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Why public health people are more worried than excited over e-cigarettes.

Pisinger C - BMC Med (2014)

Bottom Line: Therefore, no firm conclusions can be drawn on the harm of e-cigarettes, but they can hardly be called safe.It is questionable whether the potential health benefits obtained by some smokers outweigh the potential harm by use of non-smokers, of undermining of complete cessation, smokers' dual use, and of eventual re-normalization of smoking.Even if e-cigarettes are significantly less harmful than conventional cigarettes, the product may have a very negative impact on public health if its use is spread to a large part of the population.

View Article: PubMed Central - PubMed

Affiliation: Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Nordre Ringvej 57, Glostrup, DK 2600, Denmark. charlotta.pisinger@regionh.dk.

ABSTRACT
The research field on e-cigarettes is characterized by severe methodological problems, severe conflicts of interest, relatively few and often small studies, inconsistencies and contradictions in results, and a lack of long-term follow-up. Therefore, no firm conclusions can be drawn on the harm of e-cigarettes, but they can hardly be called safe. Experimental studies indicate negative health effects and, amongst others, the major ingredient propylene glycol warrants concern. Growing evidence raises doubt about the efficacy of e-cigarettes as a smoking cessation aid. Unfortunately, it seems that many smokers use e-cigarettes with the intention to quit but switch to long-term use of e-cigarettes or dual use. Use is spreading rapidly to minors, ex-smokers, and never-smokers. It is questionable whether the potential health benefits obtained by some smokers outweigh the potential harm by use of non-smokers, of undermining of complete cessation, smokers' dual use, and of eventual re-normalization of smoking. Even if e-cigarettes are significantly less harmful than conventional cigarettes, the product may have a very negative impact on public health if its use is spread to a large part of the population.

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Related in: MedlinePlus

The long-term impact of smoking and e-cigarette use on public health – year 2050. The risk models are based on assumptions of prevalence of smoking and prevalence of use and harm of electronic cigarettes (EC). Harm of smoking is known to be extremely high; this is our reference. Maximal harm = 100. In a harm reduction perspective the harm of EC-use is estimated as extremely low/very low = 1 or 5. In a public health perspective the harm of EC-use is estimated low/moderate = 10, 15 or 25. Harm reduction perspective:Smoking scenario 1: the theory assumes that smokers are reluctant to quit and smoking rates will remain high (15% smokers, harm =100). E-cigarette scenarios: the theory assumes that harm of EC-use is extremely low/very low and use will be restricted to smokers only. EC-scenario 1: 10% of the population use ECs, harm = 1. EC-scenario 2 (worst case): 20% of the population (primarily smokers) use ECs, harm = 5. Public health perspective:Smoking scenario 2: the theory is that smokers wish to quit and tobacco control efforts are effective. Smoking rates will reduce steadily over the next decades (5% smokers, harm =100). Smoking scenario 3 (worst case): EC-use might undermine smoking cessation and renormalize conventional smoking, and the smoking rates might increase. The harm indicated as squared is the extra harm indirectly caused by ECs (30% smokers, harm = 100). E-cigarette scenarios: according to the theory we might underestimate long-term harm of ECs, and use of ECs might spread to a large part of the population EC-scenario 3: 20% of the population use ECs, harm = 10. EC-scenario 4: 30% of the population use ECs, harm = 15. EC-scenario 5 (worst case): 40% of the population use ECs, harm = 25.
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Fig1: The long-term impact of smoking and e-cigarette use on public health – year 2050. The risk models are based on assumptions of prevalence of smoking and prevalence of use and harm of electronic cigarettes (EC). Harm of smoking is known to be extremely high; this is our reference. Maximal harm = 100. In a harm reduction perspective the harm of EC-use is estimated as extremely low/very low = 1 or 5. In a public health perspective the harm of EC-use is estimated low/moderate = 10, 15 or 25. Harm reduction perspective:Smoking scenario 1: the theory assumes that smokers are reluctant to quit and smoking rates will remain high (15% smokers, harm =100). E-cigarette scenarios: the theory assumes that harm of EC-use is extremely low/very low and use will be restricted to smokers only. EC-scenario 1: 10% of the population use ECs, harm = 1. EC-scenario 2 (worst case): 20% of the population (primarily smokers) use ECs, harm = 5. Public health perspective:Smoking scenario 2: the theory is that smokers wish to quit and tobacco control efforts are effective. Smoking rates will reduce steadily over the next decades (5% smokers, harm =100). Smoking scenario 3 (worst case): EC-use might undermine smoking cessation and renormalize conventional smoking, and the smoking rates might increase. The harm indicated as squared is the extra harm indirectly caused by ECs (30% smokers, harm = 100). E-cigarette scenarios: according to the theory we might underestimate long-term harm of ECs, and use of ECs might spread to a large part of the population EC-scenario 3: 20% of the population use ECs, harm = 10. EC-scenario 4: 30% of the population use ECs, harm = 15. EC-scenario 5 (worst case): 40% of the population use ECs, harm = 25.

