Making news recently are encouraging headlines that the United State’s smoking rate has reached historic lows. The Centers for Disease Control and Prevention reported that the percentage of smokers over the age of 18 dropped from 20.9 percent in 2005 to 17.8 percent in 2013. Public health advocates herald these successes, but they also understand that more work needs to be done to decrease high smoking rates among low-income individuals and minorities.
In recent times, electronic cigarettes, or e-cigarettes as they are commonly called, have risen onto the scene. These tobacco-less products still contain addictive nicotine, but instead of producing smoke, they emit an aerosol when the heating element atomizes a liquid solution known as e-liquid. E-liquids usually contain a mixture of propylene glycol, glycerin, nicotine and other various flavorings.
Proponents of e-cigarettes contend that they are safer than traditional cigarettes and help smokers to quit. Public health advocates urge caution regarding e-cigarettes until more data is gathered. They worry that the general public will perceive these tobacco alternatives as risk-free and may prove to be enticing to younger populations.
As medical students, we will encounter scenarios in which patients are seeking advice on the benefits of switching to e-cigarettes, or we may have patients, who were previously non-smokers, start “vaping.” To effectively counsel our patients and advocate for their health and well-being, we must stay current with the evolving research on e-cigarette use.
First, let us examine the current data that supports the notion that e-cigarettes may promote tobacco smoking cessation. Recent research done by UK and New Zealand researchers and also reviewed by the Cochrane Collaboration looked at the effects of e-cigarettes on both cessation rates and the number of people reducing cigarette use by at least 50 percent. The research found that 9 percent of e-cigarette users were able to quit as opposed to 4 percent who used a placebo. Similarly, 36 percent of participants who used e-cigarettes were able to curb cigarette use in half while only 28 percent of placebo users were able to do this. Though these results show promise that e-cigarettes may have some efficacy to combat the complex problem of addiction, researchers stress that further studies need to be conducted.
A contentious area of debate revolves around proponents’ assertions that e-cigarettes are a safe alternative to traditional tobacco cigarettes. While e-cigarettes may contain fewer harmful chemicals than their traditional counterparts, emerging research is showing that these sleek new products can still cause harm. A recent review in the journal Circulation found that e-cigarettes deliver high levels of nanoparticles, which can trigger inflammation and also have been linked to asthma, stroke, heart disease and diabetes. Furthermore, research has shown that heating of solvents found in e-liquid can produce formaldehyde levels similar to those found in tobacco smoke. E-cigarettes clearly pose some level of risk to its users and possibly to non-users through secondhand vapor, but it will be some time before studies can elucidate the long-term risks involved.
Public health advocates’ biggest fears regarding e-cigarettes is that they will be an attractive, new option for children and teenagers. They worry that e-cigarette use among this population will be a gateway to traditional tobacco cigarettes. Current research suggests that their fears are warranted. A study from the 2011-2013 National Youth Tobacco Survey demonstrated that the number of teenagers in middle and high school who tried e-cigarettes, despite never using traditional cigarettes, increased from 79,000 in 2011 to 263,000 in 2013. Of graver concern is that nearly half of those kids surveyed say they plan to smoke regular cigarettes within a year. Due to this finding, many are urging the Food and Drug Administration to introduce stringent guidelines to regulate the e-cigarette industry.
As medical students and future doctors, it is vitally important to stay current with the latest research and recommendations. Our scientific knowledge base continues to grow exponentially and whether it is e-cigarettes or the latest diet trend, our patients will turn to us as a trusted source of advice and counsel. Though e-cigarettes might be an effective smoking cessation tool for some patients, they are not a harmless alternative. Knowing this information will allow us to effectively partner with our patients to help them make healthy lifestyle decisions.