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What does research say about electronic cigarettes?

To mark the Great American Smokeout, a day where smokers across the country – with support from family and friends – take steps to quit the habit, we got in touch with the Editor-in-Chief of Nicotine & Tobacco Research, published  on behalf of the Society for Research on Nicotine & Tobacco, to learn more about the potential pros and cons of electronic cigarettes.

Scientific journals are more than simply vehicles for the dissemination of the latest research; they also provide an overview of the state of a field and the breadth of opinions about certain topics, as well as a forum for debate and disagreement (in the form of letters, commentaries, and editorials). In my opinion, as a journal editor, it is important to provide fair and balanced coverage, rather than preferring articles that reach one conclusion over another. In practice, though, this can be challenging.

A good example of this is electronic cigarette (e-cigarette) research. E-cigarettes heat liquid that usually (but not always) contains nicotine, and the aerosol generated (usually called “vapour”) is inhaled to deliver nicotine to the lungs. These devices have grown dramatically in popularity in recent years, and the research community is working hard to understand the epidemiology of their use, particularly their potential benefits and harms.

If e-cigarettes help people to stop smoking, and relatively few young people who would not have otherwise started smoking start using them, then they are likely to offer a substantial public health benefit. The adverse health consequences of smoking (such as the increased risk of cardiovascular disease and a range of cancers) are so great that anything that reduces smoking will improve public health.

On the other hand, if e-cigarettes don’t help people stop smoking, carry greater long-term harms than anticipated, or act as a route into smoking for young people who would not otherwise have smoked, they may be detrimental to public health. For example, although propylene glycol is regarded as a safe food product, the impact of long-term inhalation is unknown and unlikely to be entirely benign.

An example of a commercial e-liquid and an advanced personal vaporizer. Photo by AesirVanirJotnar. CC BY-SA 4.0 via Wikimedia Commons.

What is unfortunate is that tobacco researchers are now deeply divided over this issue, with researchers who previously worked closely towards reducing the harms of tobacco use now holding highly polarized opinions. The challenge as a journal editor is to reflect this plurality of opinions, whatever one’s personal opinion is. One way to achieve this is to include commentaries, key articles, and responses to those commentaries. This provides readers with a sense of the ongoing debate.

A recent article illustrates this well. David Levy and colleagues at Georgetown University Medical Center have published an analysis looking into the likelihood of individuals influenced by e-cigarettes to start smoking cigarettes; they refuted this hypothesis and have suggested that e-cigarettes are likely to have a positive public health impact and highlighted the information we need to collect to monitor this. In response, two groups published commentaries highlighting what they perceived to be shortcoming of this analysis, to which Levy and colleagues responded. The disagreement turns on how best to model e-cigarette trends in the population, and in particular, how to distinguish between those who have experimented a few times with e-cigarettes and those who become regular users.

Another question is how to model the rapidly changing e-cigarette landscape, where the relationship between experimentation and regular e-cigarette use may differ across different age cohorts. These are complex questions, and the subject of considerable ongoing debate within the research community. Highlighting this debate in the pages of academic journals is an important way of engaging the wider community.

We live in an era where social media and a variety of platforms offer opportunities for post-publication peer review. I think this is a positive development that allows for more rapid and democratic critique of published research. Nevertheless, I still see an important place for more formal, peer-reviewed commentary and response in the pages of a scientific journal not only to capture ongoing debate but also to highlight that while scientists often agree on much, they typically disagree on just as much.

Featured image credit: E cigarette by Horwin. CC0 public domain via Pixabay.

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