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If your New Year’s resolution was to stop smoking, and you were looking for support to help you quit, then recent headlines suggesting e-cigarettes ‘aren’t any safer than tobacco’ might have raised an eyebrow or two.

Since Christmas, we’ve seen three sets of critical headlines about e-cigarettes, each looking at a different aspect of a device now used by millions across the UK.

But how accurately do these stories reflect the scientific evidence? What do we really know about how safe e-cigarettes are? Can they really help you quit? And do candy flavours attract kids?

If you were to go on the media reports alone, you’d be forgiven for being alarmed.

But as is so often the case in the reporting of science and risk, taking a deeper look behind the headlines reveals a very different story.

Just because they’re not “safe” doesn’t mean they aren’t “safer”

The first study to make the headlines suggested that e-cigarettes were ‘as harmful as tobacco’. After studying cells in the lab, the researchers found some indications of increased levels of DNA damage and cell death in those treated with e-cigarette vapour.

This led one of the researchers to tell the media, “I believe [e-cigarettes] are no better than smoking regular cigarettes.” (More on this statement below).

The most important thing to remember here is that this was a study looking at the effect of chemicals on cells in a lab. Although this can be useful, it obviously can’t give a clear idea of what the impact would actually be in your body. So any claims of impact on health based only on lab studies will always be far-fetched.

The study also looked at an extremely high concentration of vapour. As the researchers admitted at the time, “it was similar to someone smoking continuously for hours on end, so it’s a higher amount than would normally be delivered.”

It boils down to this: the study showed that it might be worse for your cells to be exposed to e-cigarette vapour than the air in a lab. So e-cigarettes might not be 100 per cent harm free. And previous studies have shown there may be some dangerous chemicals present in vapour – so this isn’t a surprise. And there’s little in life that really is ‘safe’ – even drinking too much water can kill you.

But here’s the big caveat. The researchers also treated some cells with tobacco smoke. These died within 24 hours. Those treated with e-cigarette vapour were still alive to experiment on 8 weeks later.

So, contrary to the headlines, this study actually suggests that using e-cigarettes may be far less dangerous than smoking.

You’d never believe that from the headlines though.

There were a few great critiques published shortly afterwards, (notably this one in the Guardian) and the press release was amended (more than a week later) to include the following correction:.

Contrary to what was stated or implied in much of the news coverage resulting from this news release, the lab experiments did not find that e-cigarette vapor was as harmful to cells as cigarette smoke. In fact, one phase of the experiments, not addressed in the news release, found that cigarette smoke did in fact kill cells at a much faster rate. However, because similar cell-damage mechanisms were observed as the result of both e-vapor and regular cigarette smoke, Dr. Wang-Rodriguez asserts, based on the evidence from the study, that e-cigarettes are not necessarily a healthier alternative to smoking regular cigarettes. As stated in the journal paper and the news release, further research is needed to better understand the actual long-term health effects of e-cigarettes in humans.

But we’re concerned that, as far as public perception goes, the damage may already have been done.

How can you tell if something helps people quit?

So the scientific evidence on e-cigarette vapour to date suggests it’s far safer than tobacco smoke.

But can e-cigarettes actually help you quit?

Here we come across the second set of unfortunate stories, after a systematic evidence review and meta-analysis published last week claimed that those using e-cigarettes seemed to be less likely to quit smoking than those not using the devices.

But, again, there are a number of serious problems with the review.

Systematic reviews and meta-analyses are usually extremely useful, because they pull together all the evidence in one area, to paint a fuller picture than one study alone.

However the relationship between this picture and reality depends entirely on the quality and relevance of the original studies that are included. In this case, since there haven’t been many high-quality trials exploring whether e-cigarettes help people quit smoking, the researchers included a range of different types of studies.

The gold standard of evidence is the randomised control trial, which, in this case, would compare a group of smokers trying to quit using a nicotine-containing e-cigarette, to a similar group using nothing (or an e-cigarette without nicotine). But here’s the problem – there have only been two published studies like that.

A 2014 meta-analysis of these found people using nicotine via an e-cigarette were more likely to successfully quit than those using e-cigarettes without nicotine.

Last week’s review included both of these randomised trials alongside a range of other ‘real-world’ non-trial studies of e-cigarette use. This is a big problem. Whatever their strengths individually, these studies didn’t use consistent measurements – neither of e-cigarette use, nor of whether people had actually quit – so the studies aren’t necessarily comparable. And so including them together in a meta-analysis is questionable, at best.

