• Harm reduction: there's evidence that vaping helps~ No Evidence on Vaping Trends?

    I’ve been kind of reluctant to comment on vaping studies from years past, since I feel like most of the studies conducted prior to this past year have been kind of subpar. This is not to say that the researchers conducting these studies are at fault here, but rather that vaping was really, really poorly understood before its sudden explosion on the public scene within the past year, so many studies even from 2014 suffer from a severe dearth of expertise on the topic. Before the advent of vape shops and the now ubiquitous availability of e-liquids the scattered nature of the emergent “vaping culture” made it difficult to know exactly how people even vaped as well as what they vaped. Most studies from before this year, then, are kind of useless.

    That said, today I came across a short letter published last summer in the American Psychological Association’s Addiction newsletter. Though it was a full year old, the letter, which synthesized a number of the researchers’ previous studies on the prevalence of vaping, brought forth a good number of interesting points, and a lot of evidence supporting the value of vaping.

    In one of the studies mentioned, current smokers were presented with a choice of three different cigalikes, and then set free to roam the world for a week, smoking and vaping as much as they desire. Over the course of the sampling period, their confidence in their ability to quit smoking, as well as their desire to try to do so to begin with, skyrocketed. Even though none of the smokers were told to reduce their smoking by any amount, they voluntarily reduced the amount they smoked by 44% over the course of the week.

    Another study set out to test the hypothesis that vaping is a gateway into smoking. Though the study was cross-sectional as opposed to longitudinal, some of the questions asked seem to provide some temporal dimension to the findings. Out of a total of more than 1,300 college students surveyed, almost 200 of them, or 14.6%, had tried electronic cigarettes. This, of course, is in line with number we’ve seen from other sources. What’s more interesting is that of those students for whom electronic cigarettes had been the first tobacco product they had tried, 46 in total, only one had become an occasional user of vapes, with two more transitioning to smoking cigarettes with some regularity. By contrast, of the more than 300 students who had first tried cigarettes, almost 25% were, at the time of the study, regular smokers.

    The final study outlined in this paper indicated that tank-system vapes are quite reliable in reducing smokers’ number of cigarettes smoked, and that most vapers using tank-system vapes gradually decrease their preferred nicotine levels, providing evidence that vaping, far from increasing nicotine addiction, actually helps reduce it.

    All of this, to me, is pretty fascinating. What is even a little more fascinating, though, is that all of this information is readily available, and just as readily ignored. Vapers are often subjected to endless tirades about the lack of evidence regarding vaping, when what is really meant by these tirades is that the evidence does not seem credible to people who approach it with entirely preconceived ideas about what it should be saying in the first place.

    Happy vaping!

     

  • Dr. Eriksen Dr. Eriksen Talks About E-cigs on Reddit

    Last week, I wrote a post about the latest edition of the Tobacco Atlas. As you might remember, electronic cigarettes got a pretty disappointing treatment in this book; for the most part, the authors focused on the connection between big tobacco companies and their share of the vaping industry, and warned that e-cig advertising could lead to another golden age of tobacco consumption. A few days after the blog post (and obviously bearing no relation to it), the lead author of the Tobacco Atlas, Professor Michael Eriksen of Georgia State University, showed up on Reddit to give an AMA. Given his background in novel tobacco product research, the discussion unsurprisingly centered on electronic cigarettes. As usual, the content of the discussion was ultimately somewhat disappointing. Dr. Eriksen mostly just rehashed what we’ve seen from him in other venues. However, as this is the kind of discussion vapers will be having with public health representatives for a long time to come, it is still worth taking a look at some of the highlights.

    1. Dr Eriksen thinks we should regulate e-cigs in much the same way as cigarettes, though he is not convinced that flavors should be banned.
    2. As we’ve seen before, a huge problem public health experts identify in the spread of vaping is that vapers often continue smoking even after they pick up vaping. Dr. Eriksen voices similar concerns about dual use, and appears to believe that the greatest danger posed by vaping is the prospect of it inhibiting smoking cessation and “result[ing] in kids starting on a path toward lifetime nicotine addiction.” Interestingly, Dr. Eriksen does little to convince the public that e-cigs themselves are dangerous. Rather, it appears that they have been imparted “risk” by their association with combustible cigarettes, or something.
    3. At the same time, he believes that in 20 years, most nicotine consumption will occur via electronic devices, with less than 5% of the population smoking combustible cigarettes.
    4. There is little data showing that e-liquid flavorings are safe for inhalation, though most are certainly generally recognized as safe by the FDA for direct ingestion. More research is needed on that front.
    5. Since the use of snus has been proved to lower the incidence of smoking and smoking-related diseases over the long term in Sweden and Norway, he is excited about the opportunities presented by such lower-risk tobacco products. However, at this point he is reluctant to accept that e-cigs could confer similar benefits.

    So overall, there was a little information and a lot of handwaving about actual dangers posed by nicotine, etc. Most of what I get when I read these sorts of things is a sense of just how entrenched “common wisdom” regarding various “public health dangers” is. I don’t doubt that Dr. Eriksen means well, but to claim, for example, that e-cigs should be subject to the same indoor use limitations as cigarettes is just outright silly and based entirely on the myth of the dangers of second-hand smoke (not to mention that even if second-hand smoke were actually a problem, that would not translate into second-hand vaping being a problem).

    Happy vaping!

