E-cigarettes are a new technology that allow people to absorb nicotine into their systems using vaporizers as opposed to traditional cigarettes. Some stakeholders argue that this is a great innovation that can help smokers shift away from the habit through the use of a much less dangerous alternative, whereas others argue that this new technology is dangerous and will actually introduce a new generation to smoking.
Moreover, the legal and regulatory frameworks across the nation are patchy when it comes to e-cigarettes: given the nature of the technology, there has been confusion over exactly how e-cigarettes should be classified and regulated. On one hand, e-cigarettes could be treated in the same way as traditional cigarettes; on the other, they could be understood as inhabiting a category all of their own.
Capstone project on the use of e-cigarettes
The purpose of the present sample capstone project is to propose a study that can help add knowledge regarding the nature and effects of use of e-cigarettes. The proposal will begin with a literature review that addresses what is currently known about e-cigarettes. Then, it will proceed to delineate the design for a new study that could add further knowledge on this subject. Finally, the proposal will consider the implications and relevance of the potential findings of such a study.
A key point that will emerge here is that it is naive to just automatically think of e-cigarettes as being the same as traditional cigarettes. The fact is that the e-cigarette is a new technology, and it must be understood on its own terms. The conclusion may emerge that e-cigarettes are a safe alternative to traditional smoking that enables many current smokers to quit. Or, the conclusion may also emerge that e-cigarettes constitute a sort of gateway drug to actual smoking. Either way, this is an issue that must be understood on its own terms on the basis of actual research evidence, as opposed to just making assumption on the basis of biases. The present project will attempt to contribute to this endeavor.
The most important study to date on e-cigarettes is probably the one developed by the Royal College of Physicians (2016). This study is strongly in favor of the safety of e-cigarettes. Some of its main findings, for example, are: one, almost no one who uses e-cigarettes has never previously smoked; e-cigarettes do in fact help many smokers quit, making them a gateway from and not to smoking; and the likely physical harm of using e-cigarettes is about 5 percent of the known harm of smoking normal cigarettes.
The implication of these findings would be that e-cigarettes should actually be celebrated as an incredible harm reduction technology, as opposed to demonized as being just another form of normal cigarettes. This study was conducted in England; and while the findings were produced using rigorous research methods, they still remain controversial and have not managed to settle the issue for good.
Fairchild, Bayer, and Colgrove (2014), for example, have raised concern over the possibility that e-cigarettes may “renormalize” smoking. This refers to the cultural fact that whereas smoking was once considered to be a very common activity, over the last few decades, smoking has been pushed to the cultural fringe, with smoking have become attached with a social stigma. Fairchild et al. (2014) have suggested that because e-cigarettes tend to look and feel like normal cigarettes, the idea of e-cigarette use as normal may open the door to again seeing actual smoking as normal.
Even these researchers, though, have conceded the point that e-cigarettes do in fact have harm reduction potential, as it is known fact that they have already helped many smokers kick their habit. The researchers remain skeptical, however, regarding the cultural implications of the growing popularity of e-cigarettes, as well as regarding the potential health risks inherent within e-cigarettes themselves, given that the technology is still not well-understood.
Bell and Keane (2014), have considered the gateway drug theory as it pertains to e-cigarettes and taken that theory to task. In particular, these researchers have pointed out that both e-cigarettes and normal cigarettes have the active drug of nicotine—from which it follows that given that nicotine cannot be a gateway to itself, the application of that theory within this context is probably not valid. The argument could reasonably be made that no one should get hooked on nicotine, either; but this is a position that generally falls outside the scope of common debate on this subject.
There is little evidence suggesting that nicotine per se is harmful, any more than there is suggesting that caffeine or moderate alcohol is harmful. The dangerous part of smoking has to do specifically with the inhalation of smoke, which the e-cigarette eliminates. It would seem to follow that people would not transition from e-cigarettes to normal cigarettes, given that it is the same drug either way, and the transition would only add danger without providing any balancing benefit.
Moreover, Farsalinos and Polosa (2014) have conducted a systematic review on e-cigarettes, which produced the following conclusion:
“Currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes” (p. 1).
A systematic review is a high-level study that collectively analyzes all the evidence available on a given subject, which means that its conclusion should be taken quite seriously. The main theme that seems to have emerged from this literature review is that the objective research evidence points toward the safety and usefulness of e-cigarettes, with concerns about their relationship to traditional smoking appearing to be largely subjective and not grounded in hard evidence regarding what has actually happened thus far.
