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Sunday
Jun182017

Serious question: why don't more smokers switch to using e-cigarettes?

Remember The Pleasure of Smoking report, published at the end of last year?

Co-authored by Dr Neil McKeganey, director of the Centre for Substance Use Research in Glasgow, and funded by Forest, it was based on a survey of 650 'confirmed smokers'.

The study found that 95 per cent of confirmed smokers smoke because they take pleasure from the habit. Over 70 per cent had no plans to quit any time soon.

The researchers also asked respondents about e-cigarettes and got some interesting and detailed responses.

That research has now been published in a peer reviewed paper published by the International Journal of Environmental Research and Public Health.

Entitled Why Don’t More Smokers Switch to Using E-Cigarettes: The Views of Confirmed Smokers, it's summarised as follows:

Whilst e-cigarettes have been characterised by Public Health England as being around 95% less harmful than combustible tobacco products, only a minority of current smokers (around 16% within the UK) are using these devices.

In this paper we report the results of an online survey of 650 smokers in contact with a smokers’ rights group in the UK. A total of 91% of the smokers surveyed were smoking on a daily basis. Fifty nine percent reported having used electronic nicotine delivery systems, the majority of whom reported having used e-cigarettes.

Those smokers that had not used these devices principally explained this in terms of the pleasure they derived from smoking. The features smokers liked most about e-cigarettes had to do with the range of settings in which they could be used, the lack of an offensive smell associated with their use, the available flavours and the reduced level of harm.

The elements which smokers liked least about e-cigarettes had to do with the vaping experience, the technology, the chemical nature of e-liquids and the complex technology that was associated with these devices.

If a greater number of smokers are to be encouraged to take up e-cigarettes, it will be necessary not only to convey accurate information on the relative harm of these devices (compared to combustible tobacco products), but to ensure that they are able to be used in a wider range of settings than those within which smoking can currently occur and that the vaping experience more closely resembles the smoking experience.

Aside from the fact that this is the first time, to my knowledge, that Forest has ever been associated with a peer reviewed paper in any publication let alone a leading international journal, I'm delighted the CSUR's research has been recognised in this way.

It's an important piece of work because it's a rare example of the views of committed smokers being listened to and taken seriously.

Smokers are, by and large, dismissed as addicts with little or no willpower over their own behaviour. What the research found is that while 56 per cent of respondants accepted they're addicted to smoking, very few were concerned because they enjoy their habit and don't want to quit.

In other words, far from considering themselves to be unwilling slaves to the evil weed, they happily embrace their addiction.

At the same time, the research found that a substantial minority of confirmed smokers did NOT believe they were addicted.

None of these responses is something the tobacco control industry wants to hear, hence few public health campaigners were willing to acknowledge the existence of the original report.

Using the same research, Neil McKeganey's peer reviewed paper asks an important question: why don't more smokers switch to vaping?

The pleasure many confirmed smokers get from smoking is a major factor but so too is their experience of vaping.

Fifty-nine per cent of those who responded to the CSUR questionnaire provided feedback on their use of reduced risk nicotine products. Interestingly, given that we're talking about smokers who by and large don't want to quit, almost all of this group reported they had used e-cigarettes.

The paper, like the original report, highlights what they liked or disliked about e-cigarettes. It's quite illuminating and should be essential reading for tobacco control campaigners and anyone interested in tobacco harm reduction.

Over the next few days I'll watch with interest to see how many of the leading THR advocates review or tweet a link to Neil McKeganey's paper.

I'm guessing they won't because they're far too busy slapping themselves on the back about the latest ONS figures that show that the smoking rate in the UK has fallen below 16 per cent, a drop they associate almost entirely with the rise in popularity of e-cigarettes.

Inevitably it's a bit more complicated than that. Personally I think the significant reduction in smoking rates since 2012 is due to a combination of factors. Vaping is undoubtedly one of them; so too is the increasingly prohibitive cost of tobacco (which has the knock-on effect of driving some smokers to the black market).

