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E-cigarettes: No Smoke, No Danger?

We don’t yet know they’re safe, and using e-cigs to stop smoking may just help you put off quitting

Smokers turn to e-cigs to ease nicotine withdrawal, or to avoid harmful chemicals in tobacco smoke. But many use e-cigs in public spaces and regular cigarettes everywhere else. Quitting half-way won’t help. And we don’t know that smokeless vapor is safe.

Some believe e-cigarettes are less harmful than smoking tobacco since e-cig vapor doesn't contain the chemicals found in tobacco smoke. But we don't know a lot about the safety of these products, and long-term health risks from using e-cigarettes will not be known for many years. Norris Cotton Cancer Center researchers take a look at what we know about e-cigarettes and health.

E-cigarettes: how they work

E-cigarettes create an inhalable nicotine vapor by heating a liquid nicotine solution. While there are many different e-cigarette devices on the market, the basic parts of a typical device are shown in the photo below. The main components include a battery, a cartridge with nicotine (and possibly flavoring), and a heater that vaporizes the nicotine to be inhaled by the user. When the user puffs on the end of the device and creates a vacuum, a battery powers the heater and creates vapor, which then goes into a chamber. The vapor is drawn out of the end of the device and inhaled into the lungs.

Most e-cigarette devices are engineered to look like a cigarette, and they are used like a cigarette. Many even have a tip that lights up when a person is inhaling. Using an e-cigarette is called vaping. There is also a newly developing market for "e-Hookahs" or vaporizer pens for individuals who vaporize other substances such as herbs, marijuana, marijuana oils, and hashish waxes. These devices have the same mechanisms and risks as e-cigarettes.

Are all e-cigarettes the same?

No. E-cigarettes were invented by a pharmacist in China, and many of the first generation products continue to be produced there. There are now more than 400 e-cigarette devices in the U.S. market, including some manufactured in the U.S., and the newer products differ from the original. Early results suggest that the newer designs may be more like a cigarette, getting nicotine deeper into the lung with quicker absorption into the blood stream. This makes them more addictive, but may also make them a better substitute for cigarettes. The newest vaporizer pens are technically similar to an e-cigarette, but the contents of the cartridges, or what is consumed in the refills, likely varies dramatically from that in a "traditional" e-cigarette.

Will e-cigarettes help me quit?

Many people are purchasing e-cigarettes to use when trying to quit smoking, but we do not have good evidence that people quit smoking completely by using e-cigarettes. Using e-cigarettes can encourage "dual use:" smoking cigarettes and using e-cigarettes. Many will use e-cigarettes where smoking tobacco is not allowed, and smoke tobacco at other times. Since stopping smoking completely is the only way to limit the health consequences of smoking, we need to know if e-cigarettes help people quit or if they help more people put off quitting.

E-cigarettes, e-Hookahs, and vaporizers are completely unregulated by any agency, so their safety and effectiveness has not been tested. No one can say that they are safer than other tobacco products (such as non-combusted tobacco products). This is one major reason why public health officials are reluctant to tell people to use them.

Since the quality of each device may vary, and the nicotine dose that an individual user may receive varies with the brand, battery charge level, "e-juice," and experience of the user, it is hard to know how well any particular device works or what the user is inhaling.

We have little information about the safety of vapors like propylene glycol when they are heated and directly inhaled, rather than eaten or used on the skin. The safety of many of the inhaled flavorings in the e-cigarette liquid is also not known; heating these flavorings could create new chemicals and byproducts. We don't know how safe it is to breathe "second hand vapor."

What are the dangers of using e-cigarettes?

Smokers considering e-cigarettes to help them quit smoking face a difficult personal choice. No public health official is going to issue a statement endorsing e-cigarette use for stopping smoking anytime soon. Yet, in theory, the exclusive use of e-cigarettes could be safer than smoking.

These theoretical benefits will be awarded to someone who uses e-cigarettes to completely quit smoking all products that burn tobacco—cigarettes, cigars, cigarillos, and pipes. Anyone who uses e-cigarettes and continues to use those other products is unlikely to greatly lower their risk of heart attack, cancer, or chronic lung disease. There are other forms of medicinal nicotine replacement therapy (NRT) that have been used for 17 years to help smokers quit. We know that these products help people successfully quit tobacco. Until we know more about e-cigarettes, these medicinal NRT products, combined with help from quit counselors or friends and family who have quit can help you become a non-smoker without tackling the remaining questions of e-cigarette safety.

Excerpted from: Emerging Issues Brief: E-cigarettes and Health by Susanne E. Tanski, MD, MPH, Norris Cotton Cancer Center Cancer Control Research Group and Associate Professor of Pediatrics at the Geisel School of Medicine and James D. Sargent, MD, co-director of the Norris Cotton Cancer Center Cancer Control Research Program and Professor of Pediatrics at the Geisel School of Medicine

March 31, 2014