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Special Issue "Electronic Cigarettes as a Tool in Tobacco Harm Reduction"

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 September 2014)

Special Issue Editor

Guest Editor
Dr. Konstantinos Farsalinos

Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece
E-Mail
Phone: +306977454837
Interests: electronic cigarettes; tobacco harm reduction; cardiovascular imaging

Special Issue Information

Dear Colleagues,

Electronic cigarettes have been introduced to the market in recent years as smoking alternatives. Despite major concerns from public health authorities, they have gained tremendous popularity and acceptance by consumers, with sales growing exponentially every year. Users (commonly called “vapers”) have organized themselves through the development of internet forums and consumer associations. There is an important social aspect in electronic cigarette use. Such characteristics have never been observed in any other product in the tobacco harm reduction or smoking cessation area. However, there are a lot of questions that need to be answered, as well as confusions and misunderstandings that need to be clarified. Is there a potential for electronic cigarettes to be a breakthrough in tobacco harm reduction? Do they represent a gateway from or to smoking? Are they effective in promoting smoking reduction or as a complete substitution, and why? Is there a potential to cause harm, and at what level compared to smoking? How should they be regulated? These are crucial issues that need to be addressed. Therefore, I invite you to submit your research and opinion, in order to better understand and explore this new phenomenon.

Dr. Konstantinos Farsalinos
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed Open Access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs).

Published Papers (10 papers)

