December 3, 2014 at 1:07 pm EDT | by Gregory T. Angelo
E-cigarettes: A new approach to tobacco harm reduction
e-cigarette, gay news, Washington Blade

When cessation campaigns fail to make a meaningful impact on the number of smokers, exploring alternative methods—like e-cigarette technology—becomes all the more urgent. (Photo by Michael Dorausch; courtesy Wikimedia Commons)

It’s time to consider new solutions to tobacco harm reduction in the LGBT community.

According to a new study, the most effective method of cigarette cessation might be battery powered: The advent of e-cigarette technology offers a promising—albeit unconventional—approach to tobacco harm reduction.
If you question the logic of “e-cigs” as a way to mitigate tobacco harm, consider this: Nationally, the number of cigarette smokers in the United States has hovered stubbornly around 20 percent for the better part of the past decade—a problem even more pronounced within the LGBT population.
Even worse, these steadfast smokers seem resilient to the extensive—and expensive—anti-tobacco efforts that have been chugging along in the U.S. for more than two decades.
The Campaign for Tobacco Free Kids estimates that states will spend $481.2 million on anti-tobacco programs this year. But there is little evidence that the millions of dollars spent each year actually affects cigarette sales. According to one analysis, high state spending on anti-tobacco efforts cause—at best—a miniscule drop of just one pack a year per capita.

Put simply, traditional anti-smoking messaging isn’t resonating with tobacco users—and especially if that smoker is gay.

According to a recent study, LGBT Americans are not only more susceptible to tobacco harm—more than twice as likely as their straight counterparts to take up smoking—gay and lesbian men and women are also less receptive to anti-smoking campaigns.

This dichotomy is dangerous, and means that the LGBT community, a cohort with disproportionately high rates of smoking, is also disproportionately resistant to the messages that encourage them to quit.

For these hard-to-reach smokers who struggle to quit, e-cigarette technology offers an alternative form of nicotine consumption that seems to be a promising step down from old-fashioned combustible tobacco products. Eradicating cigarette use should, of course, be the ultimate goal of anti-tobacco efforts. But when cessation campaigns fail to make a meaningful impact on the number of smokers, exploring alternative methods—like e-cigarette technology—becomes all the more urgent.

In a recent eight-month study, e-cigarettes helped 44 percent of participating smokers reduce their tobacco consumption or eliminate it entirely. Even the American Heart Association has acknowledged that medical doctors should consider proscribing the use of e-cigarettes when gums, patches and other cessation methods fail.

Stanton Glantz, an e-cig critic and director of the Center for Tobacco Control Research, reiterates this sentiment, explaining: “There’s no question that a puff on an e-cigarette is less toxic than a puff on a regular cigarette.”

Of course, not smoking at all is the best course of action. But a healthier alternative is better than no alternative—especially when addressing groups, like gay and lesbian smokers, who are particularly resilient to other methods of harm reduction.

And even if science ultimately concludes that e-cigarettes are not particularly effective at aiding in ending smoking entirely, it could be years before such data is accumulated—years that someone who smokes cigarettes today could be vaping “less toxic” e-cigarettes instead.

It’s time to quit our habit of making the perfect the enemy of the good. Until we snuff out smoking for good, e-cigarettes should be considered as part of a multifaceted approach to tobacco harm reduction.

Gregory T. Angelo is executive director of the Log Cabin Republicans.

12 Comments
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  • Hmmm… the LGBT community is particularly vulnerable to tobacco marketing and MOST studies have found no evidence suggesting e-cigarettes actually aide in cessation, but oh yeah… Log Cabin Republicans receive a healthy chunk of money from at least one tobacco company. That pretty much explains this op-ed. Here's our response: http://thinkprogress.org/lgbt/2014/12/03/3599174/log-cabin-republicans-e-cigarettes/

  • It's weird to see Zack Ford commenting on how this must just be about money without actually making an substantive criticisms of ecigarettes or offering any alternative solutions that haven't proved completely ineffective over the last couple of decades.

    In his response, he actually describes the entirety of the "predatory marketing" he's hinting at here: Menthol Cigarettes exist. That's seriously it. In the twisted logic of the conspiracy theorist crazy, the mere existence of a product is exactly the same thing as an evil targeted marketing campaign of the same product to a particular group of people. And he expects you to believe the same, because he assumes you won't read very closely or think very much about it.

    I and thousands of other ecig industry members quit smoking by using non-big tobacco products and sell and market the same because we believe in the public health benefit they provide and we care enough about other smokers to offer them a viable alternative to reduce their health risks. Zack Ford offers you anger at a group and nothing but the same death tolls, year after year. Pick your poison, I guess.