Even so, when the analysis only included studies where people were actively trying to quit (as opposed to using e-cigarettes for other reasons) the results became inconclusive – people who said they’d ‘ever’ used an e-cigarette weren’t any more or less likely to succeed.

Furthermore, some of the studies included only looked at current smokers and asked about e-cigarette use. This would exclude anyone who had used an e-cigarette but successfully stopped smoking.

Quitting smoking can be incredibly hard. Someone trying an e-cigarette once probably wouldn’t have any better chance than if they hadn’t. Whatever support aid is used it would need to be as part of a concerted quit attempt and used enough to deliver sufficient nicotine to wean yourself off tobacco, and preferably alongside specialist support from a Stop Smoking Service to get the best possible chance of quitting.

E-cigarettes aren’t a magic bullet, but that doesn’t mean they couldn’t be a useful weapon in our arsenal against tobacco. The evidence for quitters using these products both within the Stop Smoking Services and without points towards this being the case in the UK.

The impact of advertising and flavours on kids

Whether or not they’re ‘safe’, or help people quit, another big concern about e-cigarettes is that they could encourage children to start smoking – either by exposing them to nicotine (the ‘gateway’ argument) or by making smoking seem more normal again (the ‘renormalisation’ argument).

The first of these arguments isn’t supported by the evidence to date: surveys across the UK last year found that young people who hadn’t smoked weren’t using e-cigarettes.

But a small study published this week found young people rated printed adverts with flavoured e-cigarettes more appealing than those without flavours, leading to headlines suggesting children are being lured in with sweet flavours.

But when you dig into the detail, again it’s a more complex picture – the young people in this study, including those who saw the flavoured e-cigarette adverts, had negative views about e-cigarettes, and said they didn’t intend to buy them. And, perhaps more importantly, it didn’t find any evidence that e-cigarette adverts increase the appeal of regular cigarettes.

There are now measures in place to protect young people (e-cigarettes cannot be sold to under 18s, and further legislation heavily restricting advertising will come into force in May) but it’s still important to continue looking at how e-cigarette adverts might appeal to children, and to track use of both e-cigarettes and tobacco cigarettes to make sure there isn’t a negative impact from these products.

However, Linda Bauld, Professor of Health Policy at the University of Stirling (and our Cancer Prevention Champion), said the study “should provide some reassurance to those who say that e-cigarette advertising will result in a new generation of tobacco smokers.”

Where does this leave us?

When you look at the bigger picture, rather than the headlines, the evidence so far actually points towards a positive role for e-cigarettes in helping combat the biggest preventable cause of cancer. However none of the questions posed here – on safety, effectiveness and impact on children – have full answers.

As we’ve said before we need years of good quality science before we can definitively answer these questions, and at Cancer Research UK we are working towards that. But for now the evidence we have suggests e-cigarettes are far safer than smoking tobacco, they might help you quit and non-smoking children aren’t being lured into using them regularly.

While the evidence on e-cigarettes continues to accumulate, and the media controversy rages on, if you’re looking for evidence-based inspiration to quit smoking in 2016, speak to your GP or local Stop Smoking Service, or check out our website… but maybe keep reading the headlines with an appropriate dose of scepticism.

Nikki Smith is a senior health information officer at Cancer Research UK

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Chopper June 13, 2016

6 weeks vaping and I tried a ciggie last weekend … just couldn’t do it, physically hated it !

If you really want to stop cigarettes this is the way to go. I started on 3mg juice and then 1.5mg, now, I’m mixing 1.5mg with 0mg and in another month I think I will be down to ZERO nicotine. The chemical addiction should be gone but the smoking addiction may remain. My total set up including juices has paid for itself 5 times over already. Don’t think I will ever smoke a cigarette again, and after 20 years of a pack a day … I am relieved

Josh June 2, 2016

I bought my mid range vape and hoped it would help me stop smoking, six days later and I have not needed a single cigarette as it works so well. I can’t believe it. I tried an early one and it was useless but the newish larger versions are much more satisfying and give you a proper hit.

Electronic cigarettes in India May 27, 2016

E cigarette is the best alternative for those who want to satisfy smoking craving without actual smoking and harm. Because it is smoke and ash free. So it wouldn’t be harmfull for your lungs aswell and comes in various flavour’s.

Kinny March 14, 2016

While a lot of research is still being done on e-cigs and the underlying health risks that may occur from vaping, i’m 100% convinced that e-cigs are far far safer than using tobacco products. I smoked 20 a day for fifteen years and was unable to quit until I picked up vaping three years ago, haven’t touched a cigarette since and I have felt the improvements in my health since making the change.

