Stoptober and the e-cigarette
Stoptober is here again - it's so much part of my vocabulary as a doctor that it's hard to remember that it was only launched for the first time in 2012. The UK government still feels there's work to be done in helping people quit, so it looks as if it will be firmly in our calendars for years to come.
Smoking is extraordinarily addictive, and it's hardly surprising that in the days when nobody realised how damaging it was, almost everyone did it. In 1948, 82% of men smoked, although 'only' 41% of women did. By 1974, 45% of adults (51% of men and 41% of women) smoked. In the 1970s and '80s, levels of smoking dropped fairly fast, but the rate started slowing down in the 1990s. Since 2007, numbers quitting among men have been pretty much matched by numbers taking up the evil week (22%), although there are slightly fewer women (17%) smoking today than at any time since records began.
Of course, the last few years have seen the emergence and extraordinary rise in e-cigarettes, used today by 2.6 million adults in the UK (1). About 1.1 million e-cigarette users are ex-smokers, while the rest are current smokers who have reduced their cigarette use by mixing the two. In the last 5 years, numbers of current smokers using e-cigarettes has increased from 2.7% to 17.6%, although it has stayed stable in the last year.
The concept behind e-cigarettes is simple, and was neatly highlighted by the tobacco researcher Michael Russell, who wrote in 1976 that "People smoke for the nicotine but they die from the tar". While nicotine replacement treatments offered a steady way of getting nicotine into the system, that nicotine 'hit' that so many smokers crave always involved lighting up before e-cigarettes came along. As far as smoking cessation is concerned, they work, and they let smokers avoid deadly tar - so what's not to like?
When e-cigarettes were first introduced, I was concerned by a World Health Organisation study which suggested we should be recommending them until we knew more about them. However, I was very reassured by a recent review from Public Health England, which found that they are 95% less harmful than smoking (2).
There's no doubt in my mind that they're better than the alternative, but there are still concerns. The first is whether they act as a 'gateway' to smoking. While so far, the vast majority of users are current or ex-smokers, a recent study (3) suggests that teens who try e-cigarettes are more likely to smoke. The second is whether they normalise or even glamorise smoking - which would be a disaster after the gradual shift that has seen smokers go from the cool rebels to the sad addicts huddled outside the pub door in the rain.
ASH (4) sums up my view on e-cigarettes. They're not cigarettes; in an ideal world I'd prefer people to be using no nicotine at all, but they're incomparably safer than smoking; they seem to offer a more attractive alternative than other nicotine replacement therapy treatments; but I'll be even happier to recommend them once there are medically licensed versions (coming soon) where we can guarantee what's in them.
But back to Stoptober - and its extraordinary success. The idea came about from research which showed that smokers who make it through the first 28 days without relapsing are five times more likely to quit for good. In the four years since it began, three quarters of a million smokers have joined Stoptober. This year, Public Health England have enlisted the support of a host of comedians, including Bill Bailey, Al Murray, Rhod Gilbert and Shappi Khorsandi. Sign up and you can get access to tips, jokes and support to keep going. Because while quitting may not be fun, the consequences of not quitting really are no laughing matter
3) Rigotti N. e-cigarette use and subsequent tobacco use by adolescents. JAMA 2015; 314 (7): 673-674