MedicalResearch.com: What is the background for this study?
Response: Many people think that it’s the nicotine that’s harmful so they opt for using a low strength in their e-liquid. We know from tobacco smoking that when people switch to using a lower nicotine yield cigarette, they compensate in order to maintain a steady blood nicotine level by taking longer, harder drags and this can increase exposure to toxins in the smoke. We also know from some of our other work with vapers (e-cigarette users) that they tend to reduce the nicotine strength of their e-liquid over time. We therefore wanted to explore whether vapers also engage in this compensatory puffing and whether this has any effect on exposure to potentially harmful chemicals.
MedicalResearch.com: What are the main findings?
Response: Our research shows that if people use a lower nicotine strength, they report that it’s less satisfying and, because they are trying to increase their nicotine intake, they tend to puff more and take longer puffs. When the power can be changed on the device they also tend to increase the power. We found that those participants who puffed more intensely and increased the power had higher levels of formate – a breakdown product of formaldehye – in their urine. These findings are consistent with a previous study that we conducted (Kosmider et al., 2017, published in Nicotine and Tobacco Research) where we found increased formaldehyde in e-cigarette vapour when people vaped using low nicotine strength e-liquid.
MedicalResearch.com: What should readers take away from your report?
Response: It’s important to emphasise that e-cigarettes are much less harmful than smoking and can be an effective way of quitting. But they are not completely risk free – our research shows that we can reduce risk even further by encouraging people to use higher strength nicotine if that’s what they feel they need.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our results are suggestive rather than conclusive. Our sample size was relatively small (20 vapers who completed four different conditions) and we used just one device. We would therefore like to encourage other researchers to replicate our study and more generally, to explore the safest and most effective way to use e-cigarettes.
MedicalResearch.com: Is there anything else you would like to add?
Response: Our recommendation for policy makers/regulators is to think carefully about restricting levels of nicotine in e-liquid. Nicotine in the absence of burning tobacco is relatively safe but restricting the availability of nicotine in e-liquids may do more harm than good.
Lynne Dawkins has provided consultancy for the pharmaceutical industry (2015, 2017) and acted as an expert witness for an e-cigarette patent infringement case (2015). Between 2011 and 2013 she conducted research for several independent electronic cigarette companies for which the University of East London received funds. The e-cigarette companies involved had no input into the design, conduct or write up of these projects.
Lynne Dawkins, Sharon Cox, Maciej Goniewicz, Hayden McRobbie, Catherine Kimber, Mira Doig, Leon Kośmider. ‘Real-world’ compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure. Addiction, 2018; DOI: 10.1111/add.14271
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