A survey of smokers in the Czech Republic shows that e-cigarettes “may develop into a genuine competitor to conventional cigarettes.” The lead author of the study, which was published online by Chest, is Dr. Eva Kralikova of the Faculty of Medicine at Charles University.

Kralikova and colleagues asked 2,012 smokers in 17 Czech cities to answer brief questions about their smoking; 1,738 (86 percent) participated.  Smokers were not told that e-cigarettes were a focus of the survey, eliminating a potential source of bias in the results.

First, smokers were asked about their experience with e-cigarettes.  Only 3 percent had never heard of them, 47 percent had heard of them but not tried them, 24 percent had tried them once, 17 percent tried them repeatedly and 9 percent used them regularly.

E-cig users were then asked to describe their first experience: disappointed, as expected, or pleasantly surprised.  A majority (53 percent) of one-time users were disappointed, while 32 percent reported as expected and 15 percent were pleasantly surprised.  Repeat users reported a lower disappointment rate (35 percent) and a higher proportion chose “as expected” (38 percent) or “surprised” (27 percent).  The majority (69 percent) of regular users had been pleasantly surprised at first use; a lower proportion chose “as expected” (29 percent) and very few were disappointed (2 percent).

Kralikova asked one-time and repeat e-cig users why they weren’t using them regularly.  The majority (60 percent) reported that e-cigs had poor taste or were not satisfying, 18 percent thought that they were impractical or embarrassing, 14 percent cited the cost, and 8 percent had other reasons.

These are important findings, and the authors’ discussion is judicious and balanced.  Kralikova and colleagues confirm the views expressed in this blog:

The key issue would then be the degree of risk [e-cigarette] use may pose. Research on switching from cigarettes to snus (references here and here) and on long-term use of nicotine replacement  (references here and here) shows that nicotine intake from a non-smoked source carries low or no health risks.  Inhalation of propylene glycol and glycerol is considered safe for most people, but inhaling e-cigarette vapour affects airways acutely (reference here) and effects of EC use over an extended period of time remain to be evaluated.

The researchers conclude:

Some 20 percent of smokers who try the current versions of e-cigarettes can be expected to go on to become regular users. The public health community needs to balance the possible benefits and possible risks of a scenario where EC become attractive enough to start to replace conventional cigarettes on a population scale. Our findings suggest that e-cigarettes may indeed have the potential to do so.

The authors warn of an unintended consequence of e-cig over-regulation:

Strict, slow and expensive regulation is likely to limit the spread of e-cigarettes and to stunt their development…careful consideration needs to be given to various regulatory proposals and bans to ensure that they do not have an unintended consequence of ensuring the monopoly of deadly conventional cigarettes.

That’s a keen observation.

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