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Study Weighs Potential Harms and Benefits of Electronic Cigarettes

May 31st is World No Tobacco Day as the World Health Organization puts the spotlight on tobacco harms -- and advocates for reduced tobacco consumption. This story looks at new research on electronic cigarettes. Next week we feature the first anniversary of CAMH’s Tobacco-Free Policy.

A comprehensive study underway on electronic cigarettes is investigating their long-term health effects as well as their potential as a cessation aid for existing tobacco smokers.

“The tobacco control and research community is split on this issue,” says Dr. Robert Schwartz, Principal Investigator and Executive Director of the Ontario Tobacco Research Unit (OTRU). While there may be potential for e-cigarettes to support tobacco harm reduction and cessation, “there are concerns about possible adverse health effects, as well as the renormalization of smoking and tobacco uptake among youth.

“The long-term effects of e-cigarettes are unknown and demand caution when it comes to public policy.”

The 18-month study is an OTRU/CAMH partnership funded by Ontario’s Ministry of Health and Long-Term Care Health System Research Fund.

E-cigarettes have arrived on the scene over the past few years as traditional tobacco cigarettes come under increasing controls. E-cigarettes use a heating device to deliver a flavoured vapour, which may contain nicotine, inhaled by the smoker. The products come in a range of shapes and sizes – some look almost identical to a standard tobacco cigarette. Some tobacco companies have now entered the e-cigarette business and market.

Approximately 15 per cent of Ontario high school students now say they have tried e-cigarettes, according to the latest CAMH survey.

Dr. Schwartz, who is also a Senior Scientist in the Social and Epidemiological Research Department at CAMH, notes that in Canada, legislation prohibits the sale of e-cigarettes containing nicotine; however that ban has not been actively enforced. Meanwhile, provincial governments have been moving to apply existing tobacco controls to e-cigarettes.

Ontario recently proposed new regulations in Bill 45 (Making Healthier Choices Act), intended to come into effect January 2016. The regulations would mirror tobacco cigarette policy by restricting:

  • e-cigarette sales to minors (under 19 years of age);
  • e-cigarette use in enclosed public places, and
  • the point-of-sale promotion of e-cigarette products.

A key element of the new OTRU/CAMH study launched in 2014 is a survey of about 2,000 tobacco smokers; of those, about 1,300 have tried or used e-cigarettes.

Preliminary findings show that:

  • Approximately 80 per cent of those who had used e-cigarettes said they did so with the intent to reduce or quit smoking tobacco cigarettes
  • Some say they successfully quit using e-cigarettes as a cessation aid
  • About 40% of e-cigarette users said the product contained nicotine
  • Both nicotine and non-nicotine e-cigarette versions may help to reduce cravings for tobacco.

For those tobacco smokers who want to quit, “it’s not yet proven whether this could be a game changer,” said Dr. Schwartz. “Designed properly, an electronic cigarette might be an effective cessation strategy for tobacco smokers who typically try to quit many times, and who try many strategies before they stay quit.”

“At the same time, we need to look closely at potential public harms related to e-cigarettes,” he says. There are several important questions:

  • What are the long-term effects of e-cigarette vapour, which may contain propylene glycol, various flavourings, and nicotine?
  • How much nicotine do e-cigarette users typically inhale and what are the long-term effects?
  • Are e-cigarettes addictive?
  • If e-cigarettes become normalized, what are the long-term harms for the population as a whole?

“We don’t want to wake up 20 years from now to see a new generation of young adults addicted to nicotine from e-cigarettes and experiencing health consequences.”

To answer those questions and others, the study looks at e-cigarettes from many different angles.

Along with the longitudinal survey of e-cigarette users, researchers are reviewing social media e-cigarette messages and have completed a web survey of young users. They will analyze results from blood samples of users, conduct a cessation effectiveness trial, and convene an international panel of experts to examine findings and trends.

In addition to this primary research, the team is synthesizing global knowledge on e-cigarettes from a variety of sources and studies, and analyzing the application for policy in Ontario.

The study will be complete in spring 2016. As findings become available, they will be used to inform the Ministry of Health as the province advances its e-cigarette regulations.

This will require a careful balancing act, says Dr. Schwartz. “The proposed regulations in their current form do leave some room for cessation strategies while balancing with controls and caution for population harms.”

As a feature of this study, the Ministry and other health system policymakers and providers can approach the research team directly with specific questions as issues surface and legislation evolves.

The research team includes:

  • Robert Schwartz and Laurie Zawertailo, Principal Investigators
  • Thomas Eissenberg, Roberta Ferrence, Shawn O'Connor, Peter Selby and Melodie Tilson, Co-investigators