Why are e-cigarettes so popular among Americans who want to quit smoking, even though so little is known about their safety or effectiveness?

The answer lies in their marketing - they are simply "cooler" than nicotine inhalers. So says Michael Steinberg of the Rutgers Robert Wood Johnson Medical School in the USA, leader of a pilot study about the perception and use of these nicotine delivery devices.

The findings appear in the Journal of General Internal Medicine², published by Springer.Nicotine inhalers work when nicotine vapor is breathed in and absorbed through cells in the mouth lining, and studies have proven their safety and ability to help people to quit smoking.

Despite being approved by the US Food and Drug Administration since 1997, these pharmaceutical products are rarely used. On the other hand, the electronic cigarette, or e-cigarette, is very popular despite limited data about its safety and benefits. No regulatory evaluation has been done on this device, by which vaporized nicotine is inhaled through the heating of a nicotine-containing solution.

Its visible "vapor" can be inhaled and exhaled.Steinberg's team conducted a crossover trial during which 38 current smokers from New Jersey tried out the e-cigarette and the nicotine inhaler over a period of three days each. The participants rated the e-cigarette to be more acceptable and "cool," and judged it to be more helpful and effective in the process of trying to quit smoking.

The e-cigarette also provided superior satisfaction and physical reward compared to the inhaler, and was even on par with the participants' own tobacco cigarettes.Seventy-six percent of the participants said they would indeed use an e-cigarette to help them quit.

Eighteen percent (seven of the 38 participants) did not smoke at all during the three-day test period using the e-cigarette, while only 10 percent (four participants) refrained while using the inhaler.Moreover, knowledge and perceptions about the e-cigarette are much stronger than those about the nicotine inhaler. Steinberg's team believes this is because of its better marketing on television, the internet, on Facebook and Twitter.

In contrast, very little advertising is done for the inhaler."E-cigarettes have the potential to be important nicotine delivery products because of their high acceptance and perceived benefit, but more data are needed to evaluate their actual efficacy and safety," emphasizes Steinberg.

He believes physicians, as trusted sources of health information, should be aware of these issues so that they can adequately inform patients about the pros and cons involved. "Physicians have the potential to be an important source for answers about e-cigarettes that may influence the public's perceptions and use of these products."