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Research

Jump to: Review, Other

Open AccessArticle How Has the Availability of Snus Influenced Cigarette Smoking in Norway?
Int. J. Environ. Res. Public Health 2014, 11(11), 11705-11717; doi:10.3390/ijerph111111705
Received: 3 September 2014 / Revised: 24 October 2014 / Accepted: 4 November 2014 / Published: 13 November 2014
Cited by 6 | PDF Full-text (741 KB) | HTML Full-text | XML Full-text
Abstract
Background: In Norway, low-nitrosamine smokeless tobacco (snus) is allowed to compete with cigarettes for market share. We aimed to study how the availability of snus influenced overall tobacco consumption, smoking initiation and smoking cessation. We discuss whether the Norwegian experience with snus
[...] Read more.
Background: In Norway, low-nitrosamine smokeless tobacco (snus) is allowed to compete with cigarettes for market share. We aimed to study how the availability of snus influenced overall tobacco consumption, smoking initiation and smoking cessation. We discuss whether the Norwegian experience with snus can have any transfer value for e-cigarettes. Methods: We analysed consumption data from registered and unregistered supply sources of tobacco. We calculated quit-smoking ratios across snus use status in nine datasets comprising a total of 19,269 ever-smokers. Trends in snus use and smoking were derived from time-series of annual; cross-sectional; nationally representative surveys for the period 1985–2013. Results: The market share for snus increased from 4% in 1985 to 28% in 2012, but overall tobacco consumption decreased by 20.3% over this same period. Snus was the most common method for smoking cessation. Compared with smokers with no experience of using snus, the quit ratio for smoking was significantly higher for daily snus users in seven of the nine datasets analysed. Among young male adults, the prevalence of smoking (daily + occasional) was reduced from 50% in 1985 to 21% in 2013. Over the same period, use of snus increased from 9% to 33%. This negative correlation (r = −0.900, p < 0.001) was also observed among young females (r = −0.811, p < 0.001), but the trend shift in tobacco preferences occurred some years later. Conclusions: The experience with snus in Norway might indicate what will happen when alternative nicotine products––are allowed to compete with cigarettes in the nicotine market. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)
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Open AccessArticle Comparative In Vitro Toxicity Profile of Electronic and Tobacco Cigarettes, Smokeless Tobacco and Nicotine Replacement Therapy Products: E-Liquids, Extracts and Collected Aerosols
Int. J. Environ. Res. Public Health 2014, 11(11), 11325-11347; doi:10.3390/ijerph111111325
Received: 1 August 2014 / Revised: 16 October 2014 / Accepted: 24 October 2014 / Published: 30 October 2014
Cited by 15 | PDF Full-text (683 KB) | HTML Full-text | XML Full-text
Abstract
The use of electronic cigarettes (e-cigs) continues to increase worldwide in parallel with accumulating information on their potential toxicity and safety. In this study, an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of
[...] Read more.
The use of electronic cigarettes (e-cigs) continues to increase worldwide in parallel with accumulating information on their potential toxicity and safety. In this study, an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of certain commercial e-cigs and compared to tobacco burning cigarettes, smokeless tobacco (SLT) products and a nicotine replacement therapy (NRT) product. The toxicity evaluation was performed on e-liquids and pad-collected aerosols of e-cigs, pad-collected smoke condensates of tobacco cigarettes and extracts of SLT and NRT products. In all assays, exposures with e-cig liquids and collected aerosols, at the doses tested, showed no significant activity when compared to tobacco burning cigarettes. Results for the e-cigs, with and without nicotine in two evaluated flavor variants, were very similar in all assays, indicating that the presence of nicotine and flavors, at the levels tested, did not induce any cytotoxic, genotoxic or inflammatory effects. The present findings indicate that neither the e-cig liquids and collected aerosols, nor the extracts of the SLT and NRT products produce any meaningful toxic effects in four widely-applied in vitro test systems, in which the conventional cigarette smoke preparations, at comparable exposures, are markedly cytotoxic and genotoxic. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)
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Open AccessArticle Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints
Int. J. Environ. Res. Public Health 2014, 11(11), 11220-11248; doi:10.3390/ijerph111111220
Received: 12 June 2014 / Revised: 8 October 2014 / Accepted: 14 October 2014 / Published: 29 October 2014
Cited by 32 | PDF Full-text (905 KB) | HTML Full-text | XML Full-text
Abstract
Background: Smoking reduction remains a pivotal issue in public health policy, but quit rates obtained with traditional quit-smoking therapies remain disappointingly low. Tobacco Harm Reduction (THR), aiming at less harmful ways of consuming nicotine, may provide a more effective alternative. One promising candidate
[...] Read more.
