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COPD

17 July 2019

Worries that tough rules on e-cigarettes may push people back to smoking

Without the draws of flavours, and lowering nicotine levels, many people would vape less and smoke more tobacco cigarettes, US researchers claim in a new study.

Banning flavours and lowering nicotine levels in electronic cigarettes is a strategy that could backfire, a new study suggests.

Without those draws, many people would vape less and smoke more tobacco cigarettes, researchers claim.

"Some regulations on e-cigarettes, like making safer batteries, would benefit the general public," said study author Lauren Pacek. She's an assistant professor of psychiatry and behavioral sciences at Duke University School of Medicine in Durham, North Carolina.

But others, like reducing nicotine, might prompt adults to cut down or quit e-cigarettes and smoke more tobacco cigarettes, Pacek said.

The US Food and Drug Administration has taken steps in the past year to try to make e-cigarettes less appealing to youth, following a huge surge in teen use of the devices.

For this new study, which was funded by the US National Institutes of Health, Pacek and her team surveyed 240 young adults aged 18 to 29 who used both e-cigarettes and tobacco cigarettes.

Nicotine reduction

In the online survey, participants were asked what they would do if the sale of flavoured e-cigarettes were limited; if e-cigarettes didn't contain nicotine, and if they couldn't adjust the amount of nicotine or the temperature of the vapour.

If nicotine was not in e-cigarettes, 47% of the participants said they wouldn't use them as often and would smoke more tobacco cigarettes.

If the ability to customize e-cigarettes was no longer available, 22% said they would use e-cigarettes less and smoke tobacco cigarettes more. About 17% said if e-cigarette flavors were limited to tobacco and menthol, they would do the same.

Pacek said that the FDA is now looking at reducing the level of nicotine in tobacco cigarettes to a very low level. Nicotine cannot be eliminated entirely, because that's beyond the FDA's authority, she explained.

"The level would be so low that smokers cannot smoke enough cigarettes to get the amount of nicotine that they're craving," she said.

Pacek has taken part in large trials in which people used low-nicotine cigarettes. Contrary to what you might expect, people actually smoked fewer cigarettes, she said.

It's possible that if nicotine was reduced in tobacco and e-cigarettes, people would seek their nicotine fix elsewhere, Pacek said.

Positives

On the positive side, Stanton Glantz, director of the Center for Tobacco Control, Research and Education at the University of California, San Francisco, said that removing flavours and nicotine reduces the use of e-cigarette, which is a plus.

Because this study is so small and the questions hypothetical, its ability to predict an actual increase in smoking tobacco cigarettes isn't firm, said Glantz, who had no part in the research.

"Flavours are absolutely crucial to attracting kids to e-cigarettes," he said. "The evidence on adult use of flavours is very limited."

Glantz believes that flavour bans on e-cigarettes and tobacco cigarettes would result in people using both these products less.

Studies of reduced nicotine cigarettes have found that people tend to quit rather than smoke more, Glantz said. "Reducing the nicotine levels in cigarettes looks like it would lead more people to quit," he said.

San Francisco has banned e-cigarettes and flavours in all tobacco products including menthol, Glantz said. He thinks this will result in more people giving up tobacco altogether.

The ban on e-cigarettes will remain in effect only until the FDA's regulations on e-cigarettes are enforced, he said.

The report was published July 15 in the journal Substance Use & Misuse.

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