E-Cigarettes, as Used, Aren’t Helping Smokers Quit, Study Shows | Hacker News Reader

E-Cigarettes, as Used, Aren’t Helping Smokers Quit, Study Shows

ucsf.edu

31 pointssundaeofshock58 comments

'Quitting' seems like an arbitrarily high bar to set.

Bob is a 20-a-day smoker. Bob takes up e-cigarettes and subsequently ceases smoking other than the odd one here and there (social events, ran out of e-liquid, etc).

If e-cigarettes are healthier than conventional equivalents, then that alone seems like a huge improvement to me.

Replace all instances of 'conventional cigarette' with 'chocolate bar', and 'e-cigarette' with 'apple'. Perhaps eating apples doesn't result in quitting chocolate, but if it reduces consumption, that's great!

While the health issues are unresolved at this time many insurance policies consider them the same as smoking with regards to penalties and such.

the only solution to smoking is to quit

Thank you for the down votes, smoking is not equivalent to abstinence

> the only solution to smoking is to quit

That's like saying the only solution to teen pregnancy is total abstinence.

We already know how that one works out.

It's clear the above poster's argument regarded insurance. Call e-cigs a metaphorical condom or whatever but you aren't paying premiums for your risk of becoming pregnant just because you have sex.

Non smokers get lung cancer too.

That describes me perfectly. Went from about 20-a-day down to maybe 4 thanks entirely to vaping.

Don't quote me on it, but I recall reading that the health effects don't scale linearly. Going from smoking 100 cigarettes a week to smoking 3 doesn't necessarily reduce the health impacts by 97%.

probably because of all the diesel fumes we are breathing in

The full text is available for free. http://www.thelancet.com/journals/lanres/article/PIIS2213-26...

You need to log in, I used http://bugmenot.com/view/thelancet.com

Having a quick skim, here's what I currently guess is going on. It's a meta-analysis, and most of the studies it looks at include smokers who aren't trying to quit. The effect remains (but weaker) when they restrict to studies of smokers who are interested in quitting. But "interested in quitting" doesn't necessarily mean they were actually trying to quit.

So my guess is Simpson's paradox: for people who try to quit, e-cigs help them quit; for people not trying, e-cigs make approximately no difference; but people trying to quit are less likely to use e-cigs, and so people using e-cigs look like they're less likely to quit.

Reading the paper more thoroughly might be able to falsify this guess.

("Quit" here means "quit cigarettes". Someone who stops smoking cigarettes, but continues smoking e-cigs, is considered to have quit.)

thank you for taking a look at the actual research and breaking down issues in the meta study methodology

I find this hard to believe. I was a smoker for a decade and I quit smoking last year only because of vapes (e-cigs).

Didn't even plan to quit smoking but I was concerned about my health so I decided to try vapes for a while. The cool thing about it is that you can control your nicotine dose, so every month I lowered it a bit. The difference was small enough that my body didn't feel it.

After a couple of months I got to 0-nicotine vape. Did that for a month and by that point my body was not addicted to it any more. Then I just stopped vaping altogether. Not because I wanted to but because my body didn't need it anymore and I couldn't care less about it.

The whole process was pretty easy. At no point did I struggle to quit. I just did what my body felt like. I'm pretty sure the story would have been totally different without e-cigs.

I have started quitting this exact same way. I'm not as far along as you are, but I have dropped to 3mg (from 18) which is the next dosage up from 0.

I don't believe this article because of the massive tobacco lobby working valiantly to combat the rise of new companies in the vaping sector. the FDA is coming close to a ban on vape products all together for this same reason.

If you feel like you can't make the jump straight to 0 yet, some places make 1.5mg liquid.

>> While they are promoted as a way to quit traditional cigarettes, they also are promoted as a way to get nicotine in environments where traditional cigarettes are prohibited

>> The studies included smokers who both were and were not interested in quitting, and included people as young as 15 years old.

This is key - if there is a group who are using them only because they provide a way of getting nicotine into your system where it is otherwise not allowed, then it seems likely to me that this group would be more committed to smoking than average, which may go some way to explaining these results.