Mentions: When we compare with a CC, the most harmful legal product on the market, everything seems harmless. For a smoker reluctant to stop smoking, the EC will most probably be a less harmful alternative – but we cannot focus on these smokers only! The impact of a product on public health is determined by two factors: i) the degree of toxicity or harm of the substance; and ii) how widespread the exposure is. Even if ECs are significantly less harmful than CCs, the product may have a negative impact on public health if the use is spread to a large part of the population (Figure 1). ECs might achieve popularity as high as that of CCs in the 1960s, before an awareness of harm became widespread in the population. The potential health benefits obtained by some smokers (Figure 2) must outweigh the potential harm by use of ex- and never-smokers, of smokers who intended to quit but switched to ECs, of smokers’ dual use, and of eventual re-normalization of smoking.Figure 1


Why public health people are more worried than excited over e-cigarettes.

Pisinger C - BMC Med (2014)

The long-term impact of smoking and e-cigarette use on public health – year 2050. The risk models are based on assumptions of prevalence of smoking and prevalence of use and harm of electronic cigarettes (EC). Harm of smoking is known to be extremely high; this is our reference. Maximal harm = 100. In a harm reduction perspective the harm of EC-use is estimated as extremely low/very low = 1 or 5. In a public health perspective the harm of EC-use is estimated low/moderate = 10, 15 or 25. Harm reduction perspective:Smoking scenario 1: the theory assumes that smokers are reluctant to quit and smoking rates will remain high (15% smokers, harm =100). E-cigarette scenarios: the theory assumes that harm of EC-use is extremely low/very low and use will be restricted to smokers only. EC-scenario 1: 10% of the population use ECs, harm = 1. EC-scenario 2 (worst case): 20% of the population (primarily smokers) use ECs, harm = 5. Public health perspective:Smoking scenario 2: the theory is that smokers wish to quit and tobacco control efforts are effective. Smoking rates will reduce steadily over the next decades (5% smokers, harm =100). Smoking scenario 3 (worst case): EC-use might undermine smoking cessation and renormalize conventional smoking, and the smoking rates might increase. The harm indicated as squared is the extra harm indirectly caused by ECs (30% smokers, harm = 100). E-cigarette scenarios: according to the theory we might underestimate long-term harm of ECs, and use of ECs might spread to a large part of the population EC-scenario 3: 20% of the population use ECs, harm = 10. EC-scenario 4: 30% of the population use ECs, harm = 15. EC-scenario 5 (worst case): 40% of the population use ECs, harm = 25.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260246&req=5

