The FDA’s discretionary enforcement against some flavored pods and cartridge-based e-cigarettes was imposed in January 2020. A total of 22 months later in December 2021, a large, cross-sectional survey published in IJERPH would find that current e-cigarette use may even be higher than recorded by the 2021 National Youth Tobacco Survey.
Among the 21 to 24-year-olds in the sample, 35.1% reported using pod/cartridge devices in the past 30 days, and 26.7% reported using pod/cartridge-based devices in the past 7 days. For 25 to 40-year-olds, 29.7% reported using pod/cartridge devices in the past 30 days, and 23.8% reported using pod/cartridge devices in the past seven days. These patterns indicate a growing number of regular users and levels of nicotine dependence while dispelling the notions that younger users are primarily experimenting with occasional e-cigarette use.
Further policy action is needed to highlight the inefficiency of vapes for smoking cessation. Thankfully, there are several studies on this topic. Let’s take a closer look at the data so that we can encourage e-cigarette users to make the shift toward safer cessation aids.
Vape and smoking cessation
E-cigarettes first appeared in the U.S. in 2007 with the promise of providing smokers with a less harmful nicotine fix. Unfortunately, this rhetoric is inaccurate and harmful. Popular vape company Juul has been criticized consistently for its campaigns, such as the one in 2019 that urged users to “make the switch” from cigarettes to their vaping devices.
Further investigation through the FDA, as our previous article US Health Officials Ban Juul features, would proclaim that the company’s research included ‘insufficient and conflicting data’. Companies must show that their e-cigarettes benefit public health to stay on the market. However, the FDA notes that big sellers like Juul may have played a ‘disproportionate’ role in the rise in underage vaping, and that Juul’s application didn’t have enough evidence to show its benefits. In fact, the dangers of potentially harmful chemicals from Juul’s cartridges were highlighted instead.
These findings are echoed in other studies. 2021 research published in NCBI concludes that vaping is linked to a new type of smoking addiction. They highlight the evident methodological flaws when discussing vaping’s supposed effectiveness as a smoking cessation aid, as well as the limited amount of research.
On the other hand, evidence from various studies — including Soneji et. al. (2017), Khouja et al. (2021), and the Health Research Board (2020), to name a few — are consistent in implicating vaping products in smoking initiation. 2020 research by Owotomo et al., published in Pediatrics, quantifies that e-cigarette users were 4.6 times more likely to become tobacco smokers one year later. Only an estimated 10% quit vaping and smoking altogether, according to 2022 research published in Tobacco Control.
Alternative strategies for smoking cessation
Dr. Amit Mahajan, from the American Lung Association, explains that there are alternative strategies that are proven to help people quit smoking. This includes counseling, nicotine replacement therapy (NRT) products, and medication.
Counseling addresses the social, financial, and emotional conditions surrounding tobacco use. Techniques can range from the 2 As + R, 5 As, motivational interviewing, cognitive behavior therapy, or acceptance and commitment therapy. All of these focus on behavior modification and are deeply personal approaches designed to adapt to individuals. 2020 research published in JAMA even finds that counseling can be effective for smoking abstinence among patients with cancer, and that effectiveness can vary among individuals when holding sustained sessions versus shorter-term counseling.
Counseling is often paired with NRT or medication to help decrease an individual’s reliance on nicotine. NRT works to provide the body with controlled amounts of synthetic nicotine that steadily decrease over a period of time, in order to reduce cravings or relapses.
NRT products have a lower abuse liability and addictive potential compared to continued cigarette smoking. 2022 research on ZoneX nicotine pouches deduce this from its lower plasma nicotine levels and slower peaking times. This is common across all nicotine pouches, with the VELO products on Prilla only offering 2mg and 4mg of nicotine. A stark difference can be noted from the approximately 40mg nicotine per pod in each 5% vape cartridge, as reported by JUUL Labs, which would be ‘approximately equivalent to about one pack of cigarettes.’ This has contributed to nicotine pouches’ rising popularity in the U.S.
Other companies have since adjusted to match this demand, with Dr. Reddy’s Laboratories launching the Nicotine Polacrilex lozenges in the strengths of 2 mg and 4 mg in 2020, and GSK partnering with digital smoking cessation company 2Morrow to offer the Nicoderm CQ Patch to smokers who complete their cessation program.
Meanwhile, medications such as Chantix and Bupropion work to desensitize the nicotine receptors in the brain to decrease the severity of withdrawals. Volunteer medical spokesperson for the American Lung Association Dr. Mahajan concludes that the data is clear: behavioral therapy combined with pharmacotherapy medications is the safest and most effective option for smokers who want to quit, not vaping.
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