General · 4th November 2015
Electronic cigarettes or e-cigarettes have now been on the market since the mid 2000’s yet what do we actually know about them. Just what are they? Who is using them and for what purpose? Are they safe, both for users and those who are exposed to their fumes? Are they regulated? Much of the information that I will impart here was compiled for the World Health Organization. For details please see E-cigarettes: A Scientific Review. Circulation.2014;129;1972-1986.
E-cigarettes are represented by a variety of mechanisms on the market (many of them looking like real cigarettes) that are all comprised of a battery that when stimulated, produces heat that changes a liquid in a cartridge to vapour. Called ‘vaping’, it was invented by a Chinese pharmacist in the early 2000’s. It has been flooding the market since all over the globe. The liquid that is heated can contain a variety of chemicals, nicotine among them though this is supposedly banned in Canada. Most e-cigarettes are produced in China and there is very little regulation of production. As a consequence, the liquid component varies widely. Most solutions contain propylene glycol or glycerol, nicotine and/or a variety of flavouring agents. The variety of heating systems also affects how the liquid is heated and thus varies the levels of chemicals and nicotine delivered to the user and the environment on exhalation of the aerosol. There is a variety of flavouring agents used (candy, cola or bubble gum), some specifically targeting adolescents. Vapers buy a ‘unit’, consisting of the battery, e-cigarette device and the liquid cartridge, an initial cost of between $30 to $100.00. Depending on how much vaping is done, the cartridges need replacement or refilling. As an example, it costs $600.00 yearly to sustain the equivalent of a pack a day smoking habit.
In Canada it is legal to use them but they cannot contain nicotine, nor can they cannot be imported, sold or be advertised. In British Columbia, sales are limited to those over the age of 19. Their use is banned in public and private schools, indoor public places and workplaces. Many of these regulations are very recent.
Despite the ban on advertising in Canada, there has been coverage in the United States and other countries like the UK. E-cigarettes have been marketed as being harmless, healthier, cheaper, and cleaner that conventional cigarettes. They are also promoted as a more effective method for smoking cessation. Celebrities have been endorsing their use.
Who is smoking? Canadian data indicates that in 2014 the cigarette smoking rate was at 15%, the lowest ever. This has not changed significantly from 2013 (16.2% or 4.2 million smokers). 2013 data indicate that 11% of those aged 15-19 smoke cigarettes, no change from 2012 data. Thus far, data indicates that 20% of young Canadians have tried vaping. Awareness and use of e-cigarettes has doubled from 2008-2012. Most countries indicate the highest useage in adults is with current smokers, followed by former smokers, with little use among nonsmokers. With young individuals, dual use (along with cigarettes) is most common.
At this time, there is little solid data with regards to the health effects of using e-cigarettes. The main ingredients of e-liquid are propylene glycol and glycerin. Both of these chemicals can cause eye and respiratory irritation, and with prolonged exposure can affect the central nervous system, behavior and the spleen. There is also potential for both chemicals to be carcinogenic. Less serious adverse events include throat and mouth irritation, cough, nausea, and vomiting. There have also been some serious injuries noted from e-cigarettes exploding and causing fires.
As stated above, since there is very little regulation into production of e-cigarettes, the chemical constituents of each brand varies, and may not be in concordance with the labeling. Actual nicotine content tends to vary by brand due to puffing behavior and how much nicotine is released per puff. At this time, is no solid evidence that suggests e-cigarettes are cytotoxic.
E-cigarettes deliver nicotine and other chemicals by creating an aerosol of ultra-fine particles which is then inhaled by the user. Although e-cigarettes do not burn like conventional cigarettes, there is second hand vapour released on exhalation. The toxins contained in the exhalation are at a much lower level than with conventional cigarettes emissions.
While e-cigarettes are touted as effective for smoking cessation, the limited amount of research done into this suggests otherwise. Most show that those using e-cigarettes as a means of smoking cessation are statistically less likely to quit than those who do not. Furthermore, among those who attempt, most end up using both e-cigarettes and conventional cigarettes.
In conclusion, more research needs to be done into the use of e-cigarettes to determine their effects and usefulness. There also needs to be greater regulation into their production. Given that the largest number of individuals who try e-cigarettes are youth, attention must be paid to advertising by the tobacco companies touting these products as harmless.