{"id":836,"date":"2019-10-07T18:14:29","date_gmt":"2019-10-07T18:14:29","guid":{"rendered":"https:\/\/depts.washington.edu\/harrtlab\/?p=836"},"modified":"2019-10-07T18:14:29","modified_gmt":"2019-10-07T18:14:29","slug":"thinking-through-the-facts-about-smoking-versus-ecigs-vaping-to-keep-kids-and-communities-safer-and-healthier","status":"publish","type":"post","link":"https:\/\/depts.washington.edu\/harrtlab\/836\/thinking-through-the-facts-about-smoking-versus-ecigs-vaping-to-keep-kids-and-communities-safer-and-healthier\/","title":{"rendered":"Thinking through the facts about smoking versus ecigs\/vaping to keep kids and communities safer and healthier"},"content":{"rendered":"\n<p><strong>Smoking\nhas created a worldwide epidemic of death and disease.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Smoking is the Number One cause of preventable\ndeath in the world. It currently causes about 8 million deaths per year (<a href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tobacco\">https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tobacco<\/a>).<\/li><li>The chemicals from cigarette smoke are inhaled\ninto your lungs and do serious damage over time. They cause breathing problems,\nsmoker\u2019s cough, emphysema and lung cancer among many other illnesses.<\/li><li>Cigarette smoke contains 250 cancer-causing\nchemicals, but there are 2 primary ones that do the most\ndamage\u2014tobacco-specific nitrosamines (TSNAs) and polycyclic aromatic\nhydrocarbons (PAHs). TSNAs are found in tobacco and are especially present in\nAmerican produced tobacco leaves due to the curing process used in the US. PAHs\nare found in smoke generally (e.g, cigarette smoke, the charred parts of your\nsteak, forest fires).<\/li><li>Red blood cells get oxygen from the lungs and\nthen distribute it throughout your body. When you inhale smoke, carbon monoxide\n(like car exhaust), TSNAs and PAHs are deposited on your red blood cells, too,\nand are then carried throughout your body. They thus affect not only your\nlungs, but your other organs, tissues and cells. This is why smokers are prone\nto various types of cancer\u2014not just lung cancer.<\/li><\/ul>\n\n\n\n<p><strong>Nicotine\nis addictive, but it won\u2019t kill you.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Nicotine is the primary drug in cigarettes\nthat gets people hooked. It is highly addictive.<\/li><li>Nicotine is like hopped up caffeine\u2014it revs up\nthe nervous system. Some people feel it helps them concentrate, gives them\nenergy. But it\u2019s also a more complex drug\u2014it can work the opposite way to help\npeople relax.<\/li><li>Nicotine is not highly dangerous or deadly for\nadults. For most, it is relatively harmless outside of its addictive properties,\nso the gold standard treatment for smoking for years has been to replace the\nnicotine in cigarettes with safer forms of nicotine: nicotine lozenges, gums,\npatches, etc.<\/li><li>Unlike with many drugs, you CANNOT overdose on\nnicotine as it is consumed in marketed products (cigarettes, ecigarettes, chew,\nsnus, patches, gums). Withdrawal is not fun but it\u2019s not life-threatening or\nphysically harmful.<\/li><li>In large amounts, however, nicotine can affect\nkids\u2019 brains. It can rewire the brain and affect concentration and impulse\ncontrol. It can lead to lifelong addiction to nicotine, which can lead to\nsmoking unless they are using safer nicotine delivery systems. As far as drugs\ngo, however, it\u2019s not as risky for kids as most others out there.<\/li><\/ul>\n\n\n\n<p><strong>Getting\nnicotine in other ways than smoking reduces risk by at least 85%.<\/strong><strong><sup>1<\/sup><\/strong><strong><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Again, the way adults typically use it, nicotine\nis not highly dangerous in and of itself. So, getting nicotine in a safer way\nthan smoking will substantially reduce smoking related harm. One international study\nfound:<ul><li>Chewing\ntobacco is 85% safer than smoking.<\/li><\/ul><ul><li>E-cigarettes\/vapes,\nare 95% safer than smoking.<\/li><\/ul><ul><li>Nicotine\nreplacement therapy is 98% safer than smoking.<\/li><\/ul><\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/depts.washington.edu\/harrtlab\/wordpress\/wp-content\/uploads\/2019\/10\/safer-nicotine-graph.png\" alt=\"\" class=\"wp-image-838\" width=\"468\" height=\"311\"\/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>So, while\nwe want to prevent nicotine use among kids, e-cigs are a safer choice than\nsmoking.<\/li><li>The more factual information kids and the\ngeneral public have about the relative risks of different drugs, the more they\ncan make scientifically informed choices. We need to provide kids with the\ntruth about nicotine, smoking and e-cigarettes. Otherwise, research has shown\nthey will get and value more the information their peers give them.