Smoking remains a leading cause of death in the United States, despite widespread interest in quitting and FDA-approved cessation methods. However, many smokers find it difficult to quit. Some public health experts have turned to e-cigarettes as a "lower-risk" alternative to traditional cigarettes for those who are uninterested or unable to quit smoking. Citing reports from institutions such as the National Academy of Sciences, Engineering, and Medicine, these experts suggest that e-cigarettes can offer a reduced chance of exposure to carcinogens and other harmful toxins when used as a substitute for combustible cigarettes.
Jessica Yingst, Assistant Professor of Public Health Sciences and researcher at the Penn State Cancer Institute, is leading a team of colleagues at the Penn State Tobacco and Health Survey Center in studying the potential of e-cigarettes to help nicotine users quit smoking or reduce exposure to harmful toxins found in cigarettes. Their latest research focuses on a common concern: whether using e-cigarettes as a way to cut back on smoking can actually increase nicotine addiction.
The research on this topic is contradictory because previous studies relied on participants using their own devices without knowing the nicotine delivery. "Our study utilized devices with known nicotine delivery characteristics, allowing us to effectively compare how different levels of nicotine in the devices may impact users' nicotine dependence and ability to reduce cigarette consumption," said Inster.
Researcher recruited 520 participants who were interested in reducing their cigarette consumption but had no plans or interest in quitting smoking. The participants were asked to reduce their cigarette consumption over a 6-month study period. Donors were randomly assigned an electronic cigarette which provided 50, 8, or mg/mL of nicotine, or a tobacco-free alternative cigarette to help them reduce their cigarette consumption.
Participants self-reported their addiction to cigarettes and e-cigarettes using validated dependence measures at 1, 3, and 6 months, including a questionnaire developed by Penn Point that ranged from not dependent at all to highly dependent (scored from 0-20). Urine samples were also collected throughout the study to measure cotinine, a biomarker for nicotine exposure.
After 6 months, all participants in the electronic cigarette group reported a significant reduction in their smoking habits, with those in the 36 mg/mL group smoking the least. Compared to the cigarette substitute group, the electronic cigarette group showed a significant decrease in their dependence on the Penn Point cigarette addiction index.
Contributors also reported on e-cigarette addiction using the Penn State Electronic Cigarette Dependence Index. Throughout the study, e-cigarette addiction did not show significant changes, except for the participants in the mg/mL group where addiction was found to have significantly increased compared to cigarette addiction, although still much lower overall. Urinary cotinine levels remained consistent across all groups throughout the study, indicating no overall increase in nicotine exposure during the research period. The study's results were published in the journal Nicotine and Tobacco Research.
Our research findings suggest that using e-cigarettes or other alternative products to reduce smoking may lead to self-reported reductions in smoking and dependence," said Dr. Inge, who is in charge of the public health PhD program at the medical school. "Importantly, the use of high-strength e-cigarettes did not increase overall nicotine dependence compared to other alternative products and was associated with reductions in smoking." Although some have speculated that e-cigarette use may increase overall nicotine addiction, the research team stated that their study found that starting to use e-cigarettes to reduce smoking led to decreases in cigarette dependence and e-cigarette dependence. In the future, they will evaluate the impact of fully switching from cigarettes to e-cigarettes on health.
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