E-cigarettes: Are they a safe alternative to smoking?
Electronic cigarettes are an increasingly popular device that produces an aerosol by heating a liquid containing solvents, flavorings, and nicotine. The effectiveness of e-cigarettes as a way to stop smoking or reducing the number smoked is uncertain. The chance of this device becoming attractive to the youth of our country is very high. The limited scientific data about the safety of e-cigarettes is a trend that must be remedied and soon.
E-cigarettes, while touted as a viable replacement to traditional cigarettes, are actually just as dangerous. In fact, these smokers could have a higher chance of stroke or coronary heart disease than traditional smokers; no to mention greater respiratory difficulties. The conference reported that in 2016 3.2% of US adults and 11.3% of high school students reported using e-cigarettes. The alarming trend is the increasing use among young people-900% between 2011 and 2015.
Further, compared to non-users e-cigarette users were younger, had a lower BMI (body metabolic index) and a lower rate of diabetes. Of the 66,795 respondents who reported regularly using e-cigarettes, researchers found they had a 71% increased risk of stroke, 59% increased risk of heart attack or angina, 40% increased risk of coronary heart disease and this was double the rate of traditional smokers. In addition, they found 4.2% of e-cigarette users reported having suffered a stroke. Sadly the study data did not show deaths attributed to e-cigarette use. In response to this data, American Heart Association has called for stronger new regulations to prevent access and marketing of e-cigarettes to our youth (AMH, 2019).
E-cigarettes: What are they?
Electronic cigarettes are a term that refers to an electric product that imitates traditional cigarettes in terms of appearance, taste, aroma, and other things. They are powered by batteries; convey nicotine to the smokers’ lungs via heating or atomizing method that leads to the same physical and psychological effects of a traditional cigarette. With traditional cigarettes burning releases chemicals for people to inhale. In the case of e-cigarettes, the nicotine and aromatic substances are provided by means of electronic heating and enable smokers to have the same physiological effect of real cigarettes.
The e-cigarette has many different structural designs but all contain three major parts. Part one-a lithium battery; part two-an atomizer; part three-liquid storage tank or cartridge that contains the liquid to be smoked. The liquid of e-cigarettes is usually made up of propylene glycol, glycerin, nicotine, essence and some other chemicals like flavors. E-cigarettes have always been packaged as harmless smoking-cessation products or substitutes without harmful substances like tar, carbon monoxide, suspended particles etc. but the safety evidence of e-cigarettes needs to be done.
Nicotine is highly involved in the development of cardiovascular disease. And while tar and other harmful ingredients have been removed with the use of e-cigarettes, evaluation of its safety is imperative. They produce their own potential hazards such as particles of aerosol and flavor additives and greater than traditional cigarettes and may cause lung and systemic inflammation leading to increased risk of lung disease and death (Zhang et al, 2018).
Are they really better?
E-cigarettes are promoted as a healthier alternative to traditional cigarettes. Many smokers use both products interchangeably. Nearly 15% of the adult population in the US smoke cigarettes and most want to quit. Many of these smokers have repeatedly quit then restarted once again. Since the advent of e-cigarettes and vapes, smokers have started using e-cigarettes with the hope of stopping smoking all together. E-cigarette companies have promoted their products as less harmful than traditional cigarettes and use as a cessation aid; not formally approved by the FDA to make these claims.
Experiments done in 2014 showed a link between e-cigarettes and effects on pulmonary function, including restriction of airways yet they are still sold. In addition, the effects of propylene glycol, the main ingredient of e-liquids is a known carcinogen. This study found no evidence that there was reduced exposure to cigarettes, e-cigarettes or health risks among dual users. The study also showed that e-cigarette users reported short-term and long-term pulmonary symptoms and conditions such as asthma, shortness of breath and chronic obstructive pulmonary disease.
This pulmonary difficulty was even greater among people who used both. It is thus recommended by this study that dual users are at a higher risk of respiratory difficulties and arrhythmias. At present research on e-cigarettes is fragmentary and incomplete with no systemic study or review to judge their safety (Wang et al, 2018).
The question has been brought if one cigarette smoked per day was okay and overall results showed that even one cigarette a day was nearly as dangerous as smoking a full pack of 20. Among approximately 25,000 adolescents 10% thought that light smoking was not harmful and only 35% of light smoking considered their habits to be associated with a lot of harm. This study found a large proportion of the risk of coronary heart disease and stroke comes from smoking only a few cigarettes.
Smoking one to five a day showed 50% excess risk for developing coronary heart disease and stroke. Obviously, cessation of smoking is the best way to reduce the risk. And although e-cigarettes are considered by some experts to be safer than traditional cigarettes, they actually are found to maintain smoking rates rather than encouraging smokers to stop. Smokers who reduce their total number of cigarettes smoked can benefit from a reduction in risk of cancer but this practice has little effect on the risk of developing heart disease or stroke (Hackshaw et al, (2018).
The advent of e-cigarettes presents a significant opportunity for addicted adult smokers to transition from conventional cigarettes to potentially less dangerous nicotine delivery products. However, they have also caught the eye of the youth of America and the rapid increase of “vaping” threatens to undermine the decades of public health pushes to prevent and/or reduce tobacco use among the youth. In 2018, more than 3.6 million middle and high school students reported e-cigarette use. April of 2018 the FDA took steps in fact to address this growing epidemic.
The FDA is ramping up methods for providing teens with the harmful side effects of e-cigarette use. These side effects include the effect of nicotine on the developing brain as well as exposure to harmful chemicals known to cause serious health issues (Zeller, 2019).
E-cigarettes or electronic nicotine delivery systems, have been gaining popularity over the past decade. They differ from traditional cigarettes in that they don’t produce smoke by burning tobacco. Instead, they heat a solution that contains nicotine, propylene glycol, glycerin and flavorings to generate an aerosol that the user then inhales.
Exhaled e-cigarette vapors contain nicotine, glycerin, propylene glycol, formaldehyde, acetaldehyde, polycyclic aromatic hydrocarbons, metals, and ultra-fine particles. These are worse than what is contained in second-hand smoke from traditional cigarettes. And depending on the actual type of e-cigarette used the concentration of nickel, silver, and formaldehyde can be higher in e-cigarette vapors than that of conventional cigarettes. And while scientific evidence of impact on the health of non-user exposure to these vapors and chemicals are limited, exposure to nicotine, formaldehyde, heavy metals and ultra-fine particles has been associated with adverse cardiovascular outcomes (DiGiacomo et al, 2019).
American Heart Association. (2019). E-cigarettes linked to higher risk of stroke, heart attack, diseased arteries. American Stroke Association News Release, Abstract 9, session A2
DiGiacomo, S.I. et al. (2019). Environmental tobacco smoke and cardiovascular disease. International Journal of Environmental Research and Public Health, 16(1).
Hackshaw, A. et al. (2018). Low cigarette consumption and risk of coronary heart disease and stroke: Meta-analysis of 141 cohort studies in 55 study reports. BMJ Research.
Wang, J.B. et al. (2018). Cigarette and e-cigarette dual-use and risk of cardiopulmonary symptoms in the Heart eHealth study. PLoS ONE, 13(7).
Zeller,M. (2019). Evolving “The Real Cost” campaign to address the rising epidemic of youth e-cigarette use. American Journal of Preventative Medicine, 56(2-supp 1).
Zhang, G. et al. (2018). Safety assessment of electronic cigarettes and their relationship with cardiovascular disease. International Journal of Environmental Research and Public Health,15(1). https://www.mdpi.com/1660-4601/15/1/75