Last week, I discussed a study, just published online ahead of print in the journal Nicotine & Tobacco Research, which reports the results of a population-based survey of smokers followed up after two years to determine whether e-cigarette use was associated with higher or lower rates of smoking cessation. The study found that intensive electronic cigarettes users at baseline were six times more likely to quit smoking after a two-year follow-up period compared to intermittent or non-users.
One additional important finding of this study deserves mention.
The study found a difference in the reasons for starting e-cigarette use between triers (those who only vaped one or two times), intermittent users, and intensive users (those who vaped daily for at least one month).
Among the intensive users, the overwhelming majority (87.6%) reported that they were vaping because of health concerns: they were concerned about their own health and/or wanted to quit smoking or cut down on the amount that they smoked.
Among the intermittent users, this percentage was only 53.6%, and among the triers, it was only 55.2%. Other major reasons given among the triers and intermittent users were vaping where smoking is not allowed and avoiding exposing others to tobacco smoke.
Overall, then, the most intensive users -- who were also more likely to quit successfully -- tended to be smokers who were using electronic cigarettes specifically with a health purpose in mind (usually, quitting smoking). There were fewer "ancillary" reasons for use among these intense users.
As the authors concluded: "those who did not progress to extended daily use of e-cigarettes were using them for reasons other than the desire to quit smoking."
The Rest of the Story
This highlights one of the major problems with the proposed regulation of e-cigarettes, as well as the way many anti-smoking groups are treating these products.
First, in terms of proposed regulation, the FDA's proposed deeming regulations would prohibit companies from telling the truth about their products. Companies could not point out that electronic cigarettes produce no smoke, nor could they truthfully make the point that these products are much safer than cigarettes. Beware of making a therapeutic claim, they could not point out that the primary purpose of these products is for smoking cessation. In short, the proposed regulations would prohibit companies from marketing these products truthfully: the companies would have to pretend that improving health has nothing to do with why these products exist or why one would want to use an e-cigarette instead of a real one.
This is absurd, and it needs to be changed in the final regulations. First, companies should be explicitly allowed to point out that these products contain no tobacco smoke. Second, companies should be allowed to truthfully inform consumers that vaping is much safer than smoking. Third, companies should be allowed to make a certain set of claims regarding smoking cessation. They should not be allowed to market these products as nicotine delivery devices or with the purpose of treating nicotine dependence or addiction (since these are diseases/conditions). But instead, they should be allowed to truthfully note that the primary intention of these products is to get smokers off of cigarettes. They should also be allowed to inform consumers that many smokers have successfully quit smoking using e-cigarettes. The FDA should allow this subset of claims to be made without running afoul of the Food, Drug, and Cosmetic Act (i.e., without having to reclassify their products as drugs and therefore pull them off the market while submitting a new drug application).
Second, in terms of the statements of anti-smoking groups, they should stop criticizing electronic cigarette companies for making truthful claims, such as that these products have helped many people quit smoking or that these products are much safer than tobacco cigarettes. By discouraging these types of truthful claims, the anti-smoking groups have in fact backed the e-cigarette companies into a corner: all they can do without arousing the ire of the anti-smoking groups is to market e-cigarettes as a glamorous or sexy form of tobacco use, or as a product that can be used where smoking is not allowed. This is exactly how we don't want these products to be marketed.
The rest of the story is that it isn't as simple as condemning electronic cigarette companies for using marketing that seems to appeal to young people, or which casts vaping as being glamorous or sexy. The companies have been boxed into a corner. And the ones boxing them into that corner are us! By us, I mean public health groups and agencies.
It is time to not only allow, but to encourage the truthful marketing of electronic cigarettes. Based on the current research, such an approach would actually aid the public's health by encouraging more serious vapers who would have a higher likelihood of making the complete switch from tobacco cigarettes to the much safer electronic ones.
Disclosure: I have not received any funding or compensation from
the tobacco, electronic cigarette, or pharmaceutical industries.
However, I am seeking funding from several electronic cigarette
companies to conduct a behavioral study on the effects of electronic
cigarettes on smoking behavior.