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Why are smokers reluctant to
exchange the risks of cigarettes
for the health benefits of
e-cigs, asks Neil McKeganey
E
Slow on the draw
-cigarettes have been characterised by Public
Health England as being as up to 95 per cent
less harmful than combustible cigarettes. On
the basis of that figure, and the fact that
smoking kills around one in two of all smokers, you
would have thought that smokers would be heading
towards e-cigarettes in their droves – but that does
not seem to be what is happening.
According to the UK charity Action on Smoking and
Health (ASH), there are approximately 2.8m people in
the UK who are using e-cigarettes, 51 per cent of
whom are current smokers. ASH has also estimated
that there are approximately 9.1m adult smokers in
the UK. On the basis of those figures, only around 15.6
per cent of adult smokers in the UK are using e-
cigarettes. Given the enormous individual and public
health benefit that would flow from more smokers
switching to the non-combustible product, it is
important to identify what the barriers are to wider
use of e-cigarettes by smokers.
As hard to believe as it might be, one of those
barriers might be a misplaced assessment of how
harmful e-cigarettes are compared to normal
cigarettes. Both in the US and the UK there has been a
wo rrying increase in the number of smokers who
think that e-cigarettes are actually more harmful than
normal cigarettes. The reason for such an erroneous
view is likely to be news media headlines that
repeatedly announce the harms of e-cigarette use,
without comparing those harms to combustible
cigarettes. It is entirely possible that some smokers are
choosing not to switch to non-combustible nicotine
products in the mistaken belief that to do so might
actually increase their level of risk and harm.
In interviews with a sample of smokers, many of
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those who said that they had tried e-cigarettes but not
continued with them commented that, in their view,
these devices were a poor substitute for smoking. Some
of the smokers said that they did not like the hard
plastic feel of e-cigarettes or the feeling that vaping was
‘cold’ in a way in which smoking was ‘warm’.
Some of the smokers were clearly confused by the
vast array of e-cigarette technology and put off by the
bewildering details of nicotine strengths, flavours,
coils, ohms, tanks, wicks and batteries. For these
smokers, the cigarette had an appealing simplicity. If
you have one, you light it, and you smoke it. The
comments from these smokers suggest that the
technology of e-cigarettes has some way to go before
these devices become attractive to the majority of
smokers.
Government can initiate measures that are likely to
increase e-cigarette use among smokers. These
measures include ensuring that e-cigarettes are taxed
at a level that makes them cheaper than combustible
products. Another thing that governments can do, is
to discourage the various bans on e-cigarette use that
have been instituted out of a misplaced belief
secondhand vaping causes harm. Public health bodies,
however, need to do much better in accurately
conveying to smokers the relative harms of
combustible and non-combustible cigarettes, tackling
the large and growing proportion of smokers who
don’t know, or who believe that smoking is actually
safer than vaping.
There are other way in which the use of e-
cigarettes can be stimulated among smokers is for
‘stop smoking’ services to become e-cigarette friendly.
While there are some services that positively
encourage e-cigarette use by smokers as a way of
Some smokers are
clearly confused by the
vast array of e-cigarette
technology... Cigarettes
have an appealing
simplicity. If you have
one, you light it, and
you smoke it...
bolstering individuals’ attempts at stopping smoking,
there are other services that either frown on e-
cigarettes and or ban the use of these products on
their premises. Such bans contribute to stigmatising
vapers and vaping, and ignore the fact that hundreds
of thousands of smokers have used these devices as a
way of stopping smoking.
Finally, manufacturers of e-cigarettes have an
important role to play in increasing the appeal of
these devices to smokers – which, ironically, may
entail ensuring that the experience of vaping is closer
to the experience of smoking.
Prof Neil McKeganey is at the Centre for Substance
Use Research, Glasgow
May 2017 | drinkanddrugsnews | 21