Electronic ecigarettes - an emerging smouldering public health issue

August 20, 2013 - please leave a comment.  There continues to be a steady stream of visitors to this site, we would love to hear why you have come to this particular posting.  DrPHealth

eCigarettes or electronic cigarettes are burning up the continent.  Perhaps smouldering north of the border, but a raging fire south of the 49^th.   The concept reached market level production following North American patents in 2009 and 2011, as such it represents an emerging public health issue  ecigarettes have been marketed in China since 2006 as a smoking cessation aid.

The burning question – is it an emerging benefit or threat to public health?

Essentially it is a delivery mechanism for often the same inhalant matrix used to deliver asthma medication.   In some instances nicotine can be delivered, but many ecigarettes are designed to replicate the tactual sensations of smoking without the need for a nicotine rush. The cost of a "pack" being comparaable to that of the tobacco based cigarette product

At the individual level they appear safe.  The evidence currently is weak at best for efficacy in smoking cessation, however it carries construct validity.  Certainly switching from tobacco based smoking products has a high probability of having individual health benefits and as such would be, and has been, strongly supported by organizations focused on individual patient care. With 4.9 Million Canadian smokers who could benefit, there is a substantive market to reach. 

Public health proponents have argued for decades the importance of modeling smoke-free behavior as an aid to population level reduction in smoking activity, hence effective bans on indoor smoking are now extending to public outdoor venues.   Tobacco reduction coalitions have been quietly vocal to date on raising objections and concerns to regulatory agencies that the tremendous efforts of the past decades could falter under this new threat.

One US television advertisement brings the ecigarette right back into a crowded elevator as a safe alternative for users and those in the immediate vicinity.

As such the battlelines are slowly being drawn.   Individualist proponents arguing for their implementation, population health folks resisting their dissemination.  The legal environment being diffuse enough in many jurisdictions to be unclear – and posing challenges for enforcers of cigarette bans that will now need to prove not only smoking in a public place, but that the smoked product contained tobacco or other “weed” and not just an electronic simulation.

Regrettably the evidence either way is sparse. Hence a brewing war of words with both sides lacking concrete evidence.

Health Canada issued a precautionary warning in 2009 Health Protection branch warning, and recently have reiterated in a communication to a non-smoking advocates group that a nicotine is a drug, where ecigarettes are used for delivery of nicotine, they must undergo Canadian approval processes.  That leaves a huge gap for those entrepreneurs that target the market of those habituated more to the tactile and oral stimulation than to the nicotine high through marketing non-nicotine ecigarettes.

The regulatory void is unlikely to be filled quickly.  Research on such products lacks industry funding and the current government environment is not likely to quickly reallocate funds to answer the smoking questions on cessation efficacy  and population effects.  Behaviourist will be interested in whether an ecigarette utilize can mix safe and unsafe smoking behaviours, more readily overcome the habituation, and what is the influence or youth or others who are already barraged with smoking images.

Rumour has it that at least one of the major tobacco companies has invested significantly in ecigarettes, if anyone can substantiate this, please advise drphealth@gmail.com and the information will be updated. 

In the meantime, public health professionals need to become better informed, recognize the conflicting messaging and be prepared to act appropriately for the sake of the population, not just based on speculation.