People's Daily: Are E-Cigarettes Really a 'Quit-Smoking Miracle'?

"Rather than calling it a 'quit-smoking miracle,' it is more accurate to say it is a smoking alternative."

The term "quit-smoking miracle" seems to be an exaggeration.

On the evening of August 6, as night fell, Guangzhou, which had been scorched by the sun all day, finally felt a hint of coolness, marking the start of the nightlife.

In an e-cigarette specialty store on Sports West Road in Tianhe District, several young people were gathered, chatting. Through the glass window, one could see them exhaling clouds of vapor with each puff.

In recent years, as people's health awareness has increased, some smokers have been continuously searching for alternatives to quit smoking, and e-cigarettes, which claim to help quit smoking, have gradually entered the public's view.

Can e-cigarettes really help quit smoking? A survey by People's Daily found that although many businesses promote e-cigarettes with the slogan "can help quit smoking," consumers have mixed reviews regarding their effectiveness in actual use; currently, there is no scientific evidence proving that e-cigarettes can be used to quit smoking. Calling e-cigarettes a "quit-smoking miracle" seems to be an exaggeration.

In response, the National Health Commission stated that it is conducting research on e-cigarette regulation in conjunction with relevant departments, planning to regulate e-cigarettes through legislation.

Market response: Sales of "quit-smoking miracles" are on the rise

Outside an e-cigarette experience store in Huachenghui, Tianhe District, Guangzhou, various e-cigarette advertisements are posted. The colorful images of the ads are eye-catching. Inside the glass cabinets, there are various e-cigarette devices, liquids, and pods on display.

"Business is generally good at night; we often have customers coming in to try new products or restock their 'pods,'" said the store owner, Akang. Industry insiders refer to the containers filled with liquid as "pods," and when these "pods" are heated, the liquid turns into vapor for users to inhale.

In an e-cigarette shop in Nanshan District, Shenzhen, several young people were playing games while vaping. "We combine a smoke bar and a bar here," the owner said, "we have quite a few people coming to play every weekend, and we stay open until 3 AM."

A search on online maps revealed that in cities like Beijing, Shanghai, Guangzhou, Shenzhen, and Hangzhou, there are over 30 similar physical "e-cigarette experience stores" or "e-cigarette bars."

The booming e-cigarette market is largely due to businesses labeling e-cigarettes as "quit-smoking miracles."
 
Searching for "quit-smoking miracle" on an e-commerce app, the top results are all e-cigarettes. App screenshot

"Healthy quitting" and "obvious quitting effects"... Opening e-commerce apps like Taobao and JD, searching for "quit-smoking miracle" brings up hundreds of e-cigarette products. When inquiring with several high-selling e-cigarette online stores, the sellers all claimed that the e-cigarettes they sold "can be used to quit smoking."

E-cigarette operator Akang also stated that with the promotion of "e-cigarettes can help quit smoking," the business has become much better in recent years. "In the past, many people didn’t know what e-cigarettes were; now most people have at least heard of them."

According to the 2018 World Tobacco Development Report, the sales of e-cigarettes that year were approximately $14.52 billion, a 27% increase year-on-year. In contrast, the sales of traditional cigarettes globally have been decreasing by 1%-2% annually over the past five years.

As a new phenomenon, e-cigarettes have attracted attention from both the public and capital. The organizer of the Shenzhen IECIE e-cigarette exhibition provided a post-event report showing that in 2019, about 1,500 e-cigarette brands from 83 countries participated in the exhibition, with visitor numbers exceeding 70,000, an increase of 30.1% compared to 2018.

"The development prospects for e-cigarettes are broad. According to experts from relevant research institutions, global e-cigarettes are expected to show at least double-digit compound growth rates in the future," said Ao Weinuo, secretary-general of the Electronic Cigarette Industry Committee of the China Electronic Commerce Association.

Smoker experiences: Mixed reviews on actual effects

After more than a decade of iteration in functionality and appearance, "quitting smoking" has remained a major selling point for many businesses.

Interviews revealed that many smokers use e-cigarettes with the intention of quitting, but their reviews on the effectiveness vary.

"I initially used e-cigarettes to help quit smoking," said Ms. Wang from Shenzhen, who has been smoking for three years. She started using e-cigarettes on a friend's recommendation. "In fact, the effect isn’t that good; after smoking for so long, it’s impossible to quit just with e-cigarettes. At most, I smoke both together, reducing the number of cigarettes I smoke."

