Are you confused about e-cigarettes? Many people are. Research shows that many Australians have heard of e-cigarettes, and some have tried them, but there is also a lot of uncertainty. Nicotine e-cigarettes are readily available in some countries but not Australia. New Zealand has joined the list of nations allowing the sale and use of nicotine e-cigarettes including the US and UK. E-cigarettes are fairly new, and since going on the market in 2004, their use has grown significantly.
In the US, the Centres for Disease Prevention estimate there are about nine million e-cigarette users. Given e-cigarette use is likely to increase in Australia as well, it is important to take stock of what we know so far and where more research is needed.
E-cigarettes are handheld electronic devices, which heat a liquid stored in the device that usually contains nicotine and produces a vapour (not smoke) that the user then inhales. The use of e-cigarettes is often referred to as vaping, and users as vapers. Some devices look like large pens, while others are slightly larger with tanks. E-cigarettes deliver the nicotine smokers crave, without the tar and many other toxic substances found in burning tobacco cigarettes.
A review published in 2016 of all the available research on whether e-cigarettes help smokers quit concluded that they appeared to be as effective as other forms of nicotine replacement therapy, such as nicotine patches. But the review acknowledged more studies were needed to confirm that e-cigarettes help smokers quit.
The evidence on the safety of e-cigarettes suggests they are likely to be much safer and pose meaningfully lower risk of harm than continued tobacco smoking. They are not entirely without risk, and the long term effects of e-cigarettes are unknown. The safest option is to not smoke or vape, but due to their reduced risk compared with cigarette smoking, switching to e-cigarettes is recommended by some health authorities, such as the American Cancer Society and the Royal College of Physicians, for smokers who find it difficult to quit smoking.
Given Australia’s youth smoking rates are at their lowest, there is concern legalising vaping in Australia will increase uptake among young people and become a gateway to tobacco smoking. However, the population data from countries like the US and UK, where vaping has been allowed for years, shows that youth smoking has not increased at all in that time. Indeed the data from those countries shows that adult smoking is also decreasing, most vapers are smokers or ex-smokers and only a negligible number of non-smokers take up vaping.
The consumer popularity of e-cigarettes means it’s no surprise that big tobacco is increasing its involvement in this market. Mistrust of the tobacco industry is warranted. However, most of the current e-cigarette makers are independents. The aggressive marketing used for e-cigarettes in the US and other countries is a related concern because it is reminiscent of the 1970s cigarette advertisements, branding and imagery.
If e-cigarettes are legalised in Australia, regulations can be designed to limit the marketability of the devices to young people and non-smokers.
E-cigarettes are a safer option than continued tobacco smoking and may help some smokers to quit. More research is needed to clarify some of the gaps in our understanding of their safety and effectiveness as quitting aids.