Prof. Jean-Francois Etter Interview: Long-Term Vaping is Not a Public Health Problem

By Lindsay Fox Posted January 6, 2014

Jean-Francois EtterA new study looking at the long-term behavior of vapers was published in Addictive Behaviors last month, surveying users on both their vaping and smoking habits to provide insight into how vapers change over a 12-month period.


The research comes from Prof. Jean-Françios Etter (Professor of Public Health at the University of Geneva) and Dr. Chris Bullen (Clinical Trials Research Unit, University of Auckland), and you can read a detailed summary here. We caught up with lead author Professor Jean-Françios Etter for a short interview about the study, its findings and the wider implications of the research.


What would you say was the most important finding of your study?


JFE: This is one of the very first studies of vapers with 12 months follow-up. We found that very few ex-smokers relapsed to smoking, and that many smokers (i.e. dual users) either reduced or quit smoking after 12 months.


You acknowledge in the paper that the recruitment methods used may have led to an unrepresentative sample, do you think their increased motivation to quit smoking as a group impacts on the weight of the findings?


JFE: Yes, it is quite possible, these results should be considered as exploratory, and preliminary. Studies in representative samples of vapers are warranted. But because this is one of the very first studies of this type, the results are valuable, and encouraging.


Do you think vapers in general are inclined to exaggerate the benefits of e-cigs in surveys like this?


JFE: It is not impossible, in particular because many participants were recruited on e-cig forums, where many participants are pro-e-cig activists. But my experience with surveys suggests that most people are honest.


Your findings show that dedicated vapers don’t really decrease their consumption over time – would you say that this shows that e-cigarettes merely prolong addiction, as many anti-smoking groups allege?


JFE: Our data (and other studies) suggest that e-cigs are not very addictive, much less addictive than tobacco cigs. The conventional definition of addiction has two components (compulsive use in spite of harm). Because e-cigs do not cause harm, it is more appropriate to talk about compulsive use rather than of addiction in the case of e-cigs. There are thousands of ex-smokers who use the nicotine gum compulsively, several months or years after quitting smoking, and this is not a public health problem either.


If further studies confirmed that most vapers continue to vape for extended periods of time, would this mean e-cigs are ineffective for their intended purpose? What would the consequences be for future safety research?


JFE: Even if there are long-term vapers, this is not a problem, as long as they quit smoking. The problem is combusted tobacco, not nicotine. At the dosage used by vapers or users of nicotine gums or patches, nicotine is not toxic. Long term vaping is not a public health problem; not any more than long term use of nicotine gums.


From your sample, it appears that dual users are actually fairly likely to quit smoking within a year – do you think the concern from anti-smoking groups about the potential risks of dual use is justified?


JFE: Dual use seems to have two consequences: reduced smoking, and eventual smoking cessation (in about half the dual users after one year in our data). This suggests that dual use should be considered positively.


No ex-smokers in your study who were vaping relapsed to daily smoking – why do you think the relapse rate is so low? Do e-cigs really seem to be that effective, or is it likely to be just a quirk of the sample selection process?


JFE: Both elements played a role here, But the effect is so large (normally 95% of ex-smokers relapse within one year) that it cannot be attributed only to selection problems, there must be a real effect here. E-cigs most probably prevent relapse in former smokers.


Is there any aspect of the behavior of vapers which you think particularly warrants further investigation?


JFE: Yes, their behavior change over time is almost undocumented; many hypotheses need to be tested (whether they switch from cig-a-likes to tank systems over time, whether they change nicotine concentrations in liquids over time, e.t.c.). Many questions remain unanswered.


We’d like to thank Professor Etter again for his time – and hope to see more interesting research like this in future! He has another long-term survey in the pipelines, which hopes to offer further insight into vapers’ long-term behavior, but it’s currently in need of more participants. If you’re over 18 and have vaped before, you can participate in the research by following this link!

  • Zillatron

    Thank you. Good questions and even better answers.
    Too bad a lot of politicians prefer to listen to scare mongers who like to base their absurd visions of apocalyptic doom on vapors from their rumbling guts (or good old filthy lucre), no matter what real science says.

    There is only one question that is grating on my nerves.

    –> “would this mean e-cigs are ineffective for their intended purpose?”
    WTF is the “intended purpose”?

    The zealots always imply and clueless media and politicians faithfully parrot it, that the main reason to use e-cigs would be the same as for NRTs: To quit smoking and ultimately stop using nicotine.

    For me and presumably a majority of vapers it is NOT quitting!

    I don’t want to quit.
    I just want a better alternative to tobacco.
    I like the infinitely better taste. With lots of variety to expierience. Or select on an whim. Or create my own mix.
    I like the ability to better cutomize the nicotine content.
    I like to explore the differences changes in the vaporiser design make.
    I like to tinker with coils and wicks.
    I like that it’s (potentially ;)) considerably less expensive.
    And it’s a very nice benefit, that it’s less harmful. But I also would prefer it if this weren’t so.

    So for THIS intended purpose e-cigs are very effective!

    • Dennis Santos

      “And it’s a very nice benefit, that it’s less harmful. But I also would prefer it if this weren’t so.”

      Great rant!

      Less harmful? Completely harmless is more like it.
      What do you mean by preferring if it weren’t so?

      • Zillatron

        I’m usually not prone to ranting. but this tunnel vision compulsively fixed on the ancillary “cessation aid” aspect of e-cigs just had built so much steam that I needed to vent some.

        Well, nothing is completely harmless. 😉
        Just less harmful, … by magnitudes … 😀

        I wanted to emphasize, that while I carefully evaluate the scientific information and do care about my health, I’m not fanatic about it. i’m hedonist enough that I also value my pleasure a lot.

        So, even if vaping were as harmful as smoking – what it fortunately ain’t by far – I would still chose vaping simply because of the superior pleasure it provides.

        • Dennis Santos

          Well I quit smoking 10 years ago and have always missed the nicotine. I gave Vaping a try and absolutely love it. I love the fact that I have re addicted myself to the sweet substance without causing harm to my body. The anti everything lobbies completely miss this point an, yes, they only bang on about ecigs being viewed as an aid to quit smoking which is extremely annoyingas iit’s obvious that interests are at play here, from the tobacco companies, BigPharma and governments due to their loss of excise duty. Then there’s always the spoil sports..

  • Mary Sohn

    All your points are spot on. I would also like to add that since vaporizing is much cheaper than smoking so most people will switch to the cheaper and safer option. After all, with ecigs you are getting a lot more with less money.

    For me, flavoring is also a good enough reason to switch to ecig because I can change
    my flavor as often as I want which is not possible with tobacco. It happened with me that after a couple of steady vaping I don’t want my ecig to taste like a cigarette which I think is a big step towards better health.

  • Craig Scott

    I think Prof. Jean-Francois is right when he said “long term vaping is not a publichealth problem”. People who use nicotine chewing gum as an alternative to smoking continue to do so for years without any harm. So also, ecigs can be used along the same lines. The study shows that when people start to vape they reduce their cigarette consumption. So, dual use can also be viewed in a positive light because when people vape they are more into vaping then smoking.

  • John Sears

    I agree ecig nicotine addition is much less than that of real cigarettes. I have been vaping since 2010 and that death grip addition I had with real cigarettes (analogs) just isn’t there. There is something going on in my brain. When I smoked, a trigger would fire where I would absolutely HAVE TO HAVE a cigarette. That trigger never seems to get pulled as a vaper.

  • Pingback: Quora()