Ask the Flight Surgeon / By CPT Scott A. Cygan, D.O.: Q: Doc, I’m thinking of trying E-Cigarettes. Are these safer than conventional cigarettes, and are they able to help me quit smoking?
FS: Unless you’ve been living under a rock, you may have heard that smoking is hazardous to your health, but do you know just how hazardous? Smoking is the leading cause of preventable disease and death in the United States. Tobacco products are associated with heart disease, stroke, certain cancers, obstructive pulmonary disease and adverse pregnancy outcomes. Approximately 480,000 deaths per year are attributed to the nicotine habit. We are often overwhelmed with statistics these days, but stop and take a few seconds to let that number really sink in… 480,000 deaths per year. That number is approximately equal to the population of Atlanta, Georgia. A population of the entire city of Atlanta is lost each year due to the very preventable diseases related to smoking. Why is it so difficult to prevent all these deaths? Unfortunately, most smokers have developed very entrenched behavioral habits and social customs revolving around their daily cigarette use. Add this habitual behavior to the highly addictive properties of nicotine and it becomes a massive uphill battle to kick the habit.
What are E-Cigarettes?
Electronic cigarettes (or e-cigarettes) came on the market in 2007 and now can be found almost everywhere that conventional cigarettes are sold. The devices are often reusable and resemble cigarettes, cigars, pipes or pens. As the user draws air into the device, a heating element vaporizes nicotine-containing liquid which can then be inhaled. This has led to the trendy term “vaping” that often is heard within the e-cigarette industry’s marketing campaigns. Marketing for these products has represented e-cigarettes as a safer nicotine delivery system than the conventional cigarette because of less carcinogenic chemicals, tar and additives. The products are also pushed as being a more effective strategy for smoking cessation than traditional methods such as nicotine gum or patches. This is mostly due to the ability of the e-cigarette to mimic the experience of conventional smoking and recreate those similar sensations that underlie the addiction to smoking.
Due to these purported benefits, e-cigarette use has dramatically increased over the past five years and became a billion-dollar industry in 2013. According to the Food & Drug Administration (FDA) in 2014, 12.6% of U.S. adults had tried an e-cigarette while 3.7% are now using them consistently.
What’s the downside?
Obviously, this is the part of the article where the doc tells you to stop using e-cigarettes or they will give you some horrible disease. Well, it’s really not that clear cut. A major concern is a lack of federal regulation of the devices and nicotine-containing liquids. The ingredients being inhaled, like conventional cigarettes, continue to contain many carcinogenic substances and a lack of oversight of the manufacturing process is worrisome. However, on May 9th, 2016, the FDA introduced new rules that extend their regulatory authority to now include Electronic Nicotine Delivery Systems (ENDS) which encompass e-cigarettes and similar devices. This will allow the FDA to phase in new requirements on e-cigarette manufacturers to include import, packaging, labeling, advertising, promotion, sale and distribution of these products to consumers. This is a good first step in the right direction.
The claims of increased efficacy for smoking cessation versus traditional methods and the overall safety of e-cigarettes have not been well supported by quality studies. These devices are still relatively new to the market and the available research remains very limited. The bottom line remains that until the FDA has imposed proper regulatory oversight and the long-term health consequences are better understood, it’s probably best to avoid the trendy e-cigarettes and rely on traditional smoking cessation methods for now.
So if not e-cigarettes, how can I quit?
As a great first step, visit www.ucanquit2.org for information on the Department of Defense’s campaign to help service members quit tobacco products. The website provides great educational products, resources and tools to assist with preparing to quit, quitting and staying quit. Fortunately, there are also many safe and effective ways to assist with smoking cessation that have been approved by the FDA. Some of these options can even be used safely while remaining on active flight status. Nicotine replacement therapy (NRT) in the patch, gum or inhaler form and a medication called buproprion (Zyban) can be prescribed and monitored by your local flight surgeon.
Remember, with a strong commitment to change, hard work and determination, you can quit smoking or chewing. Contact your local flight surgeon for support and assistance.
Stay safe! Dr. Cygan
CPT (Dr.) Scott A. Cygan is a flight surgeon at the U.S. Army School of Aviation Medicine, Fort Rucker, AL.