The American Lung Association has come out in full force by sending lobbyists to various state legislators to argue against the electronic cigarette.1 While on the surface this seems like a reasonable effort, a lack of understanding the motivations of the electronic cigarette user has placed the ALA squarely on the wrong side of the fight for public health.
A source at the ALA, an organization which claims to be dedicated to "save lives by improving lung health and preventing lung disease," acknowledged in response to a recent email inquiry that
yes there are fewer chemicals but your body is still being exposed to chemicals that should not be in your system. Nicotine can also cause the body harm, so yes many of the products do contain nicotine, but used correctly a person uses the products to wean down their nicotine level so they can completely get rid of it. Many people are using the e-cigs as an alternative to smoking the regular cigs thinking that it will not harm them and have no intention of quitting, just switching.
So, while the ALA admitted that electronic cigarettes contain fewer chemicals than tobacco cigarettes, they refuse to acknowledge the obvious health benefit that lack of the most toxic chemicals provides to the smokers who switch. Are lives and lung health the real issue here or is nicotine addiction? The ALA must know that numerous studies show that, absent the tobacco smoke, nicotine is relatively harmless and comparable to caffeine. The American Heart Association acknowledges that nicotine is "safe" in other smoke-free forms such as patches or gum.2
Research has also shown that many of the of smokers who successfully quit using nicotine gum never actually "wean down their nicotine level so they can completely get rid of it." The success rate of NRTs (nicotine replacement therapy) has dropped to 7.2%, resulting in chronic use of the products.3 Furthermore, according to a 2004 report, over 36% of gum users continue to use the products as a smoking replacement indefinitely.4 So nicotine itself is not what is killing people. The ALA's insistence on complete nicotine abstinence is admirable yet unrealistic and their claims about the dangers of nicotine, as compared to smoking, are clearly misleading.
The ALA email also acknowledged a fact already known to many e-cigarette insiders - that the majority of smokers who switched to electronic cigarettes had no intention of quitting smoking. So, why remove the only safer option available to those who would otherwise smoke the obviously deadlier tobacco cigarettes?
The only explanation is that the American Lung Association assumes that every smoker and electronic cigarette user wants to quit smoking and uses the devices as an NRT. That is an erroneous and very dangerous assumption.
In surveys of electronic cigarette owners conducted by CASAA (Consumer Advocates for Smoke-free Alternatives Association), respondents overwhelmingly stated that they did not use electronic cigarettes to quit smoking and would go back to smoking if denied access to electronic cigarettes.
An internet questionnaire of a self-selected sample of 783 daily users of electronic cigarettes asked, "Why did you start vaping?" ("Vaping" is a term for the vapor inhaled vs. smoke.) A staggering 92% chose to switch for reasons other than quitting smoking i.e. saving money or reducing the risks associated with smoking. Less than 8% stated they were using e-cigarettes to quit smoking.5
So, the ALA wishes to remove the safer alternative used by several hundred thousand electronic cigarettes users and force them back to smoking tobacco cigarettes, in order to "protect" the less than 8% who would otherwise be using an NRT?
Additionally, the ALA's belief that e-cigarette users will switch to traditional NRTs or quit altogether is disproved in yet another e-cigarette user questionnaire conducted by CASAA. This survey explored the habits and motivations of almost 1,000 electronic cigarette users. The poll indicates that, not only is the typical e-cigarette user a former smoker over the age of 26, but that they have overwhelmingly cut back or quit the use of tobacco cigarettes and have noticed improved health effects - indicating they provide the "improved lung health" the ALA is seeking to promote. Most importantly, the results indisputably contradict the assertion that electronic cigarette users will quit using tobacco should the devices be removed from the market. Over 80% of the respondents indicated they would most likely return to smoking tobacco cigarettes or use another smokeless tobacco alternative, such as snus. Less than 20% stated they would attempt to quit nicotine use altogether. 6
While the nicotine abstinence approach may be the ideal, it simply does not reflect the reality that 80% of smokers do not even wish to quit in the immediate future. Wouldn't it make sense to encourage those smokers to switch to a less harmful alternative in the meantime?
In their single-minded drive to ban e-cigarettes, focusing solely on the small minority of electronic cigarette users who use the devices to quit nicotine, the ALA will do more harm than good to the majority of e-cigarette users who will inevitably return to smoking the more toxic tobacco cigarettes.
The American Lung Association needs to re-read their own mission statement and determine if their opposition to electronic cigarettes would be saving lives - their stated goal - or putting those lives right back into harm's way.
1. Michelle Manchir, State Hopes to Snuff Out E-cigarette Sales, ChicagoTribune.com
2. American Heart Association, Nicotine Substitutes/Nicotine Replacement Therapy, AmericanHeart.org
3. Etter JF, Stapleton JA., Nicotine replacement therapy for long-term smoking cessation: a meta-analysis., ncbi.nlm.nih.gov
4. Petra Bartosiewicz., A Quitter's Delima: Hooked on the Cure, NYTimes.com
5. CASAA, Poll of Electronic Cigarette Users: Why Did You Start Vaping?, CASAA.org
6. CASAA, Ecig User Poll Graphic, CASAA.org