Personally I found the e-cig very useful when quitting, but I used it nicotine-free because the law in Australia bars e-liquids with nicotine from being sold. You can import legally but by the time my imported e-liquid arrived I'd kicked the nicotine addiction anyway.

Having seen people get very attached to their e-cigs with nicotine, I reckon I got it right.

(--edit-- As I was using no-nic liquid, when the addiction passed and I didn't need the crutch any more, I just naturally slowed and then stopped the e-cig use without even thinking about it, after about 4 months IIRC)

Who said that it should help quit smoking? ...except the marketing from some e-cig sellers anybody already knows or should know that it will not help to quit or helps only a bit.

However I am on e-cig for 3 years now and as I feel, it is much better for health then regular cigarettes.

Yeah the title is poorly worded. It looks like they're asking whether e-cigs help people quit smoking regular cigarettes, not whether they help people quit smoking entirely.

I don't know, just anecdotal evidence of course, but I stopped smoking around 3 month ago and started vaping. I don't even want to smoke cigarettes anymore. They taste disgusting if you haven't smoked one in over a month (I ran out of liquid and tried one again, threw it away after 3 puffs, rather dealing with not having a nicotine fix for 3 hours).

While YMMV I highly doubt that e-cigarettes cause people to not quit smoking. I bet this is because of how the participants were selected. I don't know, people trying e-cigs have tried quitting before/smoked for longer/whatever thus skewing the statistics.

Used to smoke 2 packs a day, got some e cigarettes and haven't smoked for 6 months. It's not even hard to do, handles nicotine addiction just fine.

I know I still inhale some shady stuff and nicotine but I feel much better, have more energy, lung capacity and a fun hobby. It's best not to smoke/vape anything but switching to this feels like quitting to me.

"Popcorn lung or bust!" I finally quit smoking after about 20 attempts last year, after having smoked about 10 years, 1-2 packs a day, 3 on occasion. I'd tried everything. Patches, gum, e-cigarettes, etc. The e-cigs didn't help me at all... in fact they extended the very same problematic habits (fingers wanting something to do while I had a drink in the other hand, primarily). Gum was good for situations where lack of nicotine was removing my capacity to concentrate. What finally worked was taking a month away from any familiar drinking/smoking environment and any work commitments. I would recommend quitting your job, changing your environment and just going cold for a month or two to successfully quit smoking. Don't rely on products, they're just feeding the same addition. Most people who successfully quit apparently fail to quit a lot of times (8-12?), though not as many as me. So I'm something of an expert. ;)

I am really happy that you are able to quit. Nicotine as an addiction is very difficult to break and one should try every approach and see what works best for them. For those for whom 'quit your job and move somewhere' is not an option, I strongly feel that e-cig provides an alternate which is worth trying. Even if you can't quit it fully, vaping definitely is a better alternative than smoking.

I am not a smoker, but I watch smokers and smoking closely, just because nicotine has neuroprotective effect.

Typical story of quitting smoker tells that there is a stack of various negative symptoms for three days. These three days have to be completely distraction-free. Then worseness of symptoms drops and by the end of second week the life goes back to normal, more or less so.

In the worst case one should be ready to fight himself just like heroin junkie, because withdrawal symptoms are quite similar in both cases, it is the magnitude that differs (and no joint pain, of course). For example, there can be problems with sleep and just like with heroin quitting it restores only after half of year.

Am not surprised. As smoking has become more costly (with anti-secondhand-smoke regulations) and socially unacceptable, many smokers have found means to quit, and surely many used vaping for this. But it seems to me that a large proportion of the people who took up vaping were hardcore smokers who want a more licit habit. And so they're frequently going on about how vaping is totally harmless, it has absolutely no secondhand consumption issue (all very dubious). If vapers were formerly the most hardcore smokers, it's not surprising that vapers would be less likely to quit. Although it is still probably a good thing, from a harm reduction viewpoint.

Vaping for smoking cessation needs more than some anecdata. It needs controlled trials where vaping is compared against placebos and other cessation methods, like Chantix. but I'm afraid that the vaping industry is nearly as interested in promoting disinformation as the tobacco industry was.

