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Electronic cigarettes: effective, or just the new “cool” sensation?

December 1st, 2014

By Samuel Tesfaye, Pharm.D. Student.

Electronic cigarettes (e-cigarettes) are becoming increasingly popular in the U.S. despite lack of evidence regarding their safety.1 According to the National Tobacco Survey, e-cigarette use in both the youth and adult population has nearly doubled from 2011-2012.2 Many smokers of conventional cigarettes are using e-cigarettes as an aid to help them quit smoking. Unlike conventional cigarettes that release smoke, e-cigarettes are battery-powered devices that deliver nicotine through emission of a vapor.3 The vapor within the e-cigarettes is generated by heating a solution made up mostly of propylene glycol or glycerol.1

Several reasons support this increased popularity of e-cigarettes, especially among the youth. E-cigarettes can easily be carried around in the pocket and come in a variety of different flavors, which makes them appealing to the user.3 There is also a “coolness” associated with e-cigarette use likely arising from aggressive advertisement of e-cigarettes on national TV and other social media.3 The lack of the appealing qualities in other treatment methods, such as nicotine patches, offers little incentive for youths to use anything other than e-cigarettes.

Because e-cigarettes are relatively new products, research on the long-term health consequences of these products is lacking. Despite this limitation, a few of the studies conducted have indicated that substances contained in the e-cigarettes are harmful to the body. Propylene glycol, the main ingredient of e-cigarettes, is one example of these harmful substances. When propylene glycol is heated, it forms propylene oxide, which has been linked to respiratory irritation, central nervous system impairment, and even various types of cancer.1

A recent article in JAMA Pediatrics evaluated the benefit of e-cigarettes in helping smokers quit.2 The researchers employed a cross-sectional analysis from the National Youth Tobacco Survey data (NYTS). The NYTS was conducted on a representative sample of US middle and high school students from all 50 states between 2011 and 2012. The number of students surveyed were 17, 353 in 2011 and 22, 529 in 2012. Respondents were asked a series of questions about their cigarette smoking habits and which product(s) they use (conventional, e-cigarette, or both). The researchers found that e-cigarette use did not discourage the use of conventional cigarettes. This suggests that e-cigarettes are not effective in helping smokers quit. Moreover, it was also found that e-cigarettes led to instances of nicotine addiction and an increased risk of switching to conventional cigarette smoking (for those who hadn’t used traditional cigarettes prior to e-cigarettes). This study is not without limitations, however. Because the survey was entirely self-reported, the information obtained may not be valid and accurate due to the fact that those who took the survey may not have been completely truthful. For instance, they may smoke more than what they reported. Additionally, their conclusion cannot be generalized to the general public because the sample only included middle and high school students.

Contrary to the findings in this article, one study has reported that e-cigarettes are effective in helping smokers quit. Some healthcare providers are even recommending e-cigarettes to their patients. A recent study conducted in North Carolina examined physician’s attitude toward the use of e-cigarettes.4 The researchers reported that over two thirds (67.2%) of the physicians indicated that e-cigarettes are a helpful tool for patients wanting to quit smoking.4 More surprisingly, 35.2% of physicians said that they have recommended them to their patients.4 This study tells us that e-cigarettes are gaining momentum not only among the public but also among health care providers.

Smokers wishing to quit have a variety of nicotine replacement therapy products from which to choose, including inhalers, lozenges, chewing gum, and nasal spray.7 Smokers can also use prescription medications such as bupriopion and varenicline, as these medications have been proven to be safe and effective.7 Maintaining a healthy support network is also one way smokers can quit smoking. Socializing with people, exercising, going to movies, and doing outdoor activities can help people quit smoking.8 Seeking professional counselling from a primary care physician or pharmacist might also help smokers quit smoking. Pharmacists can play a pivotal role in helping people quit smoking by providing patients with the health consequences of smoking and the benefits of quitting, as well as assisting the patient is selecting an appropriate nicotine replacement product. Given the number of number of smoking cessation options that have been proven safe and effective, until further research is conducted on the long-term consequences of e-cigarettes and their safety is established, I believe patients should refrain from using these products.

Do you think e-cigarettes might be an appropriate smoking-cessation aid for you, or someone you know who is wanting to quit smoking?