Many smokers share a similar experience to Ms. Wang. Mr. Qin from Guangxi, who has been smoking for 13 years, revealed that he has tried e-cigarettes. "For me, e-cigarettes are more of a novelty; they can’t help me quit smoking." Mr. Qin stated that he still smokes cigarettes and only uses e-cigarettes occasionally.

Some smokers reported that they have achieved the goal of replacing cigarettes with e-cigarettes, effectively completing a "disguised quitting."

"Since I started using e-cigarettes, I rarely touch cigarettes anymore," said Mr. Yang, who works in Guangzhou. He noted that many of his "e-cigarette friends" started using them to quit smoking. "But that’s all just advertising from businesses. E-cigarettes can replace cigarettes, but they are not very useful for quitting smoking."

Some netizens shared their quitting experiences online, stating that by using e-cigarettes, they can purchase liquids with varying nicotine levels according to their needs, gradually "downgrading" the nicotine to achieve quitting.

A sophomore student from a university in Guangzhou, Xiao Cao, believes that e-cigarettes are less harmful than cigarettes, and he would prefer e-cigarettes over traditional cigarettes. "It’s a case of 'choosing the lesser of two evils.'"

"I think e-cigarettes are helpful for quitting smoking," said Xiao Chen, who works in Shenzhen, expressing strong support for the quitting effects of e-cigarettes. He mentioned that he used to smoke at least ten cigarettes a day, but since switching to e-cigarettes early last year, his smoking volume has significantly decreased. "Although I haven’t completely quit yet, I am definitely healthier than before."

Expert opinions: Claims of quitting lack scientific basis

On one side are the loud promotions from businesses, and on the other are the ongoing debates among consumers regarding whether e-cigarettes have quitting effects. The academic community has not reached a consensus on this issue either.

In 2015, Public Health England released a research report stating that e-cigarettes could reduce harm by about 95% compared to traditional tobacco. The report suggested that e-cigarettes are a safer alternative to traditional tobacco and could potentially be used as a quitting tool.

However, the World Health Organization's Global Tobacco Epidemic Report released on July 26 this year stated that the claim that e-cigarettes can help smokers quit lacks sufficient evidence. The report claimed: "In most countries where e-cigarettes are sold, most e-cigarette users also consume tobacco products, which does not significantly reduce health risks or is ineffective."

"Both tobacco products and e-cigarette liquids contain nicotine," said Dr. Xiong Jingfan, chief physician at the Shenzhen Chronic Disease Prevention and Control Center. He explained that both e-cigarettes and cigarettes stimulate the brain through nicotine to produce a feeling of euphoria, and both have a similar basis for addiction, leading to dependency. "From this perspective, e-cigarettes do not help with quitting smoking."
 
Wu Yiqun tests the nicotine content in e-cigarette liquids. Photo provided by Wu Yiqun

Wu Yiqun, a researcher at the Chinese Center for Disease Control and Prevention, also stated that the e-cigarettes currently popular in China are not suitable for smokers trying to quit. She conducted an experiment showing that some e-cigarette liquids on the market have nicotine content that differs from the labeled amount, sometimes exceeding it by several times, which may pose higher health risks to users.

Wu Yiqun mentioned that she randomly purchased some e-cigarette liquids from the market and tested their nicotine content. The tests revealed that one 30mL bottle of liquid, labeled with a nicotine concentration of 3mg/mL, actually contained 355.5mg of nicotine. If calculated based on a typical user consuming 2mL of liquid daily and each cigarette containing 1.1mg of nicotine, this would be equivalent to consuming over 21 cigarettes daily.

Additionally, two other bottles labeled with a nicotine concentration of 3mg/mL had actual concentrations of 10.55mg/mL and 10.69mg/mL, both exceeding the labeled concentration by more than three times.

In clinical practice, medical experts believe that caution should be exercised regarding the quitting efficacy of e-cigarettes. "I have encountered many patients seeking help with quitting medications because e-cigarettes were ineffective for them," said Dr. Yang Xinyan, deputy chief physician of the Respiratory Department at the First Affiliated Hospital of Guangzhou Medical University. "In the absence of solid scientific evidence, I do not recommend using e-cigarettes to quit smoking."

In fact, within the e-cigarette industry, there are differing opinions on the claim that e-cigarettes can help quit smoking. Ao Weinuo admitted that, as of now, there is no scientific evidence indicating that e-cigarettes possess quitting functionality; they merely provide users with an alternative experience of vaporization.