There is an ongoing debate about electronic cigarettes ECs. In some studies, the use of ECs reduced nicotine intake in smokers 1 , and ECs were reported to be less addictive than regular tobacco 2.
A review study of randomized controlled trials and cohort studies concluded that ECs were potentially helpful for the cessation of smoking and had few serious side effects 3 , 4. Nevertheless, it has not been confirmed whether ECs are less harmful or beneficial to health. In another systematic review, EC use was found not to be associated with smoking cessation in the real-world 5. Existing randomized controlled trials and cohort studies have used currently unpopular EC products or did not consider confounding variables in concluding that the evidence is unreliable and not definitive that smoking cessation is related to ECs 6.
In addition, the use of ECs has been reported to induce heart disease 7 and have adverse effects on the respiratory, digestive, and neurological systems 8. Whether ECs should be recommended as a means to quit smoking, be prohibited or restricted remains controversial in academia and for government policies, across countries. Based on the conclusion that ECs are much less harmful than conventional cigarettes and are conducive to quitting smoking, the United Kingdom recommends ECs as part of nicotine replacement therapy NRT 9.
The Framework Convention on Tobacco Control FCTC of the World Health Organization WHO reached a unanimous consensus on regulating ads, promotion, and sponsorship of ECs in , as their safety and efficacy cannot be definitively confirmed, and because they induce addiction similar to that caused by nicotine in cigarettes The US Food and Drug Administration FDA is striving to regulate ECs and has concluded that ECs are not recommended as a means to quit smoking for all smokers, including pregnant women, because there are many more aspects that require investigation, including their effects on smoking cessation To address this debate, previous studies have stressed the need for further studies investigating the effects and harms of ECs Most studies to date have used non-representative samples 13 , which do not reflect the real world population.
ECs are thought to be less harmful than cigarettes. However, there is the possibility that they will not be used in real life. Therefore, this study seeks to determine how ECs are used in real life through population-based surveys. To this end, we evaluated urine cotinine UC levels, which are a classical biomarker of nicotine uptake, among non-smokers, cigarette smokers c-smokers , E-cigarette smokers e-smokers , and dual users. This survey investigated approximately people each year, and the stratified multistage sampling design STRATA was used to stratify the population by variables such as sex, age, and house type.
The survey addressed EC use in people of age 19 years and over, from to UC data, however, was available from Therefore, among those who responded, participants with UC data between — were included in the study. We also inquired about whether the use of an electronic cigarette had occurred within the past month. Individuals who smoked more than cigarettes in their lifetime and people who currently smoked only conventional cigarettes were defined as current c-smokers, and those who fell under both definitions were defined as dual user smokers dual user.
In other words, e-smokers were people who smoked e-cigarettes for the past month but did not use c-cigarettes, c-smokers were people who smoked c-cigarettes but did not use e-cigarettes for the past month, and dual users were people who smoked e-cigarettes for the past month and used the c-cigarettes concurrently.
The urine samples were collected to measure the UCC by random sampling. The UCC was tested annually in approximately people including children, but from all the subjects are investigated.
Individuals who did not qualify as either an e-smoker, c-smoker, or dual user were defined as non-smokers. Descriptive analysis was performed for age, sex, job status and form of cigarette smoking.
Geometric means GM were used for analysis to account for the skewness of UC concentration Further, analysis of covariance ANCOVA analysis used log transformed values 17 , and it was performed after adjusting for age, sex and job status to analyze the differences in UC concentration in relation to type of smoking.
In addition, descriptive analysis was conducted for identifying the reason for using ECs in current e-smokers and dual users.
Furthermore, descriptive analysis was performed on the experience of cigarette use among e-smokers. This was to identify whether e-smokers had become new smokers from previously being non-smokers. Weighted values were used for all analyses based on the stratified multistage sampling design. Of the subjects, Approximately 2. The mean participant age was The mean age was the highest among non-smokers The proportion of middle-aged participants 40—64 years was the highest among c-smokers, but the percentage of young adults 19—39 years was the highest among both e-smokers and dual users.
The percentage of unemployed individuals, such as students and housewives, was the highest among non-smokers and dual users, but the percentage of white-collar workers was the highest among e-smokers and c-smokers. Only c-smokers and dual users answered the question about the number of cigarettes they smoked per day. The majority of participants smoked 10—19 cigarettes in both groups. The average number of cigarettes per day was All percentages are weighted to reflect stratified multistage sampling.
The GM UC level of all subjects was 4. It was the highest among dual users GM: In terms of sex, men showed a higher UC concentration in the c-smoker and dual user groups, but women showed a higher UC concentration GM: Occupation-wise, the GM was the highest among white collar workers in the e-smoker group Meanwhile, e-smokers showed a greater range of UC concentration compared to that of the other two groups.
In the c-smoker group, blue collar workers had the highest UC concentration. In the dual user group, blue collar workers had the highest GM In terms of form of smoking, heavy smokers showed the highest UC concentration in both the c-smoker and dual user groups Table 2. In addition, to confirm the distribution of UC concentration, a histogram was used. Our service is free and we are here to help you. Section Menu. Make a Donation Your tax-deductible donation funds lung disease and lung cancer research, new treatments, lung health education, and more.
Make a Donation. The production and sale of e-liquids is not yet closely monitored in Canada, which means they may not always contain the ingredients and proportions listed on the label. Public health officials are now speaking out about the dangers of making smoking acceptable again, a trend that could potentially roll back decades of work achieved by anti-smoking campaigns.
E-cigarettes should never be viewed as a better way to start smoking. Maps and directions Compared with regular cigarettes, e-cigarettes have been on the market a short time—about 11 years.
E-cigarettes usually contain nicotine. Nicotine is what makes tobacco products addictive. Be aware that some e-cigarettes that claim to be nicotine-free have been found to contain nicotine. E-cigarettes are harmful for youth, young adults, and pregnant women. The nicotine in e-cigarettes is harmful for developing babies, and can lead to addiction and harm brain development in children and young adults into their early 20s.
Although there is still much to learn about e-cigarettes , the evidence is clear that the harmful health effects of using e-cigarettes means teens and young adults should not use them. E-cigarettes may contain other harmful substances.
While e-cigarettes typically have fewer chemicals than regular cigarettes, they may still contain heavy metals like lead, flavorings linked to lung disease, small particles that can be inhaled deep into the lungs, and cancer-causing chemicals. Being near someone using an e-cigarette can expose you to the aerosol and the chemicals in it. This is similar to secondhand smoke from regular cigarettes.
E-cigarettes are not approved by the FDA as a quit smoking aid. So far, the research shows there is limited evidence that e-cigarettes are effective for helping smokers quit. There are other proven, safe, and effective methods for quitting smoking. One way to start is to talk with your doctor, nurse, or a trained quitline counselor to figure out the best strategies for you.
Many people use quit smoking medication, like nicotine replacement therapy NRT , in the form of a patch or gum, which doctors and other experts agree is one of the most helpful tools smokers can use to quit.
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