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E-cigarettes help up to 22 000 smokers in England quit each year

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1243 (Published 01 March 2016) Cite this as: BMJ 2016;352:i1243

Rapid Response:

Smoking is a pediatric epidemic

Wise'sarticle is titled “E-cigarettes help up to 22,000 smokers in England quit each year”.(1) Public Health England, fooled by the “harm reduction” motto as lay people were before with low tar and light cigarettes, claimed “e-cigarettes were 95% less harmful than normal cigarettes”.(2) In France, the High Council for Public Health went further in February when updating its recommendation with: “The e-cigarette can be an aid to smoking cessation for those who want to quit smoking and a way of tobacco harm reduction".(3)

Sadly, smoking is a pediatric epidemic. Among US youths, E-Cigarette use is an intention to initiate but not to quit smoking, and the US and the Centers for Disease Control and Prevention reported a dramatic increase in E-cigarette use among high school students from 1.5 percent in 2011 to 13.4 percent in 2014.(4) The American Academy of Pediatrics warned that E-cigarette have the potential to addict a new generation of youth to nicotine, reversing more than 50 years of progress in tobacco control.(5)

In 6 months Altria spent $35 million in advertising MarkTen, becoming the top spender on e-cigarette advertising. In the US, E-cigarette advertising spending for 2014 reached $88.1 million, mostly by the big tobacco, a 52 percent increase from 2013( http://truthinitiative.org/research/rapid-increase-e-cigarette-ad-spendi...). Who could believe that the inclusion of young adult imagery in advertisements by the Big tobacco is aimed at smoking cessation? Big Tobacco has understood that nicotine plus flavour is a gateway for addiction.(6)

The craze for electronic cigarettes is an indicator that the system avoids tobacco control policies and is unable to assist smokers and provide them access to evidence-based treatment for cessation (such as combination of various form of nicotine replacement therapy, psychotherapy (support and cognitive behavioural interventions) or varenicline). In the U.S., the use of smokeless tobacco parallels smoking prevalence and tops it in Kentucky and West Virginia, where tobacco farms are concentrated.(7) Finland, which was the first country in the world to set the endgame objective by law, has prohibited sale of nicotine cartridges.

1 Wise J. E-cigarettes help up to 22 000 smokers in England quit each year. BMJ 2016;352:i1243

2 Britton J, Bogdanovica I. Electronic cigarettes: A report commissioned by Public Health England. May 2014. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...

3 High Council for Public Health. [Risk-benefit of the electronic cigarette for the general population.] 2016, Feb 24. Available at http://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=541

4 Park JY, Seo DC, Lin HC. E-Cigarette use and intention to initiate or quit smoking among US youths. Am J Public Health 2016. Published online Jan 21.

5 Etzel RA, Wilson KM, Balk SJ, Farber HJ, Groner JA, Moore JE. Electronic Nicotine Delivery Systems. Pediatrics 2015;136:1018-26.

6 Benowitz NL. Nicotine addiction. N Engl J Med 2010;362:2295-303.

7 Braillon A. Electronic cigarettes: from history to evidence-based medicine. Am J Prev Med. 2014;47:e13

Competing interests: No competing interests

07 March 2016
Alain Braillon
senior consultant
University Hospital. 80000 Amiens. France