Background: Smoking reduction remains a pivotal issue in public health policy, but quit rates obtained with traditional quit-smoking therapies remain disappointingly low. Tobacco Harm Reduction (THR), aiming at less harmful ways of consuming nicotine, may provide a more effective alternative. One promising candidate for THR are electronic cigarettes (e-cigs). The aim of this study was to investigate the efficacy of second-generation e-cigs both in terms of acute craving-reduction in the lab and in terms of smoking reduction and experienced benefits/complaints in an eight-month Randomized Controlled Trial (RCT). Design: RCT with three arms. Methods: Participants (N = 48) unwilling to quit smoking were randomized into two e-cig groups and one control group. During three lab sessions (over two months) participants, who had been abstinent for four hours, vaped/smoked for five minutes, after which we monitored the effect on craving and withdrawal symptoms. eCO and saliva cotinine levels were also measured. In between lab sessions, participants in the e-cig groups could use e-cigs or smoke ad libitum, whereas the control group could only smoke. After the lab sessions, the control group also received an e-cig. The RCT included several questionnaires, which repeatedly monitored the effect of ad libitum e-cig use on the use of tobacco cigarettes and the experienced benefits/complaints up to six months after the last lab session. Results: From the first lab session on, e-cig use after four hours of abstinence resulted in a reduction in cigarette craving which was of the same magnitude as when a cigarette was smoked, while eCO was unaffected. After two months, we observed that 34% of the e-cig groups had stopped smoking tobacco cigarettes, versus 0% of the control group (difference p < 0.01). After five months, the e-cig groups demonstrated a total quit-rate of 37%, whereas the control group showed a quit rate of 38% three months after initiating e-cig use. At the end of the eight-month study, 19% of the e-cig groups and 25% of the control group were totally abstinent from smoking, while an overall reduction of 60% in the number of cigarettes smoked per day was observed (compared to intake). eCO levels decreased, whereas cotinine levels were the same in all groups at each moment of measurement. Reported benefits far outweighed the reported complaints. Conclusion: In a series of controlled lab sessions with e-cig naïve tobacco smokers, second generation e-cigs were shown to be immediately and highly effective in reducing abstinence induced cigarette craving and withdrawal symptoms, while not resulting in increases in eCO. Remarkable (>50 pc) eight-month reductions in, or complete abstinence from tobacco smoking was achieved with the e-cig in almost half (44%) of the participants. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)
Open AccessArticle Comparison of Select Analytes in Exhaled Aerosol from E-Cigarettes with Exhaled Smoke from a Conventional Cigarette and Exhaled Breaths
Int. J. Environ. Res. Public Health 2014, 11(11), 11177-11191; doi:10.3390/ijerph111111177
Received: 21 August 2014 / Revised: 14 October 2014 / Accepted: 16 October 2014 / Published: 27 October 2014
Cited by 12 | PDF Full-text (519 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Exhaled aerosols were collected following the use of two leading U.S. commercial electronic cigarettes (e-cigarettes) and a conventional cigarette by human subjects and analyzed for phenolics, carbonyls, water, glycerin and nicotine using a vacuum-assisted filter pad capture system. Exhaled breath blanks were determined
[...] Read more.
Exhaled aerosols were collected following the use of two leading U.S. commercial electronic cigarettes (e-cigarettes) and a conventional cigarette by human subjects and analyzed for phenolics, carbonyls, water, glycerin and nicotine using a vacuum-assisted filter pad capture system. Exhaled breath blanks were determined for each subject prior to each product use and aerosol collection session. Distribution and mass balance of exhaled e-cigarette aerosol composition was greater than 99.9% water and glycerin, and a small amount (<0.06%) of nicotine. Total phenolic content in exhaled e-cigarette aerosol was not distinguishable from exhaled breath blanks, while total phenolics in exhaled cigarette smoke were significantly greater than in exhaled e-cigarette aerosol and exhaled breaths, averaging 66 µg/session (range 36 to 117 µg/session). The total carbonyls in exhaled e-cigarette aerosols were also not distinguishable from exhaled breaths or room air blanks. Total carbonyls in exhaled cigarette smoke was significantly greater than in exhaled e-cigarette aerosols, exhaled breath and room air blanks, averaging 242 µg/session (range 136 to 352 µg/session). These results indicate that exhaled e-cigarette aerosol does not increase bystander exposure for phenolics and carbonyls above the levels observed in exhaled breaths of air. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)
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Open AccessArticle Reasons for Starting and Stopping Electronic Cigarette Use
Int. J. Environ. Res. Public Health 2014, 11(10), 10345-10361; doi:10.3390/ijerph111010345
Received: 29 June 2014 / Revised: 28 September 2014 / Accepted: 28 September 2014 / Published: 3 October 2014
Cited by 29 | PDF Full-text (694 KB) | HTML Full-text | XML Full-text
Abstract
The aim of our study was to explore reasons for starting and then stopping electronic cigarette (e-cigarette) use. Among a national sample of 3878 U.S. adults who reported ever trying e-cigarettes, the most common reasons for trying were curiosity (53%); because a friend
[...] Read more.
The aim of our study was to explore reasons for starting and then stopping electronic cigarette (e-cigarette) use. Among a national sample of 3878 U.S. adults who reported ever trying e-cigarettes, the most common reasons for trying were curiosity (53%); because a friend or family member used, gave, or offered e-cigarettes (34%); and quitting or reducing smoking (30%). Nearly two-thirds (65%) of people who started using e-cigarettes later stopped using them. Discontinuation was more common among those whose main reason for trying was not goal-oriented (e.g., curiosity) than goal-oriented (e.g., quitting smoking) (81% vs. 45%, p < 0.001). The most common reasons for stopping e-cigarette use were that respondents were just experimenting (49%), using e-cigarettes did not feel like smoking cigarettes (15%), and users did not like the taste (14%). Our results suggest there are two categories of e-cigarette users: those who try for goal-oriented reasons and typically continue using and those who try for non-goal-oriented reasons and then typically stop using. Research should distinguish e-cigarette experimenters from motivated users whose decisions to discontinue relate to the utility or experience of use. Depending on whether e-cigarettes prove to be effective smoking cessation tools or whether they deter cessation, public health programs may need distinct strategies to reach and influence different types of users. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)
