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Following a high-profile Royal College of Physicians’ report encouraging smokers to consider e-cigarettes as a less harmful alternative, we asked Dr Andy McEwen, executive director of the National Centre for Smoking Cessation and Training, to answer some of the most commonly asked questions about the devices.
1. Are e-cigarettes less harmful than smoking?
Dr McEwen: Yes. Experts think that e-cigarettes are, based on what we know so far, less harmful than cigarettes. Smoking is associated with a number of very serious health risks to both the smoker and to others around them. So switching from tobacco to e-cigarettes substantially reduces a major health risk.
2. Is nicotine dangerous?
Dr McEwen: Nicotine doesn’t cause smoking-related diseases, such as cancers and heart disease, but it is addictive. However, there’s a common misconception that you can overdose on nicotine using e-cigarettes. But you are in no danger of poisoning yourself, nor have there been any cases of overdose from inhaling the nicotine-containing fluid that an e-cigarette vaporises, known as e-liquid. So you can use your e-cigarette as often as you need to help manage nicotine withdrawal and urges to smoke.
Much the same as with Nicotine Replacement Therapy, if you do have more nicotine than you’re used to, then you might feel a little nauseous or lightheaded, both of which pass quickly. If this happens, just reduce the level of nicotine in the e-liquid that you buy, or use the e-cigarette less.
3. Do e-cigarettes produce harmful chemicals or blow up?
Dr McEwen: Some studies have found chemicals in e-cigarette vapour that are known to cause health problems. But these studies have tended to use artificial conditions, and when good quality e-cigarettes are used normally (e.g. not overheated), there are far fewer harmful chemicals present in the vapour than in tobacco smoke. If the e-liquid is being overheated it tends to produce an acrid, unpleasant taste – you’ll know if this happens.
As with any rechargeable device, such as mobile phones and laptops, it’s important to charge e-cigarettes with the right charger, and don’t leave it unattended while charging. Ensure that you buy from reputable suppliers and avoid generic charging equipment. There have been reported cases of e-cigarettes causing fires, but far fewer than the number caused by cigarettes, which are the most common cause of lethal house fires.
4. Is it OK to smoke and vape at the same time?
Dr McEwen: There’s no evidence that smoking cigarettes and vaping at the same time is any worse than just smoking tobacco. But the greatest health benefits are seen when people stop smoking tobacco completely, so quitting smoking should be the goal.
Some people manage to switch completely to vaping quickly, while others take a little time. You may have to try a number of different e-cigarettes and e-liquids before you find one that helps you to stop smoking completely, but this is quite normal.
5. Can I use an e-cigarette in the Stop Smoking Services?
Dr McEwen: Yes. If you choose to use an e-cigarette, Stop Smoking Services can still support you in your quit attempt – and these services the most effective way to quit. Their trained stop smoking practitioners provide behavioural support, advice on what might be the best way for you to stop and access to approved stop smoking medications.
6. Which e-cigarette should I start with?
Dr McEwen: This is very much a personal choice. The refillable tank system e-cigarettes might take a bit of getting used to, but they allow you to use more flavours, and generally deliver more nicotine than e-cigarettes that look like tobacco cigarettes. Users tend to say these types are more satisfying. Specialist e-cigarette retailers can give you advice, and you can also chat to other e-cigarette users on a range of internet forums.
How much nicotine you need will depend upon how much nicotine you’re used to getting from your cigarettes. And, of course, how much nicotine you get from your e-liquid will depend upon the type of e-cigarette that you use and how you use it. As a rough guide, most 20-a-day smokers find that 18mg/ml (1.8 per cent) nicotine is sufficient, so you could start with this and see how you get on.
