If you ask health experts whether e-cigarettes can help you quit smoking, or if they’re a safer alternative to traditional cigarettes, the answer is one big question mark. Evidence, they say, is mixed. If you’re an adult hoping to kick the habit – not a teen trying to be trendy – here are some items to consider before going electronic.
1. Top reasons adults use e-cigarettes. “One, people think e-cigarettes will help them quit,” says Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California – San Francisco. “Two, they use them as a way to get around smoking bans. And three, they think they’ll be less dangerous.”
2. Lack of tobacco is a big plus. Nicotine is highly addictive – one reason that increased teen use of e-cigarettes is concerning. But e-cigs don’t contain tobacco or the many other carcinogens and toxins found in traditional cigarettes. Smoking is a major risk factor for lung cancer, chronic obstructive pulmonary disease, heart disease and other medical conditions.
3. E-cigarette use might make it less likely to quit. So finds a new study of 1,000 California smokers. At the study’s beginning, researchers led by Wael Al-Delaimy at the University of California – San Diego asked participants if they’d ever used e-cigarettes, and whether they intended to quit smoking. A year later, to the researchers’ surprise, the e-cigarette users were less likely than “never users” to have quit smoking or cut down on smoking cigarettes, regardless of their intention. “We hypothesize that maybe [users] are getting higher doses of nicotine, and so it becomes less likely they’re able to quit,” Al-Delaimy says.
The statewide survey, done every three years since 1990, recently added e-cigarette-related items as the trend emerged. When the new results came out, Al-Delaimy heard from vapers who say e-cigs really helped them stop smoking. “Clearly it’s working for some people – it’s helping them quit,” he says. But solid evidence is needed, he continues, not just anecdotes. “We have to give good advice to people to be aware that this may not be the magic bullet to help them quit,” he says. Additional high-quality studies will help provide answers, Al-Delaimy says.
Carla Berg, an associate professor of behavioral sciences and health education at Emory University’s Rollins School of Public Health, says “there are a lot of caveats” around the new study’s findings. For one, she says, the ever-user category is quite broad – with no breakdown of whether participants had once tried a puff of a friend’s e-cigarette, were intrigued and experimenting, or were using them specifically to quit smoking.
4. Safer for your health? Maybe. It’s hard to generalize on e-cigarettes, Berg says, when there’s no standardization, from the amount of nicotine in the liquid to the makeup of other ingredients, or how devices deliver the liquid to users. A small September 2014 study, which looked at a single brand of e-cigarettes, found that the secondhand vapor contained fewer hazardous chemicals than secondhand smoke from cigarettes.
5. Dual use – more nicotine. Given a choice, “vaping forever is probably better than smoking forever,” Glantz says, but that’s not what really happens. “What people do is dual use,” he says. That’s when people smoke tobacco some of the time, maybe at home and in their cars, while turning to e-cigarettes in public spaces.
The hazard of increased nicotine from dual use is “a huge concern,” Berg says. She’s seen people wear e-cigarettes on lanyards around their necks. “They’re carrying them around all day, in circumstances where they normally would not be able to smoke,” she says. “They’re puffing at them, and if they’re using them at the same time as their cigarettes, they’re really getting a high dose of nicotine.”
6. Consider the source. The wide assortment of vaping products can be baffling. Many users prefer refillable vaping devices that are available online or from local retailers.
Cigalikes look and feel like traditional cigarettes, with a tip that glows red from an LED light as users puff. Several popular brands come from tobacco manufacturers – such Altria, R.J. Reynolds and Imperial Tobacco – that have entered the e-cigarette arena.
Berg says tobacco companies moving into the e-cigarette market “is of concern, because they are rapidly going to leverage resources toward getting e-cigarettes as marketable and consumer-driven as possible. Having a group of addicted people really helps business.”
7. You can’t “smoke anywhere.” E-cigarettes might have once seemed like the miracle solution for smokers who couldn’t light up aboard airplanes. But e-cigarette smoking is banned on most commercial U.S. aircraft. Whether people can use e-cigarettes elsewhere depends. Legislation often comes from the state or local level, Glantz says. On Monday, the city of Portland, Maine, joined the growing list of communities prohibiting people from using e-cigarettes in public.
8. Still a lot left to learn. With little regulation and many unknowns, e-cigarettes users are in uncharted territory. Berg is now working on federal government-funded research looking at young adult users in Georgia. Interviews will seek to uncover the complex ways people use smoking products, including multiple usage of tobacco, e-cigarettes and marijuana.
9. Proven alternatives exist. People underestimate how much evidence-based, psychological resources – like counseling – can boost their confidence to stop smoking, Berg says. Getting social support and letting people know you’re trying to quit increase your odds of success. And prescription or over-the-counter medicines are effective for many smokers.
”If you’ve exhausted your options, think about the things that you would be willing to accept in terms of risk,” Berg says. “You may decide to try e-cigarettes; you may not. Just know there’s no [conclusive] research out there and [despite] what you’re hearing on the street, from your friends or even your doctors to give it a try – still be very cautious about that.”