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 "Among adults, electronic cigarette use by never smokers is
extremely rare - most users are smokers who want to quit or reduce
their tobacco consumption or former smokers who want to prevent a
relapse," said Ramchandar Gomajee, lead author of the study and a
researcher at Sorbonne University in Paris.
Gomajee and colleagues followed 5,400 smokers for an average of 23
months, including 822 people who also reported daily use of
e-cigarettes. Vapers smoked more traditional cigarettes a day - 11.2
compared with 9.8 on average.
By the end of follow-up, however, vapers cut back more on daily
cigarettes - eliminating 4.4 a day compared with 2.7 for non-vapers.
And vapers were also 67% more likely to quit smoking.
Separately, researchers also followed 2,025 former smokers for an
average of 22 months, including 176 who reported regular e-cigarette
use. Vapers were 70% more likely to resume smoking traditional
cigarettes during the study than ex-smokers who had quit without
vaping.
"Former smokers who are using electronic cigarettes are still
addicted to nicotine," Gomajee said by email. "In any situation
where they suffer from withdrawal symptoms but are not able to use
their electronic cigarette, for example because they have no
e-liquid, or because of technical problems with the electronic
cigarette, they are likely to smoke again."
The study wasn't a controlled experiment designed to prove whether
or how vaping might impact smoking habits for users of traditional
cigarettes. And, the study also wasn't designed to test the safety
or effectiveness of e-cigarettes as a smoking cessation aid.
Another limitation is that researchers lacked data on the reasons
people used e-cigarettes, making it impossible to determine whether
smoking cessation or reduction of daily cigarette use was a goal of
people who vaped, researchers note in JAMA Internal Medicine.
Big U.S. tobacco companies are all developing e-cigarettes. The
battery-powered gadgets feature a glowing tip and a heating element
that turns liquid nicotine and flavorings into a cloud of vapor that
users inhale.
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When e-cigarettes contain nicotine, they can be addictive like
traditional cigarettes. Even without nicotine, earlier research
suggests that flavorings and other ingredients in e-liquids used for
vaping could be linked to serious breathing problems.
A big question about e-cigarettes, namely, whether they're safe or
at least safer than traditional cigarettes, isn't answered by the
current study.
"E-cigarettes do not have the same level of known carcinogens as
cigarettes, so they are safer in this respect," said Thomas Wills, a
researcher at the University of Hawaii Cancer Center in Honolulu who
wasn't involved in the study.
"However, in the last three years a lot has come out on other side
effects," Wills said by email. "There are now 15 studies showing a
linkage of e-cigarette use to respiratory disease (asthma and COPD)
in both adolescence and adulthood ... so it's difficult to argue
seriously that e-cigarettes are safe from a health standpoint."
Smokers who want to quit should try other cessation aids like
nicotine replacement patches or Chantix, a prescription smoking
cessation drug, before attempting to quit aided by e-cigarettes,
Wills advised.
While some people do achieve long-term cessation with the help of
e-cigarettes, this is a small fraction of smokers, said Stanton
Glantz, director of the Center for Tobacco Control Research and
Education at the University of California San Francisco.
"E-cigarettes should not be recommended for smoking cessation,"
Glantz, who wasn't involved in the study, said by email. "Dual use
is more dangerous than smoking alone, which is an important and
under-appreciated effect."
SOURCE: http://bit.ly/2YT0pHH JAMA Internal Medicine, online July
15, 2019.
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