More research and regulation needed on e-cigarettes “to protect health of public”

More and more people around the world are switching to electronic cigarettes – known as ‘e-cigarettes’ – as a substitute for conventional cigarettes. An estimated 2.6 million people in the UK alone are using one of the nearly 500 brands of e-cigarettes available from high street shops, petrol stations and via the internet. And yet little is known about the health risks associated with e-cigarettes, which have been in use since they were invented 13 years ago in China.

The authors of a new article point out that – although e-cigarettes are often marketed as using only vapour and nicotine without the carcinogens such as tar found in conventional cigarettes – there have been various chemical compounds found in e-cigarettes that are “either already known to be carcinogens or may well prove to be carcinogenic in the future”. And since e-cigarettes are currently not regulated, users cannot be certain about which chemicals are found within each product.

The three co-authors – who are all experts in the field of respiratory medicine and otolaryngology from hospitals in England – set out to examine the regulations, trends and health risks associated with e-cigarettes, as well as summarising the evidence about the use of e-cigarettes in smoking cessation.

What they found is that many of the elements identified in e-cigarette aerosols are known to cause respiratory distress and disease.  One 2013 study found, for example, that tin, silver, iron, nickel, aluminium and silicate particles have all been found in e-cigarette aerosols. The same study also found that the concentrations of nine out of eleven elements in e-cigarette aerosols were higher than or equal to the corresponding concentrations found in conventional cigarette smoke.

A more recent 2015 study has confirmed that e-cigarettes contain toxic compounds, such as formaldehyde, nitrosamines and nickel, although these were in much lower concentrations than found in conventional cigarettes.

In addition, the authors report that there is limited evidence to prove whether e-cigarettes are an effective method for stopping tobacco smoking. Although several trials suggest that e-cigarettes may be beneficial to some smokers who are looking to quit or reduce smoking, the authors conclude that there is currently not enough long-term data available on the outcomes of using e-cigarettes as smoking cessation devices. At the moment, no e-cigarettes have been approved for smoking cessation purposes by governmental authorities, according to the authors. However, as a result of the European Commission’s Tobacco Products Directive issued in 2014, the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK is currently considering regulation of e-cigarettes and other nicotine-containing products.

In the meantime, the authors recommend that professionals should not be advocating the use of e-cigarettes as a smoking cessation tool.

“Regulation of e-cigarettes is necessary to establish a scientific basis on which to judge the effects of their use,” they conclude. In addition, they recommend that adequate research is needed on the long-term health effects of e-cigarettes, “firstly so that the public has current and reliable information as to the potential risks and benefits and secondly so that the health of the public is protected.”


The full paper by Miss Nicola Stobbs, Dr Aoife Lillis and Professor Nirmal Kumar is available online in The Journal of Laryngology & Otology (JLO) here.


Smoking cessation may lower risk for psychiatric problems

depressed smoker

Health professionals who treat smokers with psychiatric problems often allow patients to continue smoking, assuming it’s best to tackle depression, anxiety or substance abuse problems first. However, new research at Washington University School of Medicine in St. Louis shows that people who struggle with mood problems or addiction can safely quit smoking and that kicking the habit is associated with improved mental health.

“Clinicians tend to treat the depression, alcohol dependence or drug problem first and allow patients to ‘self-medicate’ with cigarettes if necessary,” said lead investigator Patricia Cavzos-Rehg, PhD. “The assumption is that psychiatric problems are more challenging to treat and that quitting smoking may interfere with treatment.”

But in the study, Cavazos-Rehg, an assistant professor of psychiatry, found that quitting or significantly cutting back on cigarette smoking was linked to improved mental health outcomes. Quitting altogether or reducing by half the number of cigarettes smoked daily was associated with lower risks for mood disorders like depression, as well as a lower likelihood of alcohol and drug problems.

“We don’t know if their mental health improves first, and then they are more motivated to quit smoking, or if quitting smoking leads to an improvement in mental health,” Cavazos-Rehg said. “But either way, our findings show a strong link between the quitting and a better psychiatric outlook.”

In addition, she believes the serious health risks associated with smoking make it important for doctors to work with their patients to quit, regardless of other psychiatric problems.

