Electronic cigarette – is it really a safer alternative to smoking?

(Bastien Hervé, Unsplash)

This article was exclusively written for The European Sting by Mr. Mathew Siu Chun Chow, a current second year medical student at the University of Hong Kong. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

The rising trend in the usage of emerging novel smoking products worldwide has sparked conversations about the adoption of such devices, and its associated safety and viability as a substitute. E-cigarettes were initially invented with the intention of being a cleaner and safer alternative to inhale nicotine as compared to traditional smoking methods. However, is this really the case?

It has been well established that traditional cigarette smoking has detrimental risks on our health outcomes, with links to multiple disease entities ranging from chronic obstructive pulmonary disorder, cerebrovascular accidents, neoplastic conditions and more. As a result, many turn to alternative smoking methods, such as electronic and heat-not-burn (HNB) cigarettes as a viable cessation tool. This logic is otherwise known as the “Harm Reduction Strategy” – it is theoretically better to choose the lesser of two evils since electronic cigarettes, although still containing nicotine, may not include other traditional carcinogenic compounds such as tar.

However, a report conducted by the World Health Organisation states that 80% of e-cigarette users do not quit smoking, and instead continue with dual use of both smoking methods (Pisinger, 2015). Moreover, increasing evidence from randomised control studies demonstrates that the use of e-cigarettes serves as a gateway to nicotine dependence – e-cigarettes users are 3.5 times more likely to initiate conventional cigarette smoking than never-users (Soneji et al., 2017). This undoubtedly defeats the purpose for replacement therapy, and may even aggravate health risks associated with nicotine and other chemicals.

The marketing and branding strategies of such products must also be included in the conversation when discussing the ‘safety’ of electronic cigarettes as a better alternative. Novel packaging designs and the availability of diverse flavours distract the public from the associated health risks, and normalises or even glamorizes behaviour that endangers their own health. Direct and targeted marketing techniques by e-cigarette companies that directly appeal to the younger generation are alarming, as most substance use cases are established during adolescence (U.S. Department of Health and Human Services, 2016).

In contrast, cigarette packaging are usually plastered with visually stimulating health warning labels, sending a clearer message to the general public about the adverse health effects that cigarette smoking entails. This mismatch in the perceived safety of traditional cigarettes and alternative smoking products is aggravated by misconceptions about the health risks of non-traditional smoking methods due to the lack of reliable and valid studies on the topic. However, scientific evidence about e-cigarettes is only beginning to emerge now, particularly as it pertains to its long term effects and health hazards.

Therefore, the safer alternative to traditional cigarette smoking would not electronic cigarettes; the better option would be abstinence and quitting altogether. A viable option would be to adopt strategies akin to the MPOWER package for alternative smoking products, particularly to strengthen the front of public education and awareness.  It is ideal to completely remove all forms of smoking methods from the market; however, we can only make progress by small steps, and this most definitely requires the collaboration of the general public, medical professionals, the government, and other important stakeholders.

References

Pisinger, C. (2015). A systematic review of health effects of electronic cigarettes. Glostrup, Denmark: World Health Organisation. Retrieved from https://www.who.int/tobacco/industry/product_regulation/BackgroundPapersENDS3_4November-.pdf

Soneji, S., Barrington-Trimis, J., Wills, T., Leventhal, A., Unger, J., & Gibson, L. et al. (2017). Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults. JAMA Pediatrics, 171(8), 788. doi: 10.1001/jamapediatrics.2017.1488

U.S. Department of Health and Human Services. (2016). E-Cigarette Use Among Youth and Young Adults: a report of the Surgeon General. Retrieved from https://article.images.consumerreports.org/prod/content/dam/consumerist/2016/12/2016_sgr_full_report_non-508.pdf

About the author

Mathew Siu Chun Chow is a current second year medical student at the University of Hong Kong. Currently, he is the President of the Asian Medical Students’ Association Hong Kong (AMSAHK – Hong Kong), which is an associate member of the International Federation of Medical Students Associations (IFMSA). He is deeply engaged with issues related to public health and the human right to health both locally and globally.