For example, there is almost nothing in the extant literature that supports the gateway drug theory in this regard, and yet this remains one of the most commonly cited arguments against the safety of e-cigarettes. To put it bluntly, this would seem to be a fantasy that has little to no corroboration in the empirical literature.
Proposed study design
The present capstone project proposes to conduct a mixed methods study that examines the perceptions of e-cigarette users themselves regarding their perceptions and feelings about their own experience. There is strong evidence, for example, that many current e-cigarette users were previously smokers (Preidt, 2016). This could lead to asking the subjects about whether they were previously smokers, whether they had previously tried to quit smoking, and the effects that e-cigarettes have had on their lives.
Likewise, if the subject has never smoked, questions could be asked about why the e-cigarette is appealing, and whether the subject has any intention of transition to normal cigarettes in the future. The proposed study will be mostly qualitative, but it can also include a quantitative element consisting of descriptive statistics. This would primarily consist of tabulations of how many of the subjects were previously smokers or not, and related metrics.
The sample for the study can be drawn in a purposive way from the local community. This is acceptable for a primarily qualitative study since random sampling is only relevant for statistical analysis, which will not be the point of the proposed study anyway. Rather, the point will to gain insight into the phenomenon under consideration with as much depth as possible.
The study will seek to explore the subjective perceptions of e-cigarette users regarding their habit, including the positives and negatives, as well as how it compares to the experience of actual smoking, if applicable for the given subject in question. This could help fill out the picture provided by the literature thus far by shifting away from abstract conjectures and instead focusing on the actual experiences of people who use e-cigarettes.
This could then serve as a foundation for more rigorous quantitative research in the future, especially research that focuses on a comparative evaluation of e-cigarettes not only against normal cigarettes but also against other common recreational drugs, such as coffee or alcohol.
It seems that a primarily qualitative study is in order regarding the subject of e-cigarettes and safety. This is the case because thus far, the quantitative research evidence seems to be strongly supportive of e-cigarettes, especially in comparison against normal cigarettes. Yet, the heatedness of public debate seems to suggest that this evidence has not really had a significant impact on the state of the debate, with many stakeholders apparently having a gut-level aversion to e-cigarettes simply because they look like normal cigarettes.
In this context, it may be valuable to develop a study that expresses the actual perspectives, stories, and perceptions of people who use e-cigarettes. This could potentially help resist some of the abstract and sometimes almost fantastic conjectures that have characterized the e-cigarette debate, despite the rigorous evidence that has already been accumulated on this subject.
It is important to understand e-cigarettes because they clearly do have the potential to serve as an almost miraculous smoking cessation tool, enabling smokers to break a habit that has always been known as notoriously hard to break. If e-cigarettes are in fact a gateway to normal cigarettes, then this effect would to a large extent be nullified. But the evidence thus far suggests that the gate actually works the other way around, with e-cigarettes leading smokers out of smoking, as opposed to leading non-smokers into it.
If this is true, then the objective data could gain depth and meaning by being complemented by the subjective testimonies of people who have experienced this for themselves. It is the objective of the proposed capstone project to contribute to the relevant literature in this regard.
Bell, K., & Keane, H. (2014). All gates lead to smoking: The ‘gateway theory’, e-cigarettes and the remaking of nicotine. Social Science & Medicine, 119, 45-52.
Fairchild, A. L., Bayer, R., & Colgrove, J. (2014). The renormalization of smoking? E-cigarettes and the tobacco “endgame”. New England Journal of Medicine, 370, 293-295.
Farsalinos, K. E., & Polosa, R. (2014). Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: A systematic review. therapeutic Advances in Drug Safety, 1-20.
Retrieved from http://www.acvoda.nl/wp-content/uploads/2013/11/Therapeutic_Advances_in_Drug_Safety-2014-Farsalinos 2042098614524430.pdf
Preidt, R. (2016, October 30). Nearly two-thirds of e-cigarette users also smoke: CDC. WebMD. Retrieved from http://www.webmd.com/smokingcessation/news/20161030/nearly-two- thirds-of-smokers-also-use-e-cigarettes-cdc
Royal College of Physicians. (2016). Nicotine without smoke: Tobacco harm reduction. Retrieved from https://www.rcplondon.ac.uk/news/promote-e-cigarettes-widelysubstitute-smoking-says-new-rcp-report