Giving up smoking

Electronic cigarettes (also known as e-cigarettes, electronic nicotine delivery systems – ENDS or ‘personal vapourisers’ -PVs) are battery powered atomisers which produce vapour by heating a liquid solution. The liquid solution usually contains nicotine with a mixture of propylene, glycol, glycerin and flavourings. Drawing air through the e-cigarette triggers the heater to create a vapour which is inhaled and exhaled the same way as smoke from conventional cigarettes. Producing nicotine vapour from a solution rather than by burning tobacco means that electronic cigarette vapour is free from some of the toxic chemicals that accompany nicotine in cigarette smoke. In Great Britain, 5.5% of people in 2017 said they currently used an e-cigarette, which equates to approximately 2.8 million adults in the population (Adults smoking habits in the UK 2017- Office for National Statistics). Action on Smoking and Health (ASH) estimates that approximately 1.5 million are ex-smokers while 1.3 million continue to use tobacco alongside their electronic cigarette use (May 2017).
 
We talked to people who had been using e-cigarettes for different lengths of time ranging from more than five years to two weeks. They all said that they used them to help cut down, or give up, smoking cigarettes (see our section on Motivations to quit).

People also mentioned financial reasons for switching to e-cigarettes. Conventional cigarettes are expensive and people could save money when they changed to e-cigarettes (although clearly not as much as those who stopped altogether – see ‘Money and smoking’). Anthony, who uses a type of e-cigarette that requires pre-filled cartridges rather than liquid re-fillers, said he is vaping the equivalent of twenty cigarettes per day so financially it does not make much difference. People we talked to liked the fact that they could use e-cigarettes in some places where smoking was banned or discouraged. At work, people had replaced their break time cigarette with vaping. Vaping does not have the ‘hit’ of smoking a conventional cigarette and some people still smoked cigarettes when they could, at home in the evenings or when with friends who smoked. However, some people were surprised at how easily they had taken to e-cigarettes and how they had cut down on conventional cigarettes. Some clearly saw this as a stepping stone to giving up smoking altogether, seeing electronic cigarettes both as an alternative and a way to gain control over their smoking. Other people did not have immediate plans to stop and seemed content to replace some, or all, of their cigarettes with vaping. Finding different flavours and trying different types of vaping had contributed to some people’s enjoyment of the substitutes. Not all electronic cigarettes include nicotine; some simply produce vapour for inhalation, but these do not seem to be as popular. People we talked with have been reducing the nicotine dose and some would like to reached the minimum dose, while others planned to replace nicotine altogether and end up vaping just water. Among the people we talked with, only Debbie talked to her GP and local pharmacists before starting using e-cigarettes. More commonly, people found information online, or talked to a family member, or friends or colleagues who were already using e-cigarettes. Recent research shows, “Respondents who reported having used an e-cigarette in their most recent attempt to quit were more likely to report still not smoking than those who used NRT bought over-the-counter or nothing.”**. Since 2016, e-cigarettes have been classed as medicines by the UK Medicines and Healthcare products Regulatory Agency (MHRA), which mean that e-cigarettes are required to be manufactured to medicinal purity and delivery standards. In other words, they undergo rigorous tests, and are subject to proactive controls on advertising. This move has been widely welcomed by medical experts and officials, as tighter regulation will help control safety and efficacy. Until 2016 e-cigarettes are only covered by general product safety legislation, which meant they could legally be promoted and sold to children, and the ingredients and amount of nicotine contained within each e-cigarette could vary. People we talked with were aware that there is a lack of medical research and reliable information about possible long-term health impacts, although reasoned that e-cigarettes were bound to be less harmful than smoking. Jai and Anthony have used e-cigarettes for quite a while and commented on the health benefits they have noticed since replacing their cigarette smoking with vaping.  The safety and long-term safety of e-cigarettes is currently a hot topic for researchers. E-cigarettes do contain chemicals and other toxins which are associated with an increase in the risk of developing cardiovascular problems and lung diseases and so should not be promoted as safe/risk free or for use by non-smokers. The World Health Organisation advise against using e-cigarettes indoors or in enclosed spaces, until the exhaled vapour is proven to be not harmful to bystanders although they do recognise that “ Switching from smoking tobacco cigarettes to using e-cigarettes – known as vaping – may reduce user harm, by supporting quitting or acting as a lower risk substitute. However, the degree of harm reduction is uncertain.”***

*Dockrell, M., et al., E-Cigarettes: Prevalence and Attitudes in Great Britain. Nicotine & Tobacco Research, 2013. 15(10): p.1737-1744.
**Brown, J., Beard, E., Kotz, D., Michie, S. and West, R. (2014), Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction, 109: 1531–1540. doi: 10.1111/add.12623
*** Bulletin of the World Health Organization 2017;95:540-541. 

Last reviewed August 2018.
Last updated August 2018.