Are e-cigarettes (vapes) actually useful for quitting smoking cigarettes? The jury appears out on this controversial question, with some schools of thought punting the benefits of the smoking replacement, saying vapes are less dangerous and do the job, while others posit that e-cigarettes produce vapour containing harmful toxins and could be a springboard for cigarette smoking among the youth.
For adults wanting to quit smoking cigarettes, e-cigarettes have become a common option. They work by heating a liquid that usually contains nicotine into an aerosol that is then inhaled.
They can still feed a nicotine addiction, but they do so without burning tobacco, which produces smoke that can damage the lungs and potentially lead to lung cancer, emphysema and other lung issues, according to the National Cancer Institute.
“Nicotine is harmful in that it perpetuates addiction to smoking,” said Jamie Hartmann-Boyce, an associate professor of evidence-based policy and practice at the University of Oxford and a member of the Cochrane Tobacco Addiction Group.
But, she added, nicotine itself is not what causes the kind of lung damage that can lead to cancer and other issues.
How safe are e-cigarettes?
That doesn’t mean e-cigarettes are entirely safe, reports The New York Times. Nicotine is highly addictive, and it can harm brain development in adolescents and young adults. It’s also toxic to developing foetuses, and is not safe for those who are pregnant. E-cigarette vapour can contain other potentially harmful substances, including flavourings, cancer-causing chemicals like acetaldehyde or formaldehyde, ultrafine particles that can be inhaled deep into the lungs, and heavy metals such as nickel, tin and lead.
Some research also suggests that e-cigarettes can be an on-ramp for cigarette smoking for young adults. In a study released in early October, federal health officials reported that 2.55m US middle and high school students said they were current users of e-cigarettes in 2022, meaning they had reported e-cigarette use at least once in the past 30 days.
That figure included about 14% of high school students and about 3% of middle school students. In one review of studies published in JAMA Paediatrics in 2017, researchers concluded that adolescents and young adults who used e-cigarettes were 3.6 times as likely to smoke cigarettes later in life when compared with those who did not use e-cigarettes.
In September, Juul Labs tentatively agreed to pay a $438.5m settlement over claims the company marketed its products to teens.
Can e-cigarettes help curb smoking?
For adult cigarette smokers, though, some evidence suggests that e-cigarettes may hold promise in helping people quit. In a 2021 Cochrane review, researchers looked at 61 studies that included 16 759 adults who smoked cigarettes.
They found that those who used nicotine e-cigarettes were more likely to stop smoking conventional cigarettes for at least six months than those who used other kinds of nicotine replacement therapies, like patches or gums, or nicotine-free e-cigarettes.
Aside from delivering nicotine, experts say, e-cigarettes may also be effective at helping people quit because they mimic the action and behaviours of smoking. “It would be stunning if e-cigarettes did not help people to quit smoking,” said Jonathan Foulds, a professor of public health sciences and psychiatry at the Penn State University College of Medicine who studies how smokers overcome their tobacco addictions.
Even occasional e-cigarette use can offer benefits. In a study published in 2021, Foulds and his colleagues found that smokers who replaced some of their cigarette smoking with high-nicotine e-cigarettes reduced their smoking by about half within 24 weeks, and reduced their exposures to harmful toxins associated with tobacco smoke.
While these reviews are promising, Hartmann-Boyce said that e-cigarettes were still a new and rapidly evolving technology, so it’s challenging to know what nicotine levels in e-cigarettes are best when it comes to helping people quit smoking cigarettes.
For adults looking to reduce or stop cigarette smoking, the available evidence suggests that e-cigarettes can be a viable option, Hartmann-Boyce said. They won’t work for everyone, she said, but “we need a tool kit of things people can try”.
Foulds said that because the US Food and Drug Administration (FDA) regulated e-cigarettes as tobacco products instead of as smoking cessation aids, there was little research on exactly how e-cigarettes could be used by people who want to stop smoking cigarettes. Instead, he recommended that people who want to quit try consulting certain online resources, like those from Britain’s National Health Service, or forums, like the E- Cigarette Forum, where e-cigarette users share what worked for them.
See more from MedicalBrief archives:
US medical association urges total ban on non-approved vaping devices
UK punts e-cigs in ambitious smoke-free plan, but US more cautious
Ban on flavoured vaping may have led teens to cigarettes — Yale study
WHO versus Public Health England over e-cigarettes
Juul to fork out millions of dollars after e-cigarette marketing probe
The health pros and cons of e-cigarettes – Evidence ambivalence