What should we think about e-cigarettes?

k300_flavors_fruitsMotherlode notes a trend in e-cigarettes and is concerned:

I was standing outside our neighborhood ice cream shop one recent evening when I noticed a plume of smoke rise above a gaggle of teenagers waiting in line ahead of me.

“Wow,” I thought, “that takes some serious chutzpah.” These kids were smoking in public without the fear of getting caught.

A few minutes later, I realized that it wasn’t actually smoke coming out of their mouths; it was vapor, being inhaled and exhaled from battery-operated electronic cigarettes.

E-cigs are devices that vaporize an addictive nicotine-laced liquid solution into an aerosol mist that simulates the act of tobacco smoking. Also known as “personal vaporizers” and “electronic nicotine delivery systems,” e-cigs are sold in trendy shops and are increasingly turning up in bars, clubs, workplaces and other spots where traditional tobacco cigarettes have long been outlawed.

As a mother, I find this terribly distressing.

I’ve spent years telling my children that smoking can kill you. And thanks to decades of sensible public health policies — including laws banning cigarette advertising and smoking in public places — as well as brutally graphic antismoking marketing campaigns, my 15- and 21-year-old kids have grown up in a culture in which puffing on cigarettes is stigmatized. Last year, cigarette smoking among teens fell to a record low.

Now, it seems, all that progress is about to vaporize. “Smoking,” at least in the form of vaping, is becoming cool again. This week, the Centers for Disease Control reported that 1.8 million middle- and high-school students said they had tried e-cigarettes in 2012 — double the number from the previous year.

Kleiman urges restraint in regulating e-cigarettes:

The FDA’s desire to have enough authority to require e-cigarette sellers to manufacture them properly and label them accurately, to limit marketing aimed at minors, and to be able to force the removal of unsafe product from the market, seems quite reasonable. What’s not reasonable, and what is likely to be bad, on balance, for health, is the idea that anything that delivers nicotine vapor should have the same rules applied to it as an actual cigarette.

At the same time, he acknowledges the unknowable:

None of this is simple or straightforward. I can imagine myself, five years from now, bitterly regretting not having spotted the e-cigarette menace before it got out of control. But regulations can do harm as well as good, and what I’m not hearing right now is much willingness to think carefully and proceed with caution. The principle of aggregate harm minimization, net of benefits (and nicotine does have benefits, including at least a temporary cognitive boost) still seems to me the right approach, for nicotine no less than for cannabis or cocaine. Unless and until someone can point to demonstrated and serious risks, rather than speculative ones, e-cigarettes ought to be thought of mostly as a part of the solution rather than as a part of the problem.

What does Kleiman mean by part of the solution? A recent study found that e-cigarettes outperformed traditional nicotine replacement for smokers trying to quit:

the New Zealand government funded a head-to-head comparison study. Chris Bullen and his colleagues at the National Institute for Health Innovation in Auckland gave e-cigarettes to 289 smokers who were trying to quit. A separate group of 295 people were given nicotine patches, while 73 received dummy nicotine-free e-cigarettes.

Six months later, the team asked participants if their attempts to quit had been a success. Those who had used the nicotine e-cigarettes had the highest success rate: 7.3 per cent had managed to stay away from tobacco. Of the nicotine patch users, 5.8 per cent had quit. And of those taking the placebo around 4 per cent were successful.

“The quitting rates were about 25 per cent better than patches for the e-cigarettes, but statistically we’re more confident with saying that they were comparable, rather than superior,” says Bullen.

Vaportrim-Fruit-Flavored-PuffsWhile we’re trying to understand e-cigarettes, manufacturers are embedding themselves in our culture. In the U.S., it’s been using b-list celebrities, appealing to current smokers’ sense of oppression and marketing them as a diet aid. In the U.K., they are using sport:

Merthyr Town Football Club is to rename its ground the Cigg-e Stadium after its sponsor, an electronic cigarette firm.

The Southern League club has signed a three-year deal with the company which has just opened a shop in the town.

 

 

Quitting Smoking and Anxiety

A 21 mg dose Nicoderm CQ patch applied to the ...
(Photo credit: Wikipedia)

 

A recent study finds that quitting smoking reduces anxiety:

 

The study followed 491 smokers attending NHS smoking cessation clinics in England. All participants were given a nicotine patch and attended eight weekly appointments.

Of the sample, 21.6% (106 people) had a diagnosed mental health problem, primarily mood and anxiety disorders.

All participants were assessed for their anxiety levels at the start of the research, and were also asked whether their motives for smoking were ‘mainly for pleasure’, ‘mainly to cope’ or ‘about equal’.

Six months after the start of the trial, 68 of the smokers (14%) had managed to quit smoking – 10 of these had a current psychiatric disorder. The researchers found a significant difference in anxiety between those who had successfully quit and those who had relapsed.

All of those who had quit smoking showed a decrease in anxiety. People who had previously smoked to cope showed a more significant decrease in anxiety compared to those who had previously smoked for pleasure.

 

However, some people who tried to quit and failed became more anxious:

 

Among the smokers who relapsed, those smoking for enjoyment showed no change in anxiety, but those who smoked to cope and those with a diagnosed mental health problem showed an increase in anxiety

 

I wonder if another study looking at the natural history of attempts to quit smoking may offer a little insight into that increase in anxiety:

 

Within the month of the study, 32% of smokers had multiple episodes of intentions to not smoke, and 64% transitioned among smoking as usual, abstinence, and reduction status on multiple occasions. When participants reported that they intended not to smoke the next day, 56% of the time they did not make a quit attempt the next day. Just under half (44%) of quit attempts occurred on days with no intentions to quit the night before. Most quit attempts (69%) lasted less than a day. Reduction in cigs/day was as common as abstinence.

 

It’s striking how fluid motivation and attempts to quit are. Relapses don’t mean I’m a smoker. Quitting is a process. Many smokers probably constantly evaluate their status in that process.