Reducing the Number of Cigarettes Smoked per Day Increases Chances of Completely Quitting

550016-575-4Completely cutting out tobacco is one of the best things you can do for your health and life expectancy. Whether quitting is achieved with the assistance of nicotine replacement therapy or (less commonly) through sheer will power, ex-smokers have done a great service to themselves and others by kicking the habit. Unfortunately, as every smoker knows all too well, quitting is no easy feat.

In an attempt to eventually quit smoking there are those who are looking to cut down on cigarettes by using electronic cigarettes and reducing their cigarette consumption simultaneously. Anti-smoking groups warn against dual use and argue that reducing the number of cigarettes smoked per day provides no health benefits.

The journal Nicotine and Tobacco Research published a study examining the correlation between reducing cigarette consumption and complete smoking cessation. The authors of this study were seeking to discover if increases in smoking cessation are due to nicotine replacement therapy (NRT) or if reductions in the number of cigarettes per day (CPD) in and of itself leads to cessation.

According to the study the results are as follows: …”every one percent decrease in CPD or carbon monoxide was associated with a 3% to 4% increase in the odds of cessation. The naturalistic studies found that ordinal (e.g., quartile) increases in participants’ magnitude of reduction in CPD were associated with 50% to 290% increases in the odds of cessation.” These findings suggest “reduction in CPD is a mechanism of increased cessation in prior NRT-aided reduction studies.”

Anti-smoking and public health groups’ warnings against dual use may discourage smokers who are attempting to quit smoking by supplementing the number of cigarettes smoked with using an e-cigarette. Perpetuating the lie that electronic cigarettes are no better for you than smoking may cause smokers to give up on their reduction attempts and return to tobacco cigarettes. However, these findings suggest that reducing the number of cigarettes smoked per day may be an effective way of achieving the ultimate goal of complete smoking cessation.






Are Public Health Groups Doing More Harm Than Good?

No-SmokingAnti-smoking and public health groups have done much in the way of informing the public on the dangers of tobacco use. Historically, their mission has been to provide education on the very serious hazards of smoking. Over the years, these groups have done a great service by taking a stand against big tobacco.

However, as of late some public health organizations have demonized electronic cigarettes. One such group is the California Department of Public Health. We recently posted an article describing the issues with a Health Advisory released by the CDPH.

The Wall Street Journal published an op-ed taking a closer look at public health organizations and their “crusade against e-cigarettes”. Sadly, deception among these groups is not limited to the CDPH. Many other public health groups are jumping on the bandwagon and their fear mongering is undermining the potential harm-reducing benefits of electronic cigarettes.

The op-ed entitled The Misbegotten Crusade Against E-Cigarettes examines false claims made against electronic cigarettes. One such claim comes from Thomas Frieden, director of the Center for Disease Control and Prevention. In September of 2013 Frieden stated, “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.” In reality, there is no evidence to support his statement. On the contrary, there are multiple studies proving electronic cigarettes are not acting as a gateway to tobacco cigarettes. We reported on one such study back in November of 2013. Additionally, the op-ed cites a recently published study in the American Journal of Preventive Medicine along with a piece in the journal Drug and Alcohol Dependence to further quell Frieden’s unsubstantiated claim.

Transparency is essential, and no one is claiming that electronic cigarettes are 100% safe. While there is a need for continued research, existing studies show that e-cigs are far safer than tobacco cigarettes. Vaping does not involve combustion, therefore vapers are not exposed to the more than 60 known carcinogens produced by smoking. With the information that currently exists, electronic cigarettes lend themselves to a categorization of harm reduction. Harm reduction does not mean “safe”; it is a way of mitigating negative consequences.

Despite a clinical trial that concluded otherwise, the California Department of Public Health said, “there is no scientific evidence that e-cigarettes help smokers to successfully quit traditional cigarettes.” If smokers are made to believe e-cigs are a “community health threat” there is no incentive to make the switch. Sadly, the war against electronic cigarettes rages on.


