NEW YORK (Reuters Health) A small U.S. study raises new questions about whether using electronic cigarettes will lead people to quit smoking, adding to the debate over how tightly the products should be regulated.

The study, which looked at the habits of 88 smokers who also used e cigarettes, was published as a research letter in the journal JAMA Internal Medicine on Monday. It found that smokers who also used e cigarettes were no more likely to quit smoking after a year, compared to smokers who didn’t use the devices.

Outside experts say the small number of respondents, and a lack of data on whether they intentionally used e cigarettes to help them quit smoking, mean the findings from the Center for Tobacco Control Research and Education at the University of California, San Francisco can’t take the place of much more rigorous study on the subject.

E cigarettes were first introduced in China in 2004 and have since grown into a $2 billion industry. The battery powered devices let users inhale nicotine infused vapors, which don’t contain the harmful tar and carbon monoxide in tobacco.

At issue is how strictly U.S. health regulators should control the products. Advocates say e cigarettes can help smokers quit. Public health experts fear they can serve as a gateway to smoking for the uninitiated, particularly teenagers. Leading U.S. brands include blu by Lorillard Inc and products from privately held NJOY and Logic Technology.

A previous report from the UK found that people who use e cigarettes primarily want to replace traditional cigarettes (see Reuters Health story here ).

“We did not find a relationship between using an e cigarette and reducing cigarette consumption,” Rachel Grana, the lead researcher on the new study, told Reuters Health.

Grana and colleagues at the University of California, San Francisco analyzed 2011 survey data collected from 949 smokers. Of those, 88 reported using e cigarettes.

When the researchers looked at those smokers’ responses a year later, they found that the people who reported using e cigarettes in the 2011 survey were no more likely to quit smoking than the people who didn’t use e cigarettes.

For those who were still smoking in 2012, using e cigarettes also didn’t appear to change how many traditional cigarettes people smoked per day.

The researchers note that the small number of participants who reported using e cigarettes may have limited their ability to detect a link between quitting smoking and using the device.

Dr. Michael Siegel, who was not involved with the new research, told Reuters Health that the new study had several design flaws, including that the researchers did not know why some of the participants tried e cigarettes or how long they had used them. Siegel is an expert on community health at Boston University School of Public Health and has studied e cigarette research.

By comparing people who smoked regular cigarettes and those who smoked e cigarettes, the researchers are assuming “that the groups are exactly equivalent in terms of their motivations and their levels of addiction to cigarettes,” Siegel said. “You can’t make those assumptions. You’re not dealing with comparable groups.”

In an emailed statement, Grana and fellow researchers acknowledged that they did not have information on the participants’ motivations to use e cigarettes, but said their analysis took into account other factors known to be linked to quitting smoking, such as their stated intention to quit and how many cigarettes they already smoked each day.

“These factors may also reflect motivations to use e cigarettes, as e cigarettes are frequently marketed and perceived as cessation aids,” they wrote. “While these factors predicted quitting as expected, we found that e cigarette use did not predict quitting.

Siegel also pointed out that only about eight percent of the people surveyed said they had any intention to quit smoking within the next month. He hopes people will reserve judgment on e cigarettes until randomized controlled studies considered the “gold standard” of medical research are published.

“We need solid data that’s based on solid science before we make decisions,” he said. “I hope no one would take this research letter and make any conclusion based on it.”

SOURCE JAMA Internal Medicine, online March 24, 2014.

(Editing by Nancy Lapid and Michele Gershberg and Andrew Hay)

Two cheers for e-cigarettes – nytimes.com

Brand cigarettes – brand cigarettes manufacturers, suppliers

Now imagine that an alternative comes to the market, an innovative device that can help people wean themselves from the deadly product. It has the same look and feel as the lethal product indeed, that s a large part of its appeal. It, too, is addictive. But the ingredients that kill people are absent.

This, of course, is no imaginary scenario. The lethal product is cigarettes, which use nicotine to addict and combustible tobacco to kill. And the alternative is electronic cigarettes, which deliver nicotine without the tobacco, and emit a vapor that almost instantly evaporates. Yes, users can be hooked on nicotine, which is a stimulant. But people who vape are not going to die, at least not from inhaling their cigarette.

You d think that the public health community would be cheering at the introduction of electronic cigarettes. We all know how hard it is to quit smoking. We also know that nicotine replacement therapies, like the patch, haven t worked especially well. The electronic cigarette is the first harm reduction product to gain serious traction among American smokers.

Yet the public health community is not cheering. Far from it groups like the American Lung Association, the American Heart Association and the Campaign for Tobacco Free Kids are united in their opposition to e cigarettes. They want to see them stigmatized like tobacco cigarettes. They want to see them regulated like cigarettes, too, which essentially means limited marketing and a ban on their use wherever tobacco cigarettes are banned.

Thomas Farley, New York City s health commissioner, trotted out most of the rationales against e cigarettes the other day at a City Council hearing. (The City Council is considering a bill, strongly supported by the Bloomberg administration, that would forbid the use of an e cigarette anywhere that cigarettes are banned.) E cigarettes, he said, are so new we know very little about them. Thanks to e cigarettes, smoking is becoming glamorous again, and could become socially acceptable. The number of high school students who have tried electronic cigarettes doubled from 2011 to 2012. He made a particular point of showing how closely e cigarettes resembled old fashioned tobacco cigarettes.

The reason to fear this resemblance, say opponents of electronic cigarettes, is that vaping could wind up acting as a gateway to smoking. Yet, so far, the evidence suggests just the opposite. Several recent studies have strongly suggested that the majority of e cigarette users are people who are trying to quit their tobacco habit. The number of people who have done the opposite gone from e cigarettes to cigarettes is minuscule. What the data is showing is that virtually all the experimentation with e cigarettes is happening among people who are already smokers, says Michael Siegel, a professor at the Boston University School of Health.

Siegel is a fierce critic of tobacco companies, but he s also not afraid to criticize the anti tobacco advocates when they stretch the truth. When we got to talking about the opposition to e cigarettes in the public health community, he said, The antismoking movement is so opposed to the idea of smoking it has transcended the science, and become a moral crusade. I think there is an ideological mind set in which anything that looks like smoking is bad. That mind set has trounced the science.

Another person who considers e cigarettes promising is David Abrams, the executive director of the Schroeder Institute for Tobacco Research and Policy Studies. It s a disruptive technology, he said, that might give cigarettes a run for their money. In his view, the anti tobacco advocates had spent so many years arguing from a total abstinence framework, that they haven t been able to move from that position. Yet, he noted, the country has long tolerated many similar harm reduction strategies, including needle exchanges and methadone maintenance.

None of this is to say that electronic cigarettes should be free of regulation. But they should be regulated for what they are a pharmaceutical product that delivers nicotine, not a conduit for tobacco poison. Let them make health claims which they can t now do so long as they are backed up with real science. And, most of all, use e cigarettes to help make real cigarettes obsolete.

At that recent New York City Council meeting, one of the fiercest critics to testify was Kevin O Flaherty of the Campaign for Tobacco Free Kids. If it walks like a duck and it talks like a duck and it sounds like a duck and it looks like a duck, it is a duck, he said.

Is this what passes for science when you oppose electronic cigarettes?