Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey

A major characteristic of the electronic cigarette (EC) market is the availability of a large number of different flavours. This has been criticised by the public health authorities, some of whom believe that diverse flavours will attract young users and that ECs are a gateway to smoking.

Published: 17 December 2013

Positive: Yes

Link to publication: http://www.mdpi.com/1660-4601/10/12/7272

Authors:

Konstantinos E. Farsalinos
Giorgio Romagna
Dimitris Tsiapras
Stamatis Kyrzopoulos
Alketa Spyrou
Vassilis Voudris


Summary

Background: A major characteristic of the electronic cigarette (EC) market is the availability of a large number of different flavours. This has been criticised by the public health authorities, some of whom believe that diverse flavours will attract young users and that ECs are a gateway to smoking. At the same time, several reports in the news media mention that the main purpose of flavour marketing is to attract youngsters. The importance of flavourings and their patterns of use by EC consumers have not been adequately evaluated, therefore, the purpose of this survey was to examine and understand the impact of flavourings in the EC experience of dedicated users. Methods: A questionnaire was prepared and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 4,618 participants were included in the analysis, with 4,515 reporting current smoking status. The vast majority (91.1%) were former smokers, while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. Both subgroups had a median smoking history of 22 years and had been using ECs for 12 months. On average they were using three different types of liquid flavours on a regular basis, with former smokers switching between flavours more frequently compared to current smokers; 69.2% of the former subgroup reported doing so on a daily basis or within the day. Fruit flavours were more popular at the time of participation, while tobacco flavours were more popular at initiation of EC use. On a scale from 1 (not at all important) to 5 (extremely important) participants answered that variability of flavours was “very important” (score = 4) in their effort to reduce or quit smoking. The majority reported that restricting variability will make ECs less enjoyable and more boring, while 48.5% mentioned that it would increase craving for cigarettes and 39.7% said that it would have been less likely for them to reduce or quit smoking. The number of flavours used was independently associated with smoking cessation.


Conclusions

The results of this survey of dedicated users indicate that flavours are marketed in order to satisfy vapers’ demand. They appear to contribute to both perceived pleasure and the effort to reduce cigarette consumption or quit smoking. Due to the fact that adoption of ECs by youngsters is currently minimal, it seems that implementing regulatory restrictions to flavours could cause harm to current vapers while no public health benefits would be observed in youngsters. Therefore, flavours variability should be maintained; any potential future risk for youngsters being attracted to ECs can be sufficiently minimized by strictly prohibiting EC sales in this population group.

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Quantifying the influence of the tobacco industry on EU governance: automated content analysis of the EU Tobacco Products Directive

**Note: no analysis of Art18 wording. Could we extract info on lobbying by tobacco industry on Art18 (now 20)?**

The tobacco industry spends large sums lobbying the European Union (EU) institutions, yet whether such lobbying significantly affects tobacco policy is not well understood. We used novel quantitative text mining techniques to evaluate the impact of industry pressure on the contested EU Tobacco Products Directive revision.

Published: 13 August 2014

Positive: Neutral

Link to publication: http://tobaccocontrol.bmj.com/content/23/6/473.full

Authors:

Hélia Costa
Anna B Gilmore
Silvy Peeters
Martin McKee
David Stuckler


Summary

Design Policy positions of 18 stakeholders including the tobacco industry, health NGOs and tobacco retailers were evaluated using their text submissions to EU consultations and impact assessments. Using Wordscores to calculate word frequencies, we developed a scale ranging from 0–tobacco industry to 1–public health organisations, which was then used to track changes in the policy position of the European Commission’s 2010 consultation document, its 2012 final proposal and the European Parliament and Council’s approved legislation in March 2014.

Results Several stakeholders’ positions were closer to the tobacco industry than that of health NGOs, including retailers (ω=0.35), trade unions (ω=0.34) and publishers (ω=0.33 and ω=0.40). Over time the European Commission’s position shifted towards the tobacco industry from ω=0.52 (95% CI 0.50 to 0.54) to ω=0.40 (95% CI 0.39 to 0.42). This transition reflected an increasing use of words pertaining to business and the economy in the Commission’s document. Our findings were robust to alternative methods of scoring policy positions in EU documents.


Conclusions

Conclusions Using quantitative text mining techniques, we observed that tobacco industry lobbying activity at the EU was associated with significant policy shifts in the EU Tobacco Products Directive legislation towards the tobacco industry’s submissions. In the light of the Framework Convention on Tobacco Control, additional governance strategies are needed to prevent undue influence of the tobacco industry on EU policy making.