7. How should I use my e-cigarette to help me to stop smoking?
Dr McEwen: Using an e-cigarette is different from smoking a cigarette. It usually involves taking slower and longer puffs over a longer period of time. This is because e-cigarettes heat a coil in a liquid (think of a kettle). You may find you need to take a few puffs on an e-cigarette at times when you wouldn’t have smoked, but this is nothing to worry about, and the way you use your e-cigarette will develop over time. It’s not like a cigarette, which you smoke from start to finish. With an e-cigarette you can use it once or twice, and then put it away. If you find you’ve got it in your mouth all the time, you might need to use a stronger e-liquid.
If you get a bit of a cough when you use your e-cigarette, this isn’t unusual and it might help to switch from an e-liquid with a high proportion of propylene glycol to one with more vegetable glycol, which can be more soothing.
8. Will e-cigarettes be cheaper for me than smoking?
Dr McEwen: Yes, and you’ll notice savings very quickly compared with buying cigarettes. A starter kit for the tank-style devices can range from £20-70. You’ll then only need to replace the atomiser (heating coil or ‘head’) occasionally for a couple of pounds and, more regularly, buy your e-liquid, which can start at £3.00 for 10 ml. How often you need to change the atomiser will depend on how you use the device, but typically it’ll be around every two weeks or when you get a ‘burnt’ taste or low vapour production.
9. Can I use e-cigarettes in places where I can’t smoke?
Dr McEwen: There are no laws preventing or restricting where you can use e-cigarettes. Some places, such as some sports stadiums and most airports, do not allow vaping while others do. If there are no signs indicating this then you should always ask. But it helps to be respectful when using e-cigarettes around others, especially non-smokers.
10. Is second-hand vapour from e-cigarettes dangerous? How can I protect my children?
Dr McEwen: Unlike second-hand smoke from cigarettes – which is known to cause cancer – there’s no evidence that second-hand e-cigarette vapour is dangerous to others. Some studies have found traces of toxic chemicals in second-hand vapour, but at such low levels that they’re not harmful to those around you. E-cigarettes aren’t recommended for use by non-smokers and children.
In order to prevent accidental poisoning, for example by young children drinking e-liquids, you should store your e-cigarettes and liquids away safely, just as you would with household cleaning products and medicines.
- Blog post: New study comes the closest yet to proving that e-cigarettes aren’t as dangerous as smoking
- Blog post: The Great British vape off
The National Centre for Smoking Cessation and Training trains stop smoking practitioners to deliver effective support to people wanting to move away from tobacco. They’ve developed a briefing to support local Stop Smoking Services to incorporate e-cigarettes into their everyday practice.
Laila Iskander June 7, 2016
Disgusting report, how long will we wait and how much harm will be caused before saying it is dangerous to health, why do we have to put up with week and selfish people’s dirty habits ?
Brian Harrison June 7, 2016
Extremely helpful, THANK YOU.
Angela Edwards June 7, 2016
I dont think I could have quit my 30 a day habit without my e-cig. Havent smoked for 4 years now.
graham healey June 7, 2016
As a non-smoker I still find it pretty disgusting to encounter e-cig smokers in public places. I hope that vapers will graduate onto not having to suck on anything at all. Some vapers do have the attitude that because it is not tobacco then they can vape anywhere, and it is precisely that attitude that needs to be suppressed.
Margaret June 7, 2016
I have passed many drivers both on motorways and rural roads with their E machines (for want of a better term) pouring out vast amount of smoke! It makes me wonder if they can really see to drive! Also walking behind people with these going and on small pavement space I wonder how much one inhales and as you report it doesn’t cause problems I’m not convinced. If it helps to give up great but please think of others about you.
Julie harris June 7, 2016
Hi,have been smoking for a number of years and I started using an e cigarette 8 months ago,and have not smoked since.i think that thay very good I have tried other products put have never stop until now.i would recommend them to other people and it has worked for them.And I have saved money which never did before.
Graham Dane June 7, 2016
A very interesting and useful article on e-cigarettes. I failed to get my sister-in-law to switch from cigarettes, which is a pity. At our local community centre and youth club we do not allow e-cigarettes because we want smoking to be socially unacceptable.
