Abstract
One person dies every six seconds from a smoking-related disease and this problem is likely to worsen. While many people try to quit smoking on their own or with using medicinal products, many of them fail. There is an ongoing debate within the public health community about e-cigarettes on whether they have a potential role in smoking cessation, whether their use can reduce harm for individual users, whether the widespread use of these devices has the potential to reduce or increase population-level harm, and how best to regulate e-cigarette use to minimize both individual and population-level harm. Although the long-term effects of e-cigarette use among smokers and non-smokers are not known, nicotine aerosol produced from a solution, rather than from burning tobacco, releases fewer harmful substances than cigarette smoke does. Some experts advocate wider availability and softer regulations regarding e-cigarette use and perceive them as having the potential to help smokers quit or switch to a harm-reducing means of consuming nicotine. Based on scientific evidence on e-cigarettes, this article explores its pros and cons to public health in order to guide practice, policy, and regulation through reviews of debate articles. ‘Quit or die’ is no longer the only option for those who cannot quit. Safer nicotine products offer another way. There is substantial international and independent evidence that these products are safer than cigarettes.
References
1. Chapman S. Should electronic cigarettes be as freely available as tobacco cigarettes? No. BMJ. 2013; 346:f3840.
2. Etter JF. Should electronic cigarettes be as freely available as tobacco? Yes. BMJ. 2013; 346:f3845.
3. E-Cigarette Politics. E-cigarettes laws worldwide [Internet]. [place unknown]: E-Cigarette Politics;2014. cited 2020 Jan 28. Available from: http://www.ecigarette-politics.com/electronic-cigarettes-global-legal-status.html.
4. McNeill A, Brose LS, Calder R, Hitchman SC, Hajek P, McRobbie H. E-cigarettes: an evidence update. London: Public Health England;2015.
5. World Health Organization. Heated tobacco products (HTPs) information sheet [Internet]. Geneva: World Health Organization;2018. cited 2020 Jan 28. Available from: http://www.who.int/tobacco/publications/prod_regulation/heated-tobacco-products/en/.
6. Lee C, Kim S, Cheong YS. Issues of new types of tobacco (e-cigarette and heat-not-burn tobacco): from the perspective of ‘tobacco harm reduction’. J Korean Med Assoc. 2018; 61:181–190.
7. Cook C, Kanaef N. The global state of harm reduction 2008. London: International Harm Reduction Association;2018.
8. Cheong YS, Moon OR, Kim GH. E-cigarette: crisis or opportunity? Yongin: NOSVOS Publishing Co;2019.
10. Harm Reduction International. About HRI: history [Internet]. London: Harm Reduction International;2019. cited 2020 Jan 28. Available from: https://www.hri.global/about.
11. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016; 3:CD008286.
12. Nutt DJ, Phillips LD, Balfour D, Curran HV, Dockrell M, Foulds J, Fagerstrom K, Letlape K, Milton A, Polosa R, Ramsey J, Sweanor D. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res. 2014; 20:218–225.
13. Cheong YS. E-cigarette, changing paradigm: ‘Trojan Horse’ or ‘Harm Reduction’. J Korean Soc Res Nicotine Tob. 2018; 9:61–70.
14. Hajek P, Etter JF, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. 2014; 109:1801–1810.
15. National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. Washington, DC: National Academies Press;2018.
16. Lubin JH, Caporaso NE. Cigarette smoking and lung cancer: modeling total exposure and intensity. Cancer Epidemiol Biomarkers Prev. 2006; 15:517–523.
17. US Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta: US Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion;2004.
18. Centers for Disease Control and Prevention. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products [Internet]. Atlanta: Centers for Disease Control and Prevention;2019. cited 2019 Dec 20. Available from: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#latest-outbreak.
19. McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014; (12):CD010216.
20. Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013; 382:1629–1637.
21. Giovenco DP, Delnevo CD. Prevalence of population smoking cessation by electronic cigarette use status in a national sample of recent smokers. Addict Behav. 2018; 76:129–134.
