“Fourth-generation nicotine salt pod system (NSPS) e-cigarettes are the current market leaders. These devices contain nicotine as the benzoate or other salt in relatively high concentrations and use a low wattage battery,” note the authors. Juul pods still lead that market sector with pods containing 59 mg/mL of nicotine compared to the 0 to 36 mg/mL found in open atomisers.
They go on to add that this level of nicotine in pod systems is linked to, “significant uptake among adolescents”, but they add that this is also a major factor in supporting switching and reducing potential harm for adult smokers.
In a welcome change from most studies emanating from the United States, the research team recognises that the National Academies of Science, Engineering, and Medicine 2018 report concluded: “When used exclusively, e-cigarette pose significantly less exposure to toxicants and less short-term health risks than combustible cigarettes.”
The authors hypothesised that carcinogen exposure would be significantly lower in the e-cigarette group compared with a smoking-as-usual control group and recruited candidates for the unblinded trial.
The vaping group were given a JUUL e-cigarette and their choice of flavoured pods. They received education, training, and action planning so they could make a complete switch from smoking to using e-cigarettes.
Subjects were measured for things like carbon monoxide levels, lung function, urine analysis, pulmonary function and respiratory symptoms.
“Of 933 participants screened, 126 were randomized to e-cigarette and 61 were randomized to cigarettes as usual; 1 participant was excluded post-randomization, for a final analytic sample of 186 participants, including 92 African American participants and 94 Latinx participants.”
The team found: “A significant reduction in the primary outcome, NNAL, was observed in e-cigarette users. e-Cigarette users also experienced a significant reduction in CO and self-reported respiratory symptoms. Cotinine was stable over time and did not vary between e-cigarette and cigarettes as usual groups, reflecting adequate nicotine replacement by e-cigarette. Additionally, the lack of between-group change in cotinine and BP suggests there was no increased risk from greater exposure to nicotine. There were no interactions by site for any outcomes, reflecting consistency in effects across populations.”
In addition, for dual users of pods and cigarettes, the “results suggest that dual use of e-cigarettes and cigarettes did not create an additive burden on biomarkers of toxicant exposure compared with cigarette smoking in this 6-week trial.”
- “Effect of Pod e-Cigarettes vs Cigarettes on Carcinogen Exposure Among African American and Latinx Smokers - A Randomized Clinical Trial”, Pulvers, Nollen, Rice, et al. – [link]