E-cigarettes are battery-operated devices that look like a real cigarette: kind of pen-shaped. Some look a bit different- those with refillable tanks, for example .
There are nearly 500 brands of e-cigarettes on the market, in more than 7,000 flavors.
All brands have the same basic mechanism:
- They have containers filled with liquid, ingredients vary with the brand or type.
- A heating device turns the liquid into vapor that you inhale when you take a drag.
Using an e-cigarette is called “vaping.”
Are They Safe?
The FDA was given the power to regulate the manufacturing, labeling, distribution and marketing of all tobacco products in 2009 when President Obama signed into law the Family Smoking Prevention and Tobacco Control Act and in 2010 a court ruled that the FDA could regulate e-cigarettes as tobacco products.
It wasn’t until 2016 that the FDA finally announced a rule to regulate e-cigarettes. Under the final rule, the FDA plans to ban the sale of e-cigarettes to anyone under the age of 18. The rule also requires all makers of e-cigarettes sold after February 15, 2007 to go through a “premarket review.” This is the process that the FDA uses to determine whether potentially risky products are safe. However, companies are allowed to have anywhere from 18 months to two years to prepare their applications. And it will take another year for the FDA to actually approve these applications. So don’t expect e-cigarettes currently on the market to be officially allowed to be sold by the FDA for another couple of years.
The popularity of electronic cigarettes has outpaced available scientific data.
Research is still preliminary and answers may vary slightly. Overall, here are some points all experts agree on.
E-cigarettes are not safe, regardless of how they are marketed to appear to the public. Yes, they may be safer than conventional cigarettes, but they are not safe on their own merit.
The e-cig works by heating a liquid to generate an aerosol (we call it “vapor”) that is inhaled by the user. The e-liquid in the cigarette (or “e-juice”) is commonly made of nicotine, propylene glycol, glycerine and flavorings.
E-cigarette users who use e-cigarettes that contain nicotine are exposed to its potentially harmful effects. Nicotine is associated with cardiovascular disease, potential birth defects, and poisoning, among other deleterious effects.
Normal usage of e-cigarettes generates low levels of formaldehyde.
Degraded products will produce very high levels of formaldehyde in the vapor. Most users will detect the degradation and avoid using the degraded product, but there is still a slight risk.
Formaldehyde is a well-known carcinogen. Exact measurements have not been established. Too much formaldehyde inhalation will cause respiratory symptoms like itchy nose and throat, coughing, and nosebleeds. It may be implicated in respiratory diseases like asthma. A little exposure once in a while will usually fade, but continuous exposure to high levels of formaldehyde might increase the chance of getting cancer even at levels too low to cause noticeable symptoms.
Metal parts of e-cigarettes in contact with the e-liquid can contaminate it with heavy metal toxins.
One of the flavors used in e-cigs is diacetyl, a harmful chemical which causes a lung disease known as ‘popcorn lung’, among other harmful effects.
No long-term data is available on the overall effects of e-cigs on the lungs. In particular, the effects in people with respiratory diseases are still unknown. “No long term data” does not equal, “Safe to Inhale!” It merely states that there is no current information.
According to a study by VA San Diego Healthcare System and UC San Diego researchers, human cells exposed to the e-cigarette vapor showed several forms of damage, including DNA strand breaks. When the DNA is harmed and the cellular repair process doesn’t work right, it raises the risk of cancer. The affected cells were also more likely to launch into apoptosis and necrosis, which lead to cell death. The team used normal epithelial cells, which line organs, glands, and cavities throughout the body, including the mouth and lungs.
The San Diego team found that the nicotine versions caused worse damage, but even the nicotine-free vapor was enough to damage cells. Nicotine free e-cigarettes caused 50 per cent more DNA breaks, while those containing nicotine raised the damage margin three fold.
They were able to identify that e-cigarettes on the whole have something to do with increased cell death but not necessarily the individual components that are contributing to the effect.
There is limited information available on the environmental issues around production, use, and disposal of e-cigarette cartridges. A 2014 review recommended that e-cigarettes should be regulated for consumer safety.
There is a concern that some of the mainstream vapor exhaled by e-cigarette users can be inhaled by bystanders, particularly indoors.
The liquid used in e-cigarettes is highly concentrated, so absorbing it through the skin or swallowing it is far more likely to require an emergency room visit than eating or swallowing regular cigarettes.
In 2012, less than 50 kids under the age of six were reported to poison control hotlines per month because of e-cigarettes. In 2015, that number rose to about 200 children a month, nearly half of which were under the age of two.
