Pod e-cigarettes are less harmful to health than traditional cigarettes

Reviewed by Emily Henderson, B.Sc.November 18, 2020

Cigarette smoking causes more than 480,000 deaths each year in the United States, according to federal government data, and some smokers find it nearly impossible to quit. Many of these smokers use regular or combustible cigarettes.

Doctors and scientists have been exploring the health benefits and drawbacks of alternatives to nicotine cigarettes for many years, and new research offers significant evidence that “pod” e-cigarettes are less harmful to health than traditional cigarettes. .

Nicotine is one of the most addictive substances on earth, both in animal models and for humans. So how can we help these people who can’t stop smoking combustible cigarettes? They need other options, and e-cigarettes could be one of those options. Our research shows that e-cigarettes are significantly safer than combustible cigarettes in the short term. “

Dr. Jasjit S. Ahluwalia, professor of behavioral and social sciences and medicine at Brown University

Ahluwalia is the senior author of a new one JAMA Network Open study, published Wednesday, November 18, on the world’s first randomized clinical trial of fourth-generation pod e-cigarettes.

The study included 186 African American and Latinx smokers, as racial and ethnic minority groups tend to experience higher rates of tobacco-related morbidity and mortality even when they smoke at the same rate as other groups. Two-thirds of the participants were provided with e-cigarettes for six weeks, while the remaining participants were asked to continue smoking combustible cigarettes as usual.

At the end of the study, participants who switched to e-cigarettes showed significantly lower levels of the potent lung carcinogen NNAL than those who continued to smoke exclusively combustible cigarettes. E-cigarette users also had significantly reduced levels of carbon monoxide (CO) and reported fewer respiratory symptoms. These benefits – NNAL reduction, CO reduction, and respiratory symptom improvements – were especially pronounced among participants who switched completely to e-cigarettes.

The researchers also measured the participants’ cotinine levels, a breakdown product of nicotine, and determined that there were no significant differences between the groups, an indication that e-cigarettes provided adequate nicotine replacement.

“Anyone under 21 shouldn’t take cigarettes, e-cigarettes, or any nicotine products – without a doubt, the best thing to do is never start – but if people use tobacco products, they should stop,” he said. Ahluwalia cautioned. “But if they can’t stop smoking combustible cigarettes, they should consider using new nicotine products to quit smoking altogether or to reduce harm by switching to these products entirely.”

Moving forward, work needs to be done to better understand the non-cancer risks associated with e-cigarettes, such as respiratory and cardiovascular diseases. The researchers also plan to conduct one-year studies to further explore the harm reduction potential of e-cigarettes.

“Most smokers who switched exclusively from combustible cigarettes to e-cigarettes during the study maintained this behavior at six months, but we need long-term follow-up,” said Kim Pulvers, professor of psychology at the California State University of San Marcos who was the principal investigator of the study. “We also need ongoing dual-user studies to determine if they maintain harm reduction over time.”

Ahluwalia said that as many people who use both e-cigarettes and combustible cigarettes will revert to fuel-only cigarettes over time, there is a critical need for interventions that support those who try to switch to e-cigarettes but fail. He also stressed the importance of alternatives to permanently quitting, given the challenge quitting poses for so many cigarette smokers.

“It is possible that nicotine e-cigarettes and other harm reduction products will change the rules of the game for our industry,” Ahluwalia added. “I hope this study inspires more people to do this research and have an open mind on it. I also hope it inspires them to let science inform politics rather than emotions.”

In addition to Ahluwalia and Pulvers, other contributors include Brown’s Christopher H. Schmid and Kexin Qu; Nicole L. Nollen of the University of Kansas School of Medicine; Dr. Neal Benowitz of the University of California, San Francisco; and Myra Rice of California State University in San Marcos.

Schmid has worked as a consultant for law firms representing Eli Lilly, Boehringer-Ingelheim and Gilead outside the firm. Benowitz has received personal compensation from Pfizer and Achieve Life Sciences and has been a consultant for pharmaceutical companies that market smoking cessation drugs and as an expert witness in litigation against tobacco companies outside the firm. Dr. Ahluwalia received personal compensation from Lucy Goods outside the office. These points were fully disclosed in the study.