22. Levy DT, Yuan Z, Luo Y, Abrams DB. The relationship of e-cigarette use to cigarette quit attempts and cessation: insights from a large, nationally representative U.S. survey. Nicotine Tob Res. 2018; 20:931–939.
23. Park SH, Duncan DT, Shahawy OE, Lee L, Shearston JA, Tamura K, Sherman SE, Weitzman M. Characteristics of adults who switched from cigarette smoking to e-cigarettes. Am J Prev Med. 2017; 53:652–660.
24. Zhu SH, Zhuang YL, Wong S, Cummins SE, Tedeschi GJ. E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys. BMJ. 2017; 358:j3262.
25. Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, Li J, Parrott S, Sasieni P, Dawkins L, Ross L, Goniewicz M, Wu Q, McRobbie HJ. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019; 380:629–637.
26. Brown J, Beard E, Kotz D, Michie S, West R. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. 2014; 109:1531–1540.
27. Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of electronic nicotine delivery systems: a systematic review. Am J Prev Med. 2017; 52:e33–e66.
28. Villanti AC, Johnson AL, Ambrose BK, Cummings KM, Stanton CA, Rose SW, Feirman SP, Tworek C, Glasser AM, Pearson JL, Cohn AM, Conway KP, Niaura RS, Bansal-Travers M, Hyland A. Flavored tobacco product use in youth and adults: findings from the first wave of the PATH Study (2013–2014). Am J Prev Med. 2017; 53:139–151.
29. Biener L, Hargraves JL. A longitudinal study of electronic cigarette use among a population-based sample of adult smokers: association with smoking cessation and motivation to quit. Nicotine Tob Res. 2015; 17:127–133.
30. Farsalinos KE, Poulas K, Voudris V, Le Houezec J. Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries. Addiction. 2016; 111:2032–2040.
31. Levy DT, Borland R, Lindblom EN, Goniewicz ML, Meza R, Holford TR, Yuan Z, Luo Y, O'Connor RJ, Niaura R, Abrams DB. Potential deaths averted in USA by replacing cigarettes with e-cigarettes. Tob Control. 2018; 27:18–25.
32. Gentzke AS, Creamer M, Cullen KA, Ambrose BK, Willis G, Jamal A, King BA. Vital signs: tobacco product use among middle and high school students - United States, 2011-2018. MMWR Morb Mortal Wkly Rep. 2019; 68:157–164.
33. Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the field: use of electronic cigarettes and any tobacco product among middle and high school students - United States, 2011-2018. MMWR Morb Mortal Wkly Rep. 2018; 67:1276–1277.
34. Jarvis MJ, West RJ, Brown J. Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey reveal about high school e-cigarette use in the USA?. Qeios 745076.3 [Preprint]. 2019. cited 2020 Jan 28. Available from: https://www.qeios.com/read/article/391.
35. McNeill A, Brose LS, Calder R, Bauld L, Robson D. Vaping in England: an evidence update February 2019. A report commissioned by Public Health England. London: Public Health England;2019.
36. Friedman AS. How does electronic cigarette access affect adolescent smoking? J Health Econ. 2015; 44:300–308.
37. Pesko MF, Currie JM. The effect of e-cigarette minimum legal sale age laws on traditional cigarette use and birth outcomes among pregnant teenagers. Cambridge: National Bureau of Economic Research;2016.
38. McAuley TR, Hopke PK, Zhao J, Babaian S. Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhal Toxicol. 2012; 24:850–857.
39. Schripp T, Markewitz D, Uhde E, Salthammer T. Does e-cigarette consumption cause passive vaping? Indoor Air. 2013; 23:25–31.
40. House of Commons Science and Technology Committee. E-cigarettes: seventh report of session 2017–19. London: House of Commons;2018.
41. Moon OR, Kim KH. Tobacco harm reduction: its health policy implication. Korean Public Health Res. 2015; 41:1–21.