Date Published: 9 June 2018

Former smokers might be better advised to use high rather than low nicotine e-cigarettes

British charity Cancer Research UK has highlighted1 recent research indicating that former cigarette smokers who want to use e-cigarettes instead of smoking cigarettes might be better off beginning with higher, rather than lower, nicotine levels in order to reduce compensatory behaviour and the amount of e-liquid used.

E-cigarettes (short for 'electronic cigarettes') are small handheld electronic devices that provide some of the experience of smoking physical (tobacco) cigarettes. They work by electrically heating a liquid called the 'e-liquid', generating an aerosol which is commonly referred to as the vapor, which is then inhaled by the user. Consequently, use of e-cigarettes is often referred to as 'vaping'. Not all e-liquids contain nicotine. Although the precise composition of the vapor generated by e-cigarettes varies, it is generally thought that most of toxic chemicals found in tobacco smoke are absent in e-cigarette vapor2. Although controversial, e-cigarettes are used by some people as an aid to stopping smoking and resisting the urge to return to using tobacco products, an urge that can be strong due to the nature of addiction to the chemicals in cigarettes.

Cancer Research UK has drawn attention to the results of research3 it funded and which was carried out at London South Bank University. The study involved collecting and analysing data from 20 e-cigarette users. It revealed that people using low nicotine e-liquid in their devices puffed more deeply and more often than those using high nicotine liquid. Those using low nicotine also increased the power of their vaping devices when possible. Even though the low nicotine vapers were unable to get as much nicotine as those in the high nicotine group, their higher puffing behaviour might have increased their exposure to toxins such as formaldehyde, a chemical formed when the e-cigarette liquid is heated.

According to Cancer Research UK1, any toxic chemicals in e-cigarette vapor are thought to be fewer and typically at lower concentrations than in tobacco smoke and use of both high and low nicotine e-cigarettes are considered less harmful than ordinary cigarette smoking.

On the subject of the recently reported research into the possible effects of using e-cigarettes with higher or lower levels of nicotine, the Cancer Research UK article1 went on to explain that using e-cigarettes ('vaping') more intensely and at higher power raises the temperature inside the device which can cause the glycerine and glycol found in most e-liquids to break down. This, in turn, increases the risk of exposure to chemicals. Even though the exposure is generally at lower levels than in the case of conventional smoking, it is argued that it should be minimised where possible. It was also noted that the low nicotine group also reported a stronger urge to vape, more acute withdrawal symptoms and were less satisfied after use.

Summarising the outcome of the group's research, the lead author of the study, Dr Lynne Dawkins of London South Bank University, said1:

" Some vapers might believe that starting out on a low nicotine strength is a good thing, but they should be aware that reducing their nicotine concentration is likely to result in the use of more e-liquid. This obviously comes with a financial cost but also possibly with a health cost. The results of our study suggest that smokers who want to switch to vaping may be better to start with higher, rather than lower, nicotine levels to reduce compensatory behaviour and the amount of e-liquid used.
_ Although e-cigarettes are much less harmful than smoking, the vapour can still contain some potentially harmful chemicals that present a higher risk to health than nicotine, which is relatively safe. Our research shows that more intense vaping behaviour associated with using low nicotine e-liquid has the potential to increase users' exposure to some of these chemicals. To draw any firm conclusions more research on a larger scale is needed
."

Alison Cox, director of prevention at Cancer Research UK, added1:

" Let's be clear. While there are potentially harmful chemicals present in the e-cigarette vapour, there are far more in tobacco smoke. The best thing smokers can do for their health is to stop smoking, and switching to e-cigarettes is one way to do this.
_ Tailored help and support from local Stop Smoking Service offers the best chance of stopping smoking for good. But this research suggests that a low nicotine approach may not be the best for everyone or the safest path to a successful attempt to give up. First time vapers should be prepared to experiment to find what suits them best and helps them to give up for good
."

Ref. to Research:

  1. Press Release entitled 'Ex-smokers might be better off with high rather than low nicotine e-cigs', cancerresearchuk.org, 8 June 2018.
  2. John Britton & Ilze Bogdanovica, "Electronic cigarettes - A report commissioned by Public Health England", PDF at bit.ly/2L7sSXD. Public Health England, 15 May 2014.
  3. Lynne Dawkins et.al., Sharon Cox, Maciej Goniewicz, Hayden McRobbie, Catherine Kimber, Mira Doig, Leon Kośmider, " 'Real-world' compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure" Addiction DOI: 10.1111/add.14271, first pub. 7 June 2018.

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