Vaping Delivers Benefits to Non-Quitting Smokers

The body of evidence supporting smokers switching to electronic cigarettes has been steadily growing for over a decade, with all of the British public health organisations recommending vaping as an alternative to smoking. In the past, smokers were told they’d only benefit if they fully swapped over, but latest work from The University of Kansas Cancer Centre, California State University San Marcos and Brown University indicates dual users may also experience health improvements.

The UK Royal College of Physicians previously said: “Among smokers, e-cigarette use is likely to lead to quit attempts that would not otherwise have happened, and in a proportion of these to successful cessation. In this way, e-cigarettes can act as a gateway from smoking.”

And, “the available data suggest that they are unlikely to exceed 5% [of the risk] of those associated with smoked tobacco products, and may well be substantially lower than this figure.”
 
Public Health England’s 2015 independent evidence report, stated: “While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals which are present pose limited danger.”

The National Health Service adding: “You will not get the full benefit from vaping unless you stop smoking cigarettes completely.”
 
But this position could be set to change following the work in America.
 
The research team carried out a randomised control study over a six-week period to determine how vaping compared to smoking within African American and Latino communities.
 
Lead researcher Nikki Nollen said: “Fourth generation e-cigarettes contain high concentrations of nicotine and other appealing features that may support switching and reduce potential health risks among those who smoke combustible cigarettes. We wanted to examine the biomarkers of exposure in both groups and determine the risk-benefit trade-off of e-cigarettes.”

The team found that dual-users showed marked drops in tobacco-specific carcinogens, a toxin (termed NNAL) that is present in high volumes in cigarette use only smokers. Plus, even though the dual-users continued to smoke some cigarettes, they returned lower carbon monoxide measurements compared to when they only smoked and self-reported improved respiratory symptoms.
 
Nikki Nollen added: “What was most surprising was the magnitude of change experienced by those in the e-cigarette group. They reduced their NNAL by 64%, carbon monoxide by 47% and respiratory symptoms by 37% compared to those in the control group who continued to smoke cigarettes as usual.”

The full findings:

“At week 6, approximately one-quarter of participants in the e-cigarette group [28.1%] were classified as exclusive e-cigarette users, more than half [57.9%] were dual users, and a small number were exclusive cigarette smokers [14.0%]. At 6 months, 24.0% were still classified as exclusive e-cigarette users, 33.3% were dual users, 32.3% were exclusive cigarette smokers, and 10.4% did not use either e-cigarettes or cigarettes.
 
“Participants who switched exclusively to e-cigarettes demonstrated significant reductions from baseline in NNAL … and self-reported respiratory symptoms. Participants classified as dual users also experienced significant reductions in NNAL and self-reported respiratory symptoms.”

They concluded:

“Dual use of e-cigarettes and cigarettes was the most common tobacco use trajectory”, meaning most did not vape exclusively or quit nicotine products altogether. This has been problematic for many traditional tobacco controllers in the past.

But they noted, “participants in the e-cigarette group who continued smoking while also using e-cigarettes significantly reduced their cigarette consumption”. Many UK quit services say that it’s not the cigarettes you smoke, it’s the ones you don’t.
 
They state that the work provides evidence that “dual use of e-cigarettes and cigarettes did not create an additive burden on biomarkers of toxicant exposure compared with cigarette smoking”. In fact, it demonstrates that there are health improvements.
 
It has yet to be shown that this group would then be more likely to swap to full-time vaping or quit nicotine, but it gives food for thought to British public health bodies and the advice they are currently handing out.