Electronic cigarettes, or e-cigs, are promoted as a healthier, cleaner, and cheaper alternative to regular cigarettes. But no one really knows how much safer e-cigs are, since there has been little good research on the health effects and no data on their long-term use.

Any realistic discussion of the risks of “vaping” (inhaling the nicotine-laced vapor) versus smoking assumes that e-cigs would replace regular cigs—that is, that they would help smokers quit. Not surprisingly, marketers often suggest that e-cigs can aid in smoking cessation, though they are not allowed to make this unsubstantiated claim.

In a wide-ranging Scientific Review in Circulation in March, researchers from UC San Francisco analyzed five observational studies looking at the effects of e-cigs on smoking behavior. On the basis of these studies, it concluded that “e-cigarette use in the real world is associated with significantly lower odds of quitting smoking” (emphasis added). The researchers also analyzed four clinical trials on e-cigs for smoking cessation and found them unconvincing and flawed.

In contrast, an English observational study in Addiction in May found that smokers who used e-cigs in an attempt to quit were twice as likely to succeed as those who used OTC nicotine replacement tools such as patches (20 percent vs. 10 percent).

How can these findings be reconciled? According Stanton Glantz, Ph.D., senior author of the Scientific Review, “Putting all six studies together (the five we reviewed plus the new study) suggests that e-cigs discourage quit attempts among smokers in general but may increase success for the (smaller number of) people who use them to quit, resulting in a net negative effect of e-cigs on overall quitting rates.”

Some of these studies suggest that e-cigs, even when they don’t help people quit, allow them to smoke less (still about half a pack a day, on average). But, as was discussed in the Scientific Review, such dual use of e-cigs and tobacco may not reduce health risks much—or at all. Research has consistently shown that when people merely cut down on smoking, the risks don’t drop in proportion to the cutbacks. Smoking even a few cigarettes a day, for instance, still greatly increases the risk of a heart attack—then add in the (still unknown) risks of vaping.

A major concern is that e-cigs will simply keep people hooked on nicotine, allowing them to circumvent no-smoking laws in public but continue smoking elsewhere.

In April the FDA finally said it intends to start regulating e-cigs (forbidding unsubstantiated health claims and sales to minors, for instance, and requiring warning labels), but this will be a long drawn-out process, especially if the industry fights some measures, as expected.

 
Meanwhile, as the UC San Francisco researchers concluded, people should be aware that e-cigs are unregulated, contain toxic chemicals, are of unknown safety, and have not been proven effective as cessation aids. Bystanders, especially children, should not be exposed to the vapor.

Thanks to Berkeley Wellness for this article