Electronic Cigarettes vs Commercial Cigarettes, Research Proposal Example

Abstract

The goal to reduce the amount of people addicted to smoking has been a topic of concern.  The commercial market has introduced a new type of nicotine delivery method for smokers known as electronic cigarettes or more commonly referred to as e-cigarettes. E-cigarettes were introduced with the notion that they could help people addicted to cigarettes quit smoking.  However, the U.S. Food and Drug Administration (FDA) have not approved this form of cigarette as a deterrent for smoking and the FDA has not indicated the safeness.  The objective of this study was to compare the use of e-cigarettes versus commercial cigarettes and the resulting adverse effects between the two though the analysis of current research on awareness, usage, and safety.  A literature review of studies conducted for the use, awareness, and safety of both e-cigarettes and commercial cigarettes was conducted.  Data was collected from a several research studies in order to compare the use, awareness, and safety and health concerns. The results of the studies found that the overall awareness of e-cigarettes resulted in approximately 38.%. In addition, significant difference in nicotine levels was observed in subjects who smoked tobacco cigarettes, as well as dependence on nicotine. Health results of health concerns compared to tobacco smoke are much less severe in e-cigarettes. More information and research could lead to better regulations and policies for the marketing and advertising for these types of cigarettes over the tobacco cigarettes.

Introduction 

According to the World Health Organization (WHO), there are almost six million fatalities a year related to smoking.  The strive to reduce the amount of people addicted to smoking has been a difficult task; therefore, the market has introduced a new type of nicotine delivery method for smokers known as electronic cigarettes or more commonly referred to as e-cigarettes. E-cigarettes main goal was to reduce the amount of deaths related to smoking. E-cigarettes are a type of cigarette which delivers nicotine via a device. This device is fairly new to the United States.  E-cigarettes are electrically operated through the use of batteries (usually lithium batteries) and with an atomizer for liquid storage.  The liquid is aerosolized through the use of energy and heat resistance from a wick.  The e-cigarette is designed to resemble a normal cigarette. (Farsalinos and Polosa, 2014)  The nicotine in the e-cigarettes is the same as a normal cigarette, in which derived from the tobacco plant.  The purpose of the introduction of the e-cigarette was to influence the user that they are a healthier form to smoking and inhaling cigarettes.  In addition, the e-cigarettes were introduced with the notion that they could help people addicted to cigarettes quit smoking.  However, the U.S. Food and Drug Administration (FDA) have not approved this form of cigarette as a deterrent for smoking and the FDA has not indicated the safeness for e-cigarettes.  In fact, preliminary testing on e-cigarettes has illustrated components of toxins and carcinogens.  (North Dakota Department of Health, 2015)  The liquid contained inside the e-cigarette device is comprised of distilled water, propylene glycol, unapproved and unapproved flavorings for food usages, and nicotine.  (Farsalinos and Polosa, 2014)

Consumers who use e-cigarettes are commonly referred to as “vapors”. Consumers are able to pick the type of strength of nicotine or non-nicotine, as well as the type of flavor.  There are currently a few different types of devices on the market that mimic the size and look of regular cigarettes.  The use of using e-cigarettes since their introduction has increased exponentially.  Recent research has found that the awareness of e-cigarettes increased in 2011 from 40.9% to 57.9% and the use of e-cigarettes also increased approximately 3%.  (King et al., 2013)  Although there has been an increase in the awareness and use of e-cigarettes, there is a concern about the health effects of e-cigarettes, such as observed in regular cigarettes.  The Centers for Disease Control and Prevention (CDC) have reported that approximately 42 million adults in the United States were cigarette smokers in the year 2012, totally approximately 18% of the adult population. It has also been reported that almost 500,000 people in the U.S. die from conditions related to smoking and that smoking actually kills more people than other fatal incidents and diseases.  Smoking has also been linked to an increase risk in cancer, such as lung, larynx, oral cavity, nose, sinuses, pharynx, esophagus, stomach, pancreas, cervix, kidney, bladder, ovary, colorectum, and acute myeloid leukemia. (American Cancer Society, 2014) In addition, lung cancer has been reported as the leading cause of death in both women and men, as well as the hardest type of cancer to treat with success. Furthermore, there other many more health problems associated with smoking, such as heart disease, bronchitis, emphysema, stroke, aneurysm, woman reproductive problems,  mortality, low birth weight in infants, increased risk of birth defects, pneumonia, asthma, gum disease, cataracts, bone thinning, and more. (American Cancer Society, 2014) The problems and adverse effects of smoking cigarettes have been long researched and determined; however, the effects of smoking e-cigarettes are still a topic of interest and research. Recent research has found that e-cigarette has indicated that e-cigarettes are less harmful than smoking due to the mere fact that there is no tobacco and no combustion occurrence during the e-cigarette process. Also, it has been inferred that the vapors in e-cigarettes do not contain several of the toxins that are found in the smoke of cigarettes.  It has been noted that there are toxins released in the vapors of the e-cigarettes, however, at a much lower level compared to tobacco smoke. (Farsalinos and Polosa, 2014)  According to Farsalinos and Polosa, studies conducted on e-cigarettes and toxins have been exaggerated in the conclusions drawn forth in regard to the harmful consequences. The researchers do suggest that there are some risks that go along with the use of e-cigarettes; however, it is much lower than the fatal consequences from the occurrence of smoking tobacco cigarettes.  In addition, the research suggests that the e-cigarettes should be used as a means of a substitute and prevention for smokers trying to quit tobacco cigarettes. (Moore et al., 2009; Rigotti et al., 2010)  More research is in need in regard to a comparison between e-cigarettes and tobacco cigarettes. Not only would research provide a means for a decision for consumers, but it will provide authorities with regulations and a better understanding of the adverse effects of e-cigarettes. The purpose of this study was to conduct an evaluation of both e-cigarettes and tobacco cigarettes.  Therefore, the objective of this study was to compare the use of e-cigarettes versus commercial cigarettes and the resulting adverse effects between the two though the analysis of current research on awareness, usage, and safety.