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The revision of the 2014 European tobacco products directive: an analysis of the tobacco industry’s attempts to ‘break the health silo’

The 2014 European Union (EU) Tobacco Products Directive (TPD) was negotiated in a changed policy context, following adoption of the EU’s ‘Smart Regulation’ agenda, which transnational tobacco companies (TTCs) anticipated would increase their influence on health policy, and the WHO Framework Convention on Tobacco Control (FCTC), which sought to reduce it. This study aims to explore the scale and nature of the TTCs’ lobby against the EU TPD and evaluate how these developments have affected their ability to exert influence.

Published: 24 February 2015

Positive: neutral for vaping

Link to publication: http://m.tobaccocontrol.bmj.com/content/early/2015/02/06/tobaccocontrol-2014-051919.full

doi:10.1136/tobaccocontrol-2014-051919

Authors:

Silvy Peeters
Hélia Costa
David Stuckler
Martin McKee
Anna B Gilmore


Abstract

Background The 2014 European Union (EU) Tobacco Products Directive (TPD) was negotiated in a changed policy context, following adoption of the EU’s ‘Smart Regulation’ agenda, which transnational tobacco companies (TTCs) anticipated would increase their influence on health policy, and the WHO Framework Convention on Tobacco Control (FCTC), which sought to reduce it. This study aims to explore the scale and nature of the TTCs’ lobby against the EU TPD and evaluate how these developments have affected their ability to exert influence.

Methods Analysis of 581 documents obtained through freedom of information requests, 28 leaked Philip Morris International (PMI) documents, 17 TTC documents from the Legacy Library, web content via Google alerts and searches of the EU institutions’ websites, plus four stakeholder interviews.

Results The lobby was massive. PMI alone employed over 160 lobbyists. Strategies mainly used third parties. Efforts to ‘Push’ (amend) or ‘Delay’ the proposal and block ‘extreme policy options’ were partially successful, with plain packaging and point of sales display ban removed during the 3-year delay in the Commission. The Smart Regulation mechanism contributed to changes and delays, facilitating meetings between TTC representatives (including ex-Commission employees) and senior Commission staff. Contrary to Article 5.3, these meetings were not disclosed.


Conclusions

During the legislative process, Article 5.3 was not consistently applied by non-health Directorates of the European Commission, while the tools of the Smart Regulation appear to have facilitated TTC access to, and influence on, the 2014 TPD. The use of third parties undermines Article 5.3.

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Understanding the evidence about the comparative success of smoking cessation methods: choice, second-order preferences, tobacco harm reduction, and other neglected considerations

Note that this is a working paper, not a study per se. The first version appeared on Nov 2014, this version is dated 22 February 2015

Published: Not yet

Positive: Yes

Link to publication: http://ep-ology.com/2014/11/24/working-paper-phillips-nissen-rodu-understanding-the-evidence-about-the-comparative-success-of-smoking-cessation-methods-choice-second-order-preferences-tobacco-harm-reduction-and-other-neglecte/

Authors:

Carl V Phillips

Catherine M Nissen

Brad Rodu


Summary

The extensive research on choices about smoking and the methods people use to quit is almost always interpreted in naïve and unhelpful ways. This is partially due to treating smoking cessation as if it were medical disease treatment, despite the fundamental differences, most notably that smoking is a choice that has benefits as well as costs]. The main problem, however, seems to be a failure to recognize what it means when someone indicates they want to quit smoking. An understanding of the preferences that motivate smoking and cessation allows us to categorize would – be quitters, par ticularly identifying the difference between first – and second – order preferences for quitting. This demonstrates the absurdity of attempts to determine what cessation method is “best” or even “better”, as well as explaining the frequent failure of medical interventions. This analysis offers advice for both readers of the research and those who wish to quit smoking.


Conclusions

There are an enormous number of studies of smoking cessation methods, and a new wave that includes e – cigarettes has begun. However, these seem to play the role of Rorschach test rather than aid to useful policy and education, or perhaps the “support, not enlightenment” role of the lamppost for the inebriated. They are interpreted as supporting the observer’s political bias about cessation methods, which may be based on other empirical observations or mere ideology. Even attempts at unbiased observations suffer from a failure to understand that the study of consumer preferences differs dramatically from medical treatment research, and must be interpreted with the eye of a social scientist.

