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E-Cigarettes: Are They Really a ‘Safe’ Alternative to Cigarettes?

One of the hottest topics in public health today is the use of electronic cigarettes (e-cigarettes), commonly referred to as “vaping.” The popularity of these products has grown rapidly, but what’s the latest on potential health risks and benefits?

Here’s a breakdown of what you need to know:

What are e-cigarettes?

  • Battery-powered devices that vaporize a liquid, known as e-liquid or vape juice, producing a vapor that users inhale. Most liquids contain flavoring and nicotine in various strengths – but not tobacco – although many producers of liquid also offer nicotine-free versions.
  • The devices come in many forms and go by many names, including vape pens, e-hookah, mods, and tanks.
  • The devices are often marketed as a safer alternative to cigarettes and represent a growing segment of the market for products containing nicotine or tobacco. But the health impact of these alternative products is not clear.

How many people use e-cigarettes?

Given the growing popularity of these products, the public health community is beginning to raise questions about safety.

Are E-Cigarettes Safer Than Traditional Cigarettes?

In August 2016, the U.S. Food and Drug Administration’s Center for Tobacco Products finalized a rule to regulate e-cigarettes. While much is still unknown about vaping, current studies show it is likely a healthier alternative to traditional cigarettes. Given the long list of harmful and toxic chemicals in cigarettes, researchers generally consider vaping to be a less dangerous alternative.

However, that doesn’t mean researchers believe vaping is safe or healthy either. Here’s why:

1. E-cigarettes Contain Potentially Dangerous Chemicals

The U.S. Surgeon General concluded that e-cigarettes can expose users to several potentially harmful chemicals including:

  • Nicotine – Most e-cigarettes contain nicotine, and studies show that it’s an addictive substance. One study  found that nicotine in e-cigarettes can damage heart cells, potentially causing heart disease. Exposure to nicotine can negatively impact brain development on young adults and adolescents, including effects on working memory and attention. It can also cause sudden infant death syndrome.
  • Other chemicals – In its initial review of products, the FDA found significant levels of toxic or cancer-causing chemicals, including:
    • Formaldehyde, a carcinogen
    • Lead, a neurotoxin
    • Silicate particles, which can cause lung disease
    • Nitrosamines, which are linked to cancer
    • Propylene glycol and vegetable glycerol, which are ingredients often used in anti-freeze
    • Diacetyl, a buttery flavored chemical often added to food products such as popcorn, caramel, and dairy products that can cause serious and irreversible lung disease

While these findings suggest the toxicant levels are “9-450 times lower than in cigarette smoke,” the levels of formaldehyde and metals were comparable to or higher than what’s found in cigarettes.

2. Another major concern of e-cigarettes is the way they are marketed to youth.

In December 2017, the U.S. Surgeon General issued a report on e-cigarette use among youth, warning that:

  • E-cigarette use is strongly associated with the use of other nicotine and tobacco products among youth and young adults.
  • The flavors in e-cigarettes are the primary reason young adults and children use them.
  • The aerosol found in e- cigarettes is not safe.
  • E-cigarette use should now be considered a significant public health concern, and “steps must be taken by parents, educators, and policymakers to discourage the use of e-cigarettes.”

3. Other concerns of e-cigarettes include:

  • Poisoning. Data released by the Centers for Disease Control and Prevention (CDC) show that calls to the nation's poison control centers for e-cigarette exposure poisonings are rapidly increasing. One study found that while most calls involving e-cigarette liquid poisoning stemmed from accidental ingestion of the e-cigarette or its liquid, about one-sixth of the calls related to someone inhaling the vapor.
  • Secondhand emission effects. While e-cigarettes do not contain smoke, they do expose others to secondhand emissions. Studies have found formaldehyde, benzene, and tobacco-specific nitrosamines (all carcinogens) in these secondhand emissions. Currently, nine states, the District of Columbia, and hundreds of communities have prohibited e-cigarette use in places where smoking is already prohibited.
  • Not a proven way to quit smoking. While many e-cigarette companies market their product as a tool to help smokers quit, the FDA's Center for Drug Evaluation and Research has not approved any e-cigarette as a safe or effective method to help smokers quit. Instead of quitting, many e-cigarette users continue smoking cigarettes. According to a 2015 report from the Surgeon General, 58.8 percent of the people who recently used e-cigarettes also continued to smoke cigarettes.

The Bottom Line

While widely accepted as a healthier alternative than conventional tobacco cigarettes, e-cigarettes aren’t considered healthy. There is much to learn about the risks and consequences of e-cigarette use.

Where Does UAB Medicine Stand on E-Cigarettes?

In light of the growing popularity of these products and recent research findings, UAB Medicine in September 2017 began screening patients for the use of electronic cigarettes/vaping devices as part of the tobacco assessment in the social history section of the electronic health record.