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Even though they "smoke" e-cigarettes as often as they did regular cigarettes, thousands of ex-smokers said they have fewer cravings and are less likely to feel impulsive and irritable over their need to smoke, researchers reported.
"The pattern was really very clear. The score was significantly less for e-cig use than for tobacco use," said lead researcher Jonathan Foulds, a professor of public health sciences and psychiatry at Penn State College of Medicine. "E-cig users feel less addicted."
E-cigarettes have become more popular during the past five years, the researchers said in background information. These battery-powered devices deliver nicotine and flavorings through inhaled vapor, and some people say they help smokers give up traditional cigarettes. While they contain far fewer cancer-causing and toxic substances than cigarettes, their long-term health effects are unknown.
For this study, recently published in Nicotine & Tobacco Research, the researchers used an online survey to assess more than 3,600 e-cig users' previous dependence on cigarettes and their current dependence on e-cigarettes.
The ex-smokers, all of whom now use e-cigarettes, reported their smoking is about the same. They have about 24 sessions a day with e-cigarettes, and used to smoke about 24 cigarettes daily.
However, their dependence on e-cigarettes is much different:
- They are more likely to wait longer for their first smoke of the day, 45 minutes on average compared to 27 minutes when they used cigarettes.
- Two out of five would wake in the middle of the night to smoke a cigarette, but only about 7 percent continued to do so with e-cigarettes.
- About one-third had strong cravings to use their e-cigarettes, compared with more than nine out of 10 when they smoked cigarettes.
- About one-quarter reported being irritable or nervous when they can't use e-cigarettes, versus more than 90 percent who recalled feeling that way as cigarette smokers.
There are a couple of reasons why e-cigarettes might create less addiction to nicotine, Foulds said.
First, e-cigarettes typically are worse at delivering nicotine than tobacco cigarettes. "Blood nicotine levels get a much larger boost with smoking than with e-cigarettes," he said.
How people use e-cigarettes also might help explain the difference.
Because people don't have to light an e-cigarette, they are under less pressure to smoke in concentrated bouts, Foulds said.
"When you smoke cigarettes, you smoke it in one go. You go outside from your workplace and you take 10 puffs, you smoke it until it's three-quarters done and then you throw it away," he said. "With e-cigs, they take two or three puffs, and then wait 10 or 15 minutes and have another two or three puffs. It's kind of like they're grazing on it, rather than binging on it."
Health advocates said they found the study interesting, but remain reluctant to endorse e-cigarette use. The devices are not regulated by the U.S. Food and Drug Administration, although the agency has announced its intention to extend its tobacco authority to cover e-cigarettes.
"Unregulated products, particularly those that are marketed as intending to help smokers quit, are very troubling," said Erika Sward, assistant vice president of national advocacy for the American Lung Association. "Where we have this unregulated situation, we don't know the ultimate health effects of using these products."
Manufacturers of e-cigarettes are producing more powerful devices that deliver higher nicotine concentrations, Sward said.
Such innovations could increase the addictive powers of e-cigarettes, and concerns exist that e-cigarettes maintain nicotine dependence for people who might otherwise have quit smoking altogether, she said. Experts also worry that kids who use e-cigarettes might find them a "gateway drug" that leads to tobacco use.
The study authors noted that dependence might vary by liquid nicotine concentration, product characteristics and could increase with time.
This study used a new addiction measurement questionnaire that could "lead to improvements in cessation treatment for both traditional cigarette smokers as well as electronic cigarette users," said Patricia Folan, director of the Center for Tobacco Control at the North Shore-LIJ Health System in Great Neck, N.Y.
However, Folan added that in this study "there is some concern about comparing an individual's past recollection of their addiction to traditional cigarettes with their current addiction to electronic devices."
The researchers received funding from Penn State Social Science Research Institute and Cancer Institute, the U.S. National Institute on Drug Abuse of the National Institutes of Health and the FDA's Center for Tobacco Products.
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