  • You mention that "MOST studies found no link with ecigs and cessation" but you don't link or quote said studies. Here's an idea: try doing some research instead of meaningless political attacks.

  • Matt Berger If you read my colleague's post, you'd see multiple links to additional sources, including a recent World Health Organization report, that explain how there's been no evidence to suggest e-cigarettes are effective in assisting with cessation. If you don't want to agree with the WHO, that's fine, but acknowledge that that is what you're doing.

  • It's hard to tell whether or not you read my colleague's post, as he linked to multiple sources that talk about how e-cigarettes have not been found to be safer and have not been found to aid in cessation.

    As to your other point, you are ignoring the extensive history of tobacco companies advertising in LGBT publications, sponsoring Pride events, and other forms of increased visibility. The effect of minority stress on LGBT people plays a significant role in making us more vulnerable to this predatory marketing, which is why LGBT people are TWICE as likely to be smokers as the general public.

    If you smoke e-cigarettes, you still smoke. An alternative form of smoking is not an end to smoking. If we truly care about ending the negative health impacts of tobacco on the LGBT community, we need to be honest about what that really means.

  • Zack Ford, I was responding to this statement: "Hmmm… the LGBT community is particularly vulnerable to tobacco marketing and MOST studies have found no evidence suggesting e-cigarettes actually aide in cessation"

    Let's examine the first objection you raise in the context of what I replying to, the assertion that most studies don't show efficacy in cessation, and your assertion that they "have not been found to aid in cessation.".

    I'm going to provide you a list of studies performed at the university level interspersed with legitimate public health university commentary on the efficacy of ecigarettes in cessation. Each source confirms that they are at the least on par with other forms of cessation aids(patch, pill, gum, ect). These are easily googleable, and you could have found them yourself if your confirmation bias and dishonesty had not precluded the effort:

    http://www.mdpi.com/1660-4601/11/11/11220/htm(21% cessation)

    http://www.ncbi.nlm.nih.gov/pubmed/25301815 (intensive users 6 times as likely to have achieved abstinence)

    http://onlinelibrary.wiley.com/enhanced/doi/10.1111/add.12623/(1.63 times more likely to have achieved abstinence as compared to NRT, 1.61 more likely than willpower alone)

    http://www.sciencedirect.com/science/article/pii/S0306460313003304 (Those who had already not quit but were vaping at baseline, a self-selecting group with a likelyhood for larger failures, were 22% likely to quit smoking after one month and 46% likely to have quit smoking after one year. Those that did not quit reduced their cigarette intake by an average of five cigarettes per day.)

    https://www.rcplondon.ac.uk/commentary/what-you-need-know-about-electronic-cigarettes(ASH UK toolkit survey indicating a general belief of the scientific community in the idea of these being lower risk, but more importantly showing that uptake is almost completely limited to those trying to reduce risk)

    Safety, which you mention, is relative to cigarette use, which ecigs replace. This reduced risk is well supported by virtually all of the existing evidence. Here's some studies:

    http://www.mdpi.com/1660-4601/10/10/5146/pdf(Ecigs found to be generally non-cytotoxic, and in worst case scenarios about 3 times less cytotoxic than cigarettes)

    http://spo.escardio.org/eslides/view.aspx?eevtid=54&fp=1375 (Do not negatively effect oxygenation of the heart)

    http://publichealth.drexel.edu/~/media/Files/publichealth/ms08.ashx (comprehensive analysis of chemical composition of e-liquid finding no cause for concern when contents are applied to cautious workplace exposure standards)

    http://ntr.oxfordjournals.org/content/early/2013/12/10/ntr.ntt203.short?rss=1(found that second-hand nicotine exposure is at most 1/10th that of cigarette levels, and combustion-produced toxins are completely absent)

    http://tobaccocontrol.bmj.com/content/early/2013/03/05/tobaccocontrol-2012-050859.short (Found that toxins in ecigarettes were 9 to 450 times less than in cigarettes, and were often at the baseline set by the reference products. Concluded that the results were consistent with the idea that these greatly reduce harm compared to combustible tobacco.

    Mitch Zeller, head of the FDA, on ecigs:

    "It is not the nicotine that kills half of all long-term cigarette smokers," said Zeller. "The nicotine creates and sustains the addictions, but it's not the nicotine that kills people."

    "Different tobacco products deliver nicotine in different ways," he continued. "Certain products pose more risk to the individuals than others. What is the best we can do to help currently addicted smokers, especially those who would not intentionally quit?"

