Life Health & Wellbeing

Sunday 8 December 2019

Willpower remains your most important ally in the battle to quit smoking for good

Quitting smoking is difficult for heart patients
Quitting smoking is difficult for heart patients

Dr Nina Byrnes

I have smoked 20 cigarettes a day for half of my life and I really want to quit. I've tried patches and tablets before but they didn't work. I know some people who use e-cigarettes and I'm thinking of trying these, but I hear a lot of mixed reports about them. Are they safe and will they help me quit?

Congratulations on trying to quit smoking. It is probably the single best thing anyone could do for their health.

Smoking 20 a day reduces your life expectancy by 10 years and increases your risk of cardiovascular and lung disease and a whole host of cancers.

E-cigarettes have been in the news a lot recently and, with all the conflicting stories, it can be hard to decide whether they are a positive or negative addition to the world of smoking.

E-cigarettes were invented by a pharmacist in Beijing only 11 years ago. They were first introduced in the USA in 2007 but it's really in the last few years that they have become widely available.

Sales of e-cigarettes are estimated to be worth nearly $3 billion annually but this is a very small market in comparison to the global tobacco industry which is worth more than $700bn. There are now more than 400 e-cigarette brands available; many are smaller companies importing product from China but big tobacco companies such as Lorillard, Phillip Morris and British American Tobacco have started investing in these companies too.

An e-cigarette contains three components: a battery, an atomiser and a cartridge containing liquid. The liquid contains nicotine along with flavouring, a chemical called propylene glycol and vegetable glycerine. When the cigarette is inhaled the battery heats the liquid in the cartridge, creating a vapour containing nicotine that is inhaled. Because e-cigarettes heat a liquid instead of tobacco, the product released is smokeless.

The smoke released from tobacco is known to contain many carcinogens so it has been suggested that the fact that e-cigarettes are smokeless makes them less harmful than traditional tobacco-containing cigarettes. There are no long-term studies available which back up that claim.

Remember, it took many years for the association between traditional cigarettes and cancer to become clear. There is no doubt that the vapour expelled from e-cigarettes contains a lot less harmful chemicals than traditional smoke, but studies suggest that it is not entirely toxin free.

E-cigarettes do contain nicotine and this is a harmful and addictive drug. Nicotine has mood-altering effects on the brain and withdrawal symptoms are common. Nicotine also increases heart rate and this can have negative effects on the cardiovascular system.

Nicotine in liquid form can be toxic. It can be dangerous if direct skin contact occurs and ingesting the liquid can be especially dangerous. Just a teaspoon of nicotine liquid could be fatal to a small child while a tablespoon could be fatal in an adult.

As many e-cigarettes are purchased with a liquid and refillable cartridge, storing these safely is essential. The chemical propylene glycol has been reported to cause airway irritation in some. There have also been reports of e-cigarettes overheating and exploding. There is much we need to learn about the health effects of e cigarettes but for now evidence would suggest that they are safer than smoking tobacco cigarettes and are similar from a health profile to other nicotine replacement products such as patches or gum.

The issue as to whether or not swapping from traditional cigarettes to e-cigarettes will help you quit smoking is a contentious one. One study showed that those who smoke e-cigarettes are no more likely to quit than regular smokers, even though 85 per cent of participants said they were using them to quit.

Another year-long study suggested many people believe e-cigarettes will help them quit, but six to 12 months after their first interview nearly all of them were still smoking. One study did show that 20 per cent of people who used e-cigarettes while trying to quit smoking had been successful. This compared with 15.4 per cent of those relying on willpower and 10.1 per cent of those using nicotine replacement.

Many of those who smoke e-cigarettes use them in areas where smoking is otherwise not allowed and some health experts have expressed concern this may, in fact, lead to increased ingestion of nicotine. E-cigarettes are also being marketed in flavours such as "gummi bear" bubblegum and fruit flavours and health experts are concerned these may be particularly appealing to younger people who may not otherwise have tried tobacco products. Ten per cent of American High School students had used e-cigarettes in 2012 versus 3.4 per cent of the adult population in 2011.

So, in summary, using an e-cigarette is likely to be less harmful than smoking tobacco products but the jury is still out as to what health risks may be posed. Some suggest swapping from tobacco to e-cigarettes is similar to a heroin addict swapping to methadone. It's less harmful but addiction continues. There is little evidence to suggest using e-cigarettes will actually help you quit. For now, although there are various substitutes for cigarettes available, willpower remains your most important ally in the battle to quit for good. For more information on quitting see

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