Electronic Cigarettes (E-Cigs)

Views of Aficionados and Clinical/Public Health Perspectives

J. Foulds; S. Veldheer; A. Berg

Int J Clin Pract. 2011;65(10):1037-1042.

Clinical Perspective

It is likely that before such research evidence is available, practising clinicians will begin to see patients who are either already using e-cigs or are considering using them for smoking cessation and may ask for advice. Current smokers who are interested in quitting smoking should be strongly directed towards evidence-based treatments (counselling, and approved medicines like nicotine replacement, bupropion or varenicline), rather than to e-cigs.^[19] Patients who have already switched to e-cigs should be informed that although it is highly likely that e-cigs are much less harmful to health than cigarettes, we do not know enough about e-cigs to recommend them to patients. However, if the patient perceives that the e-cig is helping them to stay off cigarettes and is not reporting any health problems likely attributable to the e-cig, then the focus should be on staying smoke-free rather than e-cig free. The health risks from smoking are large and are known with certainty. Comparatively, the health risks from e-cig use are likely much smaller (if any) and temporarily switching to e-cigs will likely yield a large health benefit. Even in this scenario, however, it would be prudent to make clear that the effects of e-cigs are largely unknown and that the most important thing for the patient's health is complete abstinence from tobacco smoking.

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Author contributions
JF conceived the study and collected the data and, together with SV and AB, participated in data analysis, interpretation and drafting of the paper.

Acknowledgement
The authors would like to acknowledge the help of Spike Babaian, of the National Vapers Club, for her assistance in conducting the survey, interpreting the results and permission to use Figure 1.

Cite this: Electronic Cigarettes (E-Cigs) - Medscape - Oct 01, 2011.

Table 1. Characteristics of experienced e-cigarette users and comparison between those who have used for greater than and less than 1 year
Characteristic (n)	Total sample (n = 104)	Use e-cig < 1 year (n = 48)‡	Use e-cig ≥ 1 year (n = 56)	p-value*
% Male (103)	74	72	75	0.760
% White (104)	88	90	86	0.552
% with college degree (102)	40	38	42	0.718
Mean Age (104)	34 ± 8.8	33 ± 8	34 ± 9	0.451
% employed full-time (102)	77	69	83	0.083
% making > 10% income from e-cig business (104)	13	4	20	0.017
Median days since last tobacco product use (102)	150 (0–1234)	90 (0–556)	365 (0–1234)	< 0.0001
% currently use smoked tobacco (104)	12	13	11	0.776
% who have not used tobacco in past the 30 days (102)	78	75	82	0.368
% whose last tobacco product was a cigarette (103)	95	98	93	0.238
Mean years used tobacco (102)	16 ± 10	16 ± 9	17 ± 10	0.521
Mean cigarettes per day (103)	25 ± 13	24 ± 11	26 ± 15	0.086
Time to first smoke of day, in minutes (100)	24 ± 47	18 ± 22	30 ± 61	0.202
Time to first use of e-cig, in minutes (101)	38 ± 38	33 ± 36	42 ± 40	0.238
% woke at night to smoke (104)	49	56	43	0.173
Mean number of quit attempts (91)	9 ± 16	9 ± 16	10 ± 15	0.843
% saying 'extremely important' to stay off tobacco (104)	90	88	93	0.356
% saying 'extremely confident' they can succeed in staying off tobacco (104)	93	94	93	0.856
% previously used an FDA-approved smoking cessation medication (104)	65	67	64	0.799
% previously tried ≥ 2 FDA-approved smoking cessation medications (104)	54	54	54	0.952
% tried to quit 'cold turkey' (104)	73	67	79	0.172
% tried to quit by using smokeless tobacco (104)	21	27	16	0.170
% using an e-cig ≥ 20 days out of the past 28 (103)	89	92	88	0.514
Mean length of e-cig use in months (104)	13 ± 9	5 ± 3	20 ± 7	< 0.0001
% use e-cig liquid > 12 mg concentration (102)	66	83	51	0.001
% who believe they get more or the same amount of nicotine from an e-cig (102)	58	67	50	0.089
% who agree with the following reasons for personal use of e-cig rather than a regular cigarette (104)
I believe the e-cig is less harmful to others	80	73	86	0.105
I believe it is less harmful to my health	98	100	96	0.186
I prefer the taste	80	71	88	0.035
I can use an e-cig in places where smoking is banned	64	67	63	0.658
% have a preferred type of e-cig (104)	79	75	82	0.374
% who believe they inhale e-cig less deeply than cigarettes (44)	34	40	29	0.450
% who believe they use e-cig the same or more frequently than cigarettes (83)	35	45	26	0.064
Median times e-cig used per day (82)	20 (2–60)†	20 (2–60)	20 (2–60)	0.588
% who are able to use an e-cig in places where smoking is banned (104)	90	92	89	0.681
% who started e-cig use with the intention of quitting tobacco soon (103)	73	75	71	0.730
% who believe e-cig helped them quit smoking (102)	99	98	100	0.277
% who plan to continue using e-cig for at least another year (103)	89	94	86	0.174
Median cost of current e-cig in US $ (94)	70 (8–235)	61 (8–235)	80 (20–180)	0.042
Mean weekly cost to maintain vaping, US $ (93)	13 ± 10	12 ± 6	13 ± 12	0.455

Means are expressed as the mean ± standard deviation. Medians are expressed as the median (range). *Differences between means were evaluated by two sample t-tests; proportions were evaluated by chi-square tests; differences between the medians were evaluated with Mann–Whitney test. †Does not include 23 individuals who reported they used their e-cig a 'countless' number or '100 s' of times per day. Respondents who reported using their e-cig more than 60 times per day were coded as 60. ‡The total n for each group varies depending on number who responded to each individual question.

Table 2. E-cigarette model use for those who have used an e-cig for less than 1 year and for those who have used for 1 year or more*
Model of e-cig (n)	Total sample (n = 98)	Use e-cig < 1 year (n = 45)	Use e-cig ≥ 1 year (n = 53)
% who use a modified battery housing PV (3.7/6 v) (e.g. Omega, Silver Bullet, Helix) (38)	39	20	55†
% who use a 5 v regulated battery modification PV (e.g. Triple V, Tekk Mod) (6)	6	9	4
% who use a variable voltage modification PV (e.g. Provari, Eclipse) (6)	6	7	6
% who use a large/long-life proprietary battery PV (e.g. eGo, Joye, Riva) (37)	38	53	24
% who use a standard 3.7 v e-cig (e.g. NJoy, Magma) (8)	8	9	7
% who use a multiple voltage battery compatible modified PV (3.7/5/6/7.4) (e.g. Megalodon) (3)	3	2	4

*PV, personal vaporizer. †Significantly more long-term e-cig users than short-term using modified battery housing PVs (p = 0.001).

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