    There are dozens more studies I could show you, if it would help you get your head out of the sand. The scientific evidence is extremely one-sided on two points:

    1. E-Cigarettes are exceptionally likely to provide large amounts of harm reduction, and no clear evidence of harm has been shown despite dozens of intensive studies.

    2. Those who use E-Cigarettes for cessation have results that are at least on par with traditional forms of nicotine replacement and un-aided willpower, and the best and newest studies show those advantages are large.

    As to your assertion that these are no different than cigarettes, and that a person who uses them "smokes" in exactly the same way, it's silly at best. No smoke is produced, only vapor, so your claim is factually inaccurate on it's face. Even beyond that, the harm caused by the two products are not even remotely comparable, and the science is clear and mostly one-sided on this issue.

    I understand that you'd like to keep disagreeing with groups because you are either lazy, dishonest, politically motivated or financially compelled to do so, but I'd urge you to do even a slight amount of real research and not lean on blurbs. The people you pretend to serve are absurdly likely to be harmed by combustible tobacco, and your stance encourages them to continue doing so even though viable alternatives to death exist. Please consider not killing them, if you have a moment to examine your ideology in between ill-researched screeds.

  • Zack Ford Please look closer at those studies that WHO relies upon. Many of them are citing to studies that did NOT look at intention to quit. They merely asked smokers 'Have you ever used an e-cigarette?' If a smoker reported past e-cigarette usage, regardless of their reasons for trying or using the products, that was counted as e-cigarettes not being successful for smoking cessation.

    That is not how we study whether NRTs, Chantix, or Zyban are effective. Researchers always ask about product was used in a *quit attempt.*

    A large UK study looking at the effects of e-cigarette usage in the real world found that smokers who chose e-cigs were around 60% more likely to quit than those who used NRT — http://www.addictionjournal.org/press-releases/e-cigarette-use-for-quitting-smoking-is-associated-with-improved-success-rates-

    Additionally, the monthly Smoking Toolkit study in England (the most sophisticated, data driven tracking service of smokers in the world) has found that since 2013: (a) E-cigarettes have been the most popular cessation tool; (b) NRT usage has fallen at around the same rate that e-cig use has risen; (c) Quit attempts are up; and (d) Successful quit attempts are up http://www.smokinginengland.info/latest-statistics/

    Please take this issue seriously. I have several LGBT friends who have quit smoking with vaping and support it wholeheartedly. This should not be a partisan issue. Moreover, 70% of the e-cigarette market is not controlled by Big Tobacco.

    Approximately half of the U.S.' adult smokers (and sadly, that percent is probably higher for the LGBT community) will continue to smoke until they die. Far less hazardous alternatives like e-cigarettes are giving us an opportunity to further reduce disease and death attributed to smoking in the U.S. and around the word.

  • Zack Ford

    Do you take the word of the WHO as gospel? it is a pharma funded institution and as such both have mutually promoted NRT since the late 90's see http://www.forces.org/evidence/pharma/pdf/fullwork.pdf and read http://www.dailymaverick.co.za/opinionista/2014-12-02-only-big-tobacco-and-big-pharma-want-e-cig-regulation/#.VIErXzHF_Mj . There are constant mutterings about tobacco co involvement or accusations of astroturf from opponents who are totally unaware of the origins of the phenomenon of vaping. Tobacco Co involvement in e-cigs commenced maybe 2011 ,long after the introduction in 2006-7 and only because they realised belatedly that there was something to be gained (profit)
    I actually come from the UK and can guarantee to you that 700k users HATE or strongly dislike the Tobacco Co and their relatively useless ,very expensive products .
    You moralise about the use of nicotine,why not have your crusade also against caffeine or alcohol
    The Science that you so blithely dismissed exists ,over 100 studies undertaken, not one would indicate additional harm than a tobacco cigarette .Effectiveness(Efficacy) can be shown in multitudes of studies via ASH UK, SmokinginEngland (Robert West) watch a colleague Prof Peter Hajek https://www.youtube.com/watch?v=SVS0_BGHHjM&feature=youtu.be – IMPORTANT WATCH
    I don't expect you will bother looking at any of the links,but you are pre-judging an issue without taking a step back and dispassionately looking and researching for yourself. . Don't just blindly take the crap that is fed to you by WHO and Glantz use some scepticism and reasoning with ALL articles and research from either side of this debate .
    Your opinion counts ,you have a duty to your readers to be even-handed and have an open mind . Sadly some of the comments and tweets may indicate otherwise

  • Why is this tool pretending that he's an advocate for gays?

    P.S. The correct phrase is "resistant to other methods," not "resilient to other methods." And "resilient" has exactly the opposite connotation from what the context requires.

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