A yearlong, randomized trial in England showed that e-cigarettes were almost twice as successful as products like patches or gum for smoking cessation.

It has been one of the most pressing unanswered questions in public health: Do e-cigarettes actually help smokers quit? Now, the first, large rigorous assessment offers an unequivocal answer: yes.

The study, published Wednesday in the New England Journal of Medicine, found that e-cigarettes were nearly twice as effective as conventional nicotine replacement products, like patches and gum, for quitting smoking.

The success rate was still low — 18 percent among the e-cigarette group, compared to 9.9 percent among those using traditional nicotine replacement therapy — but many researchers who study tobacco and nicotine said it gave them the clear evidence they had been looking for.

“This is a seminal study,” said Dr. Neal L. Benowitz, chief of clinical pharmacology at the University of California, San Francisco, an expert in nicotine absorption and tobacco-related illnesses, who was not involved in the project. “It is so important to the field.”

The study was conducted in Britain and funded by the National Institute for Health Research and Cancer Research UK. For a year, it followed 886 smokers assigned randomly to use either e-cigarettes or traditional nicotine replacement therapies. Both groups also participated in at least four weekly counseling sessions, an element regarded as critical for success.

The findings could give some new legitimacy to e-cigarette companies like Juul, which have been under fire from the government and the public for contributing to what the Food and Drug Administration has called an epidemic of vaping among teenagers. But they could also exacerbate the difficulty of keeping the devices away from young people who have never smoked while making them available for clinical use.

“There is an unavoidable tension between protecting kids from e-cigarettes and smoking cessation, which is also very important,” Dr. Benowitz said.

Tobacco use causes nearly 6 million deaths worldwide each year, including 480,000 in the United States, according to the Centers for Disease Control and Prevention. If tobacco use trends continue, the global death tally is projected to reach 8 million deaths annually by 2030.

E-cigarettes provide the nicotine smokers crave without the toxic tar and carcinogens that come from inhaling burning tobacco. But regulators in the United States, Britain and elsewhere have not approved them to be marketed as smoking cessation tools.

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E-cigarettes are almost twice as effective at helping smokers quit as nicotine replacement therapies such as lozenges and patches, according to a new study that immediately stoked the debate over whether e-cigarettes are an important smoking-cessation tool or a health menace.

The study, published online Wednesday by the New England Journal of Medicine, is the first randomized trial to test the effectiveness of modern e-cigarettes vs. nicotine-replacement products, said Peter Hajek, a psychologist at Queen Mary University of London, who led the trial. The researchers found that 18 percent of the e-cigarette users were smoke-free after a year, compared with 9.9 percent of those in the nicotine-replacement group. The participants also received behavioral support to stop smoking.

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I used to be a smoker. It was stupid, I know, but I did it for a very long time. I’m not alone, not unique, plenty of people made that same choice I did to take up the nasty habit when we were young and convinced we were invincible. Like tens of millions of Americans, I managed to quit and haven’t looked back. I would still be smoking today if not for the miracle (and it is indeed a miracle) of the e-cigarette. I vaped like a madman…and it was my bridge to a much healthier and happier lifestyle.

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New Jersey is home to a beautiful coastline as its rivers, bays and estuaries are a treasure. At the Recreational Fishing Alliance, of which I am executive director, we are committed to protecting the rights of recreational fisherman and a big part of that effort is keeping waterways clean.

Across the United States, Americans are making important steps to cut down on products that pollute waterways. As plastic straws and bags continue to decline, another challenge in keeping the shores and water clean is cigarette butts. According to a study done by the American Legacy Foundation, cigarette butts remain the most littered item in the U.S. and anyone who fishes the coastline witnesses hundreds of floating butts.

As a lifelong fisherman and advocate for anglers, I’ve seen firsthand the environmental impact of cigarette butts. New Jersey has some of the best fishing grounds anywhere on the East Coast, and as responsible anglers we have a responsibility to keep our waterways clean.

As an organization we do not endorse smoking of any kind or any tobacco product. However we can support new technologies like vapor products that help adult smokers quit the nicotine addiction.

