vapers helping smokers christopher russell, ph.d. centre for drug misuse research, glasgow, united...

Vapers Helping Smokers

Christopher Russell, Ph.D.

Centre for Drug Misuse Research,

Glasgow, United Kingdom

Tobacco Harm Reduction

• Using data from the World Health Organisation’s (WHO) GlobalInfo Database, it is estimated that, if all the multipronged tobacco control programs in the world were implemented fully and immediately in 2010 through to 2013, the global prevalence of smoking would reduce from 794 millions smokers to 523 million smokers.

Tobacco Harm Reduction

• What is to be done with the 523 million smokers who are not deterred by tobacco control measures and do not respond to professional assistance and peer encouragement to quit?

• An intuitive, pragmatic approach would be to encourage and assist those who are not interested, willing or able to quit smoking to use nicotine products that are substantially less toxic than inhaled tobacco smoke.

The Potential of E-Cigarettes

• Millions of individuals are now choosing to quit smoking, and hundreds of thousands are succeeding, with the assistance of electronic cigarettes and vapourisers.

The Potential of E-Cigarettes

• However, the potential public health benefit of e-cigarettes is being limited because many smokers are not likely to try switching to an e-cigarette soon, due to one or more of a lack of awareness, accessibility, accurate information and motivation.

‘Pushing the Switch’

• Persuading more smokers to try an e-cigarette, and then supporting them to persist with an e-cigarette as an alternative to smoking, is critical to the success of e-cigarettes in reducing tobacco-related harm.

• How can we persuade more smokers to give e-cigarettes a try?

‘Pushing the Switch’

• Beyond the regulatory level, the greatest opportunity to reduce TRH is found in connecting two groups of people.

“How did you do that?”

• On one side, there are smokers who want to quit smoking, are curious, cautious, or contemplating using an e-cigarette as a way of quitting smoking, but first want to hear the stories and experiences of people who have quit or cut down their smoking by using an e-cigarette.

“This is how I did it.”

• On the other side are vapers who have quit smoking by using an e-cigarette, and passionate about telling people how they did it, especially to people who want to achieve what they have achieved.

• These vapers have amassed a wealth of information and personal experiences of e-cigarettes to impart upon willing listeners, such as academics like myself, and more importantly, to those who smoke and aspire to quit.

What Smokers Want From Vapers

• Vapers who have successfully quit smoking with the help of an e-cigarette can increase the chance of a smoker trying an e-cigarette by giving that person five things.

A-E-I-O-U

Advice

• Advise smokers on where to start, how to start, and what to expect early on.

• As time goes by, they want advice on how to progress, keep it fresh and interesting, and how to cope with temptations to go back to smoking.

Encouragement

• Smokers want vapers to get behind them and be there for them.

• Positivity and self-belief are infectious. • A feeling of being in it together rather than in

it alone can determine who persists and who gives up.

Information

• Smokers want clarity about the risks and benefits of switching to e-cigarettes.

• They want to know how the can expect their health to change, now and in the future.

• They want to know what is true, and why other people say these things are not true.

• They want to know if they should be worried. • They want to know what to buy, where to buy, and

how to maintain their device for optimal performance.

Opportunity

• Smokers want to be able to access e-cigarettes and e-liquids that are inexpensive relative to cigarettes, come in flavours they like, and from devices they might like to use

• They will want to be able to use their device wherever they want so long as they aren’t harming or irritating people nearby.

Understanding

• Smokers want to hear from vapers who know what they are going through as they contemplate giving up smoking.

• Expectation that giving up something so much enjoyed in favour of an e-cigarette that may not initially satisfy them or relieve stress and craving as efficiently and rapidly as a cigarette will be an uncomfortable time.

• Smokers want people to understand the way they feel during a quit attempt and why they behave the way they do.

Our Study

• Pressing need for research that collects, summarises and communicates the views and experiences of successful vapers, to both smokers and those charged with regulating vapour products

• Vaping anecdotes, when supplied in their thousands, become a reliable, credible source of information about the ways in which e-cigarettes have enabled people to quit smoking.

Our Study• We (CDMR) created a bespoke survey that assessed the perceptions,

preferences, product use patterns and experiences of vapers who have quit smoking completely or significantly reduced their smoking since they started using an e-cigarette regularly.

• Survey was hosted at our website, www.nicotinesurveys.org, available in seven languages (English, French, Spanish, Italian, Russian, Polish, German) between 1st June and 30th August 2015.