What no-one seems to be addressing is the fact that the sharp rise in the use of e-cigarettes is said to have peaked. If that's true research such as Neil McKeganey's excellent paper is even more important because it offers a valuable insight into why more smokers aren't switching to vaping.

Unfortunately I fear many tobacco harm reduction advocates are living in a bubble, preferring to listen only to those who have quit smoking or switched exclusively to vaping.

A case in point is the Global Forum on Nicotine that concluded in Warsaw yesterday. The organisers were aware of The Pleasure of Smoking report but did they invite Neil or his co-author to address the conference? Did they heck.

To the best of my knowledge there wasn't a single presentation by anyone representing smokers who don't wish to quit or switch to e-cigarettes. Why? Surely, if vaping is to overtake and ultimately replace smoking, the views of confirmed smokers must not only be sought out and acknowledged, they must be acted upon, not sidelined or ignored because some people find them unpalatable or off message.

Yes, consumers were well represented at GFN but they were overwhelmingly (or exclusively) ex-smokers and vaping advocates, not current or confirmed smokers, so the plethora of speakers, most of them from the public health or THR communities, were preaching mostly to the converted.

Would it have been too much to invite someone to speak on behalf of smokers who don't want to quit or switch?

To read 'Why Don’t More Smokers Switch to Using E-Cigarettes: The Views of Confirmed Smokers' in full click here. To download a pdf, click here.

If you're on social media, please share.

PS. According to one tobacco control campaigner, The Pleasure of Smoking report was lightweight and contrived.

A penny for his thoughts now the same research has been peer reviewed and published in a leading international journal.

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Reader Comments (16)

I've had, and have used, an e-cig for about four or five years now, but I don't use it very much. My reasons for not switching are numerous.

First and foremost, they just don't deliver the same experience as tobacco. They feel very much like a substitute, like margarine is a substitute for butter, and cannot compare in terms of taste and quality.

Secondly, I find them cumbersome, awkward, and unattractive. They look like toys, which is what I suppose they are, really.

Thirdly, I don't much care for the available flavours of e-liquid. The various 'tobacco' flavours are quite disgusting, and don't taste like any tobacco I've ever smoked. I don't like the fruit or bubblegum (WTF?) flavours, and the only one I get along with is the plain menthol flavour, and frankly, I don't want to smoke menthol all the time.

Fourthly, all the associated paraphernalia is a pain. Batteries to keep charged (it's bad enough having to remember to charge my phone), stupid fiddly little bottles of e-liquid which is annoyingly sticky if you spill any, coils that can expire at any time etc etc.

And finally, they leak. Especially if you take them on a flight with you, when you have the additional element of different air pressure to deal with. And as I already said, the liquid is really sticky and nasty if it leaks in your bag or pocket.

And as an addendum, I don't want to be associated with the many (not all, I hasten to add) vapers who evangelise about their preferred delivery system at the expense of smokers, happily adopting all the outrageous rhetoric disseminated by the Tobacco Control propaganda machine to justify their commandeering of what they see as the moral high ground.

Sunday, June 18, 2017 at 15:29 | Unregistered Commenternisakiman

A global forum on nicotine that doesn't include smoking or smokers seems a little weird.

I tend to agree with nisakiman about e-cigs, except I finally found a kind of smoky pear flavour that's pretty nice and not too harsh, but that was after trying literally dozens of kinds of e-liquids.

Vaping dries me right out, so I always need loads of herb tea or juice with it, the tech is fiddly, all tanks leak (and that was another problem, finding a tank that gave decent flavour without spitback and isn't too leaky), the tech is generally fiddly, and the batteries scare me - even though I'm good about battery safety. Then there's finding a couple of not-too-huge devices that actually work. Most of them seem to have a very high fail rate.

