What are the harms of long-term e-cigarette use, and do e-cigarettes help with quitting smoking?

What are the dangers of long-term smoking e-cigarettes? Is e-cigarettes effective to quit smoking? Core point: Try not to touch anything with the word" smoke", be patient to quit smoking, and learn to seek professional help.

1. What is my attitude towards e-cigarettes?

2. What are the dangers of e-cigarettes? Do you have second-hand smoke?

3. Is it useful to quit smoking with e-cigarettes?

4. Final advice


Author: Gu Zhongyi, registered dietitian. Master of Public Health from Tsinghua University, director of Beijing Dietitian Association, and director of Beijing City Nutrition Society. Top Ten Science Communication Figures in 2017, Top Ten Influential Health and Medical Vs in Weibo 2018, and Healthy China's 2012 Fashion Figures. Eight years of experience as a nutritionist in a top-three hospital, he is the author of the headline contract, and the author of "Gu Zhongyi: This is How We Should Eat" and "Gu Zhongyi Says: How Should We Eat", with a total sales of more than 100,000 copies. Two days ago, the famous China tobacco king Chu Shijian passed away, and there has been a lot of discussions on topics such as tobacco and money on the Internet.

I believe everyone knows that smoking is harmful to health. When we evaluate various healthy lifestyles, when talking about the impact on life expectancy and chronic diseases, quitting smoking has undoubtedly the greatest impact. Successful smoking cessation is also more useful than buying an air purifier.

But in recent years, a new thing has become popular with e-cigarettes.

Especially in the past six months, many e-cigarette products began to circulate on the market. Luo Yonghao, a famous entrepreneur, educator and cross-talk performance artist, also introduced an e-cigarette produced by a new entrepreneurial team led by Zhu Xiaomu, a former hammer technology executive, at the press conference in January 2019.

Is e-cigarettes harmful? How much harm is it? This is the topic I want to discuss with you today.

1: What is my attitude towards e-cigarettes?

When I was studying at the Public Health Research Center of Tsinghua University, teachers who taught law and economics used tobacco as a typical case. I am also very sensitive to the topic of e-cigarettes. Over the years, I have been based on the World Health Organization's attitude towards e-cigarettes. Take the stance and popularize science with everyone.

As early as 2008, the WHO issued a notice stating that e-cigarettes are not a suitable smoking cessation treatment.

But after all, more than ten years have passed. Are there any new research progress in medicine and updates in the design of e-cigarette products? I don't understand.

I often encounter some health communicators overkill when promoting healthy lifestyles. They are not based on the best evidence at present, but use intimidating methods. In this way, if a controversy arises, the credibility of the health communicators will be easily damaged and the public will be at a loss.

Therefore, I still want to verify the relevant evidence as rigorously as possible and communicate with you comprehensively and objectively. Two: What are the hazards of e-cigarettes?

structure

There are actually many types of e-cigarettes, and some even look like a USB flash drive. The World Health Organization and the American Heart Association both refer to the Electronic Nicotine Delivery System (ENDS) as a common type.

The biggest feature of e-cigarettes is that they do not burn like ordinary cigarettes. The basic structure is composed of a cigarette bomb, an atomizer, and a battery. The main components of the cigarette oil are nicotine, propylene glycol, and may also contain glycerin and various flavors. After being electrified, the tobacco oil turns into aerosol and is then inhaled into people's lungs.

nicotine

Judging from the composition, first of all, e-cigarettes do not have the harmful substances produced by the burning of ordinary tobacco, such as tar and carbon monoxide, so the harm to the human body in this regard will be reduced.

But there is still nicotine after all. Nicotine itself is toxic. I wrote "Seven Shocking Details Before the Fall of the Sixth Master". The dissatisfaction with the male protagonist's sexual life in the movie "Old Pao Er" may be due to his years of smoking, causing microcirculation ischemia and cardiovascular function.

Nicotine is also addictive. Children and adolescents are more sensitive. Nicotine changes the way nerve synapses are formed and more likely to affect their brain functions, such as causing a decline in attention, learning ability, and impulse control, increasing the risk of future addiction. Excessive intake may also be life-threatening.# p#pagination title #e#

The State Tobacco Monopoly Administration has also specifically warned that the respiratory system of minors has not yet been formed, and inhalation of nicotine may have adverse effects on the lungs.

other ingredients

Since the current market supervision is not fully in place and there are no relevant national standards, the raw materials, flavors, and processes used in e-cigarette products are relatively random. Manufacturers may add some substances harmful to the human body in order to increase the novel experience.

Even some of the more common additives are safe to eat normally, but inhalation into the lungs may pose potential risks. For example, propylene glycol is a very common food additive, but it can easily irritate the respiratory tract after burning. The smoke of some e-cigarettes may also contain heavy metals.

accident

In addition, inferior batteries and leakage of cigarette oil may also cause accidents. In 2014, there was a report about a young man who spent 300 yuan on an e-cigarette, but it exploded and injured his hand.

secondhand smoke

It is often said that e-cigarettes do not have second-hand smoke, so they are better for people around them. First of all, compared to ordinary cigarettes, the aerosol of e-cigarettes does have almost no organic carcinogens, and the inhalable particulate matter is basically only one-tenth of that of ordinary cigarettes, which is indeed much less harmful to the human body.

But that does not mean there is no second-hand smoke at all.

There will still be diacetyl and volatile organic compounds in the aerosol. Some studies have shown that e-cigarettes in confined spaces can increase nicotine levels in volunteers. In addition, a 2014 study by the University of Southern California also found that some heavy metals in e-cigarette aerosol, such as nickel, are four times higher than ordinary cigarettes.

