Lately it seems like everywhere I look, someone is vaping as they walk by, stand outside a store, or roll up in the car next to me at a stoplight. It’s not surprising: e-cigarette use, or vaping, has become remarkably popular in recent years. About 6% of adults in the US now report vaping . That’s about 15 million people, double the number from just three years ago. Of course, regular cigarettes are known to cause cancer and a host of other health problems.
While considered less harmful than smoking tobacco, vaping isn’t risk-free. We know some, but not all, of its risks. We also know vaping is increasingly popular among teens and young adults, and this makes the recent FDA announcement authorizing sales of three additional vaping products surprising.
In its announcement, the FDA authorized the R. J. Reynolds Vapor Company to market and sell its Vuse Solo device with tobacco-flavored vaping liquid to adults.
The FDA denied marketing authorization for 10 flavored products made by the same company. It also reports having denied more than a million flavored vaping products from other companies.
By the way, the agency emphasizes it is not actually approving these vaping products, or declaring them safe. The announcement states that marketing authorization will be reversed if
The decision was reportedly based on data from the company — unfortunately not provided in the press release — demonstrating these products would benefit individuals and public health. How? By helping smokers quit.
Some studies have suggested that e-cigarette use can be modestly helpful for smokers trying to quit. For example, an analysis of 61 studies found that e-cigarette use was more effective than other approaches to quitting smoking. The study authors estimated that out of every 100 people who tried to quit smoking by vaping, nine to 14 might be successful. When only using other methods, such as nicotine patches or behavioral counselling, only four to seven smokers out of 100 might quit. A separate study suggests vaping may help smokers who aren’t able to quit reduce the number of cigarettes smoked per day — at least for six months, the duration of the study.
Despite claims that vaping is less harmful than smoking cigarettes and that it might help smokers quit, concern about its risks is well deserved.
An alarming number of middle-school and high-school age kids report vaping, despite the nationwide prohibition against selling e-cigarette products to anyone under age 18 (21 in some states). Its popularity is partly related to the marketing of flavors known to appeal to minors, such as bubblegum and berry-flavored products. According to one national survey , approximately 85% of teen vaping involved non-tobacco flavored products.
It’s important to know that
For nonsmokers and teens, there is no controversy: don’t start smoking and don’t vape.
If you’re an adult smoker trying to quit, be aware that the balance of risks and benefits and the long-term health consequences of vaping are uncertain. We need more solid research to help people make decisions. Meanwhile, the FDA has come down on the side of a limited authorization to help adult smokers quit. We’ll know only in retrospect if that was the right move.
I and many people I know, kicked the habit for good by switching to vaping, and slowly reducing the nicotine levels to 0mg. It’s a solution that works because it feels similar to smoking. Just as we shouldn’t be saying vaping is without risks, we really shouldn’t be discouraging it as an alternative to smoking too harshly. Lives are at stake, and there is an active misinformation campaign (I think from the tobacco industry) which is getting people to say “vaping is just as bad”. That is a lie and it will lead to more deaths from tobacco use.
Pamela A Caldwell
April 15, 2019
I am a FORMER cigarette smoker of 30 years. A pack per day of Marlboro lights. At age 50, I finally had enough. Quitting cold turkey and stop smoking aids never worked. I quit overnight when I found the correct VAPE MOD, along with the CORRECT NICOTINE EJUICE FLAVORED. I have been cigarette free for 2.5 years!!!
Me too. I smoked a pack and a half a day of Marlboro Lights. Switched to vaping and slowly worked my way down in nicotine. Now I vape a mix of one half .03% and 0%. Almost to total 0. I haven’t had a cig in 3.5 years. It works if you are committed to quitting. Patches, gum and lozenges did nothing for me.
February 28, 2019
I note that the data concerning the relative safety of e-cig over smoking cannot be categorzed as ‘seemingly’ safer than smoking – the data is varied and robust – the health risks are on the order of 3% those of smoking. I also note that Nicotine has limited health effects, comparable to caffeine. Finally, I note that Harvard has had numerous ethical issues related to funds from drug companies (see E.G – https://www.propublica.org/article/pharma-ties-at-harvard-medical-school), and suggest that the support of Big Pharma’s expensive smoking cessation drugs (not shown to be more effective than placebo) relates more to those ethical issues than any public health concerns
John R. Polito
February 27, 2019
Dr. Shmerling, you state that “Many people try to quit cold turkey, but success rates are quite low. ” In fairness, possibly the most comprehensive population-level quitting method snapshot ever, the July 2018 Weaver (PLoS One) study, concluded the opposite. There, cold turkey more than doubled e-cigarette, gradual weaning, nicotine replacement therapy (NRT: nicotine patch, gum and lozenge), and varenicline (Chantix) and bupropion (Zyban) rates. Except for e-cigarettes and varenicline not yet being on the market, it’s a finding mirrored in the May 2006 Doran (Addictive Behaviors) study. I’d be interested in hearing your thoughts on why cold turkey or unassited quitting is prevailing in nearly all recent real-world quitting method surveys. Thanks for the blog.
John R. Polito NIcotine Cessation Educator
February 28, 2019
Hi, John – thanks for your interest and comment – I think the reason unassisted quitting prevails is selection bias: studies looking at nicotine replacement or other measures are typically starting with study participants who have already failed unassisted smoking cessation in the past. If you’ve successfully quit on your own already, you won’t enroll in a trial. The enrollment process selects for people who may be less successful at smoking cessation going forward regardless of the type of intervention.
Survey data suggest that efforts to quit “cold turkey” are often unsuccessful at achieving sustained cessation — but that’s not the same as saying it’s better or worse than nicotine replacement treatment. Most people considering nicotine replacement systems, other prescription medications or other measures have already failed at least some attempt to decrease or stop on their own. So, the comparison of interest is not unassisted cessation vs. nicotine replacement vs. vaping – the key question is: what is the next best step for those who cannot quit on their own?
I strongly support any safe method of smoking cessation that works: quitting on your own is certainly worth a try.
One comment about the study by Weaver you reference (Weaver SR et al. Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015-2016. PLoS One. 2018 Jul 9;13(7):e0198047): it used a 30-day quit rate as the primary outcome which is really not adequate.
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