Methods

A literature review of studies conducted for the use, awareness, and safety of both e-cigarettes and commercial cigarettes was conducted. Data was collected from a research study conducted by King (et al., 2013), Pearson (et al, 2012), Farsolina and Polosa (2014) and Farsolina et al. (2014) in regard to the use and awareness of e-cigarettes in regular smokers. Data was also collected from studies conducted by Vansicket et al. (2010) and Etter et al. (2003) in regard to use and awareness of commercial cigarettes in regular smokers.

The results of the studies were analyzed for comparison between effects of e-cigarettes versus commercial cigarettes on health, use, and awareness. Graphs were extracted from the studies for use and comparison of results.  The first data review was obtained from King et al. (2013), in regard to the awareness and ever use of electronic cigarettes. In this review, data was obtained from a HealthSyles survey, which was nationally based and contained subjects greater than or equal to 18 years of age. The surveys examined were both provided via mail and internet. The awareness of e-cigarettes was examined using demographics as well.  Two surveys conducted by Pearson (et al., 2012) were taken from a national online study and a Legacy Longitudinal Smoker Cohort. Additional data from Farsolinos et al. (2014) was gathered from e-cigarette users who were former smokers.  In this study there was a sample size of 23 people.  The study cohorts were given an e-cigarette liquid and blood samples were obtained at a baseline and after every 15 minutes in order to test for nicotine levels.   Comparisons between levels of e-cigarettes and commercial cigarettes were analyzed using the collected data from Farsolinos et al. (2014) and data collected and analyzed by Vansickel et al. (2010). In addition, the dependence of users to e-cigarettes and commercial cigarettes was examined and compared using data from Farsolinos et al. (2014) and Etter et al. (2003). In order to determine if there was a correlation between dependence between e-cigarettes and commercial cigarettes, a review of surveys that were sent to a random sample of 2000 people by mail.  The question asked in this survey stated for the subjects to answer signs that indicate that smokers are dependent on cigarettes.  (Etter et al., 2003) This study was compared to the study conducted by Farsalinos et al. (2014) on Nicotine absorption from electronic cigarette use. In this study, questionnaires on smoking and e-cigarette dependence were provided. Also, the dependence or craving of nicotine from e-cigarettes was examined using a Cigarette Withdrawal Scale (CWS). The study employed the following statements, “(1) The only think I can think about is using (vaping) and EC; (2) I miss the EC terribly; and (3) I feel and irresistible need to vape”.  The answers were scored using 0 through 4, 4 being the most agreement.

A review of the safety and risk of e-cigarettes was also conducted.  Data was obtained from Farsolina and Polosa (2014). In their study, the PubMed electronic database was searched using specific keywords to identify e-cigarettes, such as e-cigarette, electronic nicotine delivery system, and electronic cigarette. In this study, there were a total of 41 studies relevant to the safety of e-cigarettes. In addition, additional research documents were searched in regard to reports chemical components of e-cigarettes.

Prospective Results

Awareness of E-Cigarettes

In the study conducted by King et al., (2013), the overall awareness of e-cigarettes resulted in 38.% from the mail surveys and 40.9% from the internet surveys. The results of the study also illustrated that the use of e-cigarettes was significantly higher in smokers compared to non-smokers. In the study conducted by Pearson et al. (2012), the online survey indicated that over 40% of the subjects were aware of e-cigarettes. In addition, it was found that the use of e-cigarettes was higher with current smokers.  The lowest percentage of awareness was observed in individuals who did not smoke.  Furthermore, it was established that young adults and individuals with a high-school diploma perceived e-cigarettes as resulting in less health effects than commercial cigarettes.

Nicotine Absorption Comparison

In regard to a nicotine absorption levels in blood samples after baseline examination and after e-cigarette use, significant difference in nicotine levels was observed.  In addition, the study compared levels of new generation e-cigarette devices on the market and it was found that there was a significant increase in plasma nicotine levels in subjects using the new generation device.  Results can be observed in Figure 1. (Farsolinos et al., 2014)  Further analysis within this study compared results from the study conducted by Vansickel et al. (2010).  The study showed that minimal e-cigarette nicotine absorption was observed compared to elevated plasma nicotine levels from tobacco cigarettes within five minutes of absorption. The plasma nicotine levels, however, were at equal levels after 35 minutes using an e-cigarette device.

