The Pros and Cons of E-cigarettes

FAMILY MATTERS

Dr. Vaughan Rees to speak in Lexington
November 6th, 2019
 7:00pm – 9:00pm
Cary Memorial Hall
1605 Mass Ave., Lexington, MA 02420
Dr. Rees is a lecturer on Social and Behavioral Sciences, and Director of the Center for Global Tobacco Control at Harvard T.H. Chan School of Public Health. He will be speaking in Lexington.
Free Presentation & Community Discussion on E-cigarettes and Vaping
(Youth attendance is permitted with adult supervision)

 

By Dr. Vaughan Rees, Director of the Center for Global Tobacco Control at the Harvard T.H. Chan School of Public Health on the Pros and Cons of E-cigarettes

Presented by Karen Feldscher & Harvard T.H. Chan School of Public Health

 

Is it wise to steer smokers toward e-cigarettes, in the hope that they offer a safer alternative to traditional cigarettes? Or do e-cigarettes pose too many health risks in their own right?

Although e-cigarettes have been available in this country since 2007, the FDA did not exert its regulatory authority over these products until 2016. The agency continues to grapple with how best to regulate these products in light of both the harms and the theoretical benefits to adult smokers. Some advertisements for e-cigarettes imply—but don’t directly state—that they may help people stop smoking. However, e-cigarettes are not FDA-approved for smoking cessation, unlike a number of other products on the market (see “Nicotine replacement options” table right). Small studies suggest they may lower cravings for conventional cigarettes and withdrawal symptoms.

One recent randomized controlled trial found that e-cigarettes were more effective than other nicotine replacement therapies such as patches or gum. After one year, 18% of the e-cigarette users, compared with 10% of the nicotine replacement users, were abstaining from regular cigarettes. However, among those successful abstainers, 80% of the e-cigarette users were still using the devices, while just 9% of those in the other group were still using nicotine replacement products.

Smokers tend to like e-cigarettes because they deliver nicotine levels similar to those from regular cigarettes, and the drug gets into the bloodstream faster than with other nicotine replacement products. Some smokers also enjoy the familiar hand-to-mouth ritual. According to a 2018 review by the National Academies of Science, Engineering and Medicine, the harmful, artery-damaging substances in cigarette smoke are absent or present at much lower concentrations in aerosol from e-cigarettes. For smokers who aren’t able to quit by other means, using e-cigarettes might be less harmful than continuing to smoke.

“New findings suggest that we’re at something of a crossroads in how we approach tobacco control issues,” Rees told an audience at Harvard University. “But we hope we can use science to guide our way through.”

Rees outlined the enormous health burden posed by tobacco around the globe. In the 20th century, 100 million deaths were attributed to smoking; for the 21st century, 1 billion deaths tobacco-related deaths are predicted. In the U.S. alone, tobacco leads to roughly 480,000 preventable premature deaths each year. The highest smoking rates—and the biggest tobacco-related health burdens—are among poor and marginalized communities, including people with substance abuse problems, mental health issues, or housing instability; members of the LBGTQ community; or those who are in prison.

As smoking rates have declined in the U.S., they’ve gone up in developing nations around the world, where deep-pocketed tobacco companies have aggressively pushed their products, Rees said. Marketing has been savvy, promoting the pleasure of smoking, suggesting that certain cigarette brands are safer, and portraying cigarette smoking as aspirational so that it appeals to those who are poor as well as groups such as women and youth. “Companies have also specifically designed cigarettes to be very addictive”, Rees said.

A safer alternative?

“E-cigarettes have been touted as a ‘safe’ alternative to smoking because they can deliver aerosolized nicotine that can be inhaled without all the toxins found in regular cigarettes,” Rees said. “However, e-cigarettes may pose health dangers too—for instance, they may contain toxic heavy metals and formaldehyde.”

There’s also concern that e-cigarettes marketed to youth, which can be used with a wide range of fruit and candy-flavored “e-liquids,” will hook kids into nicotine addiction early and possibly lead them toward smoking traditional cigarettes. Rees said that one example of this is JUUL, which looks like a USB flash drive and has become very popular among high school students. Some evidence suggests that e-cigarette use increases young people’s likelihood of smoking regular cigarettes. But Rees said that evidence may be outdated because recent statistics show that both traditional cigarette smoking and e-cigarette use have declined over the past three years.

“Even if e-cigarettes do lead to an uptick in young people smoking regular cigarettes, some researchers say this risk is outweighed by the potentially much larger benefits of reducing smoking worldwide,” according to Rees. “For e-cigarettes to deliver on the promise of reducing smoking, they would have to be potent and pleasurable enough to convince smokers to switch for the long term,” Rees said. “At the same time, it will be important to regulate e-cigarettes to minimize risks to young people—for instance, by making e-cigarette packaging and e-liquid flavors less appealing to kids and by more effectively communicating about potential long-term health impacts.”

“We need to communicate intelligently and scientifically accurately the risks and benefits of e-cigarettes,” said Rees. “We’re concerned because this is driven largely by a predatory industry that targets young people with highly addictive products,” says Dr. Rees, “The potential to cause long-term harm by encouraging the use of more deadly products is very real.”

 

Dr. Rees – Courtesy Photo

About the Author:
Dr. Vaughan Rees is Director of the Center for Global Tobacco Control, whose mission is to reduce the global burden of tobacco-related death and disease through training, research, and the translation of science into public health policies and programs. He directs the Tobacco Research Laboratory at the Harvard Chan School, where findings have been used to inform tobacco control policy, develop resources for communicating risks of tobacco products, and to enhance understanding of factors that contribute to tobacco dependence.
Dr. Rees’ academic background is in health psychology (substance use and dependence), and he trained at the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, Australia, and did postdoctoral training through the National Institute on Drug Abuse.

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