Consideration of the different categories of smokers presented here is crucial to both an informed interpretation of research and useful advice for smokers. Methods to aid smokers to understand their true preferences, and thus what might be a desirable quitting approach, follow naturally from these observations, particularly helping smokers to reflect on their motivations and desires. Standard methods for categorizing smokers or including covariates in studies can help discriminate among these categories of would – be quitters, but are likely to only be useful if explicitly interpreted in that context. For example, intensity – of – desire variables, like the standard “how soon after you wake up do you have your first cigarette”, might be used to identify subjects who are more likely to be in Category 1 rather than one of the other categories and thus allow better interpretation of the data. Blindly throwing those variables into statistical models without such structure, however, is unlikely to be particularly informative.

Unbiased and thoughtful interpretation of smoking cessation study results could provide much useful information about how to advise smokers who want to quit. But very little of that seems to be occurring. If helping people who want to quit, or want to want to quit – rather than just generating revenue or rhetoric – is the goal of the research, then some more serious attention to the nature of the phenomena being studied is in order, with smokers seen as consumers with first – and second – order preferences that drive their behavior, rather than as patients with an illness for whom assigning a cure would be appropriate.

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Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments

Old (2009), but with interesting contents regarding THR

Published: 03 November 2009

Positive: Yes

Link to publication: http://www.harmreductionjournal.com/content/6/1/29

doi:10.1186/1477-7517-6-29

Authors:

Carl V Phillips


Summary

Nicotine is so desirable to many people that when they are given only the options of consuming nicotine by smoking, with its high health costs, and not consuming nicotine at all, many opt for the former. Few smokers realize that there is a third choice: non-combustion nicotine sources, such as smokeless tobacco, electronic cigarettes, or pharmaceutical nicotine, which eliminate almost all the risk while still allowing consumption of nicotine. Widespread dissemination of misleading health claims is used to prevent smokers from learning about this lifesaving option, and to discourage opinion leaders from telling smokers the truth. One common misleading claim is a risk-risk comparison that has not before been quantified: A smoker who would have eventually quit nicotine entirely, but learns the truth about low-risk alternatives, might switch to an alternative instead of quitting entirely, and thus might suffer a net increase in health risk. While this has mathematical face validity, a simple calculation of the tradeoff — switching to lifelong low-risk nicotine use versus continuing to smoke until quitting — shows that such net health costs are extremely unlikely and of trivial maximum magnitude. In particular, for the average smoker, smoking for just one more month before quitting causes greater health risk than switching to a low-risk nicotine source and never quitting it. Thus, discouraging a smoker, even one who would have quit entirely, from switching to a low-risk alternative is almost certainly more likely to kill him than it is to save him. Similarly, a strategy of waiting for better anti-smoking tools to be developed, rather than encouraging immediate tobacco harm reduction using current options, kills more smokers every month than it could possibly ever save.


Conclusion

While it is logically possible that lowering the risk from an exposure could increase population risk, the (1-x)/x calculation shows this is not plausible for THR. The suggestion that, despite the lower population risk, many individuals might still face greater risk is also logically possible, but the calculation presented here shows that this is not a substantial practical worry.

On average, someone who would die from smoking who is going to take more than a month to quit entirely (or will experience relapses that will have a similar health impact – probably roughly a total of one month worth of days) will have less total health risk by switching immediately, even if he never quits the alternative product. The typical pattern of even dedicated quitters, starting and stopping smoking for a year or two, will cause much more risk than switching to a low-risk alternative. Moreover, even an average smoker who was going to successfully quit after only a week or two more will suffer only a tiny net increase in physical health risk from switching now, a change so trivial compared to the net benefits of switching for smokers who will not quit for years or ever that it is clearly inconsequential.

The practical implications of this analysis do not change based on plausible variations in the input parameters, including the risk from using ST. Even if we use a completely implausible high risk from ST use, say that it causes 10% of the risk of smoking, then if an average smoker would have taken ten months to quit entirely, he would have had lower risk had he switched immediately. The break-even might be as low as about half a year – recall the conservative assumption built into the calculation. Thus, even discovering that ST use is an order of magnitude worse than the ample current evidence suggests would not fundamentally change the implications of the analysis.

Since this analysis is based entirely on mortality risk, it ignores other contributions to welfare. The reason that current smokers have not already quit, in spite of the health benefits of doing so, is that it would have resulted in substantial costs to them and, similarly, whenever a smoker chooses to switch it implies that there is a net welfare benefit (compared to either smoking or abstinence) to using the alternative product. This welfare gain from switching rather than quitting probably dwarfs the welfare implications of the mortality risk from low-risk products, though quantifying that is beyond the present scope.