“About half of all smokers die from emphysema, cancer or other problems related to smoking, so we need to remember that as complicated as it can be to treat mental health issues, smoking cigarettes also causes very serious illnesses that can lead to death,” she explained.

Cavazos-Rehg and her team analyzed questionnaires gathered as part of the National Epidemiologic Study on Alcohol and Related Conditions. In the early 2000s, just under 35,000 people were surveyed. As part of the study, they answered questions about drinking, smoking and mental health in two interviews conducted three years apart.

The researchers focused on data from 4,800 daily smokers. Those who had addiction or other psychiatric problems at the time of the first survey were less likely to have those same problems three years later if they had quit smoking. And those who hadn’t had psychiatric problems at the initial survey were less likely to develop those problems later if they already had quit.

At the time of the first interview, just under 40 percent of daily smokers either suffered with mood or anxiety disorders or had a history of these problems. In addition, 50 percent of daily smokers had alcohol problems, and 24 percent had drug problems.

Compared to those who continued to smoke during the years between the two surveys, 29 percent of those who quit had mood disorders compared to 42 percent of those who still smoked. Alcohol problems affected 18 percent of those who quit smoking versus 28 percent who still smoked. And drug abuse problems affected only 5 percent of those who quit smoking compared to 16 percent of those who continued smoking.

“We really need to spread the word and encourage doctors and patients to tackle these problems,” Cavazos-Rehg said. “When a patient is ready to focus on other mental health issues, it may be an ideal time to address smoking cessation, too.”

The full paper “Smoking cessation is associated with lower rates of mood/anxiety and alcohol use disorders”, published in Psychological Medicine, can be viewed free for a limited time here.

Text messaging as a form of smoking support


The Journal of Smoking Cessation has published a new review of evidence that texting can be integrated in to smoking cessation programmes, which can help to maintain instant contact with clients and provide useful guidance for relapse prevention.

Tobacco use, primarily from cigarette smoking, is the leading cause of preventable deaths worldwide, and is associated with chronic conditions such as cardiovascular disease, chronic obstructive pulmonary disorders, and various types of cancers, including lung, oral cavity, larynx, oesophagus, stomach, pancreas, colorectal, bladder and kidney.

Despite the harm and costs tobacco use causes, there have been great efforts related to tobacco control in recent decades. There have been great strides in influencing social norms to prevent the initiation of tobacco use among adults and youth, promote cessation efforts, and reduce exposure to environmental tobacco smoke. Such smoking-control strategies include smoke-free laws, counter-advertising campaigns, and a hike in tobacco excise taxes, which have all contributed to a reduction in smoking prevalence. At the individual level, access to smoking cessation facilities and improvement in treatments of smoking dependence has provided smokers, as well as doctors and other health professionals, with more resources to make smoking cessation programs more customisable and effective.

Cigarettes are currently marketed more heavily towards adolescents and young adults. In this context, texting may be considered as an innovative intervention strategy to help prevent smoking initiation among the adolescent population and aid in smoking cessation and relapse prevention efforts. Texting is an act of communicating through the interchange of brief messages between mobile (cell) phones. With advances in mobile technology and the popularity of mobile cell phones, texting has even become the primary source of communication among some groups, but especially for adolescents and young adults. More than 75% of teenagers text, sending on average 60 texts per day. Texting has also been utilised as an intervention strategy for other health-related conditions such as asthma medication adherence, improve compliance for self-care with heart failure patients, eating disorders, weight loss, and binge drinking.

Texting is advantageous for health promotion efforts since it is low cost and widely accessible, almost all phones have the ability to send and receive texts, texting does not require a great amount of skills, text messages can be received at convenience, and will even be received at a later time in the event the phone is shut off.

Nine studies were reviewed for this article, five were texting-only interventions and four also involved web-based components that offered educational and abstinence tools. All the studies involved in this review reported that texting appeared to be an effective method for promoting smoking cessation and preventing relapse. Texting was also well received by study participants.

The review also highlights that much more research is needed in this area, for example to assess whether this approach can target smokers who are not already motivated to quit, or investigating whether a combination of social networks with texting to see if this will help to increase effectiveness for smoking cessation and relapse prevention.

Read the article in full here

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