Where I live it's also far more expensive to vape than my alternative sources for tobacco. And vaping is banned everywhere smoking is banned. I suppose if I had to get by with it, I could, but it's not that pleasurable, not near as much as a cigarette. Still, stealth vaping is a lot easier than stealth smoking, so there's that.

That, and I never want to become an evangelical ex-smoker, assuring everyone that cigarettes are horrible and if they just switch they'll hate the 'stinkies' (what tobacco cigarettes are called in the vape community), too.

I'm glad that vapes are there for the people who genuinely enjoy them, but that isn't all of us, probably not nearly all of us.

Sunday, June 18, 2017 at 16:34 | Unregistered CommenterChanah See

As someone who runs a vape shop here in Melb, Australia I would say there are a couple of different types who succeed with e cigarettes. First and foremost are those (like myself) who just really enjoy them. Whether it's the flavors or the techie aspect you really do need to have a strong motivating force to get you through all the difficulties of maintaining your e cigarette. I can certainly understand why many smokers are never going to convert.

The other type is the young person (over 18 of course!). Young people have a much wider circle of friends and acquaintances than older people. If you get one of two of them converting to e cigarettes you will very often get all of the friends converting. Vaping like smoking is very much a social thing. And the reason people start smoking or vaping has very little to do with the quality of the product. It has everything to do with being cool and fitting in with your social group.

I have said it before here, but the best chance of achieving a smoke free world is through the next generation of would be smokers being diverted into safer alternative tobacco products.

But I think asking why smokers don't convert to e cigarettes is a bit like asking why more smokers don't smoke pipes (which are safer then cigarettes). The effort of maintaining the habit is too much hassle for many.

Strangely as a former smoker I could never be bothered with roll your own, yet now, I build and wick all my own coils which if anything, is more work and hassle then rolling your own ever was. But I suspect just like a pipe smoker has to continually maintain and clean his pipe, maintaining your e cigarette becomes part and parcel of the ritual and just as enjoyable (or as those in public health would say, addictive) as the vaping itself.

Sunday, June 18, 2017 at 17:03 | Unregistered CommenterPaul McNamara

It is no surprise that tobacco controllers ignored or rejected the initial study. It is great the work is peer reviewed but I suspect they will continue to reject it as they rejected the peer reviewed research of Enstrom and Kabat and Boffetta et al.

They will reject all but their own dogmatic propaganda. That's why Forest (in all three current expressions) is important; it is essential that smokers be heard in order to counter persecution. The antismokers will try to shout out all dissent and any request for accommodation in their quest for prohibition.

Their desire for a 'smoke-free' world comes with a price. That price is a totalitarian world guided by dogma. They ignore all research except their own (much of it fabricated to meet their agenda). That makes this research impatient as it breaks the silence and challenges the monopoly on agenda setting.

Sunday, June 18, 2017 at 17:19 | Unregistered CommenterVinny Gracchus

As we know, many committed vape activists react with outrage when they're referred to as "smokers," or when vaping is categorized as "tobacco use." Then they go off into the weeds with pointless, convoluted arguments about why smoking and vaping are totally unrelated activities. They seem, regrettably, far more interested in semantics than substance.

But it's not difficult to see why they do it. For their entire smoking lives, they had it drilled into their heads that they were pathetic, subhuman drug junkies who were excluded from polite society so long as they continued choosing to smoke. So it stands to reason that a lot of them believed it, and still believe it, so the mantle of "ex-smoker" is one they doggedly defend, because they think it entitles them to a degree of self-respect that was previously off-limits.

The same phenomenon is on display when vapers wax self-congratulatory about having stepped down their nicotine intake (or at least the nicotine content in the liquid they vape). Even though nicotine is not doing them any appreciable harm, and they clearly enjoy using it, they think they're supposed to strive for abstinence so they can rid themselves of the "addict" label just as they rid themselves of the "smoker" label. They are essentially supplicating themselves at the feet of tobacco control and begging for its approval, and they are oblivious to it.

