The 10th E-cigarette summit was held in London on December 9th, 2022. The stated objective of this one-day conference is to create a “neutral meeting point for scientists, regulators, industry, public health and practitioners to explore the latest research on e-cigarettes and facilitate respectful debate on what remain highly controversial issues”.
Electronic nicotine delivery systems (ENDS or e-cigarettes) deliver nicotine in a way that is similar to that of combustible cigarettes and hence potentially provide an alternative to them.
These “highly controversial issues” oppose those who believe that ENDS, while they are free of combustion, have no effect on smoking cessation, and are creating “a new generation of nicotine addicts”, and on the other side, those who believe that they are less harmful than combustible cigarettes.
First among the opponents is the World Health Organization of which one of their main concerns is how flavours in e-cigarettes impact product appeal for the youth especially.
For Dr Jamie Hartmann-Boyce, Associate Professor and Editor at the Cochrane Tobacco Addiction Group at the University of Oxford:
“At a population level, e-cigarettes have not acted as a gateway to increase smoking…E-cigarettes are generally unattractive to non-smokers, including non-smoking adolescents but attractiveness can be increased by marketing and product design.”
Besides, she pointed out that:
“In countries with a strong tobacco control climate that permit use of e-cigarettes, they have become the most popular quitting aid and have had a detectable impact in reducing smoking prevalence but they are used in fewer than half of quit attempts and have not increased the quit attempts.”
Professor Maciej L. Goniewicz, Professor of Oncology at the Department of health Behavior at the Roswell Park Comprehensive Cancer Center, USA, shared his research and other scientific studies on flavours in e-cigarettes and recognized that: “Youths report that flavours are a primary reason they use e-cigarettes, and most youth e-cigarette users first initiate use with flavoured products.”
In his conclusions, he commented on the fact that while young people stated that they used ENDS because they tasted good, “there was judged to be insufficient evidence that use of e-liquid flavours specifically is associated with uptake of smoking and that no studies found clear associations between flavours and cessation” (studies of the University a-of Michigan 2015 & Notley et al., 2022).
He added that “policies that would have the greatest positive impact on youth and never smokers, but little negative impact on adults who vape as a method of quitting smoking, should be a priority for regulation”.
On the presence of toxicants in e-cigarettes, Prof. Alan R. Boobis, Emeritus Professor of Toxicology & Chair of the UK Committee on Toxicity at the Imperial College London stated:
“The liquid in e-cigarettes, propylene glycol and/or vegetable glycerin (glycerol) is relatively non-toxic at the levels present when inhaled over the short to medium term. This applies to both absolute and relative risk, in users and in bystanders…there is some uncertainty about the effects of long-term, repeated exposure in users.”
In addition, he noted:
“The most toxic chemicals found with conventional cigarettes are either not present or are present at much lower levels in e-cigarettes. For example, levels of the tobacco-specific nitrosamine NNK (Nicotine-derived-nitrosamine ketone) in e-cigarettes are < 0.3% levels with conventional cigarettes. Mercury was not detected in ENDS. Lead, rubidium, arsenic, silver, cobalt, bismuth, palladium and cadmium were rarely found in ENDS.”
He also stated as a conclusion:
“The evidence suggests that the risk posed by e-cigarettes to users is substantially less than that posed by conventional cigarettes, but at present we cannot quantify precisely by how much less…E-cigarettes are not without some risks, hence use as a lifestyle choice is not advisable”. And the risks to bystanders are low to very low. There are some data gaps, including long-term effects in users (but these are narrowing over time)”
Are Low and Middle-Income Countries left behind?
The last presentation of the conference was on Low and Middle-Income Countries (LMICs). It was the only speech on LMICs whereas it is estimated that among the 1 billion smokers worldwide, 80% live in those countries.
Dr Sivakumar Thurairajasingam is Associate Professor in psychiatry and Head of the clinical School Johor Bahru at the Monash University in Malaysia.
For him, “there is a need to complement existing tobacco control policies by creating access to a range of reduced harm products to assist smokers in transitioning away from combustible tobacco products and towards achieving tobacco harm reduction objectives. Tobacco harm reduction is a viable and complementary component to strengthen national tobacco control strategies” adding that policies must be in place to ensure equitable and affordable access to adult smokers, whilst limiting access to youth”.
While the adoption of smokeless tobacco in various countries coincides with the decrease of combustible cigarettes’ use, research on e-cigarettes remains deficient in Africa where only a few countries allow them.