E-Cigarettes: Are They Really Safe?

It’s just about time for the annual Great American Smokeout, a campaign that takes place on the third Thursday of November each year. Sponsored by the American Cancer Society, the Smokeout focuses attention on the dangers of smoking and encourages smokers to change to a “non-smoking” lifestyle.

According to the American Cancer Society, with about 42 million Americans smoking cigarettes–almost 1 in 5 adults–tobacco use remains the single largest preventable cause of disease and premature death in the US.

Smoking tobacco increases the risk of cancer, emphysema, cardiovascular disease and problems with the immune system. The Centers for Disease Control and Prevention estimate that cigarette smoking is responsible for more than 480,000 deaths per year in the United States.

Many people turn to e-cigarettes as an alternative to smoking tobacco cigarettes. But are they really a safe alternative?

What are E-cigarettes and How do They Work?

E-cigarettes are “smoking” devices, often shaped like tobacco cigarettes, with a battery-powered heating element inside a replaceable cartridge. The heating element vaporizes a liquid nicotine solution, plus vegetable glycerin and flavoring that is inhaled into the lungs. Upon exhalation, an odorless water vapor flows out from the device.

Puffing on an e-cigarette is called vaping. Since an e-cigarette vaporizes, but does not burn nicotine, it doesn’t contain the harmful chemicals that are found in smoke, and in theory, should be safer than smoking regular cigarettes. However, there is conflicting research surrounding this idea. Some studies indicate that the vaping technology may be a more harmful way to deliver nicotine than smoking tobacco cigarettes.

Prevalence of E-cigarette Use

Vaping technology was first patented and became popularized in China, starting in 2003, but did not become readily accessible in the U.S.  till 2007. While e-cigarettes represented only about one percent of the U.S. cigarette industry in 2013, according to a County of Los Angeles Public Health report, the sales of e-cigarettes at that time were expected to reach $1.7 billion, more than double the sales for 2012.

According the Centers for Disease Control and Prevention (CDC), in 2011 about one in five U.S. adult smokers had tried electronic cigarettes at least once, almost twice as many who reported trying them in 2010. From 2010 to 2013, the use of e-cigarettes by current and former cigarette smokers jumped from 2.5 percent to 9.6 percent, an almost fourfold increase in use. In 2011, the rate of middle and high school students who had tried e-cigarettes rose by 43 percent for those in middle school, and 102 percent for those in high school.

How Effective are E-cigarettes in Stopping the Use of Tobacco Cigarettes?

With all this vaping going on, the question is: are e-cigarettes effective in their purported intent to offer a safer alternative to cigarette smoking that will eventually help people become non-smokers?  This hope for a “step-down” way to stop smoking appears to be the goal of a large number of e-cigarette users, as indicated in a marketing study by E.C. H. Solutions, reported in 2011.

Seventy percent of respondents said they used e-cigarettes with a goal to quit smoking. Yet, in a mega-review of studies assessing the use of e-cigarettes, reported October 2013 in the journal Contemporary Reviews in Cardiovascular Medicine, it was found that 85 percent of people using e-cigarettes as a stop-smoking aid were no more likely to have stopped smoking after one year than tobacco cigarette smokers. The mega-review also found that the longer study participants used e-cigarettes, the less likely they were to quit smoking.

The Question of Safety

• According to the Contemporary Reviews in Cardiovascular Medicine review, the health risks associated with e-cigarettes may be greater than was originally believed when the devices first became available.
• One concern deals with the “vaping” delivery system, which delivers greater amounts of nicotine directly into the bloodstream that nicotine patches and gum, which are alternative products used for those who want to slowly wean off nicotine addiction.
• E-cigarettes have also been shown to deliver the same high levels of microscopic particles deep into the lungs as tobacco cigarettes, and also deliver microscopic particles of heavy metals (tin, nickel, lead, chromium) in significantly higher proportions than tobacco cigarettes. These metal particles have been linked to pulmonary inflammation, asthma, stroke and heart disease.
• A conflicting study, funded by the National Vaper’s Club, a pro-e-cigarette advocacy group, concluded that “neither vapor from e-liquids or cigarette smoke analytes posed a condition of ‘significant risk’ of harm to human health via the inhalation route of exposure.” But the review of this study, reported in the mega-study Contemporary Reviews in Cardiovascular Medicine, found that it contained “fatal errors” in its data and data analysis, which put its validity into question.

Pros and Cons of Using E-cigarettes During Recovery

E-cigarettes are a new phenomenon, and in many ways a fad, especially for younger users, and the jury is still out on the safety of these devices. So wise consumers may well be hesitant to jump on the bandwagon of e-cigarette use, when more established nicotine step-down methods, such as the patch and nicotine gum, exist.

…wise consumers may well be hesitant to jump on the bandwagon of e-cigarette use, when more established nicotine step-down methods, such as the patch and nicotine gum, exist.</Rita Milios>One major concern regarding the new technology is that many of the products are made in China in uncontrolled conditions. Differences in engineering characteristics have been shown to strongly influence nicotine delivery in different e-cigarette brands. At this point, for people concerned about addiction to nicotine, sticking with a method that delivers smaller, more consistently reliable amounts of nicotine into the body may be the best bet.

Another factor to consider is cost. A year’s worth of e-cigarette cartridges costs about $600 for the “half-a pack-a-day” consumer, while tobacco cigarettes would cost the same consumer about $1,000. Nicotine patches cost about $25 a week and are recommended for use for no more than 12 weeks. Nicotine gum, also recommended for use for no more than twelve weeks, costs an average of about $30 per week (more in early weeks as more is used; less when weaning off).

Even though e-cigarettes may be less costly in the short term, many users continue to use the devices for much longer than users of nicotine patches and gum. Also, while the use of e-cigarettes over a longer period of time appears to actually lessen the likelihood of a user being able to quit smoking, success rates for quitting with nicotine replacement therapy (patch, gum) are reported in one mega-study to be 50-70 % effective.