smoke rising

The number of adults who quit smoking by using e-cigarettes will be far lower than the number of teenagers and young adults who develop a regular smoking habit after trying these products, according to a first-of-its-kind study published Wednesday in the journal PLOS-One.

The findings promise to add fuel to a long-standing debate among scientists and policymakers over these controversial products.

Because e-cigs are less toxic than regular cigarettes, they have the potential to curb a global smoking addiction that claims billions of dollars and millions of lives every year. But because they come in fruit and candy flavors, these products may also lure teens and young adults into a dangerous smoking habit that they might otherwise have avoided.

The new study tried to measure both sides of that equation. Using census data, national surveys, and published studies, researchers analyzed three things: the additional number of current smokers who will quit smoking with the help of e-cigs, the additional number of teens and young adults who will transition to long-term daily smoking after using e-cigs, and the total number of life years that will be gained (or lost) as a result.

They estimated that 2,070 adults would quit smoking with the help of e-cigs, while 168,000 teenagers and young adults would progress from experimenting with e-cigs to steady use of regular cigarettes. Ultimately, they concluded, 1.5 million years of life would be lost by using e-cigs.

More On E-cigs

"E-cigarettes will likely cause more public health harm than public health benefit," says Samir Soneji, Ph.D, associate professor at the Dartmouth Institute for Health Policy and Clinical Practice and the study’s lead author.

But the authors also acknowledged that more research is needed. Several similar studies have reached different conclusions. And, as many health officials have said, whether e-cigs ultimately do more harm or good will depend on a whole host of factors—including how they are made, regulated, and used—that no one study can fully account for.  

“These devices do have potential to reduce the disease burden of tobacco,” says David Eaton, Ph.D, a public health researcher and dean at the University of Washington, Seattle who was not involved in the study. “But we need to figure out how to maximize their potential as a smoking cessation aid while minimizing exposure of teens and young adults to them.”

Using E-Cigs to Quit Smoking

There are 40 million adult cigarette smokers in the U.S. alone, according to the new study. The vast majority of them want to stop smoking completely. E-cigs are an appealing option to some of these would-be quitters, in part because unlike gum and skin patches, they deliver nicotine in the same way that regular cigarettes do.  

Science says: The evidence that e-cigs are safer than regular cigarettes is conclusive enough that scientists hardly dispute this anymore. Yes, e-cigs contain many toxic chemicals. But there are far fewer of those chemicals (and far lower levels of them) in e-cigs compared with conventional cigarettes. 

Researchers also agree that if e-cigs help smokers quit, they could confer a net health benefit on the population as a whole. But so far, that's a big if: Evidence that e-cigs work as a smoking cessation tool is limited. The United States Preventive Service Taskforce does not recommend them to would-be quitters.

The American Cancer Society does advise clinicians to support the use of e-cigarettes for patients who want to kick a regular smoking habit, but only if those patients refuse other smoking cessation aids. The society also advises people who refuse to quit regular cigarettes to at least switch over to e-cigs. 

What you should know: If you are trying to quit smoking regular cigarettes, you should consider other smoking cessation tools (nicotine gum, patches, and prescription medications) before turning to e-cigs because so far there's more evidence that these other aids work, and less evidence that they can be harmful. 

If those other aids have not worked for you, and you want to try e-cigs, you might want to opt for an e-cig brand that contains nicotine (not all e-cigs do). The NASEM found moderate evidence that e-cigs with nicotine are more effective at helping smokers quit.

You should also keep in mind that both the type of e-cig device you purchase and the place where you purchase it can make a big difference in how well e-cigs are able to help you quit.

Older, single-coil devices and devices that reach higher voltages tend to get hotter and thus produce more toxins; double or triple coil devices are safer, according to existing research. And some vape shops may be able to work with you to gradually reduce the nicotine dose so that you can wean yourself off slowly.

“Some shops really do cater to adults who want to quit smoking,” Soneji says. “They are like back-room chemists adjusting doses to suit the client’s needs.”

The Risk to Teens

According to the latest data from the Centers for Disease Control and Prevention, teen smoking is at a historic low, and so far e-cigs have not reversed that trend: Use of e-cigs among adolescents rose sharply between 2014 and 2015, but it declined again in 2016, and at least some studies have found most of that use to be experimental and infrequent.

Still, e-cig use among teens remains a serious concern. 

Science says: Teenagers who try e-cigarettes are more likely to smoke at least one traditional cigarette in the future; and youths who use e-cigs before trying tobacco are more likely to become frequent or intense smokers. But it's not clear that e-cigs are responsible for that progression; plenty of scientists and health officials have disputed the cause-and-effect relationship.

The British Royal College of Physicians has concluded that e-cigs are not a gateway to smoking and has called those concerns “unfounded.”

And U.S. researchers say there’s another explanation for the relationship.

“A certain portion of kids will take risks and experiment, and some of them will progress from one risky thing to the next,” says David Abrams, a behavioral and population health researcher who studies tobacco control at New York University. “What they start with is not uniquely responsible for that progression. It’s just that those kids are susceptible to risk-taking.”

What you should know: One thing not in dispute is that the safest, healthiest option for teenagers is to abstain from smoking altogether. It’s important to talk to your teenagers about smoking, even if you’re sure they’re not doing it themselves. Experts we spoke with suggest keeping the conversation as natural as possible (for example, try asking them what they think about e-cigs when you pass them in a shop window or see an advertisement).

Make sure they understand that they are more vulnerable to the negative effects of nicotine (including its addictive potential) because their brains are still developing. Explain that while e-cigarettes may be safer than regular cigarettes, they still contain toxins, and can be addictive. And remember this encouraging news: If they get through high school without smoking (e-cigs or regular cigarettes), they’re less likely to take up smoking later in life.