Nav: Home

Do less harm: E-cigarettes a safer option than smoking

January 11, 2018

Quitting smoking is among the top New Year's resolutions, but is notoriously difficult to do and often requires multiple attempts and strategies.

A growing body of research points to using a harm minimization approach for smoking cessation. Harm minimization recognizes that while quitting smoking altogether is ideal, reducing exposure to harmful cigarette smoke by switching to safer nicotine products like e-cigarettes is beneficial.

A new article publishing in the forthcoming volume of the Annual Review of Public Health focuses on harm minimization and smoking cessation, with alternative nicotine products like e-cigarettes emerging as a promising avenue for people who want to quit smoking. Compared with vaping, smoking is much more harmful and prematurely kills over half of lifetime smokers.

"Studies show that if most current American smokers switched to vaping e-cigarettes over the next 10 years, there could be as many as 6.6 million fewer premature deaths and 86.7 million fewer life years would be lost," said David Abrams, PhD, professor of social and behavioral sciences at NYU College of Global Public Health and the article's lead author.

"The safest course is to stop smoking or, better, never to start. But a harm minimization approach recognizes that demanding absolute perfection is often counterproductive and that, when a harmful behavior cannot be eliminated, we can still dramatically reduce adverse health consequences."

Correcting Misconceptions About Nicotine

When people smoke cigarettes, they consume nicotine in a lethal mix of carbon monoxide and 70 known cancer-causing chemicals; contrary to what some may believe, however, nicotine causes little if any of the health harms of smoking. The toxic smoke inhaled is the culprit and is the overwhelming cause of tobacco-related disease and death.

Many alternative nicotine products have been developed-including e-cigarettes and nicotine gums, patches, and lozenges-that do not burn tobacco and are therefore substantially less harmful.

The authors call for the correction of mistaken beliefs that vaping is as harmful or more harmful than smoking cigarettes. Most reviews of toxicological, clinical, and epidemiological evidence show that the chemicals found in e-cigarettes are far fewer and well below levels seen in cigarette smoke. In fact, the Royal College of Physicians in the United Kingdom and other systematic reviews of all the evidence to date estimate that e-cigarettes are about 95 percent less harmful than smoking.

E-cigarettes in the "Sweet Spot"

What makes someone use-and continue to use-different nicotine products? In addition to considering the harm they can cause, the authors also consider the appeal and satisfaction of products containing nicotine.

Cigarettes are the most appealing, most addictive, and most toxic of all nicotine products, while nicotine replacement therapies like gum or patches are lowest in harm, but are expensive and less appealing to consumers.

E-cigarettes fall into a "sweet spot" of high appeal and satisfaction, but low harm, making them a promising tool for smoking cessation or switching for smokers who want to use nicotine but want to safely avoid deadly smoke. As evidence of their appeal, e-cigarettes are now used more often than nicotine replacement therapies when smokers try to quit in both the United States and the United Kingdom.

"A smoker who finds an e-cigarette that is enjoyable can switch. Successful switchers have either switched quickly or slowly after a period of both vaping and cutting back on smoking and by trying a flavor other than tobacco," Abrams said.

The Future of Harm Minimization and Smoking Cessation

The U.S. government is taking notice of the evidence on harm minimization. In July 2017, the Food and Drug Administration announced a major shift in its tobacco strategy, including recognizing the role of less harmful products, such as e-cigarettes, for smokers who want a satisfying alternative to smoking cigarettes. FDA Commissioner Scott Gottlieb said, "Nicotine, though not benign, is not directly responsible for the tobacco-caused cancer, lung disease and heart disease that kill hundreds of thousands of Americans each year."

"Alternative nicotine delivery systems, such as e-cigarettes, have the potential to disrupt the 120-year dominance of the cigarette and challenge the field on how the tobacco pandemic could be reversed if nicotine is decoupled from lethal inhaled smoke," added Abrams. "E-cigarettes could provide a means to compete with, and even replace, cigarette use, saving more lives more rapidly than previously possible."
-end-
In addition to Abrams, the article's co-authors include Raymond S. Niaura of the NYU College of Global Public Health, Allison M. Glasser and Lauren K. Collins of the Schroeder Institute for Tobacco Research and Policy Studies and Truth Initiative, Jennifer L. Pearson of the University of Nevada, and Andrea C. Villanti of the University of Vermont. The research was supported by Truth Initiative.

About the NYU College of Global Public Health:

At the College of Global Public Health (CGPH) at New York University (NYU), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, inter-disciplinary model, CGPH aims to improve health worldwide through a unique blend of global public health studies, research and practice. CGPH is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. http://publichealth.nyu.edu/.

About the Annual Review of Public Health:

The Annual Review of Public Health, in publication since 1980, covers significant developments in the field of public health, including key developments and issues in epidemiology and biostatistics, environmental and occupational health, social environment and behavior, health services, and public health practice and policy. For further information contact: jrankin@annualreviews.org

New York University

Related Smoking Articles:

A case where smoking helped
A mutation in the hemoglobin of a young woman in Germany was found to cause her mild anemia.
No safe level of smoking
People who consistently smoked an average of less than one cigarette per day over their lifetime had a 64 percent higher risk of earlier death than people who never smoked.
Nearly half of women who stop smoking during pregnancy go back to smoking soon after baby is born
A major new review published today by the scientific journal Addiction reveals that in studies testing the effectiveness of stop-smoking support for pregnant women, nearly half (43 percent) of the women who managed to stay off cigarettes during the pregnancy went back to smoking within six months of the birth.
If you want to quit smoking, do it now
Smokers who try to cut down the amount they smoke before stopping are less likely to quit than those who choose to quit all in one go, Oxford University researchers have found.
Cochrane news: Have national smoking bans worked in reducing harms in passive smoking?
The most robust evidence yet, published today in the Cochrane Library, suggests that national smoking legislation does reduce the harms of passive smoking, and particularly risks from heart disease.
Advocating for raising the smoking age to 21
Henry Ford Hospital pulmonologist Daniel Ouellette, M.D., who during his 31-year career in medicine has seen the harmful effects of smoking on his patients, advocates for raising the smoking age to 21.
Stress main cause of smoking after childbirth
Mothers who quit smoking in pregnancy are more likely to light up again after their baby is born if they feel stressed.
As smoking declines, more are likely to quit
Smokeless tobacco and, more recently, e-cigarettes have been promoted as a harm reduction strategy for smokers who are 'unable or unwilling to quit.' The strategy, embraced by both industry and some public health advocates, is based on the assumption that as smoking declines overall, only those who cannot quit will remain.
Smoking around your toddler could be just as bad as smoking while pregnant
Children whose parents smoked when they were toddlers are likely to have a wider waist and a higher BMI by time they reach ten years of age, reveal researchers at the University of Montreal and its affiliated CHU Sainte Justine Research Centre.
Smoking and angioplasty: Not a good combination
Quitting smoking when you have angioplasty is associated with better quality of life and less chest pain.

Related Smoking Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Jumpstarting Creativity
Our greatest breakthroughs and triumphs have one thing in common: creativity. But how do you ignite it? And how do you rekindle it? This hour, TED speakers explore ideas on jumpstarting creativity. Guests include economist Tim Harford, producer Helen Marriage, artificial intelligence researcher Steve Engels, and behavioral scientist Marily Oppezzo.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".