IQOSTM vs. e-Cigarette vs. Tobacco Cigarette: A Direct Comparison of Short-Term Effects after Overnight-Abstinence

People who choose to smoke, subject themselves to one of the leading causes of years of potential life lost (YPLL). Many smokers try to quit, but traditional smoking cessation aids, or solely relying on willpower, unfortunately, only help a small minority to quit successfully and, especially, to remain smoking abstinent. More specifically, after one particular quit-attempt only 3-5% of smokers solely relying on willpower achieve long-term (six to 12 months) smoking abstinence, whereas these rates double or at best triple when using Nicotine Replacement Therapy (NRT) or smoking cessation medication. For example, in a recent analysis of the long-term outcomes of the Stop Smoking Services in England (standardly providing a combination of behavioral counseling plus NRT or smoking cessation medication), quit rates after one year were only around 8%. Tobacco Harm Reduction (THR)—encouraging the substitution of low-risk alternatives—may be an alternative, more feasible way of attaining smoking cessation, especially for those smokers who cannot or do not want to cease all tobacco and/or nicotine consumption. Alternative low-risk nicotine products include smokeless-tobacco (e.g., Swedish snus), long-term use of NRT, and electronic cigarettes (e-cigarettes).

Almost a decade of extensive research on e-cigarettes has recently been evaluated and summarized in several comprehensive reviews. These reviews, as well as individual studies, unanimously concluded that, beyond any doubt, using an e-cigarette (“vaping”) presents substantially less health risks than smoking; and suggested that “e-cigarette health risks are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower”. In addition, there is convincing evidence that for many smokers, e-cigarettes are a valuable tool to assist in quitting smoking. As reported in the majority of the well-conducted prospective observational cohort studies, the odds ratios of (self-reported) quitting (OR 2.69-7.88; 20-42% quitters) are substantially higher in smokers who self-select to use e-cigarettes in a quit-attempt compared to those who do not. An important contributor to quit-smoking success seems to be regular (daily) and/or long-term use of efficient e-cigarettes. In the same vein, according to national (UK/France) and EU cross-sectional population data, about half (41-52%) of the current daily e-cigarette users report to have quit smoking, completely.

However, the prevalence of current e-cigarette use in the EU population (15 years and older) centers around no more than about 2% (4% in current smokers, 4% in ex-smokers, 0% in never smokers). Among the US population, prevalence of current adult e-cigarette use is estimated at about 3%. Additionally, among current e-cigarette users, a considerable percentage (about 50%) use both cigarettes and e-cigarettes (“dual use”), and many of those dual users do not seem able, nor willing to completely quit smoking by switching to vaping. From a health perspective, reducing smoking is a step in the good direction, but smoking no more than a few cigarettes per day still has significant effects on premature mortality and overall morbidity.

A partial explanation of dual use, and of the relatively low uptake of vaping by smokers, more generally, could be that vaping is not a satisfactory alternative for some smokers who want to switch to a low-risk alternative. For example, a recent study with confirmed smokers found that 59% of the participants had tried out vaping but indicated several aspects they did not like about vaping, such as the (sensory and behavioral aspects of the) vaping experience, the material of which the e-cigarette is composed, the “chemical composition” of the e-liquids and the technical complexity of vaping. This indicates that not all smokers may benefit from trying out vaping. As the THR vision implies offering (that is, developing, correctly informing about, and encouraging the use of) any tool that reduces the harms caused by smoking, it is our position that the availability of several different alternatives for smoking should be welcomed, rather than seen as a threat. This allows smokers to freely choose, try out, and find products that are sufficiently attractive and suit them best to reduce the harmful effects from smoking.