According to this study normal smoking has virtually no secondhand consumption issue, unless you live with a smoker for 30 years.

http://jnci.oxfordjournals.org/content/early/2013/12/05/jnci...

That is not at all what that article says. From your link:

“Passive smoking has many downstream health effects—asthma, upper respiratory infections, other pulmonary diseases, cardiovascular disease—but only borderline increased risk of lung cancer,” said Patel.

...So does secondhand smoke cause lung cancer or not? “We can’t say it’s not a risk factor,” said Wang. ...“It’s hard to say anything conclusive with such small numbers,” said Wakelee.

...Moreover, of the nearly 40,000 nonsmokers in the WHI-OS, only about 4,000 reported no exposure to cigarette smoke. “That means almost everybody had passive-smoking exposure,” said Wakelee, “so it’s very hard to say that that exposure is causing the problem—it’s hard to tease out a difference.

“We don’t want people to conclude that passive smoking has no effect on lung cancer,” she said. “We think the message is, this analysis doesn’t tell us what the risk is, or even if there is a risk.”

Every two or three months we see this same headline based on the same studies or have new numbers. We all know that other methods had very low success rate yet we never see a healine about Nicorette or patches.

A large number of "vapers" have reduce or even stopped smoking, including myself.

My goal was to stop smoking, goal achieved.

Define quitting smoking.

Vaping hasn't helped me quit nicotine addiction, but I haven't breathed cigarette smoke in years.

You must be the odd one out. Apparently, people that vape are less likely to stop breathing regular cigarette smoke than those that kept using regular cigarettes.

> While there is no question that a puff on an e-cigarette is less dangerous than a puff on a conventional cigarette, the most dangerous thing about e-cigarettes is that they keep people smoking conventional cigarettes.

I started using an e-cig 5 years ago and but for one relapse haven't smoked a cigarette since. They taste like licking an ashtray.

Wow, 5 years is a long time. How much liquid do you consume? Had any chest x rays or something recently to see if it had any adverse effects on your lungs?

Yeah, I was an early adopter. As a geek who wanted to quit smoking, when I found there was a gadget that might help I was immediately interested.

As a lifelong asthmatic it was easy for me to detect what cigarettes were doing to my health. I only smoked for about 5 years (I started smoking after a divorce) and easily transitioned to an e-cig. My lung health returned quickly when I quit analogs. Now my asthma is manageable with standard treatment (Advair). I don't even need a rescue inhaler anymore.

I consume 5-10ml/day of 12mg nicotine e-juice.

I only have data from what I've personally seen, but, this just seems... off to me. Sitting here and thinking, even without going to my facebook page and looking over my friends list, I can easily rattle of over 20 names of people who now vape primarily and rarely, if ever, smoke regular cigarettes, and the few that do have cut down from a pack+ a day to one or two.

Yeah, it's anecdotal, but it's odd to me that my own personal experience has results that are a complete opposite.

Personal experience/anecdote alert.

I found that it took a few 'goes' at the vaping thing before I properly 'got it'. I enjoyed and saw the benefits of the vape from the first time I used it, but went through a few cycles of vaping-and-the-odd smoke, then a few weeks of only vaping, then back again, and almost gave up on the whole thing. Then for some reason last February, it clicked and I ditched the smokes completely. Not had one since then. No interest in smoking again, ever.

I've described it to friends and family as being a bit like I imagine methadone is to junkies, though no personal experience there. It doesn't initially fill all the holes in quite the right ways (for me anyway, some love it immediately but I suspect those are the 'odd ones out') but is 'good enough' that it can work - it does however take a little effort to make work, it's not a magic silver bullet.

It certainly was a lot more effective than any time I've tried to stop smoking using anything else, though.

This may be a really naive question (or I may be falsely inferring that you want to quit nicotine), but I'm curious:

If you've cut out the behavioral addiction with cigarettes and are now addicted solely to nicotine, couldn't you slowly ween yourself from nicotine by gradually using liquids with less and less nicotine until you eventually end up using liquids without any nicotine?

You can.

