Annoying mall
vendors have been pushing what may be one of public health's greatest
accomplishments -- and few have taken notice. Behind pillow pet stations and
the candle stand, mall shoppers can find electronic cigarettes, or
"vapes." Often targeted at smokers wanting to quit, e-cigarettes offer many of the joys of smoking without one of its major components: smoke.
Smokeless
cigarettes have become a hot product, with an estimated $1.7 billion in sales
this year. According to a recent article
in the Journal of the American Medical Association, over 10% of smokers have
tried e-cigarettes, and almost 5% have used them in the past month. Often
marketed as smoking-cessation products, a small Italian study suggested that
smokers do smoke fewer real cigarettes when given e-cigarettes. A 2011 study in Addiction found that 77% of
users used e-cigarettes for the purpose of smoking cessation and that 79% of
users were afraid of relapse if they stopped using the e-cigarette. Their
efficacy as a smoking cessation tool is still in question.
But for
e-cigarettes to be a successful public health intervention, they do no not need
to help smokers quit.
E-cigarettes need
not be just a smoking cessation tool. Instead, their potential comes as a
smoking maintenance tool that could greatly reduce individual and
public health risks. Unlike other nicotine replacement therapies such as the
patch or gum, e-cigarettes deliver the full smoking experience: as users put
cigarettes to their lips, see a light when they inhale, and even receive a
smoke-like “throat hit.”
Studies have not
yet shown that e-cigarettes are healthier than tobacco cigarettes, since
longitudinal studies of this kind are years down the line. But e-cigarettes
lack the major carcinogens in tobacco cigarettes, which come not from nicotine
but from other toxins. Most e-cigarettes use liquid cartridges with very few
ingredients: water, nicotine, flavoring, and propylene glycol. Should these
cartridges be shown to have toxic effects, they are likely to be orders of
magnitude less severe than those of traditional tobacco cigarettes.
E-cigarettes also
offer socioeconomic benefits. They can be much cheaper than traditional
cigarettes: a “5 pack” of e-cigarette cartridges costs $10 compared to the $36
for 5 packs of tobacco cigarettes. As tobacco smoking is more common among
disadvantaged groups with lower income and wealth, decreasing the cost of the
habit could help less wealthy individuals and families.
Greater still are
the societal implications of e-cigarettes. Widespread adoption of
e-cigarettes—even without a decrease in nicotine intake—would create more
smoke-free spaces and communities, reducing the negative health consequences of
second-hand smoke. “Third-hand smoke,” a newly coined term for carcinogen
deposits on clothes and furniture, which has been reported to be even more
dangerous than second-hand smoke, could disappear before most people hear of
it.
There are still
good arguments against e-cigarettes: “secondhand vapor” of propylene glycol
might still irritate others, short-term use of e-cigarettes can increase airway
resistance, nicotine increases blood pressure, and e-cigarettes may introduce
some non-smokers to an addictive behavior they would have otherwise avoided,
especially teens.
E-cigarettes
could soon become harder to acquire or more expensive, as FDA regulations this
fall may ban Internet sales or otherwise restrict their sale and marketing. But
even when accepting the potential individual health risks, electronic
cigarettes have the potential to greatly reduce one of the world’s greatest
public health risks.
E-cigarettes will
be a major research topic in the years ahead. But instead of seeing them as a
smoking cessation tool, we should see their potential as a safer smoking
maintenance option. Reducing individual health risks and, more importantly,
potentially eliminating the societal health risks of second- and third-hand
smoke makes you think: those annoying mall vendors may be saving lives.
Buy Electronic Cigarettes
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