In addition, pharmaceutical companies should look into conducting research on and eventually producing e-cigarettes specifically aimed at smoking cessation. This could help create a new, tested method of smoking cessation, and this product would not have to be taxed like normal cigarettes and e-cigarettes. This would create another resource for smokers to utilize when quitting smoking, thus hopefully encouraging more people to choose this route.
Although e-cigarettes do not present the same level of health risks as normal cigarettes, they are not proven to be an effective smoking cessation treatment in comparison with existing methods such as NRT. Although one study revealed such results, the data in this study was not reliable because it was affected by several external factors, so the observed correlation between e-cigarette use and smoking cessation cannot actually be attributed solely to the use of e-cigarettes. Thus, there is little evidence indicating that e-cigarettes can be used for smoking cessation, especially while they are still being marketed as commercial smoking products. In order to actually classify e-cigarettes as smoking cessation treatment, extensive research must be done in order to determine how e-cigarettes should be use din order to help people quit smoking rather than just smoke recreationally.
E-Cigarettes: Health Hazard or Healthy Choice?
What is an e-cigarette?
Do e-cigarettes present health risks comparable to those of regular cigarettes?
Although they do not contain tobacco, e-cigarettes still contain nicotine and carcinogenic chemicals, which are all harmful to humans
E-cigarettes present significantly fewer health risks than traditional cigarettes, and are thus a preferable substitute
Can e-cigarettes serve as a legitimate smoking cessation method?
E-cigarette use does not increase smoking cessation. Rather, e-cigarette smokers may be less likely to quit smoking than those attempting to quit using traditional methods.
Use of e-cigarettes is an effective smoking cessation method
E-cigarettes are battery-powered smoking devices
Provide nicotine and other chemicals in vapor form (1)
Do not burn tobacco
Vapor is created from a liquid composed of nicotine (extracted from tobacco) along with a base, usually propylene glycol, and other chemicals/flavorings (2)
Originally created as an alternative smoking device (not intended for smoking cessation, but soon began being marketed as such)
Blocked in the US at first because regarded as a “drug delivery system”, but now regulated like traditional cigarette products (3)
Currently sold over the counter
Do the health risks of e-cigarettes outweigh their potential benefits?
Federal and state-level taxes have been imposed upon normal cigarettes in order to decrease smoking rates
Current tax: $1.01 federal tax
State taxes vary (average of $1.69) (4)
E-cigarettes have not been regulated as such
Rarely defined as a “tobacco product” by state law, so not taxed as such by most states (5)
However, should this change? What risks or benefits do e-cigarettes provide?
Do e-cigarettes present the same public health dangers as regular cigarettes?
Do they provide sufficient public health benefits to exempt them from taxation?
Nicotine has harmful effect on brain development, and can cause impairment in young adults
Even “nicotine free” e-cigarettes have been found to contain nicotine
There are also more chemical present in e-cigarettes, including carcinogens such as formaldehyde (2)
Public Health Values
The purpose of public health is to ensure that the general public is as healthy as possible by providing them with necessary knowledge and resources and by enacting programs and legislation to minimize harmful behaviors and encourage health.
How do e-cigarettes contribute or detract from this purpose of public health?
“Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes?”
Based on studies characterizing the chemicals in e-cigarettes, the main two chemicals the FDA has focused on, TSNAs and DEG, were not present in harmful amounts in a majority of the studies
Levels of many chemicals were comparable to chemical levels in nicotine patches (6)
Cannot say that e-cigarettes are “safe”, but from a harm reduction perspective they are preferable over normal cigarettes because they seem to have fewer harmful chemicals in lower concentrations
After analyzing both perspectives, it seems that the pro e-cigarette argument has more support. They acknowledged the partial validity of the other side’s argument, but the information presented seems to indicate that, compared to normal cigarettes, e-cigarettes still present significantly fewer health risks. Thus, in accordance with the purpose of public health, it may be preferable to have more people smoking e-cigarettes rather than normal cigarettes in order to decrease overall health problems caused by cigarette smoking.