• Survey took approximately 20 mins to complete.• Recruitment materials called for anyone 18+ who has ever used an e-

cigarette, even a puff.• Survey advertised on social media and through e-cigarette fora,

discussion boards, vendors and through academic colleagues in the United States, Canada, France, Italy, Spain, Greece and Australia.

• Funded by Nicoventures; entire study conducted independently of NV.

http://www.nicotinesurveys.org/

Results

• The survey was completed by 7,326 individuals.

• The first step in the analysis was to establish the credibility and potential helpfulness of these individuals as informed, experienced ‘advice givers’ by characterising their success in quitting and reducing cigarette smoking since they first started vaping.

Question N (%) Respondents

Ever taken a cigarette puff before FVYesNo

6,976 (95.5)

327 (4.5)

Smoked regularly before FVYesNo

6,637 (95.6)

303 (4.4)

Age first smoking regularly7-12 yo13-17 yo18-21 yo22-2526+ yo

478 (7.2)

4,398 (66.5)1,422 (21.5)

233 (3.5)82 (1.2)

Smoking regularly at point of FVYesNo

5,000 (75.8)1,599 (24.2)


Current smoking statusStill smokingQuit since VR

754 (15.1)4,235 (85.9)

CPD at FVStill smokersQuitters

20.2 (13.0)24.1 (12.7)


SS Change in CPD (FV to now)Reduced smokingNo changeIncreased smoking

460 (63.8)156 (21.6)105 (14.6)

SS Percent Change in CPD (FV to now)-99% to -75%-74% to -50%-49% to -25%-24% to -1%0%1% to 25%26% to 50%51% to 75%76% to 100%101+%

293 (40.6)111 (15.4)41 (5.7)15 (2.1)

156 (21.6)14 (1.9)9 (1.2)3 (0.4)

15 (2.1)64 (8.9)


SS Quit Least 1 WeekYes, onceYes, several timesNo

107 (14.9)471 (65.7)139 (19.4)

SS Dual use on same dayYesNo

436 (60.1)290 (39.9)

SS Plan to switch completely within 6MsDefinitely yesProbably yesDon’t knowProbably noDefinitely no

330 (46.4)164 (23.1)87 (12.2)88 (12.4)42 (5.9)

SS Plan to half smoking within 6MsDefinitely yesProbably yesDon’t knowProbably noDefinitely no

536 (74.4)95 (13.2)24 (3.3)58 (8.1)7 (1.0)


SS Outcome likely in 6MsStill vaping + smoking sameStill vaping + smoking fewer CPDStill vaping + smoking more CPDStill vaping + not smokingNot vaping + not smokingNot vaping + still smoking

27 (4.5)

162 (26.9)28 (4.7)

378 (62.8)2 (0.3)5 (0.8)

Question Still Smokers n (%)

Quitters n (%)

Plan to continue using E-Cs for next 12Ms YesNo

622 (92.7)49 (7.3)

2,504 (93.2)184 (6.8)

Question SS n (%) Quit n (%)

E-cigarette risk acceptance Never heard ecigs can be harmfulHeard ecigs can be harmful but too scary to think aboutHeard ecigs can be harmful but think risk exaggeratedAccept ecigs can be harmful do not think will be for meAccept ecigs could harm me but I don’t care muchCare that I could be harmed but think risk is worth itRisk of ecigs is not worth it but no point stopping/damage doneRisk of ecigs not worth it but don’t think can stopAccept ecigs can be harmful but that’s part of attractionAccept ecigs can be harmful but would feel shame if didn’t quitCare about risks of ecigs, plan to stop but not priority

45 (14.4)

9 (2.9)168 (53.8)

6 (1.9)23 (7.4)23 (7.4)2 (0.6)4 (1.3)1 (0.3)

28 (9.0)3 (1.0)

173 (6.5)20 (0.7)

1,775 (66.4)49 (1.8)

130 (4.9)253 (9.5)2 (0.1)18 (0.6)5 (0.2)

232 (8.7)18 (0.7)


NS smoked puff since FV (n = 626) YesNo

245 (39.1)381 (60.9)

NS smoking regularly since FVYesNo

5 (2.6)

240 (97.4)FS relapsed since VR (n = 1,596)YesNo

63 (3.9)

1,533 (96.1)

Next Stage

• Retained only those who have either quit smoking (n = 4,235) and reduced pre-EC CPD by at least 50% (n = 404) since they started vaping regularly

• Total n retained = 4,639 ‘successful’ vapers.• Product use history, device/liquid/nicotine

preferences, risk perceptions, technical issues.• Views on regulation, effects of advertising, and

fairness of bans on use.• Reasons for vaping, pleasures and benefits, health

changes, and advice to smokers.