We all strive for a cleaner and healthier New Jersey. I hope our state and federal officials will work to ensure that vaping technologies are available to adults who rely on these products to help quit smoking and keep New Jersey’s waterways clean for all anglers.

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The FDA is tied in knots over e-cigarette use. On the one hand, the FDA does not want people to smoke. But, on the other hand, the FDA does not want people to use smoking alternatives that could help them quit, such as e-cigarettes. To that end, the FDA recently signaled its interest in increasing regulation of e-cigarettes including Altria’s MarkTen and British American Tobacco’s Vuse, with an eye towards protecting teens from potential health effects.

As FDA Commissioner Scott Gottlieb put it:

[Some say] in order to protect kids, [the FDA] is going to encumber adult smokers by putting in place restrictions that make these products less attractive, or harder to purchase by adults. These things may all be true.

But although the commissioner recognizes new regulation could negatively impact adult e-cigarette consumers, he does not consider that new restrictions may disproportionately affect the poor.

This is likely for three reasons. First, low-income and low-skill Americans are more likely to smoke traditional cigarettes, and more likely to smoke traditional cigarettes heavily. For example, the CDC finds the prevalence of smoking is around two times as high for smokers below the U.S. poverty line as for smokers at twice the poverty level. Likewise, adults with less than a high school education are more than 2.5 times as likely to smoke as adults with a college degree.

Second, when it comes to quitting smoking, poor and less-educated Americans have the hardest time. A CDC report suggests that smokers with less than a high school degree are less than half as likely to report recently quitting smoking as smokers with graduate degrees. And adults at or above the poverty level are more likely to report recently quitting than those below the poverty level.

Evidence suggests e-cigarettes are an easy way for poor American smokers to improve their health. Unfortunately, future restrictions may change that.

Third, poor and less-educated Americans are more likely to use e-cigarettes. According to a recent study, 10.2 percent of individuals in households with between $0-$20,000 of income have used e-cigarettes, whereas about half as many individuals in households with $75,000 of annual income or more have used e-cigarettes. Education levels break the same way: Around twice as many individuals with less than a high school degree have ever used an e-cigarette, compared to individuals with a college degree or more.

Why does this matter? Low income and less-educated Americans report lower levels of access to health care and poorer health outcomes along a variety of metrics. E-cigarettes ostensibly provide an affordable avenue to improve health for smokers that can’t afford professional help quitting or reducing cigarette use.

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By: Erin Keely O’Brien, Anh B. Nguyen, Alexander Persoskie, and Allison C. Hoffman

This research described U.S. adults’ beliefs about nicotine and low nicotine cigarettes (LNCs) using the nationally-representative Health Information National Trends Survey (HINTS-FDA 2015; N = 3738). About three quarters of people either were unsure of the relationship between nicotine and cancer or incorrectly believed that nicotine causes cancer. People who were non-White, less educated, age 65+, and never established smokers were most likely to be unaware that nicotine is not a cause of cancer. More than a quarter of people held the potentially inaccurate beliefs that LNCs would be less harmful and addictive than typical cigarettes. Whites were more likely than Blacks to believe LNCs were less harmful than typical cigarettes, and never smokers were more likely to believe this than established quitters. Whites and people with at least a college degree were more likely to believe that LNCs would be less addictive than typical cigarettes. Overall, we found that many people, particularly the demographic subgroups identified here, held incorrect beliefs about nicotine and potentially inaccurate beliefs about LNCs. Findings should be considered in assessing the public health impact of marketing low nicotine products. Incorrectly believing that nicotine causes cancer could discourage smokers from switching to safer nicotine-containing alternatives, and could lead nonsmokers to experiment with low nicotine tobacco products, believing that cancer risk would be reduced. Findings underscore the need to educate the public on the health effects of nicotine and LNCs, and can help public health practitioners determine which subgroups should be prioritized in targeted educational efforts.

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– Thomas Ashworth 

A cardiology study has found that e-cigarettes can lower heart rates and blood pressures of people who smoke.

It is well known that smoking traditional cigarettes can increase blood pressure and heart rates, but it has been found that if smokers change to an e-cigarette, their health will increase tremendously.