Dependence Results

In the study conducted by Etter et al. (2003), the results of the questionnaire indicated that daily smokers had higher dependence results compared to occasional smokers.  In comparison with the study conducted by (Farsolinos et al. 2014), it was found that craving and dependence was higher in tobacco cigarettes.  20 of the subjects stated that they quit smoking within one month after the use of e-cigarettes.  In addition, it was also found that using a new generation e-cigarette device took 35 minutes to reach the same plasma levels of nicotine in the blood stream compared to a normal cigarette. The results also indicated that the participants craving for nicotine was higher when using a new generation device, compared to the first generation e-cigarette device.  The mean percent differences of nicotine plasma levels were 70% higher in the new generation device. (Farsalinos et al., 2014)

Safety and Health Concerns

In the review conducted on safety and health of the use of e-cigarettes, after 24 month observation of e-cigarette smokers, it was found that symptoms of mild mouth and throat irritation were observed. In addition, over 100 of the smokers indicated that they had quit smoking after using e-cigarettes for eight months.  Farsalinos also found that after the use of e-cigarettes, smoker nicotine levels and ventricular heart function increased in blood pressure. Furthermore, it was found that the use of both tobacco and e-cigarettes had an effect on white blood cell count.  (Farsolina and Polosa, 2014)  Results of health concerns compared to tobacco smoke are much less severe in e-cigarettes.

Conclusions

Research has suggested that electronic cigarettes are a less harmful approach to smoking and serve as a beneficial alternative to smoking commercial cigarettes containing tobacco.  In addition, it has been indicated that people who switch from tobacco cigarettes to e-cigarettes have a significant difference in health outcomes.  Although there are some minimal effects to smoking e-cigarettes, the effects are much less adverse compared to tobacco smoke.  Also, the dependence and craving for cigarettes has been observed to decrease with the use of e-cigarettes.  The results of the dependence craving of tobacco have been referred to the quickness in which the nicotine enters the bloodstream compared to e-cigarettes.  Smokers who have switched to e-cigarettes have also shown the willingness and ability to quit smoking entirely.  Since there has been an increase in awareness to the market of e-cigarettes and there has been substantial evidence of the ability of smokers to quit smoking altogether with e-cigarette use, more research should be conducted on the toxic effects of e-cigarettes in order to provide the consumer with more information.  More information and research could lead to better regulations and policies for the marketing and advertising for these types of cigarettes over the tobacco cigarettes.

References

American Cancer Society.  (2014).  Cigarette Smoking.  Retrieved from: http://www.cancer.org/acs/groups/cid/documents/webcontent/002967-pdf.pdf

Etter, J., Houezec, JL., Perneger, TV.  (2003).  A Self-Administered Questionnaire to Measure Dependence on Cigarettes: The Cigarette Dependence Scale.  Neuropsychopharmacology.

Farsalinos, KE. and Polosa, R.  (2014a).  Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review.  Ther Adv Drug Saf. 5(2):67-86. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/

Farsolinos, K.E., Spyrou, A., Tsimopoulou, K., Stefopoulos, C., Romagna, G., Voudris, V.  (2014 b).  Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices.  Scientific Reports.  Nature. 4(4133).  http://www.nature.com/articles/srep04133

King B., Alam S., Promoff G., Arrazola R., Dube S. (2013). Awareness and ever use of electronic cigarettes among US adults, 2010–2011. Nicotine Tob Res 15(9): 1623–1627. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/

Moore D., Aveyard P., Connock M., Wang D., Fry-Smith A., Barton P. (2009) Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ 338: b1024.

North Dakota Department of Health.  (2015).  Tobacco Facts.  Electronic Cigarettes (e-cigarettes).  Retrieved from: https://www.ndhealth.gov/Tobacco/Facts/E-cigs.pdf

Pearson JL¹, Richardson A, Niaura RS, Vallone DM, Abrams DB.  (2012).  e-Cigarette awareness, use, and harm perceptions in US adults.  Am J Public Health. 102(9):1758-66. http://www.ncbi.nlm.nih.gov/pubmed/22813087/

Rigotti N., Pipe A., Benowitz N., Arteaga C., Garza D., Tonstad S. (2010) Efficacy and safety of varenicline for smoking cessation in patients with cardiovascular disease: A randomized trial. Circulation 121: 221–229

Vansickel, A.R., Cobb, C.O., Weaver, M.F., Eissenberg, T.E.  A Clinical Laboratory Model for Evaluating the Acute Effects of Electronic “Cigarettes”: Nicotine Delivery Profile and Cardiovascular and Subjective Effects .  Cancer Epidemiology Biomarkers & Prevention.  19(8); 1945–53. ©2010 AACR. Retrieved from: http://cebp.aacrjournals.org/content/19/8/1945