Fig1: The long-term impact of smoking and e-cigarette use on public health – year 2050. The risk models are based on assumptions of prevalence of smoking and prevalence of use and harm of electronic cigarettes (EC). Harm of smoking is known to be extremely high; this is our reference. Maximal harm = 100. In a harm reduction perspective the harm of EC-use is estimated as extremely low/very low = 1 or 5. In a public health perspective the harm of EC-use is estimated low/moderate = 10, 15 or 25. Harm reduction perspective:Smoking scenario 1: the theory assumes that smokers are reluctant to quit and smoking rates will remain high (15% smokers, harm =100). E-cigarette scenarios: the theory assumes that harm of EC-use is extremely low/very low and use will be restricted to smokers only. EC-scenario 1: 10% of the population use ECs, harm = 1. EC-scenario 2 (worst case): 20% of the population (primarily smokers) use ECs, harm = 5. Public health perspective:Smoking scenario 2: the theory is that smokers wish to quit and tobacco control efforts are effective. Smoking rates will reduce steadily over the next decades (5% smokers, harm =100). Smoking scenario 3 (worst case): EC-use might undermine smoking cessation and renormalize conventional smoking, and the smoking rates might increase. The harm indicated as squared is the extra harm indirectly caused by ECs (30% smokers, harm = 100). E-cigarette scenarios: according to the theory we might underestimate long-term harm of ECs, and use of ECs might spread to a large part of the population EC-scenario 3: 20% of the population use ECs, harm = 10. EC-scenario 4: 30% of the population use ECs, harm = 15. EC-scenario 5 (worst case): 40% of the population use ECs, harm = 25.
Mentions: When we compare with a CC, the most harmful legal product on the market, everything seems harmless. For a smoker reluctant to stop smoking, the EC will most probably be a less harmful alternative – but we cannot focus on these smokers only! The impact of a product on public health is determined by two factors: i) the degree of toxicity or harm of the substance; and ii) how widespread the exposure is. Even if ECs are significantly less harmful than CCs, the product may have a negative impact on public health if the use is spread to a large part of the population (Figure 1). ECs might achieve popularity as high as that of CCs in the 1960s, before an awareness of harm became widespread in the population. The potential health benefits obtained by some smokers (Figure 2) must outweigh the potential harm by use of ex- and never-smokers, of smokers who intended to quit but switched to ECs, of smokers’ dual use, and of eventual re-normalization of smoking.Figure 1

Bottom Line: Therefore, no firm conclusions can be drawn on the harm of e-cigarettes, but they can hardly be called safe.It is questionable whether the potential health benefits obtained by some smokers outweigh the potential harm by use of non-smokers, of undermining of complete cessation, smokers' dual use, and of eventual re-normalization of smoking.Even if e-cigarettes are significantly less harmful than conventional cigarettes, the product may have a very negative impact on public health if its use is spread to a large part of the population.

View Article: PubMed Central - PubMed

Affiliation: Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Nordre Ringvej 57, Glostrup, DK 2600, Denmark. charlotta.pisinger@regionh.dk.

ABSTRACT
The research field on e-cigarettes is characterized by severe methodological problems, severe conflicts of interest, relatively few and often small studies, inconsistencies and contradictions in results, and a lack of long-term follow-up. Therefore, no firm conclusions can be drawn on the harm of e-cigarettes, but they can hardly be called safe. Experimental studies indicate negative health effects and, amongst others, the major ingredient propylene glycol warrants concern. Growing evidence raises doubt about the efficacy of e-cigarettes as a smoking cessation aid. Unfortunately, it seems that many smokers use e-cigarettes with the intention to quit but switch to long-term use of e-cigarettes or dual use. Use is spreading rapidly to minors, ex-smokers, and never-smokers. It is questionable whether the potential health benefits obtained by some smokers outweigh the potential harm by use of non-smokers, of undermining of complete cessation, smokers' dual use, and of eventual re-normalization of smoking. Even if e-cigarettes are significantly less harmful than conventional cigarettes, the product may have a very negative impact on public health if its use is spread to a large part of the population.

Show MeSH
Related in: MedlinePlus