California Department of Public Health Warns Against E-Cigs

logo_CDPH_v.1_colorThe California Department of Public Health (CDPH) has issued a health advisory report warning California residents of the “toxicity” of electronic cigarettes. According to CDPH director and state health officer Dr. Ron Chapman, “E-cigarettes contain nicotine and other harmful chemicals, and the nicotine in them is as addictive as the nicotine in cigarettes. There is a lot of misinformation about e-cigarettes. That is why, as the state’s health officer, I am advising Californians to avoid the use of e-cigarettes and keep them away from children of all ages.”

We all agree, electronic cigarettes should be kept out of the hands of minors. The CDPH’s recommendations of requiring leak-proof containers and child-resistant safety packaging should be a legally required, industry standard. Regulation, within reason, is not a bad thing. In fact, standardization ensures a quality product for consumers.

Dr. Chapman mentions the significance of misinformation surrounding e-cigs. However, in the same breath he makes a statement that is simply untrue. Yes, nicotine is addictive, but to say that “the nicotine in them [electronic cigarettes] is as addictive as the nicotine in cigarettes” is misleading. In fact, the journal Nature: Scientific Reports published a study on this very topic entitled Nicotine Absorption from Electronic Cigarette Use: Comparison Between First and New Generation Devices. According to this scientific study, “The results of the study showed that nicotine absorption from e-cigarettes was significantly lower compared to tobacco cigarettes.”

The Health Advisory also states, “there is no scientific evidence that e-cigarettes help smokers to successfully quit traditional cigarettes or that they reduce consumption of traditional cigarettes.” The report cites an article by Dr. Katrina Vickerman published in the journal Nicotine and Tobacco Research to provide backing for this claim. However, the author of Vickerman’s article entitled Use of Electronic Cigarettes Among State Tobacco Cessation Quitline Callers stated,The recently published article by Dr. Katrina Vickerman and colleagues has been misinterpreted by many who have written about it. It was never intended to assess the effectiveness of the e-cig as a mechanism to quit. ”

On the other hand, there are existing clinical trials which were conducted to determine the efficacy of electronic cigarettes as smoking cessation tools. Dr. Riccardo Polosa supplied one such study. Sadly, there was no reference to this in the Health Advisory.

While there are viable concerns surrounding electronic cigarettes (e.g. keeping them out of the hands of minors), it’s unfortunate the CDPH isn’t providing the public with accurate information to accomplish their agenda.



A Closer Look at Formaldehyde Levels Found in E-Cigarette Vapor

FormaldehydeRecently we reported on a story out of Japan evaluating levels of formaldehyde released through vaping. Yesterday another study on this same topic was published in the New England Journal of Medicine and has been picked up by mainstream media. In this study, researchers measured formaldehyde using a variable voltage battery set at 3.3 and 5 volts. The vapor was collected and evaluated from an unnamed atomizer after a 4 second puff. The study found that at low voltage (3.3V) no formaldehyde was detected. However, at high voltage (5.0V), levels of formaldehyde were detected at levels up to 15 times higher than cigarette smoke.

Without further investigation on the methods and conclusion of this study, the results are very alarming. We feel it is our responsibility to dig deeper and provide the public with the whole truth.

One glaring problem with this publication is the researchers found formaldehyde hemiacetals (a combination of formaldehyde and alcohols) not formaldehyde. It is also important to know that formaldehyde is present everywhere. It is found in every person, smokers and nonsmokers alike, and can occur anytime hydrogen, carbon, and oxygen are in the presence of each other.

The truth is, this study is deeply flawed in many ways. In fact, it is highly irresponsible to publish a half truth and present it as science. For starters, as outlined by Dr. Konstantino Farsalinos, the authors of this study failed to mention (perhaps unknowingly) that volts do not measure thermal energy. Energy should be expressed in watts. Therefore, with the published information we do not know how many watts were applied to the atomizer.

Fortunately, Dr. Farsalinos used the information that was provided to approximate wattage settings. According to the study, 5mg of e-liquid were consumed at 3.3 volts. Based on measurements performed by Farsalinos, “…such consumption is observed at about 6-7 watts at 4-second puffs. Thus, the atomizer resistance is probably 1.6-1.8 ohms. This means that at 5 volts the energy was around 14-16 watts.”

