"Findings.  There were 3587 participants (70% former tobacco smokers, 61% men, mean age 41 years). The median duration of electronic cigarette use was 3 months, users drew 120 puffs/day and used 5 refills/day. Almost all (97%) used e-cigarettes containing nicotine. Daily users spent $33 per month on these products. Most (96%) said the e-cigarette helped them quit smoking or reduce their smoking (92%). Reasons for using the e-cigarette included the perception it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%). Most ex-smokers (79%) feared they might relapse to smoking if they stopped using the e-cigarette. Users of nicotine-containing e-cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non-nicotine e-cigarettes.

Conclusions.  E-cigarettes were used much as people would use nicotine replacement medications: by former smokers to avoid relapse or as an aid to cut down or quit smoking. Further research should evaluate the safety and efficacy of e-cigarettes for administration of nicotine and other substances, and for quitting and relapse prevention."

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03505.x/abstract

"The issue of harm reduction has long been controversial in the public health practice of tobacco control. Health advocates have been reluctant to endorse a harm reduction approach out of fear that tobacco companies cannot be trusted to produce and market products that will reduce the risks associated with tobacco use. Recently, companies independent of the tobacco industry introduced electronic cigarettes, devices that deliver vaporized nicotine without combusting tobacco. We review the existing evidence on the safety and efficacy of electronic cigarettes. We then revisit the tobacco harm reduction debate, with a focus on these novel products. We conclude that electronic cigarettes show tremendous promise in the fight against tobacco-related morbidity and mortality. By dramatically expanding the potential for harm reduction strategies to achieve substantial health gains, they may fundamentally alter the tobacco harm reduction debate."

http://www.hsph.harvard.edu/centers-institutes/population-development/files/article.jphp.pdf

http://www.ncbi.nlm.nih.gov/sites/ppmc/articles/PMC2910876/

"This RCP report makes the case for harm reduction strategies to protect smokers. The report demonstrates that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved. The report also argues that the regulatory systems that currently govern nicotine products in most countries, including the UK, actively discourage the development, marketing and promotion of significantly safer nicotine products to smokers."

http://www.rcplondon.ac.uk/pubs/contents/e226ee0c-ccef-4dba-b62f-86f046371dfb.pdf

"The purpose of this study was to characterize the relation between smokeless tobacco use and the risk of all-cause and disease-specific mortality. The mortality experience of smokeless tobacco users was not significantly greater than that of non-tobacco users and was appreciably less than that of cigarette smokers. Furthermore, combined use of smokeless tobacco and cigarettes did not increase overall mortality beyond that expected from use of the individual products."

http://aje.oxfordjournals.org/cgi/content/short/156/8/730

"Nicotine, at the dosage levels smokers seek, is a relatively innocuous drug commonly delivered by a highly harmful device, cigarette smoke. An intensifying pandemic of disease caused or exacerbated by smoking demands more effective policy responses than the current one: demanding that nicotine users abstain. A pragmatic response to the smoking problem is blocked by moralistic campaigns masquerading as public health, by divisions within the community of opponents to present policy, and by the public-health professions antipathy to any tobacco-control endeavours other than smoking cessation. Yet, numerous alternative systems for nicotine delivery exist, many of them far safer than smoking. A pragmatic, public-health approach to tobacco control would recognize a continuum of risk and encourage nicotine users to move themselves down the risk spectrum by choosing safer alternatives to smoking пїЅ without demanding abstinence."

http://www.drugpolicy.org/docUploads/DRUPOL_633.pdf

"One of the barriers to smoking cessation via product switching is misinformation about Smokeless Tobacco (ST) and pharmaceutical nicotine products. Most (67%) people in a telephone survey in the US and 59.8% of a sample of nurses mistakenly believed that nicotine is the main cause of tobacco-related cancers. Surveys of smokers and college students in North America found that fewer than 15% realize that ST is less harmful than smoking. In addition, a study found that most (75%) male US military recruits believe that switching from smoking to ST does not reduce tobacco users' risk. Many smokers have similar misconceptions about the health risks from using pharmaceutical nicotine products... If efforts to actively convince smokers that there is no opportunity for harm reduction were to end, we would expect to see the change begin. If the resources that are currently devoted to misleading smokers about harm reduction were instead targeted at informing them that they have satisfying choices that are almost as good for their health as quitting entirely, a very large change could happen quite rapidly."

http://www.harmreductionjournal.com/content/6/1/14

Gartner CD, Hall WD, Chapman S, Freeman B. Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure? PLoS Med. 2007 July; 4(7): e185.

"Background to the debate: The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of "harm reduction” point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a "gateway” to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control) have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904463/

CASAA encourages the use of a link to the CASAA website as a means of providing accurate, unbiased information to consumers and the industry.  Unless otherwise stated on casaa.org, CASAA does not have any affiliation with an organization, business, or individual that displays the CASAA logo or provides a link to the CASAA site.