What You Need to Know About E-cigarettes
What Are E-cigarettes?
E-cigarettes (also called ‘vapes’, ‘e-cigs’ or ‘vape pens’) are technological devices that produce an aerosol by heating a liquid. While most e-cigarettes contain a battery, a heating element and a tank to hold the liquid, they can come in many different forms, shapes and sizes. Some of them can look like actual cigarettes while others can take the form of a usb stick or a little box. You can purchase them at smoking shops, online or even in department stores as some of them are designed to keep the body and change the liquid tank and/or battery while others are disposable.
What Do They Contain?
E-cigarettes contain a liquid out of which they produce an aerosol. Some of them contain nicotine, which we all know is a highly addictive drug that is recreationally used as a stimulant, an appetite suppressant, an anxiolytic and to socialise. Nevertheless, there are other chemicals that contribute to the making of the aerosol. As shown by the American Lung Association (1), electronic cigarettes contain several toxic products as follows:
Propylene glycol – a common additive in food; also used to make things like antifreeze, paint solvent, and artificial smoke in fog machines
Carcinogens- chemicals known to cause cancer, including acetaldehyde and formaldehyde.
Acrolein – a herbicide primarily used to kill weeds, can cause irreversible lung damage
Diacetyl – a chemical linked to a lung disease called bronchiolitis obliterans aka "popcorn lung"
Diethylene glycol – a toxic chemical used in antifreeze that is linked to lung disease
Heavy metals such as nickel, tin, lead
Cadmium – a toxic metal found in traditional cigarettes that causes breathing problems and disease
Benzene – a volatile organic compound (VOC) found in car exhaust
Ultrafine particles that can be inhaled deep into the lungs
It can sometimes be challenging to know exactly what’s in e-cigarettes, as some that claim to be nicotine-free but actually contain some (2).
Although the majority of e-cigarettes are known to be an alternative to the traditional cigarettes, some e-cigarettes can also be used to deliver marijuana and other drugs.
Are They Harmful?
E-cigarettes are still fairly new which makes it challenging to determine their long-term health effects. For instance, to date, there is no research done on the effect of electronic cigarettes on the development of human fetus (3). But, we do know that e-cigarette alter the health and neurodevelopment in animal studies (4,5,6). Let’s keep in mind that most e-cigarettes contain nicotine, a harmful and highly addictive drug that can impact the brain development of young adults and that it is toxic to developing fetuses (7).
While e-cigarettes are perceived as less harmful than cigarettes, this does not necessarily make them “safe” (8). As users inhale this aerosol into their lungs, the chemicals that the liquid contains reach deep into the lungs and can have some severe consequences. Although the e-cigarette aerosol is less harmful than smoke from burned tobacco products, many of the chemicals composing the e-cigarette aerosol are cancer-causing (1). Bystanders can also breathe second hand nicotine, metals (aluminum), fine and ultra-fine particulate matter, volatile inorganic compounds and polycyclic aromatic hydrocarbons (9,10), in other words, this is bad for their health.
In some cases, it has also happened for e-cigarettes to cause fires and explosions because of the batteries. This resulted in serious injuries (11).
Can They Help With Smoking Cessation?
Smoking cessation is a huge challenge for smokers. Even though over two thirds of smokers want to quit (12), the average quit success rate has been hovering around 7.5% (13).
The problem with electronic cigarettes and smoking cessation is that they are not currently designed for this, at least not yet. It is worth noting that even if it has short to long term adverse effects, potential lifespan gained by using e-cigarette as a smoking cessation tool surpasses the lifespan lost by vaping (14). Plus, lower levels of carcinogens have been found in e-cigarettes users in contrast to cigarette smokers (15,16). This notion of harm reduction is indeed part of the US Food and Drug administration (FDA) and the Canadian strategy for nicotine-focused strategy to minimize major adverse effects of smoking (17).
Still, e-cigarettes are not currently approved by the FDA as a quit smoking aid. In fact, most e-cigarette users are young adults as the different flavors and marketing strategies tend to attract youths (18). They are most of the time used as an alternative to cigarettes. Some users even started smoking with e-cigarettes. Studies also show that most e-cigarettes users who wish to quit smoking do not stop smoking and are instead using both e-cigarettes and cigarettes (19).
Although e-cigarettes may help non-pregnant smokers if used as a complete substitute for all other smoked tobacco products including cigarettes, the evidence that we currently have is not sufficient to recommend e-cigarettes as a smoking cessation product.
Sources
(1) American Lung Association. (2020, July 13). What's in an e-cigarette? American Lung Association. https://www.lung.org/quit-smoking/e-cigarettes-vaping/whats-in-an-e-cigarette.