CountryUnited StatesFranceUnited KingdomSpainCanadaItalyOthers (ns < 100)

1,296 (27.9)1,277 (27.5) 547 (11.8)269 (5.8)260 (5.6)201 (4.3)

789 (17.1)


Current EC use frequencyNot at allSome daysMost daysEvery day

63 (1.4)65 (1.4)

117 (2.5) (1.4)4,390 (94.7)

Mean age (yrs.) of first EC puff 39 yrs, 7 mnths.

Year of first EC use20082009201020112012201320142015

64 (1.5)

141 (3.3)243 (5.7)390 (9.2)

821 (19.2)1,458 (34.2)878 (20.6)267 (6.3)


Nicotine concentration used now0 mg/ml1-12 mg/ml13-17 mg/ml18-24 mg/ml25+ mg/mlDon’t knowVaries

228 (5.0)

3,615 (79.4)238 (5.2)411 (9.0)56 (1.2)4 (0.1)2 (0.0)


Brand claims less harmful = buy?Very unlikelyQuite UnlikelyNeither likely nor unlikelyQuite LikelyVery likely

964 (33.2)327 (11.2)

1,284 (44.2)226 (4.8)106 (3.6)


How harmful are ECs?Not at all harmfulSlightly harmfulQuite harmfulVery harmfulDon’t know

1,101 (36.0)1,825 (59.7)

35 (1.1)5 (0.2)

92 (3.0)


Harm of ECs vs. cigarettesLessMoreSameDon’t know

3,020 (98.5)35 (1.1)4 (0.1)7 (0.2)

Harm of ECs vs. 5 years agoLessMoreSameDon’t know

1,864 (65.7)41 (1.4)

486 (17.1)447 (15.8)

Addictiveness of ECs vs. cigarettesLessMoreSameDon’t know

2,407 (83.0)8 (0.2)

413 (14.2)73 (2.5)


Believe nicotine main cause of addictionNot at allA littleSomewhatVery much

282 (9.7)687 (23.6)

1,107 (38.1)831 (28.6)

Believe nicotine main cause of harmNot at allA littleSomewhatVery much

1,628 (56.0)631 (21.7)398 (13.7)247 (8.5)

Sight of vapour/smoke

After-taste

Taste

Mildness

Smoothness

Overall satisfaction

Satisfying vapour/smoke

Look of the stick

Smell of vapour/smoke

Socialising

Feeling after

Look of the packaging

Feeling in hand

Lift in morning

Craving relief

Throat hit

Nicotine fix

Stress relief

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

92%

89%

88%

86%

83%

76%

72%

65%

63%

58%

57%

53%

51%

45%

42%

41%

38%

34%

6%

6%

2%

11%

12%

15%

14%

21%

26%

22%

28%

38%

23%

28%

37%

25%

40%

36%

2%

5%

10%

2%

5%

9%

14%

14%

11%

20%

14%

10%

26%

28%

21%

34%

23%

34%

Factors Determining Preferences for ECs vs. Regular Cigarattes

Prefer my EC

No difference

Prefer Regular Cigarettes

% Prefer

Feat

ure

Electric shock

Hand burn

Exploded

Poisoned

Mouth burn

Snapped

Didn't work when I really needed it

Screw-in broke

Didn’t recharge

Small parts lost

Battery drained very quickly

Battery cut out suddenly

Leaks

0%10%

20%30%

40%50%

60%70%

80%90%

100%

98%

97%

100%

100%

93%

79%

76%

76%

69%

67%

55%

56%

13%

2%

3%

0%

0%

6%

17%

21%

21%

25%

26%

34%

32%

44%

0%

0%

0%

0%

1%

3%

3%

3%

6%

7%

11%

12%

43%

Manufacturing-Related Adverse Events Experienced

No, never

Yes, once or twice

Three + times

Percentage Experienced

Adve

rse

Even

t


Regulation of NV productsSpecific regs for NV productsReg’d as general consumer productsReg’d as tobacco productsReg’d as medicinesDon’t knowNo opinion

762 (45.8)695 (41.8)

37 (2.2)21 (1.3)77 (4.6)71 (4.2)

Vaping prohibited in social venues?YesYes, with some ‘no’ exceptionsNoNo, with some ‘yes’ exceptionsDon’t know

