Electronic Cigarettes: Potential for Public Health Benefits
When given only the options of smoking or completely giving up nicotine, many smokers will not give it up and will keep on smoking, thus exposing themselves to increasing health risks. However, if it is considered that nicotine per se does not cause high risk, a third option is also available to smokers; the reduction of smoking-related diseases by taking nicotine in a low-risk form. Tobacco harm reduction (THR), the substitution of low-risk nicotine products for cigarette smoking, is likely to offer huge public health benefits. THR empowers smokers to gain control over the consequences of their nicotine addiction. Harm reduction is particularly compelling for the use of nicotine because so many people have such a strong propensity for using it. Harm reduction is arguably the most complex, controversial and divisive issue in tobacco control today.[40]
Besides the convincing example of Swedish snus (a type of finely ground moist snuff that delivers significant levels of nicotine) as a successful THR strategy,[41–43] electronic cigarettes may prove to be an even more attractive long-term alternative because of their similarities to smoking, including the hand-to-mouth repetitive motion and the visual cue of a smoke-like vapor. Of course, these products may contribute to tobacco addiction, but the dream of a tobacco-free, nicotine-free world is just that – a dream. This is owing to nicotine's estalished beneficial effects, such as an improved ability to concentrate, pay attention and remember, as well as the capacity for relieving symptoms of mood impairments.[21] Although much more research is required, early results show indications that electronic cigarettes could be effective for helping long-term, inveterate smokers to become abstinent from inhaling smoke. Health improvements enjoyed by switchers do not differ from health improvements enjoyed by nicotine abstainers. In exposure terms, switching to the electronic cigarette equates to quitting. If sufficient numbers of smokers can transfer their nicotine dependence to the less-harmful electronic cigarette, millions of lives could be saved.
Several surveys paint a picture of the typical electronic cigarette consumer as a long-term smoker who has tried repeatedly to quit.[9,10,38,212] The median age of respondents ranges from late 30s to mid-40s. The percentage of respondents using the electronic cigarette as a complete replacement for smoking ranges from 31 to over 79%. Most individuals who did not stop smoking completely reduced the number of cigarettes smoked. Over 90% reported that their health had improved. When asked the main reason why they chose to use an electronic cigarette, 64.6% stated "to continue to have a 'smoking' experience, but with reduced health risks." In actual fact, smokers gaining control over the consequences of their nicotine addiction by switching to an electronic cigarette are already putting the basic principles of THR into practice. This strategy is cost effective and accessible today to almost all smokers.
It is of paramount importance that the government and trusted health information sites provide accurate and truthful information about the relative risks of smoking and alternatives to smoking. If the public continues to be convinced that electronic cigarettes are as harmful as (if not even more harmful) than smoking, millions of smokers will be dissuaded from switching to a much less hazardous alternative. In a recent editorial published in the British Medical Journal, Ron Borland commented that by allowing these products to be sold in the UK, the government's Cabinet Office seems to be taking the approach with the greatest potential for public health benefits.[44] The Royal College of Physicians has stated: "It is possible that alternative nicotine products could provide a safer long-term substitute for cigarette smoking. If so, this could benefit individual and public health".[212] The electronic cigarette may provide a safer long-term substitute for cigarette smoking.
Expert Rev Resp Med. 2012;6(1):63-74. © 2012 Expert Reviews Ltd.
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