettes and nicotine altogether.”
Policy Statement on Electronic Cigarettes from the Royal Society for Public Health
In this Policy Statement, the Royal Society for Public Health notes the need for greater research “to understand the long-term health impacts of e-cigarette usage,” while at the same time reporting the existing of a “growing consensus amongst health professionals that these products offer a safer alternative to combustible tobacco products.” The Report also points the body of “growing evidence “demonstrating the efficacy of both NRT and e-cigarettes as smoking cessation tools.” It references one study in particular that “found that individuals using e-cigarettes on a daily basis were six times as likely to report quitting tobacco smoking as non-users or ‘triers’ of e-cigarettes.”
Policy Statement on Electronic Cigarettes from the American Heart Association
This is a policy statement on electronic cigarettes from the American Heart Association. The co-authors are Aruni Bhatnagar, Laurie P. Whitsel, Kurt M. Ribisl, Chris Bullen, Frank Chaloupka, Mariann R. Piano, Rose Marie Robertson, Timothy McAuley, David Goff and Neal Benowitz. It was published on August 24, 2014. This policy statement covers a broad range of topics, including electronic cigarettes and cessation, health effects, nicotine, particles, and regulation. In general, the statement sounds a cautionary note regarding these products. It acknowledges the existence of some evidence that electronic cigarettes can help smokers quit, but calls the evidence “sparse.” With respect to safety, the statement points out that “[e]-cigarettes either do not contain or have lower levels of several tobacco-derived harmful and potentially harmful constituents compared with cigarettes and smokeless tobacco.” However, the statement cautions that “the health effects of e-cigarettes have not been well studied, and the potential harm incurred by long-term use of these devices remains completely unknown.”
Policy Statement on Electronic Cigarettes from the American Association for Cancer Research
This policy statement, among other things, addresses what the authors regard as a lack of sufficient data, stating: “There are currently too few data on the safety of ENDS [electronic cigarettes] and their efficacy as cessation products to recommend their use for the general population or for patients with chronic diseases such as cancer.” The authors call for more research into these issues.
Review of Scientific Literature Regarding Electronic Cigarettes
This is a survey of scientific articles concerning electronic cigarettes, which is a condensed version of a report prepared for the World Health Organization. It was published in May 2014. The authors are Rachel Grana, Neal Benowitz and Stanton Glantz.
The authors note, based on the articles reviewed, that electronic cigarettes deliver lower levels of some of the toxins found in cigarette smoke. At the same time, they point out that electronic cigarette vapor contains “ultra-fine particles,” though acknowledge that it is unclear whether these particles have toxicity similar to those generated by tobacco smoke. The article addresses a number of other topics, including who is using these products, dual use and health effects. With respect to what health care providers should tell smoking patients who ask about electronic cigarettes, the authors state: “If a patient has failed initial treatment, has been intolerant of or refuses to use conventional smoking cessation medication, and wishes to use e-cigarettes to aid quitting, it is reasonable to support the attempt.” In general, the article proposes that electronic cigarettes be regulated in essentially the same manner as combustion cigarettes.
Click here to read the full article.