118 (7.1)

359 (21.5)485 (29.1)683 (40.9)

24 (1.4)Vaping prohibited in workplace?YesYes, with some ‘no’ exceptionsNoNo, with some ‘yes’ exceptionsDon’t know

118 (7.1)

259 (15.5)623 (37.3)648 (38.8)

21 (1.3)

Vaping prohibited in public places?YesYes, with some ‘no’ exceptionsNoNo, with some ‘yes’ exceptionsDon’t know

17 (1.0)31 (1.9)

1,428 (85.4)187 (11.2)

6 (0.4)


Advertising ECs encourages switching?YesNoDon’t know

1,447 (86.6)

138 (8.3)86 (5.1)

Advertising ECs encourages uptake NS?YesNoDon’t know

285 (17.1)

1,186 (71.0)199 (11.9)

Advertising ECs should be prohibited?YesYes, with some ‘no’ exceptionsNoNo, with some ‘yes’ exceptionsDon’t know

38 (2.3)60 (3.6)

1,178 (70.5)346 (20.7)

46 (2.8)Media stories about vaping likely to…Scare smokers away from vapingEncourage smokers to switch to vapingDon’t knowDon’t care

1,454 (87.0)

92 (5.5)78 (4.7)37 (2.2)

Imbalance

d

Misl

eading

Sensationalis

ing

Scare

mongering

NegativeLy

ing

Exaggerated

Positive

Accurate Fa

ir

Balanced

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

76% 73%67% 66% 64% 63%

50%

2% 1% 1% 1%

Perceptions of Media Stories About E-Cigarettes

Perceptions

Perc

enta

ge R

espo

nse

What are the main reasons why you started vaping? (n = 21) N Respondents

To quit smoking 514Concern over health 230Save money 159Heard Ecs are safer alternative 137Hate smell of stale smoke 98Recommended/observed 96Novelty/curiosity 83Use nicotine in NS areas 72Reduce cough/wheeze/SoB 66Use nicotine without smoking risks 60Disease/health diagnosis 51Try flavours 39Replicate smoking behaviour/sensation 37Avoid secondhand smoke 30To cut down smoking 29Stigma of smoking 20Feeling disgusting 18Avoid cigarettes 15Hygiene 5Dental problems 4Appetite control 2

What are the main reasons why you continue to vape today? (n = 21) N Respondents

Hobby /enjoyment 321No bad smells on clothes, fabrics / good smell from vapour 270No negative health impact / improved health 262Feels like a safer alternative to smoking 221Like/love the flavours 150Keeps me from smoking 139Appearance has improved 114Enjoy being part of the vaping community 111Maintains smoking behaviours / rituals 110In control of how much nicotine I use 89No mess / better hygiene 63Can use in non-smoking areas 29Cheaper than smoking 28No secondhand smoke 28Can control my weight/appetite when vaping 28Enjoy continuing to get nicotine 22Out of habit 21Able to participate in recreational activities 13Improved sense of smell / taste 9Good for stress / anxiety / relax / focus 8No stigma, unlike smoking 2

Can you please tell us all the things you enjoy about vaping, that is, the benefits and pleasures it brings you? (n = 18)

N Respondents

Flavours taste great 496

Improved health / appearance 325

Hobby / enjoyment 224

Smoking behaviour / rituals / clouds 199

Vapour smells good 151

Feel more relaxed 130

Vaping community / socialising 113

Nicotine is satisfying 111

Keeps me from smoking 98

Enjoy experimenting with different gadgets 89

Can use in non-smoking areas 76

Sense of smell / taste returned 71

No immediate ill effects / feeling good physically 65

Feel like I have control over nicotine 61

Able to participate in recreational activities 44

Convenient and clean to use 39

Helps with weight / sugar control 37

Social approval 17

Have you noticed any changes in your health since you started vaping fairly regularly that you attribute to using e-cigarettes? Please describe

any health benefits and health harms you have personally experienced as a result of vaping. (n = 62)

N Respondents

> breathing 512> stamina < breathless 274< wheeze/cough 265> general health 235> sense of taste 232> sense of smell 199> energy 111< smell on clothes, house 84< colds/ flu / allergies 76< bronchitis, asthma symptoms 67< BP 66> teeth appearance 62< phlegm 59> sleep quality 57> skin appearance 55> able to focus/concentrate 55

