Two of the UK’s leading experts on vaping, Professor Peter Hajek and Jamie Hartmann-Boyce, answer your questions about whether e-cigarettes really are a safer alternative to tobacco cigarettes.
Peter Hajek is Professor of Clinical Psychology and Director of the Health and Lifestyle Research Unit at the Wolfson Institute of Preventive Medicine at Queen Mary University of London.
Jamie Hartmann-Boyce is lead author of the Cochrane review on electronic cigarettes for smoking cessation and Senior Researcher at the University of Oxford’s Nuffield Department of Primary Care Health Sciences.
1) In your opinion is vaping still a safer alternative to smoking?
JAMIE: Yes, vaping is still a less harmful alternative to smoking. Cigarettes are uniquely deadly, and all of the information we have so far suggests that vaping poses significantly fewer risks. People switching from smoking to vaping should use regulated products, and should not try to tamper with the devices or buy them off the street.
PETER:Yes of course. The recent spate of lung injuries in USA has been caused by a contaminant in bootleg marijuana products and has nothing to do with e-cigarettes used by smokers here.
2) Is vaping harmful in any way?
PETER: On current estimates, vaping is unlikely to pose more than some 5% of risks of smoking. This would still be an unnecessary risk for non-smokers, but there is no question that smokers who switch to vaping reduce risks to their health dramatically.
JAMIE: Vaping is not risk-free, and non-smokers should not start to vape. However, compared to smoking it carries a fraction of the risk.
3) What advice would you give to vapers concerned about deaths linked to e-cigarette use in the US?
JAMIE: The deaths in the US are concerning, and a definite cause has yet to be identified. However, many of these cases are linked to vaping THC (marijuana vapes), bought off the street or via the black market. The US Center for Disease Control (CDC) has recently identified vitamin e acetate as playing an important role in these illnesses and deaths. Vitamin e acetate is not permitted in vaping products in the UK. Vapers concerned about US deaths should ensure they are using regulated e-cigarettes. The UK has more regulations in place than the US.
PETER: These cases are linked to contaminated illegal cartridges with a marijuana extract and have nothing to do with e-cigarettes that are used by smokers in this country.
4) Research has been published in the European Heart Journal linking e-cigarettes to cardiovascular issues. How concerned should vapers be about that?
PETER: The authors detected two effects. In human smokers, nicotine from e-cigarettes produced a typical acute stimulant effect, also seen after drinking coffee, that on its own signals no danger. In mice and in tissue samples, acrolein, a chemical that can be generated when e-liquid is fried, had more damaging effects. This however is not relevant for human vapers. Frying e-liquid produces this chemical, but this also produces aversive taste that vapers avoid. Human vapers have acrolein levels that are the same as in non-smokers and much lower than in smokers. A British Heart Foundation study conducted at University of Dundee has now been published showing that smokers who switch to vaping have significant improvements to their cardiovascular health within four weeks!
JAMIE: Vapers should not be concerned about that article – it was a small study over a small period of time, and showed expected acute effects of using nicotine (a stimulant). More recently, a larger, longer term study was published that showed improvements in vascular health after smokers switched to vaping.
5) How effective is vaping as a smoking cessation tool?
JAMIE:There is a growing body of evidence that vaping helps people quit smoking. People using vaping to quit smoking should seek support from a stop smoking advisor to give them the best chance of quitting for good.
PETER: E-cigarettes have helped many smokers quit and as the product is developing and improving, it is likely to help many more.
6) Can vaping be as addictive as smoking?
JAMIE: The addictiveness of an e-cigarette depends on many different things about the e-cigarette itself. Overall, though, evidence suggests vaping is less addictive than smoking. Smokers considering switching to vaping should not worry about becoming addicted to vaping, as being addicted to vaping poses far fewer risks than being addicted to smoking.
PETER: So far, very few non-smokers have become regular vapers.
7) Is it safe for non-smokers to vape?
PETER: Becoming dependent on vaping or nicotine is not a healthy option. Also, even 5% of risks of smoking is still a risk. If you are a non-smoker, it is best to avoid e-cigarettes. However, if you are a smoker who does not want to or cannot quit, this is something you should definitely try.
JAMIE: Vaping is not risk free and non-smokers should not vape. Vaping is a way for smokers to quit smoking and improve their health. In non-smokers, there is not a benefit of vaping.
8) What advice would you give to any smokers who want to quit using e-cigarettes but are concerned about the potential risks?
JAMIE: All the evidence we have suggests vaping is much safer than smoking. Make sure you use a regulated product sold from a retailer you trust, and if you can, also get support from a stop smoking advisor. Your GP can help you get in touch with one. People should switch entirely from vaping to smoking, and stop using cigarettes altogether. Remember that nicotine helps people stop smoking, and is not the cause of the illnesses seen in the US. Do not worry about using e-cigarettes with higher doses of nicotine – this may be what you need if you are a heavy smoker.
PETER: If you are finding quitting difficult, this is something that may well prove to be a useful aid.