“E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis.”
Purpose: Using 18 real world studies and 2 clinical trials, a meta-analysis was conducted to determine whether e-cigarettes are more or less effective than other smoking cessation methods. (7)
Purpose: Examines studies conducted on e-cigarettes in order to develop understanding of the risks and benefits of e-cigarettes, while also addressing arguments against the harm reduction approach to smoking. (6)
Public health strategy which emphasizes decreasing the harmful effects of drug or alcohol use without actually stopping the activity
Has not been used for smoking because many argue that, since there are methods to help people quit completely, harm reduction is not necessary (6)
E-cigarettes deliver nicotine to users without the chemicals that tobacco smoke contains
Through research, we already have a more holistic understanding of chemicals in e-cigarettes than regular cigarettes (6)
Benefits of E-Cigarettes
Based on the data collected in these 20 research studies, the odds of quit smoking using e-cigarettes is 28% lower than without. The studies indicated that, although there may be some methods of e-cigarette use which could assist in smoking cessation, such as frequent use as opposed to intermittent use, e-cigarettes are not currently a more effective smoking cessation method than other options (7).
“Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study”
Purpose: Cross-sectional study examining the efficacy of e-cigarettes in helping individuals quit smoking compared to individuals using NRT or no treatment. Based on the Smoking Toolkit Study, a national survey being conducted in the UK from 2009-2014 regarding smoking cessation habits (8).
Individuals in this study who attempted to quit using e-cigarettes were almost twice as likely to stop smoking than individuals who quit using NRT or no aid
Adjusted the values for outside factors which could have affected the values, such as age, race, and nicotine dependence (8).
In addition, in other studies, it has been found that just the physical stimulus of smoking an e-cigarette, even a non-nicotinic form, can reduce nicotine cravings
E-cigarettes can also provide smokers with nicotine in a less dangerous form, thus reducing the need to smoke regular cigarettes (6)
According to this population study, individuals in the UK who attempted to quit using e-cigarettes between 2009 and 2014 were more likely to report continued abstinence than those who attempted quitting without any aid or using NRT. However, this study is not completely reliable because, since it s a population study, there was little control over outside variables which could have affected the results. For example, individuals who quit using e-cigarettes could have been more motivated to quit. In addition, although the sample size was large, there were much fewer individuals who attempted to quit by e-cigarette. Thus, even though a greater percentage of the e-cigarette users quit smoking, there were fewer of these people.
The purpose of public health is to educate the public and create legislation which protects people from threats to their well-being, while also encouraging individuals to maintain their own health. Based on the information collected and analyzed here, I believe the proper course of action in this situation would be to not tax e-cigarettes as much as regular cigarettes because they do not present as much risk to human health. However, they should still be taxed slightly more than normal sales tax because they do still contain nicotine and other harmful substances, albeit in smaller proportions than traditional cigarettes. Such practices would hopefully encourage individuals to smoke e-cigarettes rather than normal cigarettes, reducing the harm they are causing to themselves.
Initially, I thought that my research would lead me to the conclusion that e-cigarettes should be taxed just as m normal cigarettes. However, after doing research I realized that it would be in the best interests of the public to encourage smokers to use products which cause them the least harm, but to educate them on the drawbacks of smoking nonetheless and encourage them to quit.
In addition, I know that most smoking cessation researchers I currently work with are skeptical of e-cigarettes as a smoking cessation treatment. Thus, if more research were done on this topic and e-cigarettes specifically for smoking cessation were designed, I believe experts in the field would be much more likely to support this product.
Evidence for the safety of e-cigarettes compared to traditional cigarettes
Evidence that e-cigarettes present risks to human health comparable to traditional cigarettes
Evidence that e-cigarettes are not an effective smoking cessation treatment
Evidence for the efficacy of e-cigarettes as a smoking cessation method