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Electronic cigarettes as a method of tobacco control

Journal Editorial Article 1)

Allow them, but research and monitoring are needed so that the risks can be regulated.

Electronic cigarettes (e-cigarettes), cigarette shaped products that vaporise nicotine in ways that enable it to be inhaled, have become increasingly popular in the past few years.1 2 3 E-cigarettes are a potentially more attractive substitute for smoking than low toxin smokeless tobacco because the nicotine is delivered by puffing, as when smoking a cigarette. A range of products are now on the market, with new improved ones promised, and—something almost unheard of in tobacco use—self organising groups of users (who call themselves “vapers” because they inhale vapour, not smoke)—who are advocating for these products and sharing their experiences.1 3 Opposition has come from some health groups, either for pragmatic reasons or because they are opposed to any recreational use of nicotine.

Medical journals including the BMJ have called for more research or regulation (or both),4 5 6 7 8 with the main difference being whether this should occur before allowing the products on to the market,4 or accepting that they might continue to be allowed.5 6 7 8

1. Ayers JW, Ribisl KM, Brownstein JS. Tracking the rise in popularity of electronic nicotine delivery systems (electronic cigarettes) using search query surveillance. Am J Prev Med 2011;40:448-53.

2. Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? J Public Health Policy 2011;32:16-31.

3. Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction 2011; published online 27 July.

4. Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nicotine delivery systems and public health: the rise of the “e-cigarette.” Am J Public Health 2010;100:2340-2.

5. Cobb NK, Abrams DB. E-cigarette or drug-delivery device? Regulating novel nicotine products. N Engl J Med 2011;365:193-5.

6. Etter JF, Bullen C, Flouris AD, Laugesen M, Eissenberg T. Electronic nicotine delivery systems: a research agenda. Tob Control 2011;20:243-8.

7. Flouris AD, Oikonomou DN. Electronic cigarettes: miracle or menace? BMJ 2010;340:c311. Henningfield JE, Zaatari GS. Electronic nicotine delivery systems: emerging science foundation for policy. Tob Control 2010;19:89-90.

8. UK Cabinet Office. Behavioural insights team. Annual update 2010-2011. www.cabinetoffice.gov.uk/sites/default/files/resources/Behaviour-Change-Insight-Team-Annual-Update_acc.pdf.

Re: Electronic cigarettes as a method of tobacco control

26 September 2012

Dear Sir.

A year has passed since your editorial[1] on the regulation of electronic cigarettes and little appears to have changed. A recent interchange between a staff member and a patient regarding electronic smoking on hospital premises identified a lack of coherent local guidance and made us wonder what colleagues in neighboring hospitals were doing.

We contacted nine trusts in the Wessex deanery and asked whether they had a policy regarding electronic smoking. Only three trusts had clear guidelines which stated that e-cigarettes are prohibited. The remaining six were unclear when challenged with the scenario of a patient smoking an e-cigarette on site. Some stop smoking services within these trusts were promoting their use as part of a cessation programme, despite concerns around their regulation[2], safety and efficacy[3] due to inconsistent standards across manufacturers[4].

Why are they prohibited in hospitals? Surely as a nicotine replacement device they are no different from patients using patches or chewing gum and should therefore be celebrated. Are we in fact banning the imagery that accompanies smoking? Research shows that visualizing somebody smoke is a trigger for other smokers to light up[5]; something that the electronic cigarette’s smoke-like water vapour may stimulate.

Interestingly the BMJ’s Editorial stated that the “alternative of waiting for the research may end up essentially as prohibition”[6]. Either way, some smoking cessation teams use e-cigarettes and the hospitals in which they are advocated should support this therapy by allowing the device’s use on site. What is clear is that there is inconsistency of policy across hospitals, and a wider NHS statement may be welcome.

Yours sincerely.

Mr Manroop Bains. BA, BMedSc. University of Southampton.
Ms Hazel Agombar. Senior smoking cessation advisor. Solent Trust.
Dr Emily Clarke. MSc MRCP. Solent Trust.
Dr Rajul Patel. FRCP. Solent Trust.

1. Electronic cigarettes as a method of tobacco control. BMJ Editorial. BMJ 2011;343:d6269. Published online 30 September 2011.

2. Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? J Public Health Policy 2011;32:16-31.

3. Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction 2011; published online 27 July.

4. Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? J Public Health Policy 2011;32:16-31.

5. Journal of Neuroscience, DOI: 10.1523/jneurosci.5174-10.2011.

6. Electronic cigarettes as a method of tobacco control. BMJ Editorial. BMJ 2011;343:d6269. Published online 30 September 2011.

Competing interests: None declared


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1)
Borland (2011), Electronic cigarettes as a method of tobacco control, http://www.bmj.com/content/343/bmj.d6269?view=long&pmid=21964546 accessed: 2013-10-23
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