E-cigarettes remain as controversial as they were when they were first introduced in 1963. Herbert A. Gilbert introduced a smokeless “non-tobacco cigarette” but never marketed it commercially. It wasn’t until smokers in China picked up on “vaping” that e-cigarettes became more widespread and mainstream. The modern e-cigarette was patented in 2003, and from that moment on, curiosity and controversy swelled as researchers rushed to study the potential effects from this new type of nicotine delivery system.
The verdict? It’s not so simple to say that e-cigarettes are universally positive or negative.
It should first be pointed out that not smoking, either traditional cigarettes or e-cigarettes, is always the safest choice. Smoking kills at least 480,000 people in the U.S. annually, and a new report ties smoking to another 60,000 to 120,000 deaths per year. Approximately 17% of adults in the U.S. smokes. This is a dramatic drop over the last decade, when the rate of smokers was over 20%. Advertising, education, and early outreach for kids has helped prevent new smokers from starting while offering resources for adults who already smoke to quit.
Some credit the rise of vaping with helping to decrease the rate of traditional smokers. While no one could argue that helping smokers quit traditional cigarettes is a positive, there are many different points of view and conflicting research as to the safety of e-cigarettes.
Smoking an e-cigarette is generally referred to as “vaping” because nothing actually burns (causing smoke). E-cigarettes use a replaceable cartridge that has flavoring, nicotine, and some type of carrier liquid (usually vegetable glycerin or polyethylene glycol). When a user inhales, a sensor triggers a small amount of heat that then vaporizes a bit of the liquid. Users exhale water vapor only.
This last action, the exhalation, has caused some to deem e-cigarettes a healthy alternative in terms of secondhand smoke. Secondhand smoke kills 42,000 people annually, many of them children who do not have a choice to move away from the smoke. Proponents of vaping have long touted the fact that there is no secondhand smoke from e-cigarettes, but a small study in 2014 found that vaping did, in fact, affect air quality, adding small but measureable amounts of carcinogenic chemicals into the air upon exhalation.
But what about the smoker and what they inhale?
There is currently very little research on the long-term effects of e-cigarettes, but one study in 2015 found that the flavored liquids in e-cigarettes induce toxicity, oxidative stress, and inflammation in the lungs and epithelial cells of mice. These are conditions that are present at the beginning of chronic respiratory illness and disease. Another study confirmed this toxicity to epithelial cells and issued an urgent call for more rapid assessment of potential carcinogenic effect.
But in August of 2015, an analysis of 42 models of 14 different brands of e-cigarette flavored refills found no significant toxicity levels beyond what is acceptable based on U.S. Food and Drug Administration measures. The only caveat was that certain flavored refills had higher potential toxins than unflavored, which could mean that the chemical flavorings are more dangerous than the nicotine itself.
Many e-cigarette users claim that vaping helps them to reduce their tobacco consumption or quit altogether, but another study in 2015 found that while vaping caused an increase in attempts to quit, those who used e-cigarettes did not reduce their daily consumption or successfully quit at a higher rate than traditional smokers.
To counter that, researchers publishing in the journal Addiction found that those adults who used e-cigarettes for longer, utilizing new devices with non-tobacco or non-menthol-flavored cartridges had a higher rate of smoking cessation.
Quitting is one thing, but not starting is the best.
Ignoring past public relations disasters from traditional tobacco advertising that targeted children, e-cigarettes are working hard to lure a new generation of smokers. A study presented at the 2015 Pediatric Academic Societies (PAS) annual meeting in San Diego highlighted the rise of e-cigarette smoking in teens, up 3% from 2012 to 2014. Teens are engaging in vaping and hookah use, both of which may be seen as more social forms of smoking, a fact that is alarming to principal investigator Jonathan D. Klein, MD, MPH, FAAP, director of the AAP Julius B. Richmond Center of Excellence and associate executive director of the American Academy of Pediatrics (AAP).
He notes that whatever the delivery system:
“Electronic cigarettes are of great concern. They are highly addictive nicotine delivery devices, and the vapor can and does cause harm to lungs.”
This back and forth in the research could go on for many years while large-scale studies are organized and validated. For now, it is important to realize that whether it is with a traditional cigarette or an e-cigarette, ingesting chemicals into the delicate tissues of the lungs is not healthy or ultimately sustainable behavior. Leading public health officials are calling for a tobacco-free world by 2040, citing the many positive efforts already in place and calling for an expansion into low-income areas of the world.
There is also enough evidence regarding the toxicity of e-cigarette smoke to warrant the World Health Organization (WHO) to call for stronger regulation of e-cigarettes. Because they are tobacco-free, e-cigarettes are currently unregulated by the U.S. government. Several cities (Boston, New York, Chicago, and Los Angeles) have begun to restrict their use in public places, and other states (Utah, New Jersey, and North Dakota) treat e-cigarettes as traditional cigarettes, banning their use in smoking-prohibited areas.
There is still much research to be done on e-cigarettes, even beyond what is already out there. The best advice is still this: if you don’t smoke now, don’t start. If you do smoke or vape, be aware of your options for quitting or reducing your intake.