Electronic cigarettes will very soon be banned from public indoor spaces in New York State, making it the 11th state in line with World Health Organization guidance, which called for bans on indoor vaping in 2014. This comes after a bill signed on Monday by Gov. Andrew M. Cuomo who stated that “These products are marketed as a healthier alternative to cigarettes but the reality is they also carry long-term risks to the health of users and those around them.”
E-cigarettes, electronic devices which mimic smoking tobacco, contain a nicotine-based liquid that is vaporized and inhaled. Since first coming to the US market in 2006, they have grown significantly in popularity among adolescents and never smokers.
Although the health consequences of this product are not well understood, the CDC says there are still reasons for concern, with nicotine addiction being one of them. The New York State ban brings to the forefront a major public health divide between researchers in the US and UK; while US research into the smoking substitutes has focused on the potential for children to get hooked on fruity vaping flavors, the potential that children could move on to cigarettes and the detrimental effects on the cardiovascular system, public health messages in England have focused on the potential for e-cigarettes and vaping products to be used to help people quit smoking regular cigarettes. However, amid rapid adoption of the devices in the UK, it has also just been announced that a parliamentary panel will hold an inquiry to establish the health and economic impact of e-cigarettes which about 3 million people in the country use. The inquiry will also set out to examine whether e-cigarettes are effective at promoting quitting regular smoking or whether they instead play a role in normalizing smoking.
Smokers vs Non-smokers
Research recently published in BMC Public Health investigated behaviors, perceptions, and motivations underlying the use of e-cigarettes in three Baltimore vape shops. The survey respondents were predominantly young, Caucasian males (which is the most common demographic among current e-cigarette users) and authors found that current smokers were more recent initiators of e-cigarette use compared to former smokers. They also found that the motivations for e-cigarette use did not significantly differ between former and current smokers. The most frequently cited primary motivation for initiation of e-cigarette use among both former and current smokers was to quit smoking tobacco, followed by the belief that they were healthier than tobacco cigarettes. The prevalence of never smokers identified in the study is consistent with several studies from the US suggesting that an increasing number of electronic cigarette users are never-smokers.
In 2015, BMC Public Health published an article which showed that one in five teenagers in a large survey in the north west of England has accessed e-cigarettes, and of these, 16% have never otherwise smoked. The highest number of e-cigarette users though, were teenage smokers – of whom 75% admitted using them. In this study, researchers from Liverpool John Moores University surveyed 16,193 secondary school students in the region aged from 14 to 17 years. The team also found that there was an association between alcohol and e-cigarette access. Students who drank alcohol were significantly more likely to have accessed e-cigarettes than non-drinkers. It was found that those who regularly drank alcohol but didn’t smoke were four times more likely to access e-cigarettes than those who didn’t drink. The findings suggest that teenagers who access e-cigarettes are those that are most susceptible to other forms of substance use and risk-taking behaviors.
In the first longitudinal study to use a nationally representative sample of U.S. smokers to provide evidence regarding the impact of e-cigarettes on smoking behavior at the U.S. population level, Karen Messer et.al. tested whether ever-use of e-cigarettes among early adopters was associated with: 1) increased cigarette smoking cessation; and 2) reduced cigarette consumption. They found that, among early adopters, ever-use of first generation e-cigarettes to aid quitting cigarette smoking was not associated with improved cessation or with reduced consumption, even among heavier smokers. The study advised that it was premature to conclude that e-cigarettes will be helpful to smokers who make a quit attempt; that it also seemed premature to conclude that e-cigarettes will be an effective way for smokers, especially heavy smokers, to reduce the number of cigarettes that they smoke each day.
E-cigarette companies are aggressively marketing their products in a manner akin to how tobacco was marketed in the 50s and 60s. Flavored e-liquids in particular are seen as a means to enticing young people to smoke who are also increasingly being exposed to e-cigarette adverts through TV, billboards, print media and the internet.
Research published in 2014 indicated that the vast majority of information on YouTube about e-cigarettes promoted their use and depicted their use as socially acceptable. The researchers found that one of the most prevalent topics in the “pro” e-cigarette videos was a claim that e-cigarettes are safer and healthier alternatives to conventional cigarettes through delivering the experience of smoking while eliminating health risks associated with tobacco smoke. They also promoted that e-cigarettes could help smokers quit smoking.
With the rapid increase in the retail availability of e-cigarettes in the UK and elsewhere and the increasing concern about the rising prevalence of e-cigarette use among children and young people in particular, it is important to understand what factors predispose adolescents to initiate e-cigarette use.
A Scottish study in BMC Public Health examined the relationship between the recall of e-cigarette point-of-sale displays and children’s use and future intention to use e-cigarettes. Researchers found that adolescents who recalled seeing e-cigarettes in small shops were more likely to have tried an e-cigarette and adolescents who recalled seeing e-cigarettes for sale in small shops or supermarkets were more likely to intend to try them in the next 6 months. Further longitudinal data is required to confirm a causal relationship between e-cigarette point of sale exposure and their use and future use by young people.
The impact e-cigarettes have on health remains uncertain. The US National Institute on Drug Abuse has warned that these could contain potentially toxic metal nanoparticles and research has also found that the vapor from some e-cigarette products contains known carcinogens and toxic chemicals. More research is needed on the health consequences of repeated exposure to these chemicals.