< sinus problems 51< crackling in lungs / lung problems / lungs are clear 38< addiction 36< chest tightness 32weight loss 27


any health benefits and health harms you have personally experienced as a result of vaping. (n = 62) (continued)

N Respondents

> BP / better circulation 20> fresher breath 18< headaches 18> cardiovascular health 14> dry mouth / throat 12< sore throat 11> HR 10> appetite 10> health of others 9> money 9> blood oxygen 9> weight 8< sleep apnea 6PG allergy 6< blood sugar (diabetes) 5> sexual appetite 5> dehydtration 4> coughing 4< burns 3< heartburn 3< cholesterol 3


any health benefits and health harms you have personally experienced as a result of vaping. (n = 62) (continued)

N Respondents

< Crohn's symptoms 2> self-esteem 2< sleep if using too high nicotine content 2> anxiety 2> acid reflux 2> temporary sore throat 1< hangover 1< angina symptoms 1> acute headache from overuse 1< eyes watering 1< Tachycardia symptoms 1skin peeling from juice spills / mishandling 1oily skin 1< dental problems 1> kidney function 1< skin problems 1

> allergies 1> heartburn 1< hair loss 1> going to toilet 1

What advice would you give to a person who is thinking about using an e-cigarette or a vapourizer as a way of quitting smoking? (n = 32)

N Respondents

Best way to quit 170Take time to find the right device and flavour for you 137Take time with reducing nicotine/puffing until completely off cigarettes/wean off cigarettes (dual use ok) 77They feel much safer than cigarettes 60Look for/ask for expect advice and support before committing to a product 59You will feel a physical difference 54Don't buy a cig-a-like to start, start with a newer generation device 46Start with cheap setup to ease in / decide whether vaping is right for you / give it a try for few days at least 40Vaping has been much cheaper than smoking 27Vaping is a different experience from cigarettes / do not expect cigarette experience or treat as cigarettes 23Always buy from reputable vendor/local shop 22E-cigarettes don’t work for everyone - don’t get down if they don’t work for you 17E-cigarettes are really easy to use 15Very similar hand-to-mouth and puffing actions as smoking 12E-cigarettes become more satisfying than smoking 11E-cigarettes are more comfortable than other quit methods 11

E-cigarettes are only for those with smoking habit / zero nicotine for non-smokers 10Difficult to get used to, but worth it 10Set a quit date; you have to want to quit 10Learn about your battery / device safety / liquid safety 9Start-up is an investment 5

What advice would you give to a person who is thinking about using an e-cigarette or a vapourizer as a way of quitting smoking? (n = 32)

(continued)

N Respondents

Have backup equipment & juice 5

I can't say it's 100% safe / not comfortable to recommend until proven safe 5

Vaping can become a new habit / hobby / addiction in itself 4Buy a cig-a-like, it can feel more like smoking / ease in 3Don't dual use (smoke and vape) 3Vaping will put you in control of what you ingest 3There's still a stigma attached to vaping 3

Friendly community / friends to be made 2Drink lots of water 1

Know what to expect and be prepared for tobacco withdrawals 1Need to take care of / maintain equipment 1

Successful Vapers’ Top 9 Pieces of General Advice to

Aspiring-to-Quit Smokers

1) Don’t expect miracles.

2) Do what you can do.

3) Don’t compare yourself to anyone else.

4) Small steps taken with purpose are better than impractical giant leaps.

5) If you smoke, don’t beat yourself up, it happens. Just go again.

6) Every cigarette less is an achievement; going again after a slip is a bigger achievement.

7) Define yourself by your achievements, not your failures.

8) Don’t measure how far you have to go; measure how far you have come.

9) Always be mindful of the harms of smoking that are being avoided by vaping instead.

Successful Vapers’ Top 9 Pieces of General Advice to

Aspiring-to-Quit Smokers

Vapers ‘Paying It Forward’

• Largest survey of vapers who have quit or reduced smoking.

• Many vapers are experts, or at least, ‘well-informed students’ of how to use an e-cigarette as part of an attempt to quit smoking.

• To dismiss, misuse or under-use these individuals’ insights and experiences as part of health services’ efforts to engage with smokers would, in my opinion, be a monumental missed public health opportunity.

‘Pay It Forward’

• Think of the potential public health benefit of connecting smokers who are thirsty for A-E-I-O-U about e-cigarettes with vapers who are keen to help smokers turn their quitting aspiration into reality.

Thanks For Listening

Questions?

For slides, email…

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vapers helping smokers christopher russell, ph.d. centre for drug misuse research, glasgow, united...

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