Finally, it is worth noting that someone who switches from smoking to a low-risk alternative still has the option of quitting entirely, lowering his risk slightly more still. Indeed, there is reason to believe that eventually quitting alternative products is easier. This means that even the young smokers who might have been better off with several more months of smoking rather than a lifetime of THR product use stand a good chance of quitting entirely anyway (if they decide that the benefits of consumption are outweighed by the benefits of quitting), further favoring the option of switching now. Even those smokers who cannot afford another day of smoking but fortunately switch just in time (who are likely from older demographics that are the primary target for THR) could then survive long enough to quit nicotine entirely.

Many of the claims about health risk made to try to discourage the adoption of THR have been proven to be out-and-out false. This includes the « total social health risk will increase » claim. The present analysis does not relegate the « some people would be stopped from quitting entirely and thus have worse health outcomes » claim to universal falsehood – it will still inevitably be true for a very few individuals. But this is common in public health interventions, from automobile safety equipment to vaccines – the net social effects are overwhelmingly beneficial, though some people (who cannot be identified ex ante, and often not even ex post) suffer net harm rather than benefit. The analysis shows that only a tiny portion of all future quitters will be quitting soon enough that they would have higher expected risk by switching immediately. Moreover, the net increase in expected risk even for those individuals would be extremely small, and the net welfare effects would still be positive. Clearly, then, the claim does not represent a sufficient concern to override the huge net expected social benefit, to say nothing of the ethical requirement that smokers be informed about their options. The claim is thus relegated to being a distraction from rational and honest discourse on the subject, not a contribution to it.

This calculation emphasizes the cost of delaying the adoption of THR at the individual level also: Those of us who promote THR are familiar with smokers who, upon learning about THR, insist that they do not need to consider that option because they will eventually be exercising the « perfect » option of quitting anyway. But many such individuals never quit, and almost none quit in time for it to be a healthier choice. Similarly, each additional month that anti-THR activism keeps a potential switcher from learning about THR is more likely to kill him than is a lifetime of using ST or another low-risk nicotine product. To put it bluntly, anti-THR activism and disinformation do far more damage to public health than smokeless tobacco, electronic cigarettes, or other THR products ever could.

Since THR can be self-tailored and requires no clinical or government intervention, it does not matter that there may be smokers for whom no low risk product is an adequate substitute or that there is no political will to actively endorse it. THR can be adopted by individuals who do find an acceptable substitute, and likely will be widely adopted if smokers were simply given accurate information. The usual explanation for the lack of such information is that anti-tobacco extremists promulgate disinformation it and then even the opinion leaders who are genuinely concerned about public health repeat the inaccurate claims because they have been misled. But an alternative explanation is misplaced optimism on the part of the public health leaders: That is, many may not be misled by the disinformation about THR, but may genuinely believe that most smokers will successfully quit using nicotine very soon or that a perfect new anti-smoking method, policy, or product will be developed and cause everyone to quit soon, reducing their risks more than THR would. The present analysis shows just how overly-optimistic that belief needs to be in order to justify the failure to immediately promote THR using current technology.

Whatever the explanation for it, the present analysis shows that anti-THR activism is deadly. Hiding THR from smokers, waiting for them to decide to quit entirely or waiting for a new anti-smoking magic bullet, causes the deaths of more smokers every month than a lifetime using low-risk nicotine products ever could.

Continuer la lecture de Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments

Harmful effects of nicotine

With the advent of nicotine replacement therapy, the consumption of the nicotine is on the rise. Nicotine is considered to be a safer alternative of tobacco. The IARC monograph has not included nicotine as a carcinogen. However there are various studies which show otherwise. We undertook this review to specifically evaluate the effects of nicotine on the various organ systems.

Published: 19 February 2015

Positive :  No

Link to publication: http://www.ijmpo.org/article.asp?issn=0971-5851%3Byear%3D2015%3Bvolume%3D36%3Bissue%3D1%3Bspage%3D24%3Bepage%3D31%3Baulast%3DMishra

Authors:

Aseem Mishra
Pankaj Chaturvedi
Sourav Datta
Snita Sinukumar
Poonam Joshi
Apurva Garg


Summary

With the advent of nicotine replacement therapy, the consumption of the nicotine is on the rise. Nicotine is considered to be a safer alternative of tobacco. The IARC monograph has not included nicotine as a carcinogen. However there are various studies which show otherwise. We undertook this review to specifically evaluate the effects of nicotine on the various organ systems. A computer aided search of the Medline and PubMed database was done using a combination of the keywords. All the animal and human studies investigating only the role of nicotine were included. Nicotine poses several health hazards. There is an increased risk of cardiovascular, respiratory, gastrointestinal disorders. There is decreased immune response and it also poses ill impacts on the reproductive health. It affects the cell proliferation, oxidative stress, apoptosis, DNA mutation by various mechanisms which leads to cancer. It also affects the tumor proliferation and metastasis and causes resistance to chemo and radio therapeutic agents. The use of nicotine needs regulation. The sale of nicotine should be under supervision of trained medical personnel.