  • AGDs v FDGs AGDs vs. FDGs: Battle of the Vapes

    Since the publication of the now infamous “Hidden Formaldehyde” paper, articles on e-cigs have seemingly been flooding academic journals. A new study, published recently in Nicotine & Tobacco Research and conducted at Penn State, takes a look at vaping habits and preferences among a group of more than 4000 survey respondents. The main data researchers tracked had to do with vapers’ use of first generation devices (FDGs), meaning cigarette-like vapes, versus advanced generation devices (ADGs), namely open system vapes.

    Most of the findings shouldn’t come as a surprise to anyone who is at all familiar with the vaping industry. While more than half of vapers begin vaping using FGDs, more than 60% of these vapers eventually switch to ADGs if they choose to continue vaping. By contrast, fewer than 10% of vapers who start off with AGDs switch to FDGs. AGD users are also more likely to be male, be educated beyond high school, and have been vaping for longer than FDG users.

    Buried in this data is an interesting data point: while a full 39% of cigalike vapers are concurrent tobacco smokers, only 10.5% of AGD vapers still smoke cigarettes. The researchers somehow do not tease this point out further, though it is deserving of more attention.

    Keep in mind that AGD vapers are the ones who are supposed to be in the gravest danger. They vape twice as much every day as FGD vapers, show slightly higher levels of nicotine addiction, and it has been shown many times that they can, through practice, get far higher yields of nicotine in their nicotine aerosol than cigalike users, despite the latter group usually using liquids higher in nicotine concentration. The fact that AGD users manage to quit despite their higher levels of dependence on nicotine should be indisputable proof that vaping actually works as a quitting aid, and that it is certainly not a gateway drug into more tobacco consumption. I find it difficult to believe that AGD users are not subjecting themselves to significantly less harm than FGD users, who do not appear to be as well equipped to fully quit smoking.

    This kind of study is also crucial in determining the implications of various proposed vaping regulations. For one, they show that regulations with differential impacts on ADGs versus FDGs might well reduce the usefulness of vaping for many users. Since so many long term vapers appear to have finally managed to quit smoking on switching to the far more effective AGDs or starting off with AGDs, regulations that would stifle innovation in the AGD market would have devastating effects on quit rates. These regulations do not have to go so far as to ban AGDs. Though Reynolds executives famously urged the FDA to ban open system vapes, which would be categorized as advanced generation devices by this study, the FDA thankfully does not appear to have taken these suggestions into account, and open system containers will likely not be banned; however, restrictions aimed at bottled e-liquid, for instance, do carry differing consequences for AGDs versus FGDs, as do restrictions on the online sale of vapes and e-liquid. These restrictions are very much real, as shown by the latest Washington bill, which would both ban flavored e-liquids and outlaw the online sale of vaping products. These restrictions will also have a very real effect on quit rates among vapers.

    Happy vaping!

  • blu: a Lorillard brand Lorillard Study: Should You Trust Its Findings?

    Lately I’ve seen a recent article about the safety of vaping make the rounds. The article, published in late 2014 in Regulatory Toxicology and Pharmacology, is neither entirely credible nor definitive, so I have so far held off on writing about it in an effort to provide somewhat reliable information. On the other hand, wider media coverage on the article, which appears to have started last week with an article on Reason.com, has been overeager and misleading, showing that pro-vaping activists can sometimes be as careless as anti-nicotine activists in promoting their cause.

    This main problem with the study, which according to Reason “confirms that e-cigarettes generate virtually no toxins,” is that it was designed and funded by Lorillard, the producer of Newport cigarettes and blu e-cigs, among other products, and conducted in Lorillard labs. While this aspect of the study is not entirely damning, it should throw up a huge red flag to anyone who has, in the past, scowled at studies funded by big pharm companies that “prove” that electronic cigarettes are more dangerous than even smoking. I would thus be hesitant to say that this study “confirmed” much at all.

    That said, the study is not entirely without value. So let’s take a look at the findings. Researchers compared aerosol produced by 5 electronic cigarettes (all Lorillard) in different flavors to smoke produced by Marlboro and Imperial Tobacco cigarettes (interestingly not Lorillard brands), and found that the amount of potentially harmful chemicals present in e-cig aerosol is on average 1500 times lower than the amount of these same chemicals in cigarette smoke. The study analyzed 55 of these chemicals, and found that e-cigarettes produced only 5 of these at rates significantly different from “air blanks,” that is air drawn through the apparatus without any e-liquid. Reporters have translated this to mean that e-cigs do not produce these chemicals at rates different from ambient air, but that interpretation sounds disingenuous to me. It is possible that the device itself is what ends up producing these chemicals, in which case eliminating them altogether is a matter of vape design. Even so, the findings on the concentration of these potentially harmful compounds did appear to fall in line with other studies we’ve seen in the past.

    Beyond the misgivings one might have regarding the source of this study, another shortcoming is that the only e-cigs studied were disposable and rechargeable Lorillard cigarette-like vapes. This shortcoming becomes more obvious when one looks at nicotine yields from the e-cigs studied: while the nicotine content of the e-liquid is relatively high, nicotine yield in the vaping aerosol is about 8 times lower than that in cigarette smoke. As we’ve seen before, though, the level of aerosolization of nicotine varies greatly depending on the vaping device used, and this difference may also apply to other byproducts. Larger atomizers might produce different results, then, but this is a question for follow-up studies.

    So what does this mean for e-cig research? Should we refuse to acknowledge any research performed by people with ulterior motives altogether, such as the scientists working for Lorillard? My answer would be that no, that would be a mistake, but yes, we should certainly be more cautious about the things we choose to accept as definitive.  Comparisons with findings from studies funded by different parties are useful in determining whether the source of funding for a particular study influenced its results, and overall research consensus is what we should ultimately aim towards. So far, though, research consensus is looking pretty good.

    Happy vaping!