The electronic cigarette online survey.

Electronic cigarettes (e-cigarettes), which rush in popularity in 2008, may be the most promising product for tobacco harm reduction yet. E-cigarettes deliver a nicotine vapor without the combustion products that are responsible for nearly all of smokingâ??s health effects. Other than anecdotal accounts, there is little information about who uses e-cigarettes, and whether people who switch from cigarettes to e-cigarettes experience changes in symptoms caused by smoking. This pilot online survey, conducted by tobaccoharmreduction.org, investigated e-cigarette use for smoking cessation and changes in health status and smoking caused symptoms.

A convenience sample (n=303) was enrolled by e-mail and links on various blogs and forums in May-June 2009. Independent university researchers at the www.tobaccoharmreduction.org project analyzed the data.

 

All respondents previously smoked and 91% had attempted to stop smoking before trying ecigarettes.

Most respondents resided in the USA (72%) and 21% were in Europe. About half

(55%) were 31-50, while 32% were >50 years old. Most (79%) of the respondents had been using e-cigarettes for <6 months and reported using them as a complete (79%) or partial (17%) replacement for, rather than in addition to (4%), cigarettes. The majority of respondents reported that their general health (91%), smokerâ??s cough (97%), ability to exercise (84%), and sense of smell (80%) and taste (73%) were better since using e-cigarettes and none reported that these were worse. Although people whose e-cigarette use completely replaced smoking were more likely to experience improvements in health and smoking caused symptoms, most people who substituted e-cigarettes for even some of their cigarettes experienced improvements.

 

These are highly motivated and passionate e-cigarette users who may have different experiences than average e-cigarette users or smokers, and thus the estimates cannot be extrapolated to all smokers or e-cigarette users. However, the results still suggest that very few e-cigarette users are not using them to replace cigarettes and there are many switchers and current smokers who could have the reported experience. Unfortunately e-cigarettes have been banned in some jurisdictions (e.g., Canada, Victoria (Australia)) where switching from cigarettes to e-cigarettes was documented. The lack of available and legal e-cigarettes may cause some users to resume smoking.

 

Introduction

Awareness and use of electronic cigarettes (e-cigarettes) has dramatically increased in the past two years. These devices, which are manufactured and sold by several different companies, deliver nicotine by vaporizing a gel composed of water, propylene glycol, flavorings, and nicotine. E-cigarettes deliver nicotine without the products of combustion that are inhaled by smoking cigarettes. Therefore, the health risks are likely similar to those from smokeless tobacco, which has approximately 1% of the mortality risk of smoking. There is likely some remaining risk due to the stimulant effects of nicotine. E-cigarettes are one category of no combustion nicotine product (others being smokeless tobacco and pharmaceutical nicotine products) that are promising for tobacco harm reduction, the substitution of less harmful nicotine products for cigarettes [3,4].

E-cigarettes are widely available in the United States and Europe and are also available online through many different distributors. E-cigarettes have been banned in some jurisdictions including Canada [5,6] and Victoria (Australia) [6] and are subject to the indoor â??smokingâ? bans in others (e.g., [7]). Although there are legitimate concerns about quality control and product tampering, the importation/sale bans have been criticized by public health advocates because they do not merely address the productsâ?? flaws, but eliminate a promising smoking cessation intervention, offering few realistic options for bringing the product back to market. There is a high likelihood that some people who switched from cigarettes to e-cigarettes but lose access to e-cigarettes will resume smoking.

There are many testimonials and anecdotes on the internet about people switching from cigarettes to e-cigarettes but, to our knowledge, there have been no quantified data published.

One online e-cigarette distributor based in the United Kingdom conducted an online marketing survey of their e-cigarette users and made their data available to researchers at the University of Alberta School of Public Health for re-analysis.

The objectives of this study were to describe e-cigarette users’ patterns of cigarette and e-cigarette usage and smoking cessation attempts and to compare health status and smoking-attributable symptoms between people who completely switched from smoking to e-cigarettes, those who partially switched, and those who supplemented cigarette smoking with e-cigarette usage.

 

The survey assessed respondents’ use of cigarettes, e-cigarettes, smoking cessation (including use of pharmaceutical products and switching to e-cigarettes) and changes in smoking-caused symptoms since using e-cigarettes. The dataset included 304 observations, one of which excluded from all analyses because only country of residence and comments were entered.

There were two sets of two observations each, which had the same IP address. There were no entries with the same e-mail address. In addition, there were 31 observations with no IP or email address.

 

Results

Approximately half of the sample was between the ages of 31 and 50, one-third were more than 50 years old and none were under the age of 18. Nearly three-quarters resided in the US, followed by 17% from the UK. Most of the respondents had been using e-cigarettes for less than six months and all had smoked prior to using e-cigarettes. Most of the respondents had previously tried to stop smoking multiple times.

The majority (86%) of respondents had tried pharmaceutical products to quit smoking, nearly two-thirds of whom indicated that these products did not help them to stop smoking. However, most of the sample was able to use e-cigarettes as a complete replacement for cigarettes.

The majority of the respondents indicated that their general health, smokerâ??s cough, ability to exercise, sense of smell and sense of taste were better since starting to use e-cigarettes and none indicated that these were worse when responding to these five questions.

 

On average, respondents who lived in Europe had used e-cigarettes for longer than respondents in the US, but were less likely to use e-cigarettes as a complete replacement for cigarettes. There was a positive relationship between the number of times participants had tried to stop smoking and using e-cigarettes as a complete replacement for cigarettes. Most (81%) of the respondents who indicated that pharmaceutical products did not help them stop smoking used ecigarettes as a complete replacement for cigarettes.

Although the majority of respondents reported that their health and smoking-caused symptoms improved since using e-cigarettes, there were some notable trends in which groups were more

likely to report improvements. Respondents who had been using e-cigarettes for a longer period of time, who had completely replaced their cigarettes with e-cigarettes, or were younger, were more likely to report improvements.

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