Conclusion

Nicotine is the fundamental cause of addiction among tobacco users. Nicotine adversely affects many organs as shown in human and animal studies. Its biological effects are widespread and extend to all systems of the body including cardiovascular, respiratory, renal and reproductive systems. Nicotine has also been found to be carcinogenic in several studies. It promotes tumorigenesis by affecting cell proliferation, angiogenesis and apoptotic pathways. It causes resistance to the chemotherapeutic agents. Nicotine replacement therapy (NRT) is an effective adjunct in management of withdrawal symptoms and improves the success of cessation programs. Any substantive beneficial effect of nicotine on human body is yet to be proven. Nicotine should be used only under supervision of trained cessation personnel therefore its sale needs to be strictly regulated. Needless to say, that research for safer alternative to nicotine must be taken on priority.

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Former WHO scientist: ‘Smoking kills, nicotine doesn’t’

A great article in today’s spectator.

Dr Derek Yach, who developed the World Health Organisation’s Framework Convention on Tobacco Control, talks about vaping in no unclear terms.

Why are we in this position? One reason is that governments have become addicted to tobacco excise tax and may fear that, as e-cigs take off, they will lose a valuable source of revenue. Many leading NGOs and academics exert strong influence at WHO, within governments, in the media and among the general public. In the past, they helped bring tobacco control out of the shadows and into the mainstream of health policy. Now, alas, their intransigence threatens more profound progress.

And further down the page

His support for electronic cigarettes and vaping products rests on what he regards as the stark truth: that they help people quit smoking more effectively than other remedies. It is therefore not just unfortunate but scary that the World Health Organisation persists in treating them as if they were almost as dangerous as cigarettes.

Counseling Patients on the Use of Electronic Cigarettes

Published: January 2015

Positive: No

Link to publication: http://www.mayoclinicproceedings.org/article/S0025-6196%2814%2900989-6/fulltext#sec7

DOI: http://dx.doi.org/10.1016/j.mayocp.2014.11.004

Authors:

Jon O. Ebbert, MD, MS
Amenah A. Agunwamba, ScD, MPH
Lila J. Rutten, PhD, MPH


Summary

Electronic cigarettes (e-cigarettes) have substantially increased in popularity. Clear evidence about the safety of e-cigarettes is lacking, and laboratory experiments and case reports suggest these products may be associated with potential adverse health consequences. The effectiveness of e-cigarettes for smoking cessation is modest and appears to be comparable to the nicotine patch combined with minimal behavioral support. Although a role for e-cigarettes in the treatment of tobacco dependence may emerge in the future, the potential risk of e-cigarettes outweighs their known benefit as a recommended tobacco treatment strategy by clinicians. Patients should be counseled on the known efficacy and potential risks of e-cigarettes.


Conclusions

Clinicians are ethically obligated to promote smoking cessation using evidence-based treatment strategies. Smokers will ask about e-cigarettes, and we must be prepared to offer appropriate counseling. With the evidence available to date, clinicians must be circumspect in recommending e-cigarettes for use by cigarette smokers interested in quitting smoking for the following reasons:

1. They are not demonstrably superior to FDA-approved medications for smoking cessation.

2. They may not be effective for smoking cessation and dual use (ie, using e-cigarettes and continuing to smoke) will prolong exposure to tobacco.

3. They are not FDA-approved for the treatment of tobacco dependence.

4. Short-term safety data suggest they may cause airway reactivity.

5. The long-term health risk of exposure to e-cigarette constituent chemicals is unknown.

6. No regulatory oversight, such as requirements for good manufacturing practices, is currently in place for e-cigarette devices or e-juice.

More clinical safety data and increased product reliability and regulation are needed before e-cigarettes can assume a place in the standard clinical approaches to the treatment of tobacco dependence.

Continuer la lecture de Counseling Patients on the Use of Electronic Cigarettes

Use of e-Cigarettes among Current Smokers: Associations among Reasons for Use, Quit Intentions, and Current Tobacco Use.

