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Mixed smoke signals on e-cigarettes

Long-term impact still not known, but a big U.K. study trumpets lower health risks.

By Jules Johnston

Two major new studies send seemingly conflicting messages about whether e-cigarettes help people quit smoking or are a path right back to the habit.

A U.K. review of multiple studies concluded that e-cigs, which provide controlled doses of nicotine without the majority of harmful substances found in combustible cigarettes, are a drastically less harmful alternative to tobacco. Those results came within hours of the release of a U.S. study into smoking among teenagers that suggested the devices may be a gateway for children to move to traditional cigarettes.

Confused? Here are the main findings of both studies.

The U.K. review

The independent review, commissioned by Public Health England, estimates that smoking e-cigarettes is 95 percent less harmful than combustible smoking, even going so far as to suggest that e-cigarettes may be contributing to falling smoking rates among adults and young people.

Researchers found that nearly all of the U.K.’s 2.6 million adults using e-cigarettes are current or ex-smokers, who mostly started with the aim to quit smoking or to prevent them going back to cigarettes. However, data also showed that an increasing number of U.K. citizens think e-cigarettes are equally or more harmful than smoking.

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Professor Ann McNeill, the report’s lead author from the National Addiction Centre at King’s College London, told POLITICO that there is a need for “a comprehensive tobacco control strategy, and e-cigarettes are part of that.”

Many anti-smoking campaigns have not reached the more vulnerable groups in society, McNeill said, adding that “e-cigarettes are a low-cost, wide-reach option which could do that.”

McNeill said the claim that e-cigarettes are 95 percent less harmful than traditional combustible cigarettes is based on a number of factors.

For one, just a few potentially harmful inhalants have been identified in e-cigarette vapor. By contrast cigarette smoke contains at least 70 known carcinogens as well as many chemicals that are toxic and harmful to health. In e-cigarettes, the few potentially harmful inhalants are at much lower concentrations than those found in tobacco cigarettes.

But she added some caveats to the review’s headline, noting that there have been no studies of people who have used e-cigarettes for a number of years.

The report concludes that “there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers.”

A study conducted by U.K. health charity showed an increase in the number of young people who have used e-cigarettes: 4 percent in 2013, compared to 10 percent in 2015 (among a test group of approximately 2,000 11-to-18 year olds).

However, the group welcomed the review, with Deborah Arnott, the organization’s chief executive, commenting that “the evidence is clear: electronic cigarettes are very much less harmful than smoking.”


A study published in the Journal of the American Medical Association Network by researchers from the University of Southern California released on the same day linked trying out e-cigarettes to a higher probability of ending up smoking regular cigarettes for teens.

The California study

Conducted in 2013 in 10 public high schools in Los Angeles, the study asked groups of 14-year-old students to chart their experiences with smoking, and followed up at six-month intervals over the next year with self-reported surveys.

At the study’s start, less than 10 percent of the 2,530 students involved reported having used e-cigarettes.

After six months, 31 percent of those who had used e-cigarettes had subsequently smoked combustible tobacco products, compared to just 8 percent of those who had never used the devices.

Do e-cigarettes lead to teens smoking? We just don’t know yet.

Adam M. Leventhal, first author on the study and associate professor and director of the Health, Emotion, & Addiction Laboratory at the Keck School of Medicine at University of Southern California, explained that although “we cannot conclude that e-cigarette use directly leads to smoking, this research raises concerns that recent increases in youth e-cigarette use could ultimately perpetuate the epidemic of smoking-related illness.”

The results concluded that the students who had used e-cigarettes “were more likely to report initiation of combustible tobacco use over the next year.” However it also acknowledges: “Further research is needed to understand whether this association may be causal.”

This is further supported by the U.S. drug regulator’s position. The Food and Drug Administration website notes that “it is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.”

Big Tobacco weighs in

Tobacco companies have increasingly diversified into e-cigarettes, as global smoking rates generally dropped in recent decades.

Steve Stotesbury, head of regulatory science at Imperial Tobacco, said that “researchers looking at the U.S. data tend to get excited about the numbers of school-age children who use EVPs (electronic vapor products), but fail to see what the (other U.S.) data actually shows.”

He referred to a different study conducted by the U.S. Centers for Disease Control and Prevention, the National Youth Tobacco Survey, which also reports a consistent rise in the use of e-cigarettes in middle school and high school students over the period 2010 to 2014.

While this could suggest that more teenagers are being exposed to small amounts of nicotine, Stotesbury argues that combined with other data showing a drop in teen cigarette smoking, there is evidence backing the use of e-cigarettes as an alternative rather than a gateway drug.

Next steps

On a wider level, the EU is working to clear the air. As part of last year’s tobacco products directive, the European Commission is obliged to conduct further research on the issue, and it is publicizing what it calls a collection of myths on e-cigarettes.

It warns that the long term health effects are not yet known and states that “e-cigarettes simulate smoking behavior and can lead to further experimentation with other nicotine-containing products.”

Consumers will still be able to buy e-cigarettes under the EU directive. For those classified as consumer products, the maximum threshold of nicotine is 20 milligrams per milliliter, with e-cigarettes at higher concentration levels required to go through a more rigorous set of rules.

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