(2) Goniewicz, M. L., Gupta, R., Lee, Y. H., Reinhardt, S., Kim, S., Kim, B., Kosmider, L., & Sobczak, A. (2015). Nicotine levels in electronic cigarette refill solutions: A comparative analysis of products from the U.S., Korea, and Poland. The International Journal on Drug Policy, 26(6), 583–588. https://doi.org/10.1016/j.drugpo.2015.01.020
(3) Bozier, J., Chivers, E. K., Chapman, D. G., Larcombe, A. N., Bastian, N. A., Masso-Silva, J. A., Byun, M. K., McDonald, C. F., Crotty Alexander, L. E., & Ween, M. P. (2020). The Evolving Landscape of e-Cigarettes: A Systematic Review of Recent Evidence. Chest, 157(5), 1362–1390. https://doi.org/10.1016/j.chest.2019.12.042
(4) Lauterstein, D. E., Tijerina, P. B., Corbett, K., Akgol Oksuz, B., Shen, S. S., Gordon, T., Klein, C. B., & Zelikoff, J. T. (2016). Frontal Cortex Transcriptome Analysis of Mice Exposed to Electronic Cigarettes During Early Life Stages. International Journal of Environmental Research and Public Health, 13(4), 417. https://doi.org/10.3390/ijerph13040417
(5) Nguyen, T., Li, G. E., Chen, H., Cranfield, C. G., McGrath, K. C., & Gorrie, C. A. (2018). Maternal E-Cigarette Exposure Results in Cognitive and Epigenetic Alterations in Offspring in a Mouse Model. Chemical Research in Toxicology, 31(7), 601–611. https://doi.org/10.1021/acs.chemrestox.8b00084
(6) Zelikoff, J. T., Parmalee, N. L., Corbett, K., Gordon, T., Klein, C. B., & Aschner, M. (2018). Microglia Activation and Gene Expression Alteration of Neurotrophins in the Hippocampus Following Early-Life Exposure to E-Cigarette Aerosols in a Murine Model. Toxicological Sciences: An Official Journal of the Society of Toxicology, 162(1), 276–286. https://doi.org/10.1093/toxsci/kfx257
(7) Ross, E. J., Graham, D. L., Money, K. M., & Stanwood, G. D. (2015). Developmental consequences of fetal exposure to drugs: what we know and what we still must learn. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 40(1), 61–87. https://doi.org/10.1038/npp.2014.147
(8) Baeza-Loya, S., Viswanath, H., Carter, A., Molfese, D. L., Velasquez, K. M., Baldwin, P. R., Thompson-Lake, D. G. Y., Sharp, C., Fowler, J. C., De La Garza, R., & Salas, R. (2014). Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bulletin of the Menninger Clinic, 78(3), 243–252. https://doi.org/10.1521/bumc.2014.78.3.243
(9) Czogala, J., Goniewicz, M. L., Fidelus, B., Zielinska-Danch, W., Travers, M. J., & Sobczak, A. (2014). Secondhand exposure to vapors from electronic cigarettes. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 16(6), 655–662. https://doi.org/10.1093/ntr/ntt203
(10) Melstrom, P., Koszowski, B., Thanner, M. H., Hoh, E., King, B., Bunnell, R., & McAfee, T. (2017). Measuring PM2.5, Ultrafine Particles, Nicotine Air and Wipe Samples Following the Use of Electronic Cigarettes. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 19(9), 1055–1061. https://doi.org/10.1093/ntr/ntx058
(11) Harshman, J., Vojvodic, M., & Rogers, A. D. (2018). Burns associated with e-cigarette batteries: A case series and literature review. CJEM, 20(S2), S20–S28. https://doi.org/10.1017/cem.2017.32
(12) Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020 [accessed 2020 May 21].
(13) Creamer, M. R., Wang, T. W., Babb, S., Cullen, K. A., Day, H., Willis, G., Jamal, A., & Neff, L. (2019). Tobacco Product Use and Cessation Indicators Among Adults—United States, 2018. MMWR. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. https://doi.org/10.15585/mmwr.mm6845a2
(14) Warner, K. E., & Mendez, D. (2019). E-cigarettes: comparing the possible risks of increasing smoking initiation with the potential benefits of increasing smoking cessation. Nicotine and Tobacco Research, 21(1), 41-47.
(15) Carroll, D. M., Wagener, T. L., Peck, J. D., Brame, L. S., Thompson, D. M., Stephens, L. D., Campbell, J. E., & Beebe, L. A. (2018). Biomarkers of Exposure in ENDS Users, Smokers, and Dual Users of American Indian Descent. Tobacco Regulatory Science, 4(2), 3–15. https://doi.org/10.18001/TRS.4.2.1
(16) Shahab, L., Goniewicz, M. L., Blount, B. C., Brown, J., McNeill, A., Alwis, K. U., Feng, J., Wang, L., & West, R. (2017). Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Annals of Internal Medicine, 166(6), 390–400. https://doi.org/10.7326/M16-1107
(17) Koval, R., Willett, J., & Briggs, J. (2018). Potential benefits and risks of high-nicotine e-cigarettes. Jama, 320(14), 1429-1430.
(18) Center for Disease Control and Prevention. (2021, June 30). Quick Facts on the Risks of E-cigarettes for Young People. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html
(19) Patnode CP, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Evidence Synthesis No. 134. AHRQ Publication No. 14-05200-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2015.