<sup>2<\/sup><\/li><li>We know\ninformation from peers is often inaccurate and thus potentially harmful, so we\nare best served combatting it through correct yet thoughtful information about\nhealth and safety.<sup>3<\/sup><\/li><\/ul>\n\n\n\n<p><strong>Completely\nswitching to e-cigs is 95% safer than smoking and can promote harm-reduction\namong heavy smokers<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In their 2018\ncomprehensive, systematic review, the National Academies of Sciences,\nEngineering and Medicine concluded ecig use is safer than smoking.<sup>4<\/sup> They even included a chapter on harm reduction involving\ne-cigarettes.<\/li><li>The concentration of\nTSNAs is 97% lower in ecig users than smokers.<sup>5<\/sup> <\/li><li>A study of smokers\nwho switched to ecigs for 2 weeks showed toxin exposure was substantially\nreduced.<sup>6<\/sup><\/li><li>E-cigarette vapor\ndoes not contain the cancer-causing toxins in cigarette smoke that kill people\n(i.e., TSNAs or PAHs). Vaping does not entail other toxins that anyone can link\nto specific serious harm or health conditions.<\/li><li>While we don\u2019t know\nthe long-term effects of vaping, the most cutting-edge science indicates that\n\u201cthe adoption of ENDs rather than cigarette smoking might result in an overall\nbenefit for public health.\u201d<sup>7<\/sup><\/li><li>Some smokers&#8211; esp\nthose who are marginalized and from Communities of Color&#8211;often prefer e-cigs\nto other stop-smoking aids. This makes ecigs a more viable choice as a\nstop-smoking aid than nicotine replacement therapy or other pharmaceuticals for\ncommunities who have been most seriously impacted by the effects of smoking.<sup>8<\/sup><\/li><\/ul>\n\n\n\n<p><strong>How can we\nprotect kids AND leverage e-cigarettes as a support to reduce harm in heavy\nsmokers?<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>We need to continue to do research on ecigs.\nWe do not yet know the long-term health effects.<\/li><li>We must warn the public to purchase ecigs from\nreputable sources only. The recent wave of lung disease in youth was caused by\nvaping cannabis that was illegally produced. It contained an additive that is\nnot used in mainstream ecigs or vapes. It was NOT caused by mainstream vaping\nor ecig use (e.g., Juul).<\/li><li>In the meantime, tightly regulating all\nnicotine products is key. This can be accomplished by setting a high legal age\nto purchase, regulating advertising and how it is pitched to youth, limiting\nvenues where these can be purchased, having consequences for stores and\nindividuals who make nicotine products available to minors.<sup>9,10<\/sup><\/li><li>The FDA\u2019s plan is to start regulating the ecig\nindustry, reduce nicotine content in cigarettes, which will essentially drive\nexisting smokers to safer forms of nicotine use. And it will keep kids and\nothers safer if there is better regulation of the purity of these products and\nlaws against selling products to minors.<\/li><li>Prohibition has\u2014historically and notably&#8211;\nbeen associated with unintended negative consequences. In this case, banning\nindustry-grade ecigs and flavoring means people obtain lower quality and\nillegally produced products or go back to smoking, which would undo positive\nstrides we have made in keeping people\u2014including kids\u2014away from smoking. It\ncould lead to the same kind of public-health-induced crisis we saw with\nopioids.<\/li><\/ul>\n\n\n\n<p><strong>What are\nwe doing to understand ecigarettes and health and safety in Seattle?<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Our long-standing science partnership between the\nUniversity of Washington and Downtown Emergency Service Center (DESC) showed that\nproviding health counseling, which included the above information paired with\nthe provision of e-cigarettes, was an effective combination for heavy smokers\nexperiencing homelessness, a very vulnerable, high-utilizing, high-cost,\nheavy-smoking population.<sup>8<\/sup><\/li><li>Participants rated the acceptability and effectiveness\nof this approach as \u201ctotally acceptable\/effective\u201d (10 out of 10 possible\npoints).<\/li><li>For each 1 week in the study, participants experienced\nan 18% increase in their odds of reporting 7-day, biochemically validated,\npoint-prevalence smoking abstinence. The 6 participants who achieved abstinence\nreported using ENDS, not nicotine replacement therapy (even though we offered\nthem NRT as well).