Pat June 7, 2016
Good range of information. I would like to have “shared” the article on Facebook, but I couldn’t see this as an option
Morag skinner June 7, 2016
Found this very interesting. I stopped over 11 years ago with willpower but still crave at times but would not go back.
Craig S June 1, 2016
Great to see this sort of article on CRUK, I quit smoking 18 months ago thanks to ecigs. I had smoked for 12 years and failed to quit several times using alternative methods such as gum and patches etc. I don’t think I could ever have given up without using ecigs
My concern is that this sort of of article and the research it references have all come a bit late, from what I’m reading about the new EU laws that came in on 20/5/16 the ecig market has been pretty much strangled.
J. Molloy May 22, 2016
@Prof Preben Aavitsland
When you reference a study done (or even touched) by Stanton Glantz you immediately become laughable.
The man is a charlatan who has absolutely ZERO medical knowledge (mechanical engineer) and is a big pharma funded shill who will do anything to protect his own/his universities INSANELY lucrative funding streams. This includes BLATANTLY manipulating studies/figures to generate the result HE wants. Simply put, he and his type are a danger to public health.
No surprise to see a post from Simon Chapman either, yet another ‘champion of public health’ or more accurately “champion of whatever cause pays the most today”. After-all he’s a self-proclaimed “expert in marketing and public manipulation via media sources.” He also, conveniently, has no actual medical education, but he sure is good at finding/linking studies that support his views.
There are now MILLIONS of people worldwide who have either reduced or completely quit smoking via e-cigs (including me, 3 years on July 13th), that’s a positive ‘public health gain’ no matter how you look at it.
People like Mr. Glantz and Mr. Chapman call us ‘anecdotes’, when in reality we’re just people trying not to die horrible cancer related deaths or at the very least trying to GREATLY reduce the harm done by our nicotine addiction/consumption.
It seems quite perplexing that two men, such “champions of public health”, would fight so hard against something that has been shown, with a decent level a certainty, to be beneficial to millions of people.
‘It is difficult to get a man to understand something, when his salary depends on his not understanding it.’
Henry Spencer May 20, 2016
I am sorry prof Aavitsland but you do not know what you are talking about as I am a living example together with thousands of others that e-cigs do stop you smoking.
Prof Preben Aavitsland May 20, 2016
Do e-cigarettes help you quit smoking?
Harm to smokers will be reduced only if they switch to e-cigarettes. If the switch does not occur, it remains irrelevant that e-cigarettes are less harmful than tobacco cigarettes.
The evidence that e-cigarettes really help smokers stop smoking is scarce (1). In fact, the most recent review (2) indicates that e-cigarettes may make it harder to quit smoking: It’s easier to quit smoking without the help of e-cigarettes.
Thus, the e-cigarette may not solve the problem that some English colleagues argue that it will. Instead, a liberal regulatory framework may, coupled with intensive marketing, increase the exposure of new, smokefree generations to an extensive and highly addictive product that they do not need at all.
1. McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev 2014; 12: CD010216. (http://www.ncbi.nlm.nih.gov/pubmed/25515689)
2. Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med 2016; 4: 116-28. (http://www.ncbi.nlm.nih.gov/pubmed/26776875)
Henry Spencer May 19, 2016
I was a life long smoker until four years ago and discovered ecigs. With in two weeks of using the ecig I had stopped smoking and have not had a cigarette since. If people want to ban ecigs then they should ban all secession items.