So, what does this mean in terms of realistic user conditions? If the resistance was between 1.6-1.8 ohms and the wattage is somewhere between 14-16 watts, the vaporizer is being overheated and the wicking materials are being burned. Essentially, these researchers are collecting data on a dry or burnt hit.

What the authors of this study aren’t accounting for is how easily this scenario is detected by the user. Although the atomizer used was unnamed, it was most likely incapable of withstanding those settings. No one continuously vapes an overheated atomizer. The taste is unpleasant, to put it mildly. Therefore, it’s highly unlikely any vaper will ever be exposed to the reported levels of formaldehyde.

This method of measuring aldehydes in a lab environment is deceptive and unfair. The public deserves clear and concise results from scientific studies. If researchers continue to publish misleading findings and the media continues with its sensationalism the results can be damaging. How many smokers are afraid to switch to a device that could potentially save their lives?

For a more detailed breakdown on this study, I urge you to read Dr. Farsalinos’ response by following this link:




Do E-Liquid Flavors Entice Nonsmoking Teens?

E-cigarettes continue to grow in popularity and are proving to be a harm reducing alternative to tobacco cigarettes. The general consensus on electronic cigarettes is they are safer than smoking combustible tobacco. However, concerns remain on the issue of flavored e-liquids attracting nonsmoking teens.

Electronic cigarettes are intended for adults. Without regulation it is the vendors’ responsibility to keep these devices out of the hands of minors. The quality and variety of e-liquid flavors play a large role in the vaping experience, but do flavors like raspberry, bubble gum, gummy bear, and vanilla bean pique the interest of teenagers who would otherwise avoid smoking and using e-cigs?

Dr. Saul Shiffman, professor of psychology at the University of Pittsburg and member of PinneyAssociates, weighed in on this issue. “Concerns about the initiation of e-cigarette use by nonsmoking teens have focused on the expected and assumed appeal of flavors. It is important to replace assumptions with data.”

We’ve heard opinions from doctors, vendors, consumers, and the general public, but what do teenagers have to say? Do e-cigarette flavors appeal to nonsmoking teens? The journal Nicotine and Tobacco Research published an online study on this very issue. Researchers surveyed 216 nonsmoking teens ages 13-17 and 432 adult cigarette smokers ages 19-80 on their interest in potential e-liquid flavors.

Using a scale from 0-10 teens who had not consumed tobacco in the past 6 months and adult smokers of at least 3 years were recruited from an Internet research panel. They were asked about their interest in using electronic cigarettes with varying flavor descriptions.

Nonsmoking teens’ interest in electronic cigarettes was extremely low with a mean of 0.41 on a scale of 0-10. Adult smokers’ interest was higher on average with a mean of 1.73 using the same 0-10 scale. Of the adults surveyed, those who had used electronic cigarettes within the past 30 days showed the most interest in e-cigs, with their interest being mostly affected by flavor. Nonsmoking teens’ interest was the lowest. According to the study, adult smokers’ interest varied by flavor while teen interest did not.

The study concludes that while interest in e-liquid flavors was low for both groups, the appeal was stronger for adult smokers than nonsmoking teens. “Flavors just didn’t seem to matter to these nonsmoking teens”, said Dr. Shiffman.

Shiffman reports, “Our study shows that flavor descriptors, even those expected to appeal to youth, do not do so. This is reassuring because nonsmoking teens would gain no health benefit from using e-cigarettes, since they don’t smoke. In contrast adult smokers could dramatically reduce health risks by switching from tobacco cigarette smoking to e-cigarette use.”

“For adult smokers of combustible tobacco cigarettes, switching completely to e-cigarettes should lead to substantial health benefits. Knowledge about which flavors appeal most to adult smokers without appealing to nonsmoking teens presents an opportunity to greatly reduce health risks among adult smokers without increasing the risks for youth.”






Dr. Farsalinos Challenges Published Misinformation on Formaldehyde in Electronic Cigarettes

konstantinos-farsalinosA misleading statement regarding levels of formaldehyde in electronic cigarettes has made news. According to Naoiki Kunugita, a researcher at the Department of Environmental Health-National Institute of Public Health in Japan, e-cigarettes have “more than ten times the level of carcinogens contained in one regular cigarette”. Kunugita and his colleagues submitted their report on Thursday and understandably it has alarmed the public.

