Professor Robert West,
Director of tobacco studies, University College London

Encouraging people to cut down or stop smoking is a key part of a wider Government public health strategy to reduce the harm from smoking. In July the National Institute for health and social Care Excellence (NICE) published new guidance to help smokers who want to cut down.

For people who want to stop or cut down on smoking there are treatments available, including a range of nicotine replacement treatments and medical treatments. Professional counselling and support can improve the chances of people cutting down and stopping.

But experts argue that electronic cigarettes (e-cigarettes) – alternatives to real cigarettes, which don’t contain tobacco, smoke, or many of the harmful chemicals in cigarette smoke – could prove to be another tool alongside more conventional options.

Public health gains
Professor Robert West, director of tobacco studies at University College London and author of The SmokeFreeFormula, says that “if e-cigarettes substantially replace smoking, then from a public health perspective the gains could be enormous.”

“They allow people to get their nicotine without doing themselves very serious harm. Nicotine is the addictive substance in cigarettes, but it’s the tar and other toxins in cigarettes that are harmful to health. If you can get nicotine without tar and toxins then in theory there’s no reason why you can’t avoid having major lung and health problems.”

Psychology of addiction
E-cigarettes could help by dealing with the psychology and biology of addiction, Professor West says. “The interesting lesson we’re learning is about the psychology that goes along with e-cigarettes. Replacing the cigarette is not the big deal. It’s replacing nicotine that people are addicted to that’s important. The relish and enjoyment of smoking seem to come from the smoke, but it’s also tied to getting the nicotine hit.”

There are concerns that e-cigarettes could undermine the success of the UK public smoking ban and renormalise smoking, or that people who have stopped smoking could be tempted to start again.

Professor West warns: “We do not want to create a whole new cadre of new smokers. But there’s no evidence of this so far.”

Long-term questions
Doctors still don’t know the effects of inhaling nicotine and other chemicals contained in e-cigarettes into the lungs, and whether this is safe in the long-term.

“While we can’t say that there’s no risk whatsoever, from what we know about e-cigarette vapour it should be at least 100 times safer than smoking. Standing next to someone when they are smoking an e-cigarette poses no measurable health risk. Any chemicals you may inhale second hand would not be expected to be at a concentration that could lead to significant harm.”

An estimated 1.3 million people used e-cigarettes in the UK in 2013, suggesting there is a demand for them. But there will still be still a need for other stop smoking treatments too, and experts say that the more options people have to help them stop smoking the better.