Amid aggressive actions of commercial interests and their political allies to undermine regulation by trying to discredit the Food and Drug Administration (FDA), Action for Economic Reforms (AER) refuted the claim that electronic cigarettes (electronic nicotine/non-nicotine delivery systems, or ENDs/ENNDs) or heated tobacco products (HTPs) are an effective tool for smoking cessation.
“There is a limited body of evidence regarding the effectiveness of ENDs in smoking cessation. However, based on what we have so far, there is no credible data suggesting that the usage of e-cigarettes leads to quitting smoking regular cigarettes and successfully eliminates nicotine dependence,” said Filomeno Sta. Ana III, coordinator of AER.
Although e-cigarettes are marketed as a tool to quit traditional tobacco smoking, AER emphasized that there is a lack of credible evidence to support the link between e-cigarettes and smoking cessation. E-cigarettes are classified as consumer products, and have yet to be approved by the Food and Drug Administration as a smoking cessation tool.
In fact, recent studies suggest that e-cigarettes are an ineffective tool for smoking cessation. AER cited a 2020 paper by Luk, Weng and Wu published in Tobacco Control, which studied a group of conventional cigarette smokers who joined a smoking cessation contest in Hong Kong. After 3 and 6 months, no association was found between heated tobacco product use and quitting cigarette smoking.
A longitudinal analysis of Grana et al. showed that e-cigarette use was not associated with higher rates of smoking cessation. In this study involving a national sample of US smokers, the self-reported quit rate was not higher among smokers using e-cigarettes as a smoking cessation device. E-cigarette users had lower quit rates and a lower reduction in cigarette consumption. While intention to quit and cigarettes smoked per day significantly predicted quit status, past 30-day e-cigarette use did not.
AER also noted that two randomized controlled trials have shown that e-cigarettes are not effective tools for smoking cessation. One of the studies by Bullen et al. showed that e-cigarettes were not superior to nicotine patches as a cessation tool, with no statistical differences in the quitting rates between the groups using nicotine e-cigarettes, non-nicotine e-cigarettes, and nicotine patches. A 2018 study by Halpern et al. also showed that e-cigarettes were not more effective than usual care (counselling and support) or cessation aids (nicotine-replacement therapy or pharmacotherapy) in lowering smoking abstinence rates.
A systematic review of 38 studies on e-cigarette use in real world and clinical settings by Kalkhoran and Glantz (2016) showed that e-cigarettes are associated with significantly less quitting among smokers. In fact, the odds of quitting smoking traditional cigarettes were 28% lower for those who used e-cigarettes, compared to those who did not use e-cigarettes.
Furthermore, results from a US national survey showed that using e-cigarettes does not reduce the use of traditional cigarettes. Instead, smokers return to smoking traditional cigarettes or smoke both e-cigarettes and traditional cigarettes. This dual use of e-cigarettes and traditional cigarettes is associated with higher risks of cardiovascular disease, according to a study by the American Heart Association.
“Aside from being marketed as a smoking cessation product, e-cigarettes are also commonly advertised as a safe alternative to traditional cigarettes. However, it actually poses many health risks,” Sta Ana added.
AER said that although e-cigarettes contain lower levels of carcinogens compared to cigarettes, they still expose users to high levels of toxins and are accompanied by much potential long term harm (cardiovascular, pulmonary and other long term impacts). It said that some carcinogens cause cancer if there is exposure to even a very small amount — ultimately, it puts at risk both the user and bystanders who inhale secondhand emissions from ENDs.
Advertisements for e-cigarettes also normalize smoking among the youth, thus widening the nicotine market, AER said.
AER urged the e-cigarette industry to refrain from marketing ENDs products as smoking cessation tools to the public, given the lack of scientific evidence behind the claim. It said that marketing ENDs as smoking cessation devices poses a serious danger on human health.
“We implore our legislators to stop all attempts to dilute regulatory measures included in Republic Act No. 14467, which raised taxes on e-cigarettes,” Sta Ana added. “Weakening these measures will lead to more young users introduced to the harms of e-cigarettes.”