Amidst the media frenzy, Dr. Konstantinos Farsalinos interjects with scientifically accurate information. While the media presented this story as a comprehensive analysis of all carcinogens in cigarettes, the Japanese researchers only reported on one such carcinogen: formaldehyde. The findings described formaldehyde as “a substance found in building materials and embalming fluids”. In his response, Dr. Farsalinos informs readers that in reality formaldehyde is present in all of our surroundings.

Armed with factual data, Dr. Farsalinos manages to poke holes in the claim that electronic cigarettes contain formaldehyde at “ten levels higher than cigarettes”. In his rebuttal, Farsalinos compares the list of published studies in which Prof. Kunugita sourced his results to a Canadian study conducted on the levels of formaldehyde in cigarette smoke. On average a single cigarette contains 200mcg of formaldehyde. This is six times higher than the highest amount (34mcg) found in the e-cigarettes reported by Kunugita.

The average level of formaldehyde found in the e-cig samples was 4.2mcg per 10 puffs. This is an average of 50 times lower than levels found in tobacco cigarette smoke.

Fortunately, there are scientists and doctors dedicated to providing the public with factual information. These findings reinforce the need for scientifically correct information. In the pursuit of science, we will continue to publish only accurate research.



Are Electronic Cigarettes Effective Tools for Craving and Smoking Reduction?

Any smoker who has attempted to quit knows that cigarette addiction is so much more than nicotine dependency. It is because of this that nicotine replacement therapies (NRT) have such low success rates (usually around 10% or lower). Expecting smokers to completely abstain from nicotine and all forms of tobacco may be unrealistic, as many people enjoy the act of smoking and are seeking a less harmful way to do so. Tobacco harm reduction (THR) may give smokers a better chance at giving up cigarettes.

The goal of THR is to provide smokers with a substantially less harmful way to consume nicotine and/or tobacco. Electronic cigarettes not only deliver nicotine in a satisfying way; they address the behavioral aspects that play such a huge role in cigarette addiction. A new study was conducted to examine the potential of electronic cigarettes as an effective THR tool.

Participants who were unwilling to quit smoking were placed into three groups to assess the effectiveness of  electronic cigarettes as they relate to acute cravings and smoking reduction in an eight month Randomized Controlled Trial. The groups consisted of two experimental/e-cig groups and one control group who continued to smoke tobacco cigarettes exclusively during the first eight weeks of the study.

Three lab sessions took place over a two month period. Forty eight participants abstained from smoking for four hours and then vaped/smoked for five minutes. Next, they were monitored for cravings and withdrawal symptoms. In between lab sessions the two experimental/ecig groups were permitted to use e-cigs or smoke tobacco cigarettes as desired. The control group was only allowed to smoke cigarettes. Questionnaires were supplied to monitor craving and the perceived benefits and complaints reported by participants. Additionally, breath carbon monoxide measurements (eCO) and saliva cotinine levels were taken. Cotinine is a metabolite of nicotine that binds to nicotine receptors and can be found in tobacco.

The results are as follows:

Beginning with the first lab session, use of an electronic cigarette was equally as effective as smoking a tobacco cigarette in terms of craving reduction. Cravings were monitored after four hours of abstinence.

After two months, 34% of the e-cig groups had stopped smoking cigarettes. 0% of the smoking only, control group had stopped.

After five months, the e-cig groups showed a total quit rate of 37%. Once the use of e-cigs was permitted to the control group, a quit rate of 38% was demonstrated after three months of initiating e-cig use.

After eight months, 19% of the e-cig groups and 25% of the control group were completely abstinent from smoking. Compared to initial intake, an overall reduction in the number of cigarettes smoked was 60%.

ijerph-11-11220-g007-1024Cotinine levels remained the same in all groups and eCO levels decreased.

