E-cigarettes were first introduced into the US market in 2007 as a device to help smokers cut back on their habit. Despite growing dramatically in popularity, opinions remain divided as to their long-term impact on health. Should people be worried about using e-cigarettes?
There is an apparent lack of knowledge of evidence for the effects of e-cigarette use. Knowledge regarding their effects are becoming more and more concerning for health experts.
In a study of American adults published in Nicotine and Tobacco Research last year, 37% were against to e-cigarette use in smoke free-areas, with 40% uncertain. This suggests both caution and uncertainty regarding the safety of e-cigarettes.
We will take a closer look at what the dangers associated with e-cigarette use are, along with whether or not we should be worried about them.
E-cigarettes and their regulation
What exactly are e-cigarettes composed of and what could make them dangerous? – Most of the e-cigarettes seen today have a mouthpiece, cartridge, an atomizer and a battery. Cartridge holds the liquid solution, which normally contains different levels of nicotine (from no nicotine to 24-36mg/ml of nicotine); which gets heated up and vaporized by the atomizer. Once this fluid becomes vapour, the user can inhale it; just like you would after lighting up a cigarette.
A report from the Centers for Disease Control and Prevention (CDC) published that calls to poison centres went from one call per month in 2015, to 215 calls per month by 2014.
Does this increase signal a dangerous toxicity in e-cigarettes? Dr. Tom Frieden, director of CDC, started that the report “raises another red flag about e-cigarettes: the liquid nicotine used in e-cigarettes can be hazardous.”
More than half the calls to the poison centres had involved children 5 years and under, which shows a misuse of the product for adults. Child poisoning was normally due to the direct contact with the liquid through it being ingested, inhaled or exposure to the liquid on skin or eyes.
“Use of these products is skyrocketing and these poisonings will continue,” says Dr. Frieden. “E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavours that are appealing to children.”
The fact that they are not required to be childproof comes from their position in the regulatory gray area. The FDA can only regulate those who market as therapeutic, giving those who choose not to market their products this way more freedom to construct them as they please.
Last year the FDA announced a proposal to extend current tobacco regulation to include all e-cigarettes and other products that meet the legal definition of a tobacco product. This would allow them to restrict the way e-cigarettes are advertised and promoted, especially campaigns designed to appeal to youths.
Until this proposed rule is finalized, the aspects of e-cigarette presentation that Dr. Frieden is most concerned about are likely to continue. Consumers will also have to wait for an accepted set of measures to confirm the purity of e-cigarettes and the liquids used within.
A matter of substances
In terms of the chemicals contained in e-cigarettes, much is still unknown about precisely what is present and what their long-term effects are. While manufacturers will claim that their devices are safe, various studies have questioned this presumption.
The FDA themselves analyzed samples of two popular brands of e-cigarette. The investigators found that variable levels of nicotine – perhaps not so much a surprise – but shows traces of toxic chemicals such as carcinogens which cause cancer. Examples of these chemicals are formaldehyde and acetaldehyde.
The FDA started to issue warnings about potential dangers of e-cigarette use, after these findings.
Another study from the University of Southern California showed that the vapour produced from a well-known brand of e-cigarette contained high toxic levels of certain metals; far more found in the smoke of regular cigarettes.
“Our results demonstrate that overall, electronic cigarettes seem to be less harmful than regular cigarettes, but their elevated content of toxic metals such as nickel and chromium do raise concerns,” says Prof. Sioutas, coauthor of the study.
The researchers believe that these metal found; mainly chromium and nickel, likely come from the e-cigarette cartridges, suggesting that better manufacturing standards for the devices may be necessary.
Finally, researchers have also pointed out the dangers of nicotine, which is found in the majority of e-cigarettes. A study published last year in Oncotarget found that nicotine exposure caused cells to mutate in a manner similar to oxidative stress, a precursor to cancer.
The authors concluded that exposure to nicotine over a long period could lead to mutated genes that increase an individual’s likelihood of developing cancer, even though nicotine itself is not yet considered to be carcinogenic.
Although e-cigarettes do not contain some of the most harmful substances found in traditional cigarettes – tobacco, tar and the chemicals produced by burning tobacco – and are, therefore, safer to use, there is evidence to suggest that e-cigarettes should not be viewed as being without risk.
A smoking cessation aid or gateway to tobacco?
The main argument with the use of e-cigarettes, and their main selling point is that they can help people quit smoking. According to the National Institute on Drug Abuse (NIDA), however, it is unclear whether e-cigarettes may be effective as smoking-cessation aids.
A Cochrane study have concerns regarding the e-cigarette and although they may help people quit smoking, it may also have an opposing effect, acting as a “gateway” or introductory product for people, such as youths; to try traditional cigarettes.
This fear has grown due to the increase in marketing which may appeal to adolescents. A study published in 2014 revealed the exposure to e-cigarette advertising on TV to young adults of ages 18-24 rose by 321% between 2011 and 2013.
The CDC reported the use of e-cigarettes had more than doubled amongst middle age and high school students in the US from 2001-2012.
“The increased use of e-cigarettes by teens is deeply troubling,” states Dr. Frieden. “Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”
“Electronic cigarettes have been shown to help people quit smoking and there is no evidence to currently suggest that they act as a gateway to smoking for young people in the UK,” state Action on Smoking and Health (ASH), a UK charity set up to eliminate the harm caused by tobacco.
“Research suggests that smoking rates amongst UK children overall, while still too high, have continued to decline since the emergence of e-cigarettes last decade,” reports Dr. Penny Woods, Chief Executive for the British Lung Foundation, implying that e-cigarettes may be contributing to falling smoking rates.
The Mayo Clinic say until more is known about these risks, there are many other FDA-approved meds which are both safe and effective in helping to quit smoking.
Lack of evidence hurts both sides of the argument
Policy makers who don’t allow the use of e-cigarettes in public places are being criticized due to them being found dangerous. Manufacturers promoting this as a quitting smoking aid, are being criticized for the lack of evidence.
Dr. Nick Hopkinson, an honorary medical advisor to the British Lung Foundation, suggests that as e-cigarettes are certainly far less harmful than normal cigarettes, completely replacing tobacco with the electronic devices should improve health. However, avoiding both electronic and traditional cigarettes is preferable.
“Although safer than smoking, the long-term health impact of e-cigarettes is still not fully known and in need of further research,” he adds. “We would recommend that anyone using e-cigarettes to quit smoking, especially if they have lung disease, should eventually try to quit using [e-cigarettes] too.”