They don't want to talk about the fact that they vape for the same reasons they once smoked (i.e. because they enjoy it and gain a benefit from it). They don't want to talk about the fact that smokers' rights and vapers' rights are exactly the same thing. They think they have somehow earned the right to stand alongside tobacco controllers and finger-point at the "icky smokers." It is, like so many other things, merely an excuse to indulge in a false sense of superiority over other people.

Sunday, June 18, 2017 at 18:24 | Unregistered CommenterNate

For any critics who try to pin the 95% figure as coming from a "pro-smoking organization," there's a handy rejoinder available.

Go back 30 years ago when the Antismokers were still building the foundations of their power and didn't have full control over the statements made by individual researchers and organizations. Here's a 1985 article in the Chicago Tribune ( http://archives.chicagotribune.com/1985/01/27/page/66/article/smoking ) where the American Cancer Society itself offered the statement that almost 88% of smokers stated that they "find smoking pleasurable."

The figure would naturally be higher nowadays since many smokers who didn't find it particularly pleasurable would have been induced to quit by antismoking campaigns and taxes.

Is the ACS a "lightweight and contrived" source?

- MJM

Sunday, June 18, 2017 at 19:55 | Unregistered CommenterMichael J McFadden

I personally knew someone who gave up smoking real ciggies for two years, her son also gave up for almost the same amount of time. He then realised they were slating the e-cigs and could not be used where real ones were banned. He knew it was not about health at that point and has now gone back to proper ciggies. His mum, my friend went through a traumatic divorce and went straight back to proper ciggies. I used them myself for 6 months and cut my smoking down by half. For some reason they just make me cough now so just gave up using them myself after a considerable amount of money spent on them.

Sunday, June 18, 2017 at 23:11 | Unregistered Commentermandyv

I'm always a little sceptical about these magical reductions in the number of people smoking which various groups of anti-smokers - whether it's the NHS, Tobacco Control "charities," the Government or vapers - all seem to try to claim total credit for. Surely, in this day and age, with smoking being seen as little short of heresy, the drop in numbers must at least to some extent indicate not so much a lower number of people smoking, but must include a much lower number of people who are prepared to confirm that they do so. Which isn't the same thing at all. I know a fair few "non-smokers" who will happily cadge a cig off me if the opportunity arises, and who will even bring along their own if they think they can get away with smoking without some prying spouse/partner/child/finger-wagger spotting them. Ditto the similarly-acclaimed recent figures indicating a drop in the number of young people smoking. How many teenagers, when asked by an adult whether or not they smoked or had "tried smoking," would answer "yes," do you think?

Monday, June 19, 2017 at 2:33 | Unregistered CommenterMisty

For me there is nothing like the beautiful aroma of a cigarette made with Turkish tobacco. A true pleasure !

Monday, June 19, 2017 at 8:41 | Unregistered CommenterTimothy Goodacre

The reason I tried e-cigs in the first place was because my doctor told me to go off alcohol for six months, (a pancreatic problem).
I did so and stuck rigidly to it and the most difficult aspect of it was my routine habits which included visits to pubs to meet with friends. This is when I discovered non-alcoholic beer and even grape juices instead of wine with food.
The substitute liquids were adequate/satisfactory without being a direct replacement long term. But I thought, if I can do that with the booze I can do it with cigarettes also and I bought two e-cigs. The analogy is the same with the e-cigarette. It is not a proper smoke but my local positively encourages e-cig patrons to puff away, (rather than leave and go home). Non-smokers there never complain about it. When overnighting in hotels too it has become more difficult to locate a smoking bedroom so here too I use the e-cig.

Monday, June 19, 2017 at 12:23 | Unregistered CommenterJohn Mallon

I am never put off by the alleged "offensive smell" of fresh aromatic tobacco burning. If researchers want to force us to ecigs, they might try not using the language of smokerphobics when describing our delicious product of choice.

I tried ecigs and found them wanting, I also find the smell of some of them "offensive" but that's me. There is no law, yet, demanding we like some smells and dislike others.