Open AccessArticle Effect of Smoking Abstinence and Reduction in Asthmatic Smokers Switching to Electronic Cigarettes: Evidence for Harm Reversal
Int. J. Environ. Res. Public Health 2014, 11(5), 4965-4977; doi:10.3390/ijerph110504965
Received: 3 April 2014 / Revised: 24 April 2014 / Accepted: 30 April 2014 / Published: 8 May 2014
Cited by 26 | PDF Full-text (393 KB) | HTML Full-text | XML Full-text
Abstract
Electronic cigarettes (e-cigs) are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who
[...] Read more.
Electronic cigarettes (e-cigs) are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who quit or reduced their tobacco consumption by switching to these products. We retrospectively reviewed changes in spirometry data, airway hyper-responsiveness (AHR), asthma exacerbations and subjective asthma control in smoking asthmatics who switched to regular e-cig use. Measurements were taken prior to switching (baseline) and at two consecutive visits (Follow-up/1 at 6 (±1) and Follow-up/2 at 12 (±2) months). Eighteen smoking asthmatics (10 single users, eight dual users) were identified. Overall there were significant improvements in spirometry data, asthma control and AHR. These positive outcomes were noted in single and dual users. Reduction in exacerbation rates was reported, but was not significant. No severe adverse events were noted. This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)
Open AccessArticle Characteristics, Perceived Side Effects and Benefits of Electronic Cigarette Use: A Worldwide Survey of More than 19,000 Consumers
Int. J. Environ. Res. Public Health 2014, 11(4), 4356-4373; doi:10.3390/ijerph110404356
Received: 10 February 2014 / Revised: 14 April 2014 / Accepted: 15 April 2014 / Published: 22 April 2014
Cited by 88 | PDF Full-text (232 KB) | HTML Full-text | XML Full-text
Abstract
Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely
[...] Read more.
Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use. Methods: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions. Conclusions: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)
Open AccessArticle Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey
Int. J. Environ. Res. Public Health 2013, 10(12), 7272-7282; doi:10.3390/ijerph10127272
Received: 19 November 2013 / Revised: 11 December 2013 / Accepted: 12 December 2013 / Published: 17 December 2013
Cited by 51 | PDF Full-text (192 KB) | HTML Full-text | XML Full-text
Abstract
Background: A major characteristic of the electronic cigarette (EC) market is the availability of a large number of different flavours. This has been criticised by the public health authorities, some of whom believe that diverse flavours will attract young users and that ECs
[...] Read more.
Background: A major characteristic of the electronic cigarette (EC) market is the availability of a large number of different flavours. This has been criticised by the public health authorities, some of whom believe that diverse flavours will attract young users and that ECs are a gateway to smoking. At the same time, several reports in the news media mention that the main purpose of flavour marketing is to attract youngsters. The importance of flavourings and their patterns of use by EC consumers have not been adequately evaluated, therefore, the purpose of this survey was to examine and understand the impact of flavourings in the EC experience of dedicated users. Methods: A questionnaire was prepared and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 4,618 participants were included in the analysis, with 4,515 reporting current smoking status. The vast majority (91.1%) were former smokers, while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. Both subgroups had a median smoking history of 22 years and had been using ECs for 12 months. On average they were using three different types of liquid flavours on a regular basis, with former smokers switching between flavours more frequently compared to current smokers; 69.2% of the former subgroup reported doing so on a daily basis or within the day. Fruit flavours were more popular at the time of participation, while tobacco flavours were more popular at initiation of EC use. On a scale from 1 (not at all important) to 5 (extremely important) participants answered that variability of flavours was “very important” (score = 4) in their effort to reduce or quit smoking. The majority reported that restricting variability will make ECs less enjoyable and more boring, while 48.5% mentioned that it would increase craving for cigarettes and 39.7% said that it would have been less likely for them to reduce or quit smoking. The number of flavours used was independently associated with smoking cessation. Conclusions: The results of this survey of dedicated users indicate that flavours are marketed in order to satisfy vapers’ demand. They appear to contribute to both perceived pleasure and the effort to reduce cigarette consumption or quit smoking. Due to the fact that adoption of ECs by youngsters is currently minimal, it seems that implementing regulatory restrictions to flavours could cause harm to current vapers while no public health benefits would be observed in youngsters. Therefore, flavours variability should be maintained; any potential future risk for youngsters being attracted to ECs can be sufficiently minimized by strictly prohibiting EC sales in this population group. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