Research has documented growing availability and use of e-cigarettes in the U.S. over the last decade.

We conducted a national panel survey of current adult cigarette smokers to assess attitudes, beliefs, and behaviors relating to e-cigarette use in the U.S. (N=2254).

Published: 14 January 2015

Positive: Yes

Link to publication: http://www.ncbi.nlm.nih.gov/pubmed/25589678

PMID:25589678

Authors:

Rutten LJ
Blake KD
Agunwamba AA
Grana RA
Wilson PM
Ebbert JO
Okamoto J
Leischow SJ


Summary

Among current cigarette smokers, 20.4% reported current use of e-cigarettes on some days and 3.7% reported daily use. Reported reasons for e-cigarette use included: quit smoking (58.4%), reduce smoking (57.9%), and reduce health risks (51.9%). No significant differences in sociodemographic characteristics between e-cigarette users and non-users were observed. Prior quit attempts were reported more frequently among e-cigarette users (82.8%) than non-users (74.0%). Intention to quit was reported more frequently among e-cigarette users (64.7%) than non-users (46.8%). Smokers intending to quit were more likely to be e-cigarette users than those not intending to quit (OR=1.90, CI=1.36-2.65). Those who used e-cigarettes to try to quit smoking (OR=2.25, CI=1.25-4.05), reduce stress (OR=3.66, CI=1.11-12.09), or because they cost less (OR=3.42, CI=1.64-7.13) were more likely to report decreases in cigarette smoking than those who did not indicate these reasons. Smokers who reported using e-cigarettes to quit smoking (OR=16.25, CI=8.32-31.74) or reduce stress (OR=4.30, CI=1.32-14.09) were significantly more likely to report an intention to quit than those who did not indicate those reasons for using e-cigarettes.


Conclusions

Nearly a quarter of smokers in our study reported e-cigarettes use, primarily motivated by intentions to quit or reduce smoking. These findings identify a clinical and public health opportunity to re-engage smokers in cessation efforts.

Continuer la lecture de Use of e-Cigarettes among Current Smokers: Associations among Reasons for Use, Quit Intentions, and Current Tobacco Use.

E-cigarettes: methodological and ideological issues and research priorities

Cigarette combustion, rather than either tobacco or nicotine, is the cause of a public health disaster. Fortunately, several new technologies that vaporize nicotine or tobacco, and may make cigarettes obsolete, have recently appeared.

**Note: this is an article, not a study per se.

Published: 16 February 2015

Positive: Yes

Link to publication: http://www.biomedcentral.com/1741-7015/13/32

doi:10.1186/s12916-014-0264-5

Author:

JF Etter


Summary

Abstract

Cigarette combustion, rather than either tobacco or nicotine, is the cause of a public health disaster. Fortunately, several new technologies that vaporize nicotine or tobacco, and may make cigarettes obsolete, have recently appeared. Research priorities include the effects of vaporizers on smoking cessation and initiation, their safety and toxicity, use by non-smokers, dual use of vaporizers and cigarettes, passive vaping, renormalization of smoking, and the development of messages that effectively communicate the continuum of risk for tobacco and nicotine products. A major difficulty is that we are chasing a moving target. New products constantly appear, and research results are often obsolete by the time they are published. Vaporizers do not need to be safe, only safer than cigarettes. However, harm reduction principles are often misunderstood or rejected. In the context of a fierce ideological debate, and major investments by the tobacco industry, it is crucial that independent researchers provide regulators and the public with evidence-based guidance. The methodological and ideological hurdles on this path are discussed in this commentary.


Conclusion

A window of opportunity is now open but will soon close. In the United States, the Food and Drug Administration is developing regulations that will apply to e-cigarettes and vaporizers, and European Union Member States are now transposing the Tobacco Products Directive into national laws. Once these regulations are in place, they will be very difficult to change. However, because harm reduction strategies are often misunderstood or rejected [14], there is a risk that e-cigarettes and vaporizers will be excessively regulated. Regulators must consider the unintended consequences of excessive regulation, and should be held accountable for any such consequences. Given that e-cigarettes and vaporizers are already much safer than combustible cigarettes, any benefit of regulations will be small, whereas the unintended consequences can have a large negative impact. Unfortunately, current proposals for regulation are often worse than the status quo. It is sad that this is happening with the help of some public health professionals, scientists and elected representatives of the people.

Continuer la lecture de E-cigarettes: methodological and ideological issues and research priorities