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E-cigarettes: Helping smokers quit, or fueling a new addiction?

(CNN) It’s a portable piece of technology providing seemingly bottomless access to a drug craved by more than 1 billion people worldwide — nicotine. That craving is caused by smoking tobacco but is now being increasingly satisfied by e-cigarettes and the trend to “vape” instead of smoke.

The selling point is the clean image e-cigarettes purvey by removing the simultaneous exposure to the tar and thousands of chemicals found in the tobacco smoke of regular cigarettes — removing the cause of lung diseases as well as other tobacco-related conditions. Tobacco kills almost 6 million people each year, according to the World Health Organization (WHO), and a growing number of people are now “vaping” instead of smoking, resulting in industry worth $2.7 billion worldwide. Since their introduction in 2006, e-cigarettes have become commonplace among smokers trying to kick their habit, with a third of smokers trying to quit in the United Kingdom turning to e-cigarettes to aid them, according to one study. But some critics argue these electronic nicotine delivery systems (ENDS) are fueling a new addiction to nicotine — particularly among young people experimenting with them.

Allure for adolescents

“While ENDS may have the potential to benefit established adult smokers … [they] should not be used by youth and adult non-tobacco users because of the harmful effects of nicotine and other risk exposures,” says Tim McAfee, director the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention. “Exposure to nicotine can harm adolescent brain development.” Studies conducted by the CDC through its Adult and Youth National Tobacco Surveys found increased experimentation by youth trying out e-cigarettes but not conventional cigarettes. The gadgetry and flavors associated with the devices is suggested as a reason behind this, with fears of them acting as a gateway into real tobacco smoking. But others in the field of tobacco control disagree, stating that whilst people — including youth — may have tried e-cigarettes, the evidence is lacking for their regular use. “Kids like new technology and just experiment or use it once or twice,” says Jean-Francois Etter, professor of Public Health at the University of Geneva. Etter has been researching the use of e-cigarettes since 2009 and believes they are much safer than conventional cigarettes. “The most dangerous way of consuming nicotine is to smoke it,” he says. Etter argued this point last week at the World Conference of Tobacco or Healthin Abu Dhabi. Whilst Etter says that use among young people should be monitored, he believes the role of e-cigarettes in reducing global tobacco consumption is more important. “They are a gateway out of smoking,” says Etter. The number of people using a combination of tobacco and e-cigarettes is on the rise, according to Etter, resulting in smokers switching and consuming less tobacco each day. “[They have] the same level of nicotine but people are less exposed to toxins … nicotine is not a health problem,” he says. However, further evidence on the long-term health effects of e-cigarettes or nicotine is needed.

Satisfying the craving

Nicotine is the main substance keeping people addicted to smoking tobacco and consequently exposing them to the tar and toxins found in cigarettes. Whilst many people try to kick the habit cold turkey, nicotine replacement through gums and patches has long been advocated as a helping hand. “Nicotine withdrawal is a very unpleasant process,” says Linda Bauld, professor of Health Policy at the University of Stirling, whose recent report for Public Health England identified an extensive and growing market for e-cigarettes worldwide. “The vast number of people using e-cigarettes are using them to stop smoking; [they’re] about 60% more effective than going cold turkey or buying nicotine replacement therapy over the counter.” Bauld’s research hasn’t identified a dependence on nicotine with e-cigarettes in the same way as the addiction resulting from regular cigarettes. “E-cigarettes are not the best nicotine delivery devices,” she says referring to the fact nicotine is not seen to enter the bloodstream as readily when using e-cigarettes. That’s backed up by Etter’s research as well as a recent study by researchers at Penn State College of Medicine, in which e-cigarettes were found to be less addictive than tobacco cigarettes.

Benan Barwick/CNN

They do, however, provide nicotine more effectively than aids such as patches or gums, according to Bauld. “Patches and gums are a very small market,” says Etter about the quitting devices which first came onto the market 40 years ago. He fears too much restriction on e-cigarettes will limit their impact in achieving a world free of tobacco. Both Bauld and Etter recognize the need to monitor the consumption of nicotine among teenagers but feel the value of e-cigarettes among adult smokers and their potential to save lives by reducing tobacco consumption should not be underestimated — a sentiment recognized by the World Health Organization. “[E-cigarettes] could be a way to help people quit but we need more evidence and regulation,” says Armand Peruga, program manager for the WHO’s Tobacco Free Initiative, which has celebrated 10 years of its Framework for Tobacco Control whilst at the conference in Abu Dhabi.

Legislate and regulate

The greatest impact to date in reducing the number of smokers worldwide has been the taxation and legislation restricting tobacco advertising and increasing prices. “For every 10% increase in tax you have 4% reduction in tobacco consumption,” says Peruga. The growing fear is the increasing domination of big tobacco in the e-cigarette market, which was once seen as a competitor. Their ownerships of popular e-cigarette brands could push out smaller companies in the field, reminiscent of the original tobacco epidemic. “The intent of big tobacco is to sell their product,” concludes Peruga. “[They may] expand their market to other customers who didn’t use cigarettes but might consider nicotine use.” But as it seems e-cigarettes are here to stay, most calls are for informed regulation rather than prohibition. “The majority of e-cigarettes — especially when they are well regulated — are likely to be less toxic than cigarettes — and that for smokers is an advantage,” says Peruga. – Charts: Prevalence of e-cigarettes in youth: Variations in nicotine levels:


4 Star


E-cigarettes: Helping smokers quit, or fueling a new addiction?