Review

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Open AccessReview Carbonyl Compounds Generated from Electronic Cigarettes
Int. J. Environ. Res. Public Health 2014, 11(11), 11192-11200; doi:10.3390/ijerph111111192
Received: 24 June 2014 / Revised: 2 October 2014 / Accepted: 16 October 2014 / Published: 28 October 2014
Cited by 32 | PDF Full-text (189 KB) | HTML Full-text | XML Full-text
Abstract
Electronic cigarettes (e-cigarettes) are advertised as being safer than tobacco cigarettes products as the chemical compounds inhaled from e-cigarettes are believed to be fewer and less toxic than those from tobacco cigarettes. Therefore, continuous careful monitoring and risk management of e-cigarettes should be
[...] Read more.
Electronic cigarettes (e-cigarettes) are advertised as being safer than tobacco cigarettes products as the chemical compounds inhaled from e-cigarettes are believed to be fewer and less toxic than those from tobacco cigarettes. Therefore, continuous careful monitoring and risk management of e-cigarettes should be implemented, with the aim of protecting and promoting public health worldwide. Moreover, basic scientific data are required for the regulation of e-cigarette. To date, there have been reports of many hazardous chemical compounds generated from e-cigarettes, particularly carbonyl compounds such as formaldehyde, acetaldehyde, acrolein, and glyoxal, which are often found in e-cigarette aerosols. These carbonyl compounds are incidentally generated by the oxidation of e-liquid (liquid in e-cigarette; glycerol and glycols) when the liquid comes in contact with the heated nichrome wire. The compositions and concentrations of these compounds vary depending on the type of e-liquid and the battery voltage. In some cases, extremely high concentrations of these carbonyl compounds are generated, and may contribute to various health effects. Suppliers, risk management organizations, and users of e-cigarettes should be aware of this phenomenon. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

Other

Jump to: Research, Review

Open AccessDiscussion The Case in Favor of E-Cigarettes for Tobacco Harm Reduction
Int. J. Environ. Res. Public Health 2014, 11(6), 6459-6471; doi:10.3390/ijerph110606459
Received: 10 April 2014 / Revised: 19 May 2014 / Accepted: 9 June 2014 / Published: 20 June 2014
Cited by 8 | PDF Full-text (186 KB) | HTML Full-text | XML Full-text
Abstract
A carefully structured Tobacco Harm Reduction (THR) initiative, with e-cigarettes as a prominent THR modality, added to current tobacco control programming, is the most feasible policy option likely to substantially reduce tobacco-attributable illness and death in the United States over the next 20
[...] Read more.
A carefully structured Tobacco Harm Reduction (THR) initiative, with e-cigarettes as a prominent THR modality, added to current tobacco control programming, is the most feasible policy option likely to substantially reduce tobacco-attributable illness and death in the United States over the next 20 years. E-cigarettes and related vapor products are the most promising harm reduction modalities because of their acceptability to smokers. There are about 46 million smokers in the United States, and an estimated 480,000 deaths per year attributed to cigarette smoking. These numbers have been essentially stable since 2004. Currently recommended pharmaceutical smoking cessation protocols fail in about 90% of smokers who use them as directed, even under the best of study conditions, when results are measured at six to twelve months. E-cigarettes have not been attractive to non-smoking teens or adults. Limited numbers non-smokers have experimented with them, but hardly any have continued their use. The vast majority of e-cigarette use is by current smokers using them to cut down or quit cigarettes. E-cigarettes, even when used in no-smoking areas, pose no discernable risk to bystanders. Finally, addition of a THR component to current tobacco control programming will likely reduce costs by reducing the need for counseling and drugs. Full article
(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Type of Paper: Article
Title: Nicotine safety in the context of e-cigarette use and tobacco dependence
Author: Jacques Le Houezec
Affiliation: Amzer Glas, 176, rue de Brest, F-35000 Rennes, France; E-Mail: Jacques.lehouezec@amzer-glas.com
Abstract: Nicotine is responsible for tobacco dependence but not for tobacco-related diseases. Nicotine is quite safe when used at doses smokers or electronic cigarette users (vapers) inhale. Moreover, its toxicity has been unduly exaggerated for more than a century and repeatedly reported in articles without citing original references. Smoking-related harm is due to the more than 7,000 substances of the smoke, including cancer causing substances, oxidant gases, and carbon monoxide (CO), but not from nicotine. Most toxic substances are generated from the combustion of tobacco, which does not occur in electronic cigarettes, meaning that there is no CO and no oxidant gases. Although some toxic substances (cancer causing substances such as aldehydes or heavy metals) have been found in the vapour of electronic cigarettes, their concentrations are considerably lower (by one to two orders of magnitude) compared to cigarette smoke. On the contrary, nicotine intake has been found to be safe when inhaled, is not classified as a carcinogenic substance and has minimal (if any) contribution to smoking-related cardiovascular disease. Consequently, electronic cigarettes are a considerably safer method of nicotine intake and should not pose significant health problems, at least in case of short-term use. More data are needed for long-term use. However, considering the long-term effects of inhaled nicotine, no alarming health effects have emerged from animal studies, which is reassuring for smokers who would use electronic cigarettes for harm reduction.

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