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US report challenges e-cigarettes ‘smoke screen’

Conventional cigarette (Joyfull/Dreamstime.com)

Most users of e-cigarettes also smoke conventional cigarettes, say researchers

Researchers have called for tougher regulation of the use of e-cigarettes after a review of literature about the devices found many marketing claims are untrue or unsupported.

Several studies have identified nicotine and toxins, including carcinogens, in the exhaled aerosol and nicotine absorption and reduced lung function has been documented in people passively exposed.

The authors of the review, based on analysis of 82 studies and which appears in Circulation (2014;129:1972), say that rather than helping smokers to quit, e-cigarettes “renormalise” smoking behaviour and that most users also smoke conventional cigarettes.

The researchers urge restricting the use, sale and marketing of e-cigarettes to bring them into line with controls on conventional cigarettes. They say marketing claims that e-cigarettes are a healthy alternative should be banned unless they are supported by robust evidence. They also want a standard to be set for the product’s ingredients and prohibition of the use of flavoured liquid, particularly candy and alcohol flavours.

The US research is the first comprehensive analysis of published studies on marketing, health and behavioural aspects of the devices. It found that there has been rapid market penetration of e-cigarettes following “aggressive marketing messages similar to those used to promote cigarettes in the 1950s and 1960s”. Typical advertising claims say that the products are healthier, cheaper and cleaner than conventional cigarettes, that they can be smoked anywhere and circumvent smoke-free policies, that they do not produce secondhand smoke, and that they help people to quit smoking.

The study’s authors say that e-cigarette advertising goes on in many countries that have long banned similar advertising for cigarettes and other tobacco products and may be indirectly promoting smoking conventional cigarettes. They raise health concerns beyond exposure to nicotine, including the unknown impact of inhaling ultrafine particles and exposure to ingredients in the e-liquid.

The industry’s message that e-cigarettes help smokers to quit has been made more plausible by the sale of the devices in pharmacies and the decision by some policy-makers, including those in the UK, to seek to regulate the devices as “medicines”, the researchers say.

However, a separate study published after the review, has found that smokers attempting to quit are more successful if they use e-cigarettes than if they use nicotine replacement therapy or willpower alone.

Evidence from population-based surveys suggests that “dual use” is common and up to one-third of young people who use e-cigarettes have never smoked a conventional cigarette, say the researchers.

“Nicotine is a highly addictive substance with negative effects on animal and human brain development, which is still ongoing in adolescence,” the authors write. “Furthermore, high rates of dual use may increase individual risk if a smoker maintains an even low-level tobacco cigarette addiction for many years instead of quitting.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11138575

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