E-cigarettes could do “more harm than good”, according to a study suggesting they may result in a transition to cigarette use among previous “never smokers”.
Researchers from the United States found that e-cigarette use substantially increased the number of adolescents and young adults who eventually became cigarette smokers, and marginally decreased the number of adult cigarette smokers who quit.
A team lead by Samir Soneji, associate professor at The Dartmouth Institute for Health Policy and Clinical Practice, used census counts, national health and tobacco use surveys, and published literature to calculate the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers. They also looked at how it affected the transition to long-term cigarette smoking among ‘never-smokers’.
Researchers found that, based on existing scientific evidence related to e-cigarettes and assumptions about the relative harm of e-cigarette use compared to cigarette smoking, e-cigarette use represents more population-level harm than benefit. They suggested that while tobacco control efforts have successfully led to a substantial reduction in youth cigarette smoking since the 1990s, e-cigarettes have the potential to slow or even reverse that trend.
“E-cigarettes could lead to more than 1.5 million years of life lost because their use could substantially increase the number of adolescents and young adults who eventually become cigarette smokers,” said Soneji.
He said although the tobacco industry markets e-cigarettes as a tool to help adult smokers quit smoking, “e-cigarette use actually only marginally increases the number of adult cigarette smokers who are able to successfully quit”.
“On the other hand, e-cigarettes may facilitate cigarette smoking initiation and confer substantial harm to adolescents and young adults once they are introduced to nicotine,” he warned.
He said e-cigarettes “will likely cause more public health harm than public health benefit, unless ways can be found to substantially decrease the number of adolescents and young adults who vape, and increase the number of smokers who use e-cigarettes to successfully quit smoking”.
Aileen Bryson, practice and policy lead for the Royal Pharmaceutical Society (RPS) said: “While we acknowledge that there is a harm reduction role for e-cigarettes in the short term, versus tobacco smoking, we have had concerns since they were first marketed about the longer-term safety and implications both for individuals and at public health level.
“There is still no licensed product available, little quality assurance and emerging evidence regarding passive ‘vaping’.
“We have not analysed this paper as yet, but have been calling for more research into the long-term effects of e-cigarettes, and are therefore pleased to see more work being done in this area.”
She said the RPS was currently updating its policy “to look closer at the toxicity of carriers and excipients used in these products as well as new trends in use”.
Darush Attar-Zadeh, respiratory lead pharmacist at Barnet Clinical Commissioning Group, said there was growing evidence of the effectiveness of e-cigarettes as a stop-smoking aid, with “similar or better results than nicotine replacement therapies, such as patches”.
“If more smokers made the switch to e-cigarettes and abstained from smoking completely, then this can only be a good thing. It’s the tar that kills, not the nicotine,” he said.
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