Liquids generally have a nicotine rating in mg per ml. I started with 18mg liquids, then 12, 6 and now 3mg (which is the lowest rating on most brands). I consume a little more liquid than before but it's probably due to my recent switch to 3mg from 6mg. As soon as I get used to 3mg, I'm finally gonna get some nicotine free liquids and start diluting 3mg to 2, 1 and then 0.

Most people don't do this as far as I can tell though.

I did this a few years back, after about 9 months of vaping at decreasing nicotine levels. pretty much the day I swapped to 0 nicotine I started noticing people smoking in the street, within a couple of weeks I'd stopped vaping, and within a month I was smoking again.

Up until this point I had not realised just how ingrained my nicotine addiction was (before this I assumed I was mainly just behaviourally addicted).

I could, but that's not my goal now. I've used nicotine for about 30 years. I've quit smoking/nicotine a couple times, for a few years each time. I was so much less productive and nearly failing at my job for those years that I went back to nicotine. I'd sure like to quit, but not sure my old brain can change at this point.

I was a light smoker (a pack in 3 days) and hated that I was addicted to cigarettes. I tried nicotine gum and patch to help me quit but it didn't really work.

Then I realized that I am more addicted to the act of having something in my hand blowing smoke then nicotine. I have switched to e-cigarettes and have moved to juice with 3mg nicotine. I feel much better overall and have quit regular cigarettes.

I haven't looked at all the papers regarding e-cigarette's ill side effects but based on how my body feels, it is definitely better than regular cigarettes, no question about it.

Smoked 60 a day, from around 2001 til August of 2012. Began using an e-cig in August of 2009, off and on again until I found what worked for me. Now 1,242 days without a cigarette.

No, it's not for everyone and it won't help everyone quit. But, as it says right in the article, no business or brand markets it as a smoke cessation device. Only end users are making those claims. Furthermore, it's not clarified on the page as to whether or not people who continued vaping were considered to not have quit smoking.

Congratulations! For me, it's 353 days, and I attribute this success to having vaped for a year prior to that, and being able to gradually reduce the nicotine levels without reducing the frequency of vaping.

I think it's unfortunate that the conclusion of the paper (that all smokers are 28% less likely to quit if they also vape) will be confused with the questions that doctors and policy-makers will be interested in: whether smokers who want to quit are more or less likely to quit with the aid of e-cigarettes, and whether smokers who use e-cigarettes are more or less likely to die of cancer.

It seems like there's a huge, irrational split between pro-smokers and anti-smokers, and it's a big shame that what really matters might get lost in the argument: helping people to not die early.

I'll +1 to the other comments here of people who stopped smoking cigarettes and took up vaping. I didn't even intend to quit, and I know a lot of other people in the same situation.

For some people, vaping is just far more pleasant than smoking cigarettes and they don't look back.

The couple of times I started back up again with cigarettes early on was when I ran out of e-liquid, since it is heavily regulated (or illegal, as in AU) and can be difficult to obtain.

I really find this result difficult to believe.

Same here, I was happy to keep smoking and had no intention of quitting. I just thought e-cigarettes were a cool new gadget to try, and I liked the idea that I could now 'smoke' even more places. I fully expected to continue smoking but over the course of about three months, I just stopped all of it very gradually. It wasn't the expected outcome at all, but it's nice. Haven't smoked for at least eight years now, but I tell people (only half joking) that I would start again if medical science advanced far enough to counter the health risks.

but what about the health benefits? isn't that the real bottom line we care about? not something arbitrary and meaningless like whether people completely stop smoking? isn't reducing smoking a good thing too?

it does need some regulating though. the volume of nicotine in the default over the shelf vaping kit... you never get anywhere near to consuming as much as that smoking 20 a day of the strongest brands.

The volume of nicotine may be higher, but note that the 'nicotine content' marked on cigarettes is generally the amount considered to be available/absorbed, whilst the content marked on e-liquids is the total present.

Whether the amount absorbed is higher I'd be interested to know. I suspect it depends quite strongly on the mechanism (tiny vape pen vs mech setup, how long vapour is held before exhaling, etc).

> the volume of nicotine in the default over the shelf vaping kit...

