The Truth About E-cigarettes
The rise of e-cigarettes is being fuelled, in part, by their purported use as a cessation tool. Too bad they don’t seem to work.
It’s been 20 years since I lit my first cigarette. I was standing in a filthy corner of my high school courtyard. I remember the sensation-there was a rush, right down to my toes-but mostly I remember feeling free. As I looked at the banal scene through the blur of smoke-the football practice, the knapsacks dotting the field-I felt, for the first time, like I had a say. I could be a grown-up woman and not a boring kid.
The same scene today would look a little different. Instead of a Player’s Light, a teenage girl might be “vaping” on a Blu, an NJOY or any of the other e-cigarette brands currently flooding the market. According to the National Youth Tobacco Survey from the U.S. Centers for Disease Control and Prevention (CDC), the percentage of American middle and high school students who have tried e-cigarettes doubled from 3.3 per cent in 2011 to 6.8 per cent in 2012. While research shows the majority of vapers are either former or current smokers, the survey found that 160,000 students who had tried e-cigarettes had never smoked traditional cigarettes.
Today it’s also a lot easier to purchase e-cigarettes than analogs, a term used for old-school cigarettes. While Health Canada hasn’t authorized the sale or advertising of any e-cigarettes, minors can buy them from suppliers online, where no proof of age is required. (Nicotine-free brands, such as eRoll and Dune Cigs, are sold over the counter in Canada at convenience stores and are exempt from age restrictions.) There’s no real data yet, but medical authorities such as the CDC are concerned young non-smokers exposed to nicotine in e-cigarettes may be enticed to take up traditional smoking.
As more tobacco companies enter the e-cig market, the “gateway” risk rises, says David Hammond, an associate professor at the School of Public Health and Health Systems at the University of Waterloo in Ontario.
“If I’m a CEO, there’s an incentive to grow the nicotine market, not shrink it by having people transition from cigarettes to e-cigarettes to abstinence,” Hammond says. “They want people to use both. Even the marketing of e-cigarettes is similar. They use superattractive models-images that say it’s fashionable. It doesn’t look like a health message, as in ‘Here’s a way to quit smoking.’ What it does look like is, ‘Wouldn’t you like to try these?'”
Last year, Blu, which holds 40 per cent of the e-cigarette market, signed Jenny McCarthy and Stephen Dorff as spokespeople and rolled out unprecedented web, TV and print campaigns. NJOY premiered a web ad starring Courtney Love, and tabloids ran stories showing Kate Moss, Sienna Miller and Robert Pattinson holding e-cigarettes.
According to a report by Citibank, from 2011 to 2012, print-ad spending on e-cigarette marketing in the United States rose 71.9 per cent, while spending on TV ads rose 17.9 per cent-a significant new revenue source for media. But the financial windfall may be short-lived because the attorneys general from 40 states are urging the Food and Drug Administration (FDA) to restrict the advertising and sale of e-cigarettes so that it doesn’t directly target youth (for example, by playing up e-cigs’ fruit and candy flavours).
In Canada, almost all advertising of tobacco products is banned, although there are exceptions-it’s permitted in publications with an adult readership of 85 per cent or more. In addition to advertising, “seeding” influential cultural events has become a popular strategy in both the U.S. and Canada. At the spring/summer 2014 New York Fashion Week, NJOY distributed e-cigarettes after shows; samples of the nicotine-free brand Luli were handed out during the 2013 Toronto International Film Festival.
Sharon Anne Cook, a professor in the faculty of education at the University of Ottawa and author of the 2012 book Sex, Lies and Cigarettes, says the marketing strategy behind e-cigarettes may appeal to women for the same reasons we flocked to slimmer cigarettes in the mid-20th century. “The so-called ‘light’ cigarettes in the women’s market were driven by the belief that they were far safer than regular cigarettes, and this belief was promoted by tobacco manufacturers.”
But the majority of e-cigarettes are made in Chinese factories where a lack of standardized manufacturing poses a risk. A study by the FDA, carried out in 2009, found cancer-causing chemicals and toxins used in antifreeze in several brands of e-cigarettes. The study also discovered traces of nicotine in products that were being marketed as nicotine-free. “E-cigarettes have great potential as a harm-reduction tool but only after they’ve been tested and regulated,” adds Selby. “They’re not ready for prime time, in part because they’ve fallen into a ‘regulatory abyss.'”
Prime time or not, Susan Willis and her partner, N. Maxwell Lander, started vaping in January 2013 as a way to stop smoking with minimal agony. The couple, who are in their 20s and run a photography business in Toronto, are former pack-a-day smokers. “I was sick and tired of feeling sick and tired,” says Willis. “Since I started vaping, my headaches and fatigue are completely gone, and I have more money in my pocket.”
E-cigarette kits, which come with an atomizer, cartridge and plastic-tip filter, cost between $40 and $80. The nicotine refills average $10 a week for the equivalent of a $70 analog pack-a-day habit.
Elaine Lui, who runs the popular celebrity site laineygossip.com, turned to e-cigs in 2012 to help wean herself off a 25-year cigarette habit. “I had a real love affair with smoking,” she explains. “But I was turning 40, and I just really needed to quit.”
E-cigarettes may turn out to be a healthier option, but what is their potential for helping smokers kick the habit completely? In the U.S., they’re currently the second most popular method, after cold turkey, followed by the nicotine patch and gum.
While long-term data isn’t available, a recent study from New Zealand researchers shows that e-cigarettes are roughly as effective as the patch. The World Health Organization sees it differently. In July 2013, it released a statement saying that there’s little proof e-cigarettes are an effective method of quitting.
Health Canada hasn’t approved the use of e-cigarettes as a cessation tool, warning they “have not been fully evaluated for safety, quality and efficacy.” And while the FDA has yet to weigh in on the issue, several U.S. studies published last year hint at their potential to help people make the switch from cigarettes. For its part, the American Association of Public Health Physicians has recommended e-cigarettes for smokers struggling to quit.
According to Selby, the difference is both biological and social. Female brain structure, hormones and body composition may make us more sensitive to nicotine addiction and increase our cravings. “Women’s smoking tends to be embedded in their relationships-with partners or friends,” he says. “Smoking comes to mean socializing with others, so quitting can lead to a disconnect, which can be a struggle.” Unlike cold turkey or the patch, e-cigarettes allow the ex-smoker to maintain her social patterns: joining the smokers huddling in their designated zones.
Experts agree that the smoking rate continues to decline overall due to successful anti-smoking advertising, less visibility in films, increasing taxation and fewer places where smoking is legal. But, according to Selby, women don’t seem to respond as well as men to nicotine-replacement therapy, such as patches and gum.
“If one takes a look at how cessation occurs, the process is about setting a date and getting it over with,” says Selby. But these methods target the physical component of addiction instead of the psychological factors unique to women. In other words, by failing to take into account the specific reasons women smoke-how our relationship with smoking is as addictive as the cigarettes themselves-the cessation industry has left female smokers behind.