Whenever I tell anyone I research e-cigarettes, they almost always have an opinion about them. Some will be vapers themselves, and those who are will almost without fail sing the praises of the device that finally helped them quit smoking. But often people who’ve never tried e-cigarettes will focus on the potential risks from using them, and in particular whether they’re likely to reintroduce smoking to a young generation who have been steadily shunning it in larger and larger numbers over recent decades. A particular fear is that young people will experiment with e-cigarettes and that this will be a gateway in to smoking, as well as fears around the harms from e-cigarettes themselves.
A recent detailed study of over 60,000 UK 11-16 year olds has found that young people who experiment with e-cigarettes are usually those who already smoke cigarettes, and even then experimentation mostly doesn’t translate to regular use. Not only that, but smoking rates among young people in the UK are still declining. Studies conducted to date investigating the gateway hypothesis that vaping leads to smoking have tended to look at whether having ever tried an e-cigarette predicts later smoking. But young people who experiment with e-cigarettes are going to be different from those who don’t in lots of other ways – maybe they’re just more keen to take risks, which would also increase the likelihood that they’d experiment with cigarettes too, regardless of whether they’d used e-cigarettes.
Although there are a small minority of young people who do begin to use e-cigarettes without previously being a smoker, as yet there’s little evidence that this then increases the risk of them becoming cigarette smokers. Add to this reports from Public Health England that have concluded e-cigarettes are 95% safer than smoking, and you might think that would be the end of the fear surrounding them.
But e-cigarettes have really divided the public health community, with researchers who have the common aim of reducing the levels of smoking and smoking-related harm suddenly finding themselves on opposite sides of the debate. This is concerning, and partly because in a relative dearth of research on the devices the same findings are being used by both sides to support and criticise e-cigarettes. And all this disagreement is playing out in the media, meaning an unclear picture of what we know (and don’t know) about e-cigarettes is being portrayed, with vapers feeling persecuted and people who have not yet tried to quit mistakenly believing that there’s no point in switching, as e-cigarettes might be just as harmful as smoking.
An unexpected consequence of this could be that it makes it harder to do the very research needed to elucidate longer-term effects of e-cigarettes. And this is something we’re experiencing as we try and recruit for our current study. We are conducting a research project funded by CRUK, where we’re collecting saliva samples from smokers, vapers and non-smokers. We’re looking at DNA methylation, a biological marker that influences gene expression. It’s been shown that smokers have a distinct methylation profile, in comparison to non-smokers, and it’s possible that these changes in methylation could be linked to the increased risk of harm from smoking – for example cancer risk. Even if the methylation changes don’t cause the increased risk, they could be a marker of it. We want to compare the patterns seen in smokers and non-smokers with those of e-cigarette users, potentially giving us some insight in to the long-term impact of vaping, without having to wait for time to elapse. Methylation changes happen relatively quickly as compared to the onset of chronic illnesses.
Part of the difficulty with this is that we know that smokers and ex-smokers have a distinct methylation pattern, and we don’t want this clouding any pattern from vaping, which means we need to recruit vapers who’ve never (or certainly only very rarely) smoked. And this is proving challenging for two reasons. Firstly, as borne out by the recent research, it’s very rare for people who’ve never smoked cigarettes to take up regular vaping. Yes, maybe they’ll experiment, but that doesn’t necessarily lead to an e-cigarette habit.
But on top of that, an unexpected problem has been the unwillingness of some in the vaping community to help us recruit. And they’re put off because of fears that whatever we find, the results will be used to paint a negative picture of vaping, and vapers, by people with an agenda to push. I don’t want to downplay the extreme helpfulness of plenty of people in the vaping community in helping us to recruit – thank you, you know who you are. But I was really disheartened to hear that for some, the misinformation and scaremongering around vaping has reached the point where they’re opting out of the research entirely. And after speaking to people directly about this, it’s hard to criticize their reasoning. We have also found that a number of e-cigarette retailers were resistant to putting up posters aiming to recruit people who’d never smoked, as they didn’t want to be seen to be promoting e-cigarette use in people who’d never smoked, which is again completely understandable and should be applauded.
What can we do about this? I hope that as more research is conducted, and we get clearer information on e-cigarettes ability to work as a smoking cessation tool, the disagreement around them will disappear. Until then, I hope that vapers continue to agree to take part in research so we can fully explore the potential of these devices, in particular those rare “unicorns” who vape but have never smoked, as they could be crucial to helping us understand the impact of vaping, as compared to smoking.