Our Review Summary

This story summarizes arguments on the benefits and harms of e-cigarettes, also called “electronic nicotine delivery systems” or ENDS, as gleaned from a recent conference in Abu Dhabi. While it effectively communicates the opinions of a number of experts on these issues, the story is light on actual data and fails to reference or convey the findings of the many recent studies that address the questions raised in the story.


Why This Matters

The growing popularity of e-cigarettes presents society with opportunities as well as risks. First, relying on ENDS instead of traditional cigarettes may well be the lesser of two evils (as suggested by this report from the UK government) for those who would otherwise continue to smoke tobacco (although the U.S. Department of Health and Human Services emphasizes that ENDS are not regulated and may not be safe). ENDS may also be a more effective alternative to established smoking cessation interventions that rely on nicotine gum, patches, or other medications. Another issue raised by the story is whether e-cigarettes pose a risk to teen users who wouldn’t otherwise take up tobacco products. This is important, since tobacco companies (who have bought several leading brands of ENDS) are promoting these new nicotine systems with flavors and other enticements attractive to youth. The bottom line is that there are a lot of questions here that demand solid, evidence-based reporting to help readers make sense of what we know and what we don’t.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

We are disappointed that the story did not give any direct costs for tobacco cigarettes, e-cigarettes, or smoking cessation aids such as nicotine gums and patches.

The story does bring cost into the discussion when it quotes a researcher noting that increasing tobacco prices has an effect on consumption. “For every 10% increase in tax you have 4% reduction in tobacco consumption.”

But it would have been easy to attach some real numbers to the claim: A pack per day smoker of tobacco spends roughly $2,500 per year, according to a reference we found at NerdWallet

Consumption of a similar number of e-cigarettes from a rechargeable device would cost about $600, the same story said.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story suggests that e-cigarettes could be a better alternative to combustible tobacco. It walks us through many different points of view on the topic, but its quantification of potential benefits isn’t satisfactory. The story notes, for example, that a third of smokers trying to quit turn to e-cigarettes, and that ENDS are “about 60% more effective than going cold turkey or buying nicotine replacement therapy over the counter.” But since the success rates for the other approaches are never stated, it’s impossible to tell just how big that 60% improvement is. Providing the actual success rates of those who quit with ENDS compared with other approaches would’ve given readers the best perspective on the size of this potential benefit.

Does the story adequately explain/quantify the harms of the intervention?


On the harms possible from e-cigarettes, the story was not as thorough as it could have been. For example, there is a growing scientific literature on known harmful molecules in the vapor. Nickel, for instance, is in some ENDS vapor and is known to be harmful in other inhaled scenarios. Concerns have also been raised about the quality of different brands of cartridges and the batteries used in some devices, which have in rare cases been reported to catch fire.

But we acknowledge that the story took the time to quote different experts by name and let them make their harms arguments, so we’ll award a satisfactory rating. Jean-Francois Etter, professor of Public Health at the University of Geneva, urged people to see the benefit of e-cigarettes in cutting smoking as outweighing their harms. Another expert argues that while they may benefit adults who are trying to quit traditional smoking, “[they] should not be used by youth and adult non-tobacco users because of the harmful effects of nicotine and other risk exposures. ” He adds that “Exposure to nicotine can harm adolescent brain development.”

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

This story links to a couple of studies and quotes some expert sources at length, but it doesn’t give readers any real insight as to the evidence underlying the issues being discussed.  The briefest of searches yielded a number of studies, including randomized controlled trials and longitudinal studies, as to the effect of e-cigarette use on improving smoking cessation rates — one of the major benefits suggested by the story. Delving into that research would have strengthened the story considerably.

Does the story commit disease-mongering?


There was no disease mongering.

Does the story use independent sources and identify conflicts of interest?


The story showed good initiative in chasing down and quoting a variety of experts.

Does the story compare the new approach with existing alternatives?


The story did not describe the efficacy of alternative smoking cessation methods (e.g. nicotine gum and patches), but it did at least mention some.

Does the story establish the availability of the treatment/test/product/procedure?


All of the products discussed are readily available.

Does the story establish the true novelty of the approach?


The story notes that e-cigarettes have been around since 2006, and that there is growing debate as to the balance of benefits and harms surrounding their use.

Does the story appear to rely solely or largely on a news release?


There is enough original reporting here that we can be sure the story does not rely on a press release.


Total Score: 7 of 10 Satisfactory

Comments (2)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Muriël Schipper

March 26, 2015 at 7:27 am

Maybe you guys should also take a look at… “Evidence” on ecigs health scare campaign by the state of California. I’d love to see what you think of that!