My Aunt is in her late fifties and has smoked for almost 40 years she has a lot of health issues, one of which is severe breathlessness, needing to use an inhaler constantly and not being able to even walk more than a few paces without feeling short of breath.

I convinced her to give e-cigs ago, it took a while to find the device that worked for her, however when she did she has not looked back and as of writing this, has not had a cigarette in just over six months!

When we spoke on the phone last week, she was telling me all about how she went on a *long walk in the countryside* and how she *no longer needs her inhaler wherever she goes*

I think that really speaks for itself…….

Paul February 24, 2016

Unfortunately much of the problem comes from public health itself. The meta analysis of quitting should never have been written let alone published. The fact that it was is a very poor reflection on the scientific standards required in public health.

Greg February 12, 2016

Vaping is playing with fire. It will take years for the data to come through on safety . Man up and quit smoking cold turkey or risk becoming addicted to vaping and all the unknown risks it presents .

Michael Atkins February 5, 2016

E-cigarettes are still not really regulated, so how do we know what’s in them? We don’t know about the long term implications either… surely a product should tested as safe before release to the public for use.

Pauline February 4, 2016

Really interesting article.
I started using e-cigarettes as a means to stop smoking and 2 years later have never felt the need for a ‘traditional’ cigarette. I feel so much better, I look a whole heap better and I’ve saved a fortune.

Sarah February 4, 2016

I think the e cig is a brilliant invention!

I had no intension of giving up, as I had tried numerous times before and failed. I also knew, as an addict, I would have to ‘psyc’ myself up to quit.

But one Saturday, my partner decided to go to our local market to buy one of these ‘e cigs’ to help him quit. I tagged along for support and ended up buying one myself!

I have not touch a cig since that day, and that day was just over 2 years ago!!!!

I weaned myself down through the different strengths of nicotine over a 9 month period (not a set time, it just happened that way), to 0%. Once there was nothing in the vape my body needed…. I no longer needed to vape, and have been vape free for 15 months.

Jbl williams February 4, 2016

I’ve been vaping for 2years now. I haven’t had a cigarette since .also my nicotine intake is reduced to the lowest level .

My friend name is mike January 28, 2016

My friend quit cigarettes and started to vape he started at 18, went down to 12 went down to 6 and now is using a no nick vap. Used it less then picking up a cigarette. He uses that no nicotine vape do to habit of smoking. But is ready to stop the vape altoghter. So it worked for him to quit smokeing

James Walker January 24, 2016

I can only relay my own experience.
I tried over 5 years to quit, using patches, gum and lozenges, all without success, managing at best a couple of weeks with intense cravings throughout.
I used an e-cig and gave up relatively easily over four years ago.
I do not miss tobacco and I will never go back.
After approximately six weeks my taste had returned, my breathing and fitness were better and the weight on my chest and wheezing had vanished when I laid down at night.

Do all the studies you want.
I know e-cigs helped me quit.
I know they were far safer than tobacco from my own well being.
I also know, the only losers financially from e-cigs are
– our governments
– the tobacco industry
– big pharma (NRT)

Work it out yourselves

Chris January 23, 2016

I’ve gone from 20 red Marlboro a day too…. No red Marlboro a day. And for about a year. Don’t miss them, no inclination to buy them. I tried everything to stop smoking, patches, gum, lozenges, cold turkey. But at the end of the day, I liked to smoke. Some of my friends gamble, some drink. Still not the best of habits! I smoked and that was my thing. Now vaping is my thing. In the end I decided it should be something I chose to do instead of smoking, not just something I’d do to help me give up smoking and I’ve not gone back, I feel better and much healthier, and most importantly of all, I no longer use tobacco! Personally I think it would be incredibly naive to rule out vaping as a credible way to stop people using tobacco! At the end of the day if people want to stop smoking, they’ll find a way that works for them. Vaping must be considered as an option for people that choose that route if it works for them.

Country Tecc January 22, 2016

I was up too 2.5 to 3 packs a day of roll your own cigs the healthier way to smoke and cheapest less chemicals in the roll your own but still bad and they stank worse!! Well went straight into DIY vaping and yes I have smoked about 3 packs over the 3 months since I have started vaping just because I am a singer and the vape seemed really harsh on my throat but that was because I had my nicotine too high! now that I have figured stuff out LOL not as bad.. and in the 3 months of vaping my smokers cough is gone!! and when I do smoke a cig it tastes horrible and stinks even worse than I remember them stinking LOL

William January 22, 2016

As far as I have been able to research, there is zero evidence that nicotine itself causes cancer.

