| The electronic cigarette online survey. | | | | they do not merely address the products’ flaws, |
| Electronic cigarettes (e-cigarettes), which rush in | | | | but eliminate a promising smoking cessation |
| popularity in 2008, may be the most promising product | | | | intervention, offering few realistic options for bringing |
| for tobacco harm reduction yet. E-cigarettes deliver a | | | | the product back to market. There is a high likelihood |
| nicotine vapor without the combustion products that | | | | that some people who switched from cigarettes to |
| are responsible for nearly all of smoking’s health | | | | e-cigarettes but lose access to e-cigarettes will |
| effects. Other than anecdotal accounts, there is little | | | | resume smoking. |
| information about who uses e-cigarettes, and whether | | | | There are many testimonials and anecdotes on the |
| people who switch from cigarettes to e-cigarettes | | | | internet about people switching from cigarettes to |
| experience changes in symptoms caused by smoking. | | | | e-cigarettes but, to our knowledge, there have been no |
| This pilot online survey, conducted by | | | | quantified data published. |
| tobaccoharmreduction.org, investigated e-cigarette use | | | | One online e-cigarette distributor based in the United |
| for smoking cessation and changes in health status | | | | Kingdom conducted an online marketing survey of their |
| and smoking caused symptoms. | | | | e-cigarette users and made their data available to |
| A convenience sample (n=303) was enrolled by e-mail | | | | researchers at the University of Alberta School of |
| and links on various blogs and forums in May-June | | | | Public Health for re-analysis. |
| 2009. Independent university researchers at the | | | | The objectives of this study were to describe |
| project analyzed the data. | | | | e-cigarette users' patterns of cigarette and e-cigarette |
| | | | | usage and smoking cessation attempts and to |
| All respondents previously smoked and 91% had | | | | compare health status and smoking-attributable |
| attempted to stop smoking before trying ecigarettes. | | | | symptoms between people who completely switched |
| Most respondents resided in the USA (72%) and 21% | | | | from smoking to e-cigarettes, those who partially |
| were in Europe. About half | | | | switched, and those who supplemented cigarette |
| (55%) were 31-50, while 32% were >50 years old. | | | | smoking with e-cigarette usage. |
| Most (79%) of the respondents had been using | | | | |
| e-cigarettes for <6 months and reported using them | | | | The survey assessed respondents' use of cigarettes, |
| as a complete (79%) or partial (17%) replacement for, | | | | e-cigarettes, smoking cessation (including use of |
| rather than in addition to (4%), cigarettes. The majority | | | | pharmaceutical products and switching to e-cigarettes) |
| of respondents reported that their general health (91%), | | | | and changes in smoking-caused symptoms since using |
| smoker’s cough (97%), ability to exercise (84%), | | | | e-cigarettes. The dataset included 304 observations, |
| and sense of smell (80%) and taste (73%) were | | | | one of which excluded from all analyses because only |
| better since using e-cigarettes and none reported that | | | | country of residence and comments were entered. |
| these were worse. Although people whose e-cigarette | | | | There were two sets of two observations each, |
| use completely replaced smoking were more likely to | | | | which had the same IP address. There were no |
| experience improvements in health and smoking | | | | entries with the same e-mail address. In addition, there |
| caused symptoms, most people who substituted | | | | were 31 observations with no IP or email address. |
| e-cigarettes for even some of their cigarettes | | | | |
| experienced improvements. | | | | Results |
| | | | | Approximately half of the sample was between the |
| These are highly motivated and passionate e-cigarette | | | | ages of 31 and 50, one-third were more than 50 years |
| users who may have different experiences than | | | | old and none were under the age of 18. Nearly |
| average e-cigarette users or smokers, and thus the | | | | three-quarters resided in the US, followed by 17% from |
| estimates cannot be extrapolated to all smokers or | | | | the UK. Most of the respondents had been using |
| e-cigarette users. However, the results still suggest | | | | e-cigarettes for less than six months and all had |
| that very few e-cigarette users are not using them to | | | | smoked prior to using e-cigarettes. Most of the |
| replace cigarettes and there are many switchers and | | | | respondents had previously tried to stop smoking |
| current smokers who could have the reported | | | | multiple times. |
| experience. Unfortunately e-cigarettes have been | | | | The majority (86%) of respondents had tried |
| banned in some jurisdictions (e.g., Canada, Victoria | | | | pharmaceutical products to quit smoking, nearly |
| (Australia)) where switching from cigarettes to | | | | two-thirds of whom indicated that these products did |
| e-cigarettes was documented. The lack of available | | | | not help them to stop smoking. However, most of the |
| and legal e-cigarettes may cause some users to | | | | sample was able to use e-cigarettes as a complete |
| resume smoking. | | | | replacement for cigarettes. |
| | | | | The majority of the respondents indicated that their |
| Introduction | | | | general health, smoker’s cough, ability to exercise, |
| Awareness and use of electronic cigarettes | | | | sense of smell and sense of taste were better since |
| (e-cigarettes) has dramatically increased in the past | | | | starting to use e-cigarettes and none indicated that |
| two years. These devices, which are manufactured | | | | these were worse when responding to these five |
| and sold by several different companies, deliver | | | | questions. |
| nicotine by vaporizing a gel composed of water, | | | | |
| propylene glycol, flavorings, and nicotine. E-cigarettes | | | | On average, respondents who lived in Europe had |
| deliver nicotine without the products of combustion that | | | | used e-cigarettes for longer than respondents in the |
| are inhaled by smoking cigarettes. Therefore, the | | | | US, but were less likely to use e-cigarettes as a |
| health risks are likely similar to those from smokeless | | | | complete replacement for cigarettes. There was a |
| tobacco, which has approximately 1% of the mortality | | | | positive relationship between the number of times |
| risk of smoking. There is likely some remaining risk due | | | | participants had tried to stop smoking and using |
| to the stimulant effects of nicotine. E-cigarettes are | | | | e-cigarettes as a complete replacement for cigarettes. |
| one category of no combustion nicotine product | | | | Most (81%) of the respondents who indicated that |
| (others being smokeless tobacco and pharmaceutical | | | | pharmaceutical products did not help them stop |
| nicotine products) that are promising for tobacco harm | | | | smoking used ecigarettes as a complete replacement |
| reduction, the substitution of less harmful nicotine | | | | for cigarettes. |
| products for cigarettes [3,4]. | | | | Although the majority of respondents reported that |
| E-cigarettes are widely available in the United States | | | | their health and smoking-caused symptoms improved |
| and Europe and are also available online through many | | | | since using e-cigarettes, there were some notable |
| different distributors. E-cigarettes have been banned in | | | | trends in which groups were morelikely to report |
| some jurisdictions including Canada [5,6] and Victoria | | | | improvements. Respondents who had been using |
| (Australia) [6] and are subject to the indoor | | | | e-cigarettes for a longer period of time, who had |
| “smoking” bans in others (e.g., [7]). Although there | | | | completely replaced their cigarettes with e-cigarettes, |
| are legitimate concerns about quality control and | | | | or were younger, were more likely to report |
| product tampering, the importation/sale bans have | | | | improvements. |
| been criticized by public health advocates because | | | | |