A double-edged sword: e-cigarettes, and other electronic nicotine delivery systems (ENDS): reply
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CE - LETTER TO THE EDITOR
A double‑edged sword: e‑cigarettes, and other electronic nicotine delivery systems (ENDS): reply Riccardo Polosa1,2,3 · Konstantinos Farsalinos4,5,6 · Domenico Prisco7,8 Received: 1 October 2019 / Accepted: 29 October 2019 © The Author(s) 2019
Dear Editor, Disagreement in a scientific debate is healthy. Although we commend the intent of Lal et al. [1] to further elaborate on the impact of e-cigarettes and other electronic nicotine delivery systems (ENDS) on human health, we disagree on some of these authors’ assessment of the literature. And we certainly disagree with their statement that e-cigarettes are “becoming a nuisance for the society” when it is evident that these tar-free-emitting technologies are displacing cigarette smoking globally. While several studies have found that e-cigarette use at baseline predicts smoking at a later period, there is convincing evidence that there is a bidirectional association, with smoking at baseline predicting follow-up e-cigarette use too (Table 1). In fact, it is more plausible for these findings to be explained by the common liability model, rather than the gateway model [2]. Further indications for the absence of gateway to smoking effects for e-cigarettes come from * Riccardo Polosa [email protected] 1
Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero‑Universitaria “Policlinico‑V. Emanuele”, Università of Catania, Catania, Italy
2
Dipartimento di Medicina Clinica e Sperimentale (MEDCLIN), University of Catania, Catania, Italy
3
Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
4
Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
5
Department of Pharmacy, University of Patras, Patras, Greece
6
National School of Public Health, Athina, Greece
7
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
8
Interdisciplinary Internal Medicine, Careggi University Hospital, Florence, Italy
examining the smoking rates among US youth over time. Reductions of > 60% and 50% in middle school and high school students’ rates of past 30 days smoking have been reported from 2011 to 2018, the period when e-cigarettes became very popular (Table 1). US youth now have the lowest smoking rates that have historically been recorded, with an accelerated rate of decline compared to previous years. Combined with the minimal rates of frequent e-cigarette use among never-smoking youth, it is likely that e-cigarettes have distracted US youth from smoking rather than recruiting more smokers (Table 1). While flavors could appeal to youth, they are particularly important for adult former smokers who are using e-cigarettes as smoking substitutes, and could possibly contribute to successfully quitting and preventing relapse (Table 1). Of course, it is not desirable for youth (as well as neversmoking adults) to initiate e-cigarette use, and continuous monitoring of use according to smoking status is warranted. In an
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