E-cigarettes as a low-risk alternative to smoking.

Electronic cigarettes have gained attention from media and consumers due to their addictive nature, various flavors, and increasing use by adolescents, leading to regulatory policies. A study from the Pennsylvania Medical School shows that these devices can help people reduce their addiction to combustible cigarettes without increasing their overall addiction to nicotine.

Smoking is a leading cause of death in the United States. Despite interest in quitting and FDA-approved cessation methods, quitting smoking is still found to be difficult. Public health experts have referenced reports, such as those from the National Academies of Sciences, Engineering, and Medicine, to offer electronic cigarettes as a "low-risk" alternative to cigarettes for those who are uninterested or unable to quit smoking. These reports have found that replacing combustible cigarettes with e-cigarettes can reduce users' exposure to carcinogens and other harmful toxins.

Jessica Yingst, Assistant Professor of Public Health Sciences and Researcher at the Penn State Cancer Institute, and her colleagues at the Pennsylvania Tobacco and Health Survey are studying electronic cigarettes to determine if they can help users quit smoking or reduce their exposure to harmful and toxic substances found in traditional cigarettes. Their latest research is focused on a common concern: whether beginning to use e-cigarettes to reduce smoking could actually increase nicotine addiction.

Yingst stated that research on the topic is contradictory due to previous studies where participants used their own devices, and the parameters of the nicotine delivery devices were unknown. In this study, known parameters of nicotine delivery devices were used, allowing for effective comparisons of how different levels of nicotine impact users' dependency and can reduce cigarette consumption.

Researchers recruited 520 participants who were interested in reducing their cigarette consumption but not quitting, and asked them to reduce their cigarette use over a six-month study period. Participants were randomly assigned to receive either an electronic cigarette with a maximum nicotine concentration of 80mg/ml, or a tobacco-free smoking alternative to aid them in reducing their cigarette consumption.

Participants self-reported their addiction to cigarettes and e-cigarettes using effective dependency measures at the 1, 3, and 6-month marks, including a questionnaire developed by Penn Point which ranged from "not at all dependent" to "extremely dependent" over 20 months. Urine samples were also collected throughout the study to measure cotinine, a biomarker for nicotine exposure.

After six months, all participants in the electronic cigarette group reported a significant decrease in the number of smokers, with those in the 36mg/ml group reporting the least number of smokers per day. Participants in the electronic cigarette group reported a much lower dependence on the addictive nature of cigarettes compared to those in the cigarette substitute group.

The author also referenced the Pennsylvania Electronic Cigarette Dependence Index report to discuss addiction to electronic cigarettes. Throughout the study, electronic cigarette addiction did not significantly change. Additionally, the level of cotinine in urine – a marker for overall nicotine exposure – remained consistent across all groups throughout the study period. These findings were published in the journal Nicotine and Tobacco Research.

Yingst, the director of the Public Health PhD program at the medical school, said, "Our findings suggest that using e-cigarettes or other alternatives to smoking to reduce smoking, specifically high-intensity e-cigarettes, did not increase overall nicotine dependence and was associated with a decrease in smoking quantity.

Despite some speculation that using e-cigarettes may increase overall nicotine addiction, a research team has found that using e-cigarettes can actually reduce dependence on traditional cigarettes. In the future, they plan to assess the health impact of completely transitioning from cigarettes to e-cigarettes.

This study was supported by the National Institute of Health and Fitness, National Institute on Drug Abuse, and the FDA Center for Tobacco Products (Grant numbers P50DA036105 and U50DA036105). Data collection was supported by the Pennsylvania State University Clinical and Translational Science Institute (Grant number UL1TR002014). Kenneth and Dianne Wright Medical and Translational Analysis High School, from Virginia Federal College (Grant number UL1TR002649), was funded by the National Institutes of Health National Center for Advancing Translational Science. The content is solely the responsibility of the authors and does not necessarily represent the official views.

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