I would not use them where smoking is banned because I am banned also. I don't need to suck on an inferior toy to get pleasure. It's comes with smoking because I am a smoker.

It really is not rocket science. All ecigs do is force smokers into third class citizenship.

Monday, June 19, 2017 at 15:05 | Unregistered CommenterPat Nurse

I'm not interested in a puff of nicotine instead of a cigarette, any more than I am interested in a caffeine tablet rather than a cup of coffee, and I'm quite sure that I can tell the difference between a spoonful of flour and a slice of cake.

You can only push propaganda so far

Monday, June 19, 2017 at 15:12 | Unregistered CommenterRose2

Just about all the smokers at my workplace have tried vaping. In my estimation, the majority have ended up smoking cigarettes. They just didn't find vaping satisfying.

Monday, June 19, 2017 at 15:47 | Unregistered CommenterJonathan Bagley

Beside the taste issue, I think e-cigs also have an image issue...I mean, there is a range of things conveyed by smoking cigarettes, cigars or pipes from rebelliousness to power to being an intellectual/philosopher. On the other hand, e-cigs are like toys...and their users like kids trying to look like adults.

Monday, June 19, 2017 at 16:44 | Unregistered CommenterVlad

It is completely unreasonable to expect that all (or nearly all) cigarette smokers would eventually switch to e-cigs if, somehow, convinced that they are potentially less harmful. However, usage of e-cigs should be seen as an "either or" binary process, but rather as an extra product in the pool of products accessible for the enjoyment of nicotine, together with cigars, pipes, chewing tobacco and snus. Dual (or multiple) product usage is not a downside but a bonus, as each product has its own advantages and disadvantages (and health risks), and each product works better(worse) with different users. Some posters have mentioned various downsides of e-cigs: mods need to be charged, liquid may leak (due to atomizers not well tightened), etc. However, e-ciga have also nice features: no fire, no ashes, so no ashtrays needed, they leave practically no odor remain and can be kept in a pocket to be puffed when desired. Snus is fantastic for transatlantic fights.

In my case, I remain an obstinate nicotine consumer from multiple devises: cigars, pipes, e-cigs and snus. Usage of e-cigs was immediate and natural, as their mechanics and rituals are very similar to those of pipe smoking: pipes are non-disposable, require maintenance, pipe tobacco is enjoyed for its taste and aroma and comes in many flavors sold in attractive colored cans and envelopes (analogous to e-liquids). However, a lot of cigarette smokers dislike e-cigs for the same reason I like them. The best for the consumer is a variety of products to be freely chosen through personal taste and good factual information, all of this enhanced by technological development. Nobody should be excluded and no product should be declared as compulsory (even for health reasons).

Tuesday, June 20, 2017 at 19:44 | Unregistered CommenterRoberto

Quoth Dr. Sussman: "It is completely unreasonable to expect that all (or nearly all) cigarette smokers would eventually switch to e-cigs if, somehow, convinced that they are potentially less harmful."

This has been tobacco control's playbook for 40 years. They believe, in their heart of hearts, that you just have to convey the health warnings in exactly the right way, and then everyone will quit smoking.

At first they thought simple, innocuous, small-print warnings on the side of the pack would do the trick: "Quitting smoking greatly reduces the risk to your health" and such. Then they reacted with bewilderment when people kept smoking.

So then they dialed up the strength of the language in the small-print warnings: "Smoking causes lung cancer and other serious health problems." Then they reacted with bewilderment when people kept smoking.

"Well, these idiot smokers still aren't getting the message," they said. "Obviously they're not seeing the warnings, or they just can't read, because no one would voluntarily keep doing a thing if they know it's bad for them. We must now festoon all cigarette packs with pictures of diseased organs harvested from the corpses of dead smokers!" Then they reacted with bewilderment when people kept smoking.

Saturday, June 24, 2017 at 2:12 | Unregistered CommenterNate

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