I did the calculation myself and was shocked at how much nicotine was in the liquids, but after looking into it, I believe the nicotine absorption rate from vaping is much lower than from traditional cigarettes[0]:

> Compared to smoking one tobacco cigarette, the EC devices and liquid used in this study delivered one-third to one-fourth the amount of nicotine after 5 minutes of use. New-generation EC devices were more efficient in nicotine delivery, but still delivered nicotine much slower compared to tobacco cigarettes. The use of 18 mg/ml nicotine-concentration liquid probably compromises ECs' effectiveness as smoking substitutes; this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes.

[0]http://www.nature.com/articles/srep04133

And it's not only about nicotine. Think about all the other harmful chemicals you inhale when you smoke a regular cigarette, and not when you smoke an e-cigarette. Such as tar, ammonia and arsenic.

It isn't clear to me how useful this study is. There is no indication that the people found "less likely" to quit even intended to do so in the first place. The story seems to make the assumption that anyone vaping is doing so as a cessation technique but that certainly is not true in my anecdotal experience.

Since this came from the UCSF Center for Tobacco Control Research and Education, it's pretty easy to assume a senseless agenda behind the whole thing.

I will say, as someone who shuns nicotine after a decades-long addiction, I find vapers far more pleasant than smokers. If people are switching with no intent to quit, that's still a big win in my eyes. Particularly since I don't see it as my job to regulate what people put into themselves.

If it's like smoking, but safe, then who cares if less quit?

The projected amount of damage done by means of people hurt by not quitting ecigs needs to be higher than the projected amount of damage done by means of people not switching to ecigs for this to be alarming.

They are saying e-cigarettes are not contributing to people quitting regular cigarettes. People who vape also smoke.

Why are vapers so convinced that vaping is "safe"? The supposed "safety" of e-cigs mostly looks like industry marketing to people desperate to preserve their habit.

I vape and I don't know if vaping is safe or not. But here's what I do know. From seeing how my body reacts to it, I think vaping is a better alternative than cigarettes to get nicotine. I am a full advocate for further research in to vaping and identifying the exact side effects.

It would be implausible for vaping to not be less harmful than smoking. And harm reduction is good! But that's a far cry from "vaping is 'safe'".

You can't quit if you don't really want to. E-cigs aren't a get out of jail free card and cannot replace willpower. It is a quitting aid. Like all quitting aids you will still have a job to do - it just takes a little less effort.

I am certain that I would have still quit on my final and successful attempt, regardless of the e-cig. I wanted to quit, instead of others wanting me to quit. It was merely a less harrowing experience.

Anecdotally e-cigs are not absolutely healthy, my lungs actually felt unhealthy after using one for a long time - something that I never felt with normal cigarettes. They are a tool and not a solution.

I was smoking 40-50 cigarettes per day before I met with vaping(smoking e-cigarette) 3 years ago.

In the last three years, I only consumed around 50 traditional cigarettes. Compared to 49.275 that I would have smoked if I haven't switched to vaping, that's a big win.

OTOH, will I quit vaping? I don't know, and don't care for now.

EDIT: For anyone looking for information about e-cigarettes, https://www.e-cigarette-forum.com/forum/ was a big help for me. (Not affiliated)

They helped my husband quit. He did it gradually over a period of two years, using a re-fillable e-cigarette. Every few months we would buy a few bottles of the vapor juice, stepping down the nicotine concentration each time. At the end, he used nicotine free vapor juice for quite some time. He didn't give up the e-cigarette until it finally quit working about three years ago.

I don't think using the disposable ones with the fixed nicotine content would have allowed him to quit. It was the very gradual dosage decreases that did it for him.

That's a very good point. Even if a smoker cuts down on volume and smokes less of each cigarette than before, the first puff will always carry the same blast of nicotine.

E-cigs also give you something to do that takes up roughly the same amount of time as regular smokes, which is probably one of the biggest behavioral barriers to longtime smokers.

I don't understand. Why is everyone against nicotine all the sudden. These puritans need to mind their own business. Nicotine by itself hardly does anything to anyone.

Uh, it's actually extremely poisonous.

One addiction replaces the other.

The catch is to replace smoking with something better.

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