References

  1. Grana, R., Benowitz, N., & Glantz, S. A. (2014). E-cigarettes: A scientific review. Circulation, 129(19) 72-86.
  2. Dutra L, Glantz S. Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study. JAMA Pediatrics [serial online]. July 2014;168(7):610-617. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 24, 2014.
  3. Trumbo C, Harper R. Use and Perception of Electronic Cigarettes Among College Students. Journal Of American College Health . April 2013;61(3):149-155. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 21, 2014.
  4. Kandra, K. L., Ranney, L. M., Lee, J. G., & Goldstein, A. O. (2014). Physicians’ attitudes and use of E-cigarettes as cessation devices, North Carolina, 2013. PloS One, 9(7).
  5. Pepper, J. K., McRee, A., & Gilkey, M. B. (2014). Healthcare providers’ beliefs and attitudes about electronic cigarettes and preventive counseling for adolescent patients. Journal of Adolescent Health, 54(6), 678-683.
  6. S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2014 October 21].
  7. Electronic cigarettes (e-cigarettes). CA: A Cancer Journal For Clinicians [serial online]. May 2014;64(3):169-170. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 2, 2014.
  8. Glynn, T., & Manley, M. W. (1992). How to help your patients stop smoking: A manual for physicians.DIANE Publishing

6 Responses to “Electronic cigarettes: effective, or just the new “cool” sensation?”

  1. Samantha A Smolinski Says:

    I think e-cigarettes are an interesting new therapy because many people feel that they are safe because it eliminates the other bad chemicals found in cigarettes. I am concerned with the fact that physicians are recommending these products to their patients. Do they not understand the harm? Do you think that educating physicians more about the product and the potential side effects would change their perspectives? I feel that this topic is important for pharmacists to understand, so that we can counsel patients properly about the risks and benefits. I am interested to see the future data that will be gathered from long term use of electronic cigarettes. Thank you Samuel for sharing this information.

  2. Kelly Wright Says:

    Great post, Samuel! Tobacco cessation is a huge interest of mine. Another thing to consider is that most e-cigs do still contain nicotine. So, regardless of whether or not they are harmful to the body, they can still cause harm via the disease of addiction. Most of the patients I see who are trying to quit are tired of being addicted to nicotine. Once they find out that e-cigs are addictive, they choose not to use them. On the other hand, I’ve had a couple patients who’ve tried everything and still can’t quit their last couple cigarettes a day, so they switch to an e-cig. I am hopeful that these patients will eventually reach their goal of being nicotine-free, but am concerned that they may be more likely to relapse to cigarettes since they are still dependent on nicotine.

  3. Brandon Kime Says:

    Very interesting topic. I have seen e-cigs before but never knew much about them, so this post was very informative for me. It is definitely a little concerning seeing so many health professionals recommending e-cigs without data showing their safety. Did you happen to see any studies comparing the safety of e-cigs and “conventional” cigarettes? I would assume that e-cigs are at least safer than those, but I would be interested in seeing data to support that. Data for other age groups would be interesting to see as well. Do most smokers begin smoking in middle-high school?

  4. Courtney Noll Says:

    This is a great article. I think it is super interesting that propylene glycol is dangerous to one’s body when it is heated in the electronic cigarette. We have been learning about propylene glycol being used as an excipient in our Pharm Sci class with the manufacturing of certain drug dosage forms, and I find it interesting that in some contexts it is dangerous and in others it is not. I’ve heard a lot of people say that you can get e-cigs without the nicotine and just smoke the flavor, is that true?

  5. Dr.Hartzler Says:

    Did you know Propylene glycol is in some ice-creams! Ekk!

  6. Scarlet Lau Says:

    I enjoyed reading this article, as I didn’t know much about e-cigarettes and the potential harm of use in patients. Before reading this, I had always assumed that e-cigs were definitely safer than conventional cigarettes. I found the article from JAMA Pediatrics interesting because not only did the study find that e-cigs caused increased nicotine addiction, but also an increased chance in switching back to conventional cigarettes. Could it be possible that some subjects are also be “dual-users” who use both e-cigs and normal cigarettes at the same time, causing even higher risk of nicotine addiction? I know that some countries, such as Singapore, ban e-cigs from being marketed. Do you think e-cigs should be banned from the US, despite some positive results from conducted studies on this topic?

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