Prof Simon Chapman May 19, 2016
Dr McEwen’s bald statement “Nicotine doesn’t cause smoking-related diseases, such as cancers and heart disease” needs to be read in context against the International Agency for Research in Cancer’s list of “high priority” topics for its 2015-2019 research monographs on carcinogenicity (“Nicotine—increasing population exposure via electronic nicotine delivery systems; recent mechanistic data suggest an association with DNA damage and other pathways of carcinogenesis) Lancet Oncology http://dx.doi.org/10.1016/S1470-2045(14)70168-8
Recent examples of health risk studies include http://www.sciencedirect.com/science/article/pii/S0012369216485624 showing that both cigarettes and ecigarettes caused “a significant increase” in several measures of oxidative stress (although ecigarettes caused less) and this one suggesting that ecigarettes may be a risk factor for asthma in youth. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151022
I am very surprised that CRUK published McEwen’s statement
Shaun May 18, 2016
Brilliant I have used e cigarettes for 2 years now and it the best thing I ever did but reading this there stuff I didn’t know about vaping and smoking
Max May 18, 2016
LVD May 18, 2016
After next Friday, what would you recommend to a heavy ex-smoker, since patches do not provide the necessary throat-hit: buying higher strength e-liquid from the black market with the risk of contamination or buying tobacco cigarettes from a well controlled supplier and try to smoke as little as possible?
Nick Peel May 18, 2016
Thanks for your comment.
The possibility that e-cigarettes may renormalise smoking is a big area of debate, but evidence so far shows this is not the case. Experimentation with e-cigarettes in people who have never smoked remains low and coincides with the continuing decline in youth smoking rates. So as things stand, arguments about renormalisation and e-cigarettes being a gateway to taking up smoking aren’t backed up by evidence. In terms of advertising, the new e-cigarette legislation that will be implemented on Friday (the revised Tobacco Products Directive) will put stricter regulations on e-cigarette marketing and advertising. We are carrying out research to monitor the impact of these regulations, and are closely monitoring the involvement of the tobacco industry.
Nick, Cancer Research UK
Vladimir Poutine May 18, 2016
I quit smoking 27 months ago when I started using e-cigs(refillable tank). My Doctor noticed an improvement after 1 month, and my Eye Doctor during an eye exam remarked, ‘I see you quit smoking’ He could tell by looking inside my eyes. I live in Canada where a pack of 25 cigarettes cost $12. E-cigs pay for my yearly trip to Cuba
Jonathan Bagley May 18, 2016
Thank you Dr McEwen. I’m amazed and delighted to find this article on the CRUK website. Unfortunately, as Rob mentioned, the TPD will nullify much of the progress that has been made in getting vaping accepted. If taken at its word, currently available tank systems may be prohibited on grounds of leakage during filling. Back in April 2014, CRUK was celebrating the TPD.
Patrick McGuire May 18, 2016
A very useful blog, based on current available evidence. One issue it doesn’t address is the possible impact on attitudes to smoking. Is there a danger that the use of e-cigarettes may re-normailse smoking as socially acceptable? Also, the way the tobacco companies, who increasingly own the producers of e-cigarettes, advertise their use is very reminiscent of the way they promoted cigarettes back in the 1950’s and 60’s and, similarly, there is no long-term studies of the impact of the use of e-cigarettes. They are clearly a useful aid to help smokers stop smoking so should they therefore be regulated in the same way as other such products?
Rob Crewe May 18, 2016
Congratulations on this well thought out and considered guidance.
One point I would like to make is that in section 7. entitled How should I use my e-cigarette to help me to stop smoking? you state “If you find you’ve got it in your mouth all the time, you might need to use a stronger e-liquid.”
This was the case in my experience, the recommended 18mg strength was insufficient and resulted in an excessive liquid consumption and hence an increase in exposure to any harmful elements contained in it. I was successful in decreasing the frequency of use, and thus my liquid consumption by increasing the nicotine concentration to 36mg.
As from the 20th of May this year the maximum nicotine concentration allowed under the EU TPD will be 20 mg/ml (realistically 18mg) so the option of a higher strength liquid will not be available to those who need it. The official advise it to use a nicotine patch in conjunction with a vapour device, but I fear for many it will be far simpler just to slide out a cigarette and light it.