A Cardiologist, Dr K Farsalinos, provided this study and spoke out against those who want to ban e-cigarettes, he said: “You should fight for your lives and your health. It is absolutely irresponsible and dangerous behaviour to ban e-cigarettes.”

Dr Farsalinos is a long-term e-cigarette researcher, conducting numerous studies that have been widely reported by mainstream media outlets. The Greek is a researcher at the Onassis Cardiac Surgery Center in Athens and at the Department of Pharmacy, University of Patras, Greece.

“All of these studies until now, without exception, were done without considering realistic e-cigarette use, that was the major problem.”

There have been wayward reports indicating e-cigarettes produce harmful chemicals that are carcinogenic, Dr Farsalinos says there is “absolutely no evidence hamiacetals are toxic”.

Dr Farsalinos’ findings were summarised:

• “Smokers who reduce or quit smoking by using EC (E-cigarettes) may lower their systolic BP (blood pressure) in the long term, and this reduction is particularly apparent in smokers with an elevated BP.”
• “The use of low risk nicotine-containing products (including e-cigarettes) should be investigated as a safer alternative approach to harm reversal“
• “The evidence-based notion that substitution of conventional cigarettes with ECs is unlikely to raise significant health concerns can improve counciling between physicians and their cardiovascular patients using or intending to use ECs.”

E-cigarettes are widely considered 95% safer than regular cigarettes and the NHS is looking to prescribe e-cigs to smokers.

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– ROBERT SKLAROFF, BILL GODSHALL, AND STEPHEN F. GAMBESCIA, 3/7/17

The Surgeon General recently joined tobacco control groups to condemn vaping, claiming this was another attack on public enemy number one.

This time, however, public health advocates need to assess and reject the mission-creep by these federal and nonprofit agencies.

And, as the new Administration pledges to slash many harmful regulations, it should include the Food and Drug Administration’s (FDA) recent vapor product regulation, which was touted as another important measure to protect children from Big Tobacco and nicotine.

Over the years, clinicians, behavioral scientists, and researchers have offered a sundry of ways to help addicted smokers to cut down on or, ideally, to quit smoking. Other than promoting price hikes and indoor smoking bans, those approaches have had humbling levels of success.

While not an elixir, a smoking reduction and abatement kit has come along — in the form of vaping — that satisfies the addiction by delivering nicotine, but sharply reduces the harm caused by inhaling cigarette smoke dozens or hundreds of times every day.

Because smoking is physically and psychologically addictive, some researchers think e-cigarettes satisfy both needs by mirroring the ritual of handling a nicotine-delivery device. Studies have found vaping to be more effective than other cessation techniques (drugs, counseling, psychotherapy, hypnosis, etc.) because of its capacity to yield sustained remissions.

Since 2009, adult cigarette smoking has declined by 25 percent and, since 2011, youth smoking has plummeted by 50 percent, due in part to vaping. But 27.6 million daily adult-smokers remain addicted to cigarettes.

Meanwhile there is no evidence that all other tobacco products combined cause more than minuscule levels of morbidity, disability, mortality and healthcare costs relaed to tobacco-related illnesses.

This is pivotal, for these other tobacco products are used by a total of 51 million adults in America (as of 2013-2014): E-Cigarettes (16.7 million), Cigars (13.2 million), Hookah (10.5 million), Smokeless Tobacco (8.6 million) and Pipes (2.0 million).

The 2015 National Health Information Survey found that 2.5 million adult vapers had quit smoking, and 5 million vapers were still smoking. In addition to helping many smokers quit, vaping has also emerged as the best strategy for sharply reducing cigarette consumption by smokers who continue to smoke.

Concomitantly, the risk associated with vaping e-cigs is negligible, save for a few reports of battery fires, largely due to consumer ignorance or negligence that can be reduced by better consumer education and repeal of the FDA’s regulation that has banned sales of all new safer vapor products in the U.S. since August.

Since cigarette smoking causes virtually all tobacco-linked diseases and deaths, it was counterintuitive that health groups lobbied President Obama’s FDA to extend cigarette regulations to vapor products. Vaping advocates rightly suspect that these nonprofits have exhibited mission-creep, as they abandoned their public health goals by lobbying to ban vaping and vapor products.

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