E-cigarettes got a virtually spotless bill of health Wednesday in a UK research study, which found that e-cigarette use, or “vaping,” is approximately 95% less harmful than tobacco smoking. In addition, the study found that vaping can help people quit altogether, that it poses negligible risk to others through passive inhalation, and that e-cigarettes are not contributing to increased smoking by young people.
The 111-page evidence review and update, commissioned by Public Health England and authored by Professor Ann McNeill and colleagues, was based on two reviews of the literature plus a synthesis of prior work, current findings, unpublished research and national survey data.
The new study does raise one serious concern – but it’s not a health risk. It’s the widespread belief that e-cigarettes are just as dangerous as ordinary cigarettes, if not more so – a belief, researchers say, that is not supported by evidence.
“[T]his report clarifies the truth,” wrote Duncan Selbie, Chief Executive of Public Health England, in the study’s foreword.
“E-cigarettes are not completely risk-free, but when compared to smoking, evidence shows they carry just a fraction of the harm,” said Professor Kevin Fenton, Director of Health and Wellbeing at Public Health England. “The problem is people increasingly think they are at least as harmful, and this may be keeping millions of smokers from quitting.”
McNeill, lead author of the study, added, “There is no evidence that e-cigarettes are undermining England’s falling smoking rates. Instead the evidence consistently finds that e-cigarettes are another tool for stopping smoking, and in my view smokers should try vaping and vapers should stop smoking entirely.”
In fact, she said, “E-cigarettes could be a game-changer, in public health in particular, by reducing the enormous health inequalities caused by smoking.”
The study holds particular significance for people impacted by those health inequalities, notably persons with psychiatric diagnoses, who account for a disproportionate number of adults who still smoke – with devastating health consequences – and often have a tougher time quitting. Vaping, study results indicate, offers a safer alternative that could improve their health and their chances of quitting altogether.
According to the Centers for Disease Control, the smoking rate for U.S. adults with a mental illness is 70% higher than it is for adults with no mental illness. Although people with psychiatric disorders represent only about a fifth of the population, they smoke 3 out of every 10 cigarettes.
Yet persons with mental illness often have fewer options to help them stop smoking. In the U.S., both of two FDA-approved smoking cessation drugs, varenicline (Chantix) and buproprion (Zyban), carry the risk of psychiatric side effects, making them a poor choice for many people with mental illness.
Marcia Purse, who worked as About.com’s Bipolar Disorder Expert for 17 years, and who also has a diagnosis of bipolar disorder II, discovered these risks the hard way when her doctor prescribed her a stop-smoking medication.
“I took bupropion for eight days,” she wrote last June. “My sleep was so disrupted and unrestful that I was left exhausted all the time. Even when I was asleep, my dreams were frenetic. It felt like I was getting no delta (deep) sleep at all. I would fall asleep twice during the day, be down for three hours each time, and still get up unrefreshed.”
Her doctors advised her to quit the medication, and she did – but that didn’t keep her from plummeting into a serious depression, which lingered and deepened even after she quit the drug. She wrote, “I got worse and worse.”
But Purse rallied, and now she’s mounting a new effort to quit smoking. This time she’s trying something different: e-cigarettes.
The UK report validates that decision. “Recent studies support the Cochrane Review findings that [e-cigarettes] can help people to quit smoking and reduce their cigarette consumption,” the study says.
Moreover, according to the new study, there is evidence e-cigarettes can even help diehard smokers and people who have been unsuccessful with other methods.
“E-cigarettes can encourage quitting or cigarette consumption reduction even among those not intending to quit or rejecting other support,” researchers said.
And vaping could be an answer for Purse. In an interview yesterday, she recounted her smoking history and quitting efforts.
“I have been a 1 to 2 pack-a-day smoker for 40 years – with a three-year break in the middle,” Purse told me. “The problem was that during those three smoke-free years, my desire for cigarettes NEVER went away – in great part, I think, because I missed the hand-to-mouth activity. After three years I couldn’t stand it any more, especially because I was gaining weight steadily, so I started smoking again.
“Recently, though, more than one of my doctors has told me that I have to quit smoking. I’m developing some form of COPD and my vocal cords are shot – I’ve been a singer all my life and now I can’t even stay on key. We tried me on bupropion, but it was an instant failure due to side effects, and I can’t take Chantix because of my bipolar disorder. And I LIKE smoking.”
But vaping didn’t seem like a promising alternative at first; it took some trial and error.
“The first e-cigarette I tried was a failure,” Purse said, “mainly because I bite deep into my filters and the ‘filter’ end had no give. Now I’ve been able to find an e-cigarette with a soft rubber tip so I can bite on it.”
And now, she is cautiously hopeful.
“I haven’t switched over completely by any means,” said Purse, “but at this point I feel it is the option for quitting that is most likely to work.”
Resources and Further Information
Marcia Purse’s blogs:
- Echo’s Web
- Echo’s Gardens
“E-Cigarettes, an evidence update: A report commissioned by Public Health England,” 8/19/2015
Reuters UK: E-cigarettes are 95 percent less harmful than tobacco: UK study, 8/19/15
PsychCentral: Smoking Rates Still High Among Mentally Ill, 8/10/15
CDC Vital Signs: Smoking among those with Mental Illness