Is Vaping Better Than Smoking?’
E-cigarettes aren’t thought of as 100% safe, but most experts think they’re less dangerous than cigarettes, says Neal Benowitz, MD, a nicotine researcher at the University of California at San Francisco.
Tobacco smoke contains 100 known carcinogens, and 900 potentially cancer causing chemicals, none of which has been found in more than trace quantities in e-cigarette vapor.
Those present are mostly below 1% of the corresponding levels in tobacco smoke Another review found that compared with cigarettes, e-cigarettes are likely to be much less, if at all, harmful to users or bystanders.
The e-cigarette aerosol can contain toxicants and traces of heavy metals at levels permissible in inhalation medicines, and potentially harmful chemicals not found in tobacco smoke- at concentrations permissible by workplace safety standards.
When vaping, there is no ash, tar, carbon and carbon monoxide entering inhaler’s lungs. However, chemical concentrations may exceed the stricter public safety limits. There is considerable variation between vaporizers in terms of quality of their liquid ingredients and thus the contents of the vapor.
A study funded by Cancer Research UK showed that when smokers switched completely to e-cigarettes, bodily level exposure to established and important smoking-related carcinogens and toxicants was reduced by between 56 percent to 97 percent.
E-cigarettes are a safer alternative to smoking tobacco in the context of developing smoking-related cancer.
(Dual smokers and vapers, who vape where smoking is prohibited but smoke regular cigarettes as well, saw very different results. Vaping and smoking did not lower the level of toxins in the body and also had too many variables to produce entirely accurate study results.)
Dr. Lion Shahab reported that according to the study, smokers who switched entirely to e-cigarettes cut their intake of toxins and carcinogens. Levels of nicotine — the addictive ingredient in cigarettes — remained constant, but their intake of cancer-causing chemicals fell to levels found in people using nicotine-replacement therapies. E-cigs reduced toxin intake at a level comparable to those who quit smoking by using nicotine replacements like the patch, gum or lozenges.
Proffessor Kevin Fenton, National Director Health & Wellbeing at PHE, agrees: “Public Health England has always been clear that e-cigarettes are not 100 per cent safe, but our major world leading review, published recently, found that e-cigarettes carry a fraction of the risk of smoking.”
“Electronic cigarettes are a much safer alternative source of nicotine for smokers than cigarettes, but that doesn’t mean they are risk free and we would discourage anyone who’s not a smoker from using them,” says Kenneth Warner, a tobacco policy researcher at the University of Michigan. “The worst critics of e-cigarettes would probably argue they’re a half to two-thirds less dangerous. But from a practical view, they’re probably on the order of 80% to 85% less dangerous, at least.”
Can They Help Me Quit Smoking?
“We don’t have the definitive study on that,” Warner says. “My reading of the evidence is that it is quite convincing that e-cigarettes are helping some people quit smoking.”
The American Heart Association says e-cigarettes should only be used as a last resort way to quit.
There is research that supports the idea that e-cigarettes can reduce smoking urges and help motivated smokers quit.
Last year, two out of three smokers who combined e-cigarettes with expert support from a local service quit successfully.
E-cigs have been shown to be as effective as nicotine inhalers in reducing both craving and withdrawals effects. Another study found that e-cigs may be comparable, but not more effective, than other methods for smoking cessation, like nicotine patches and even placebo e-cigs.
Whether e-cigs can safely help people quit smoking remains to be seen.
“We don’t know what is in e-cigarette vapor because the devices haven’t yet been fully regulated by the FDA,” says Norman H. Edelman MD, of the American Lung Association. “If you want to stop smoking, you may as well use an FDA-approved nicotine replacement, such as the patch or the lozenge. You can have more confidence because it’s been analyzed by the FDA, while e-cigarettes haven’t been analyzed by the FDA.”
Since e-cig manufacturers have not submitted an application to the FDA for their use in smoking cessation, e-cigs are not currently FDA-approved for such use
According to the FDA, there’s no evidence any e-cigarette is safe and effective at helping smokers quit.
The best thing a smoker can do is quit completely now and forever. The best way to succeed is to get help from your local stop smoking service. Smokers who have struggled to quit in the past could try vaping, and vapers should stop smoking.
Talk to your doctor about medications and other strategies that are proven stop-smoking tools. And if you need help quitting or reducing the number of cigarettes you are smoking, check out the smokefree.gov website.
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