<\/li><li>Participants also showed reductions in self-reported\ncigarette dependence (-45%), smoking frequency (-29%), and smoking intensity\n(-78%; all <em>p<\/em>s&lt;.05), the latter of which are associated with increased\nlikelihood of future quit attempts. <\/li><li>More important, participants who reported using ENDS\nduring the study experienced a 44% reduction in smoking intensity and a\n1.2-point reduction in dependence on cigarettes compared to participants who\ndid not use ENDS.<\/li><li>Our pilot findings echo the balance of the literature\nwhich has shown ENDS may help promote smoking reduction and cessation, even\namong smokers who do not intend to quit.<sup>4<\/sup><\/li><li>We are currently conducting a randomized\ncontrolled trial of this counseling + ecig approach compared to the current\ngold standard treatment for smoking in WA State (i.e., brief advice to quit +\nquitlilne referral). We plan to finish this study in 2021.<\/li><li>We do not endorse or receive any funding from\nthe ecigarette, tobacco or pharmaceutical industries.<\/li><\/ul>\n\n\n\n<p><strong>References<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size\">1.\u00a0\u00a0\u00a0 Nutt DJ, Phillips LD, Balfour D, et al. Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach. <em>European Addiction Research. <\/em>2014;20(5):218-225.<br>2.\u00a0\u00a0\u00a0 Liu J, Zhao S, Chen X, Falk E, Albarrac\u00edn D. The influence of peer behavior as a function of social and cultural closeness: A meta-analysis of normative influence on adolescent smoking initiation and continuation. <em>Psychological Bulletin. <\/em>2017;143(10):1082-1115.<br>3.\u00a0\u00a0\u00a0 Romer D, Jamieson PE, Jamieson KH, Jones C, Sherr S. Counteracting the Influence of Peer Smoking on YouTube. <em>J Health Commun. <\/em>2017;22(4):337-345.<br>4.\u00a0\u00a0\u00a0 National Academies of Sciences Engineering and Medicine. <em>Public health consequences of e-cigarettes.<\/em> Washington DC: The National Academies Press; 2018.<br>5.\u00a0\u00a0\u00a0 Shahab L, Goniewicz ML, Blount BC, et al. Nicotine, carcinogen, and toxin exposure in long-term e-cigarette and nicotine replacement therapy users: A cross-sectional study. <em>Annals of Internal Medicine. <\/em>2017;166(6):390-400.<br>6.\u00a0\u00a0\u00a0 Goniewicz ML, Gawron M, Smith DM, Peng M, Jacob P, 3rd, Benowitz NL. Exposure to Nicotine and Selected Toxicants in Cigarette Smokers Who Switched to Electronic Cigarettes: A Longitudinal Within-Subjects Observational Study. <em>Nicotine &amp; tobacco research : official journal of the Society for Research on Nicotine and Tobacco. <\/em>2017;19(2):160-167.<br>7.\u00a0\u00a0\u00a0 Benowitz NL, Fraiman JB. Cardiovascular effects of electronic cigarettes. <em>Nature Reviews Cardiology. <\/em>2017;14:447.<br>8.\u00a0\u00a0\u00a0 Begh R, Lindson-Hawley N, Aveyard P. Does reduced smoking if you can\u2019t stop make any difference? <em>BMC Medicine. <\/em>2015;13:257.<br>9.\u00a0\u00a0\u00a0 Hardesty J, Awopegba A, Cohen J. Tobacco 21 Policy in Maryland: State of the Evidence. Available at: <a href=\"https:\/\/globaltobaccocontrol.org\/resources\/tobacco-21-reportsummary\">https:\/\/globaltobaccocontrol.org\/resources\/tobacco-21-reportsummary<\/a>. 2019.<br>10.\u00a0 Stockings E, Hall WD, Lynskey M, et al. Prevention, early intervention, harm reduction, and treatment of substance use in young people. <em>The Lancet Psychiatry. <\/em>2016;3(3):280-296.<\/p>\n\n\n\n<p><strong>Created by:<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size\">Susan E. Collins, PhD<br>Professor in the Department of Psychology at Washington State University<br>Affiliate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington<br>Codirector of the Harm Reduction Research and Treatment (HaRRT) Center<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Completely switching to e-cigs is 95% safer than smoking and can promote harm-reduction among heavy smokers.<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,1],"tags":[14,35],"class_list":["post-836","post","type-post","status-publish","format-standard","hentry","category-announcements","category-uncategorized","tag-hart-s","tag-harts-trends"],"_links":{"self":[{"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/posts\/836","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/comments?post=836"}],"version-history":[{"count":9,"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/posts\/836\/revisions"}],"predecessor-version":[{"id":846,"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/posts\/836\/revisions\/846"}],"wp:attachment":[{"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/media?parent=836"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/categories?post=836"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/depts.washington.edu\/harrtlab\/wp-json\/wp\/v2\/tags?post=836"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}