Jeannie Cox presently enjoys a flavor called Coffee & Cream when she vapes. She’s also fond of White Lotus, which tastes “kind of melow.”
She purchases those nicotine-containing liquids, along with her other e-cigarette supplies, at Mountain Oak Vapors in Chattanooga, Tenn., where she lives. A retired secretary in her 70s, she’s often the oldest client in the shop.
Not that she responsebilities. What matters is that after avoiding decades of doctors’ warnings and smoking two packs a day, she hasn’t lit up a ordinary cigarette in four years and four months.
“Not one cigarette,” she said. “Vaping took its place.”
Like Ms. Cox, some smokers have been capable to stop smoking by diverting to e-cigarettes, and many are trying. A recent study by the Centers for Disease Control and Prevention found that more smokers now try to quit by utilizing e-cigarettes as a partial or total backup for cigarettes than by utilizing nicotine gum or lozenges, prescription medications or several other more established techniques.
Her success is what researchers skeptically call “anecdotal victims,” however. There’s “no compelling evidence” that e-cigarettes assist people stop smoking long-term, said Brian King, deputy director of the C.D.C.’s Office of Smoking and Health.
At the moment, therefore, neither the C.D.C., the Food and Drug Administration nor the United States Preventive Services Task Force has allowed or recommended e-cigarettes for smoking cessation. In fact, the rise of e-cigarettes has achieved contentious debate among public health officials and advocates.
But while the bulk of Americans who smoke continues to loss — down to 15.1 % in 2015 — the decline has inturrepted among older adults.
People over age 65 have ever been less likely to smoke than adults in general, in part because incomplete death means fewer smokers survive to older ages. In 1965, when the C.D.C. began tracking smoking rates, 18.3 % of older adults were smokers. It took 20-plus years for the bulk to fall below 15 %.
But over the last 6 years, that percentage has plateaued, bounding between 8 % and 9 %. That still leaves millions of older smokers who possibly know they should quit, and may need to, but haven’t.
Might switching to vaping increase their health, even if they never become fully nicotine-free?
“Vaping is clearly less painful than regular cigarettes,” said Dr. Steven Schroeder, who directs the Smoking Cessation Leadership Center at the University of California, San Francisco, and is a co-author of a recent JAMA article reviewing tobacco control developments.
Some studies have predicted that e-cigarettes confer at least a two-thirds reduction in health risks, related with smoking.
Nicotine, Dr. Schroeder pointed out, isn’t the initial culprit in the long list of smoking-related diseases. It’s the obsessive ingredient that keeps smokers lighting up, but the thousands of other chemicals in combustible cigarettes, among them 70 known toxin, do most of the harm.
“If you could get nicotine in a safer form, like an F.D.A.-approved medication, even for the rest of your life, you’d be in far better shape,” said David Abrams, a clinical psychologist at New York University who researches nicotine and smoking.
This brawl, known as harm reduction, recognizes that the best course for older smokers is to quit both cigarettes and e-cigarettes — especially since querries remain about the latter’s safety, for users and for those puffing secondhand vapor.
But damage reduction proponents like Dr. Abrams maintain that given the difficulty of quitting altogether, vaping could give a acceptable alternative. “Any smoker, especially an older smoker, who isn’t thinking about switching is doing himself a main disservice,” he said.
Ms. Cox wasn’t indeed thinking about switching. She had loved smoking always since she was a teenager sneaking Marlboros, and although she had developed a nighttime cough, she wasn’t trying to give up.
But she’d planned a fall visit to her nonsmoking children in Alaska in 2013, and standing outside their house to smoke sounded unappealingly chilly. Ms. Cox did some online research, tried several flavors at Mountain Oak and bought a starter kit.
“I’m not quitting smoking, I’m just attempting this newfangled thing,” she told herself. “Three days later, I accomplished I hadn’t smoked a cigarette in three days. I thought, ‘This is working out kind of nice. Quitting is not supposed to be this simple.’”
Usually, it’s not. Although older smokers don’t seem to have a harder time than others, stopping cigarettes cold-turkey only hardly works.
Would-be quitters can greatly grow their odds of success by using F.D.A.-approved nicotine replacement products, or a prescription drug like Chantix, and by searching support from smoking cessation counselors or telephone quit lines like 1-800-NOBUTTS.
“We know what works,” said Dr. King of the C.D.C. “We have 50 years of science displaying what works.” Still, smokers make an average 15 attempts before they become ex-smokers.
The fear that they’ll stop attempting to go nicotine-free, and vape instead, is one reason the C.D.C. and most public health groups don’t embrace e-cigarettes.
In fact, the C.D.C. reports that most smokers don’t perfectly switch; they become “dual users” who go on to smoke while vaping. Because even a few regular cigarettes daily increment the risks of fatality and cardiovascular disease, “you’ll still get an adverse health response,” Dr. King said.
Further, the C.D.C. takes a deep view of what grows public health, and it worries about growing e-cigarette use by adolescents (though ordinary smoking has declined in that age group), even if the products might assist others stop.
Longtime distrust of Big Tobacco plays a role in the e-cigarette controversy, too, as the industry muscles into an ara now populated by hundreds of small vapor companies.
The F.D.A. had planned to start regulating e-cigarettes next August, prompting an outcry that small manufacturers helpless to afford the hefty costs of applying for approval would easiuly shut down, leaving the field to the likes of Philip Morris.
The agency has since pushed e-cigarette regulation back to 2022. “A delay of execution,” said Gregory Conley of the American Vaping Association. For now, the industry can’t advertise vaping products as safer than cigarettes or even as smoke-free.
The industry has not notably targeted older smokers, Mr. Conley said, probably seeing them as set in their buying habits, and unwilling to waste time in vape shops experimenting with vaporizers and liquids to find a satisfying substitute for cigarettes (and a economical one, after the basic equipment purchase).
But older smokers also have a greater want to give up cigarettes. Not only can quitting boost their lives, but it can ward off many of the cripple effects of heart disease, diabetes and other chronic disorders. Nonsmokers respond better to surgery and chemotherapy, Dr. Schroder noted, and older adults often face one or both.