Comparing the mg/ml nicotine concentration of a ml of eliquid to the nicotine content of a single cigarette is absolute nonsense.It would only have meaning if a person vaped a full ml of juice in the same period of time that a person smoked a cigarette and NO vaper does that.

Let’s look at Sawa’s figures and do some calculations.

Vapers seem to use 2 – 4 ml of juice a day. Let us assume that the typical smoker smokes 1 pack a day (20 cigarettes). We will also use the averages of the respective values she provided:

20 x 3 mg/ml = 60 mg nicotine/day from cigarettes.

3 ml x 12 mg/ml = 36 mg nicotine from vaping in 24 hours.

So the vaper only gets roughly half then nicotine in 24 hours. That is why some experts on NRT using person vaporizers have stated the vaping juice should contain much higher concentrations of nicotine.

Ash January 21, 2016

Tina N Sawa – It isn’t the nicotine in cigarettes that’s harmful. It’s the by products associated with smoking. The carcinogens inherent in this smoke.

I’d seriously suggest doing some proper research before commenting.

Nicotine is a poison. At large doses. And sure, it’s probably not brilliant for you. But there is no definitive proof it causes cancer.

Ash January 21, 2016

Tina N Sawa – Not true.

Tina N Sawa January 21, 2016

http://www.atsdr.cdc.gov/phs/phs.asp?id=1120&tid=240
The milligrams of nicotine in the vapor e cigarettes is more harmful then smoking!
The liquid contains 8mg to 16mg of nicotine as compared to a package of cigarettes light brands are 2-4 milligrams.

Rand Valentine January 21, 2016

As a linguist and vaper, I have been absolutely amazed at the hysteria flowing around so-called e-cigarettes. I myself quit smoking using a vape pen, and while it’s only been 4 months, I can’t imagine going back to cigarettes. I have met many other vapers who have quit smoking as well. Admittedly anecdotal evidence, but accurate. I think a big part of the problem for those seeking to quit is the complexity of various kinds of effective vaping apparatus. I think it would be very hard to quit using cigalikes, i.e., vaping devices that look like cigarettes, but these are what is usually marketed as “e-cigarettes” in the U.S. and probably what most smokers know, if anything, as e-cigarettes. One must do one’s own research to find effective vaping devices, such as the vaping pens I now use. I think that quitting success would be much higher with vaping pens and other more sophisticated devices, since these actually offer a FAR superior physical experience to tobacco cigarettes. I have many family and friends that I would like to introduce to vaping, but know that, without my direct help, they will find vaping too complex, e.g., finding a good device, understanding coils, getting suitable (and safe) e-liquid, using e-liquid, practicing safe-battery charging, etc. The public and media seem to have almost zero knowledge of e-cigarettes, other than the provocative and hysterical headlines. My experience with vaping has been a profound education in the ignorance and incompetence of the press, and the ideology and subjectivity of anti-tobacco crusaders. PLEASE continue to inform the public with accurate information.

Dom Finn January 21, 2016

It’s worth noting that the survey and other information below in the comments isn’t really evidence (a survey is not evidence enough for such consultation). This is the science blog not the here-say blog. Large scale public health advice needs to be backed by rock solid evidence. There are several Stop Smoking Services that are taking part in study at the moment that I really hope will be able to tell us how effective E-Cigs are at helping people to quit.

For me though, I think the studies are currently looking at the effectiveness of it helping a 4 week quit (Happy to be correct but I think this is right). I would like to see the effectiveness over a year and looking the return to smoking rate following 52 week follow-ups but still the work going on is excellent.

Tony January 21, 2016

The Telegraph might consider replacing Sarah Knapton with Nikki Smith…

Kyle January 20, 2016

Double negative in title, so they are better, right? :P

Seriously though, these are way safer than regular cigarettes, 10 or so items in them versus over 4000 toxic chemicals. only dangerous if you drink the liquid directly, or try to rewire the battery or device and bypass safety features.

people that use them can slowly wean themselves off nicotine by using lower concentrations, or they can go nicotine free and just enjoy the flavours, which is not dangerous at all.

please research next time before writing scare tactic fluff pieces.

Dodderer January 20, 2016

“they might help you quit”

The ASH surveys show 1.1m GB ex-smokers using ecigs.It is interesting to speculate what may have caused them to quit if not ecigs – I can’t think of anything else but can you?

DeepThroat January 20, 2016

who gains from damaging e-cigs ? Follow the money….

Paul T January 20, 2016

The damage is absoloutely already done! I’ve been urging a couple of collegues who smoke to give e-cigs a go, but they’re both convinced they’re ‘just as bad as real cigs’.