3: Is it useful to quit smoking with e-cigarettes?

Many people will explain that I did not smoke e-cigarettes for no reason, but used e-cigarettes as a substitute for cigarettes and used e-cigarettes to quit smoking. Is this scientific?

Quit smoking is a big benefit

First of all, actively quitting smoking is to be encouraged! Currently, the U.S. FDA has approved several smoking cessation therapies (it has not approved e-cigarettes), such as nicotine replacements, which can achieve a smoking cessation rate of around 10% to 20% within a year.

Some people may think that the success rate of smoking cessation is not high, but if you take into account the impact of smoking on life expectancy, and the comprehensive calculation can effectively extend the life of quitters by several years on average, even if only a small number of people succeed, it is still worth it.

E-cigarettes are recognized as first invented by China and produced and sold on a large scale in the market, which is the Ruyan brand in 2003. According to the founder, he originally developed this product to replace the nicotine patch. He once used the nicotine patch to quit smoking, but was awakened by nightmares at night (this is also a relatively common side effect of the nicotine patch). Are e-cigarettes less harmful than smoking?

However, as I said before, the World Health Organization did not consider e-cigarettes an appropriate smoking cessation treatment in its 2008 notice.

However, Luo Yonghao gave a statement at his press conference:

I went to check and found that it was true that the British Public Health (PHE) gave this statement in August 2015:

PHE is an executive agency affiliated with the UK Department of Health and Social Services. It is composed of thousands of scientists and public health personnel. It was established in 2013. PHE conducted research and concluded that e-cigarettes may help smokers quit smoking. It proposed that e-cigarettes are compared to smoking. The risk is much smaller (less than 5%), but not without risk.

However, the scientific community did not fully agree with this document. The Lancet quickly issued a document in response that year, accusing it of extremely fragile evidence and potential conflicts of interest between two authors. The quality of the peer review process was not high enough and should have been based on high-quality evidence. The task of evaluating high-quality evidence was not completed.

The U.S. Preventive Services Task Force is one of the best agencies in terms of evidence-based work on disease prevention strategies. In September 2015, the agency updated its opinion on smoking cessation among adults, arguing that the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) are used for adults (including pregnant women) to quit smoking.

The controversy at that time has come to an end.

The latest high-quality evidence?

From the level of evidence, clinical trials are clearly more credible than based on component analysis and animal experiments.

In January 2019, a randomized controlled trial conducted by the National Institutes of Health and supported by the Cancer Research UK was published in the New England Journal of Medicine, a top medical journal as famous as The Lancet.# p#pagination title #e#

Tests have shown that when combined with behavioral support treatment, e-cigarettes are easier for people to successfully quit smoking than nicotine replacement treatment, and some adverse reactions are also lower. That is to say, the smoking cessation effect of e-cigarettes is better than nicotine replacement treatment.

Don't be optimistic

It should be noted that all subjects in this study also received one-on-one behavioral support therapy for at least four weeks. The previous statement from the British Department of Public Health also mentioned that with the help of smoking cessation services, this made these subjects completely different in terms of knowledge and attitudes from those who smoke e-cigarettes at will without guidance. Moreover, this study did not use a blind method, and the experimental results were more susceptible to psychological suggestions or subjective tendencies.

More importantly, although it seemed that the results and status of the subjects in the e-cigarette group were relatively good during this year, after one year, the number of people who continued to use e-cigarettes reached 79.8%, while the proportion of people who continued to use nicotine substitutes was only 9.1%. The frequency and duration of e-cigarette use were also slightly higher than that of the group with nicotine replacements.

In other words, although these people have quit smoking, they cannot live without e-cigarettes.

Do you consider this a successful cessation of smoking?

Four: Final advice

The above is my science popularization, and I will give you a few final reminders:

Teenagers should stay away

I have previously analyzed that e-cigarettes may lead to nicotine addiction on the one hand, and on the other hand, they may also have an impact on the brain, and even produce inhalable particulate matter in a closed environment.

Therefore, teenagers should pay special attention to staying away from e-cigarettes!

Anyone who wants to tempt you to try is a bad person! At the same time, these people are also breaking the law!

In 2018, the U.S. FDA announced that it would require manufacturers to provide corresponding plans to reduce the use of e-cigarette products by young people. Our country's State Administration for Market Regulation and the State Tobacco Monopoly Administration issued a notice banning the sale of e-cigarettes to minors, so we advise those who want to sell e-cigarettes to young people should not commit crimes against the trend!

Why touch e-cigarettes? Isn't it fun to be the glory of the king?

Smokers seek professional help

If you are a smoker and really want to quit smoking, you can go to the smoking cessation clinic of a regular hospital for medical treatment. Even call the 12320 health hotline to provide free smoking cessation assistance services. With professional guidance, the effect of smoking cessation will be twice the result with half the effort.

You may also wish to read books on smoking cessation, study the "China Clinical Smoking Cessation Guidelines (2015 Edition)", and use regular drugs under the guidance of professionals. In addition to nicotine replacements, the U.S. FDA has also approved two smoking cessation drugs, bupropion and varenicline.

If these already marketed smoking cessation drugs are not used, consider using e-cigarettes to quit smoking. After all, there is a large amount of clinical data behind these smoking cessation drugs, which are more reliable than e-cigarettes, which have little data.

The American Heart Association's position statement issued in 2014 also stated that mature methods of quitting smoking are recommended compared to e-cigarettes.