The study concludes that “…e-cigs were shown to be immediately and highly effective in reducing abstinence induced cigarette craving and withdrawal symptoms, while not resulting in increases in eCO. Remarkable (>50 pc) eight-month reductions in, or complete abstinence from tobacco smoking was achieved with the e-cig in almost half (44%) of the participants.”





E-Research Foundation Launches Website

erf-logo,The electronic cigarette industry is growing exponentially without any signs of slowing down. Unfortunately, misinformation and baseless opinions continue to spread. There are also doctors and politicians who claim there simply isn’t enough information to back e-cigs. Consumer protection along with impending FDA regulations increase the need for scientific data and credible studies.

There is now a foundation whose mission is to “collectively fund and advance independent medical/scientific research [as it relates to electronic cigarettes] targeted for peer-review and publication.” The E-Research Foundation consists of active individuals in the electronic cigarette industry. Included in ERF’s team is Vapor Shark CEO, Brandon Leidel, serving as a board member.

The E-Research Foundation is a nonprofit, collective funding structure aiming to provide consumers, suppliers, law-makers and the general public with factual information. All studies funded by ERF must undergo a process of peer-review to ensure transparency and availability to all. Previous independently published research is also available in the Existing Studies portion of the site.

The use of electronic cigarettes continues to be a polarizing issue. With so much conflicting information it’s difficult to decipher fact from fiction. E-Research Foundation has provided the public with one reliable source where only credible studies are published.

For more information visit


Study Examines Electronic Cigarettes and Smoking Cessation

Quit-Smoking-CigarettesA population-based survey of smokers was conducted to assess electronic cigarette use and its connection with abstinence rates. At baseline 1,374 adult smokers from the Dallas and Indianapolis areas were surveyed and agreed to be contacted two years later. Of this group 695 were re-contacted in 2014.

After the initial interview of the surveyed smokers’ tobacco use, the follow up interview assessed their smoking rates and electronic cigarette use. Those surveyed were categorized as one of the following: intensive users (using electronic cigarettes every day for at least one month), intermittent users (using e-cigarettes regularly, but not every day for more than one month), and non-users/triers (using e-cigarettes once or twice at most).

The results of the follow up interview categorized the 695 re-contacted respondents as 23% intensive users, 29% intermittent users, 18% triers, and 30% non-users. According to the results, intensive users of electronic cigarettes were six times more likely than non-users/triers to quit smoking. In this study smoking cessation was defined as abstaining from cigarettes for at least one month.

Only intensive users of e-cigs were successful in terms of smoking cessation. For this reason more research is needed to determine why many smokers do not become intensive users.

The study concludes that “daily use of electronic cigarettes for at least one month is strongly associated with quitting smoking at follow up. Further investigation of the underlying reasons for intensive versus intermittent use will help shed light on the mechanisms underlying the associations between e-cigarette use, motivation to quit and smoking cessation.”



Groundbreaking Clinical Study to Assess the Temperature of E-Liquid Evaporation

Latest-E-Cig-StudyDr. Konstantinos Farsalinos is a Greek cardiovascular specialist. In recent years he has devoted most of his time to clinical research on electronic cigarettes and the effects of their use. His work is important because it arms the public with scientific data on the safety and efficacy of e-cigs.

An important, new study is in the works. The main objective is to evaluate the temperature at which e-liquid evaporates. A significant difference between tobacco cigarettes and electronic versions is combustion. Electronic cigarettes do not burn material to create vapor. However, heat is required to convert e-liquid into the vapor that is inhaled by its users. This may cause decomposition and release of e-cigarette chemicals.

Until now, no study has evaluated temperatures inside the wick. In addition to gathering data in a lab, this research will be conducted under real life conditions. Natural patterns of electronic cigarette use, including duration of inhalation and wattage settings, will be analyzed for the release of potentially harmful chemicals. Hazardous emissions will also be evaluated in “dry hits” and sub-ohm vaping. All results will be compared to exposure from tobacco cigarettes.

The data gathered through this study will provide electronic cigarette users with valuable information needed to make informed decisions on the safest methods to vape. Manufacturers can also use the results to ensure safety with the release of new devices. As popularity of e-cigs continues to grow, this exciting study will shed light on possibly the most crucial factor of electronic cigarette safety and new development.