The e-cigarette is a very new addition to the study of nicotine addictions and thus is under researched in South Africa. There have been debates regarding the benefits and risks of it but in the main these have been anecdotal. For example, on the one hand the belief is that the benefits of using it is to reduce nicotine addiction but on the other there may also be dangers in using it as a result of the liquid used in the e-cigarette. Thus, any information would be most grateful.
e-Cig (Electronic Cigarettes): A Brief Review [updated: 1 Dec, 2013]
Adapted from my site: http://shs.evidencewatch.com/
Electronic cigarettes do not contain tobacco, rather they are recreational nicotine devices which the user manipulates in such manner as to closely mimic the act of smoking. They are neither tobacco products nor cessation devices, although they hold some considerable promise in the latter capacity as some studies suggest [14,15]. Electronic cigarettes are essentially hand-held devices for the delivery of nicotine to the user through a battery-powered vaporization of a nicotine/propylene-glycol solution. 'Smoking’ an electronic cigarette is termed ‘vaping’ and it mimics the act of smoking, but, there is no combustion and so no evidence of second-hand phenomena, and the user inhales vapor, not smoke. Note further that although the nicotine is derived from tobacco, electronic cigarettes contain no tobacco.
Theoretically, therefore, we would strongly expect vaping to be less harmful than smoking, since it delivers nicotine without the several thousand known and unknown toxicants and carcinogens in tobacco smoke. And a product that mimics the act of smoking, while also delivering nicotine, is well poised to address both the pharmacologic, and behavioral, components of tobacco addiction. Finally, electronic cigarettes are neither manufactured nor distributed by the tobacco industry, nor by the pharmaceutical industry, but rather hundreds of small distributors have been marketing them over the internet and in shopping mall kiosks, starting back in 2007.
Are They Safe?
Studies demonstrate that there are three primary components of electronic cigarette cartridges: (1) nicotine, (2) propylene glycol (PG), and (3) glycerin. Of other chemicals identified so far, the FDA has focused on potential health hazards associated with two: tobacco-specific nitrosamines (TSNAs), and diethylene glycol (DEG) [1].
It is reassuring that electronic cigarettes contain only 0.07 – 0.2% of the TSNAs present in cigarettes, a 500-fold to 1400-fold concentration reduction, while as to DEG, although the FDA found it in one of the 18 cartridges studied1, none of the other studies [2-13] detected any, so it can be speculated that this contamination may be due to use of a non-pharmaceutical grade of propylene glycol from which DEG is derived. In addition, several animal studies that investigated repeated propylene glycol vapor exposure found no deleterious effects [18,25] and propylene glycol has already been classified by the FDA as Generally Recognized As Safe (GRAS) [26]. These safety data on TSNAs, PG and DEG, collectively with the most methodologically robust evidence to date, strongly finds the preponderance of the available evidence supporting the conclusion that electronic cigarettes are both (1) much safer than tobacco cigarettes and (2) comparable in toxicity to conventional nicotine replacement products already now on the market and judged safe [16].
In addition although the FDA in its July 2009 press release warned of the presence of carcinogens at ‘detectable’ levels, it omitted mention of the fact that the levels of these carcinogens was similar to that in NRT products, and that the amounts detected were only trace levels of carcinogens, being 0.07% to at most 0.2% of the corresponding levels in cigarettes [1,16], and at levels similar to the already FDA-approved nicotine patch and nicotine gum [16] Source: Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? J Public Health Policy 2011 Feb; 32(1):16-31.]
And again bear in mind that the aggregate evidence to date indisputably demonstrates that electronic cigarettes are significantly much safer than cigarettes. Indeed, electronic cigarettes appear to pose far lower capacity for carcinogenicity than regular cigarettes, and likely similar in minimal carcinogenicity potential to FDA-approved NRTs [19].
It's also important to remember that in contrast to both (a) reduced risk cigarettes like low-tar forms or some low-yield or 'light' brands and novel smoking devices such as R.J. Reynolds’ 'Eclipse' and Phillip Morris' 'Accord', and (b) smokeless tobacco products, electronic cigarettes are in fact not tobacco products at all, nor are they combustion products, so that switching to electronic cigarettes should not be seen primarily as an alternative to smoking cessation, but rather as in fact a form of smoking cessation, alongside the traditional long-term use of nicotine replacement therapy (NRT), and there is some highly suggestive data showing that smokers, with a documented history of recurring relapses, were able to quit smoking and to remain abstinent for at least six months after switching to and using an electronic cigarette [14,15].
Conclusions on Safety
We systematically review and critically appraised the literature to date on the safety of electronic cigarettes (“e-Cigs”) and find that the best evidence supports these conclusions:
(1) the vastly greater relative safety of electronic cigarettes over standard tobacco smoke products;
(2) that any safety concerns appear to be no greater than those associated with already FDA-approved nicotine replacement therapy (NRT) products whose benefit-harm ratio has been judged manifestly positive;
(3) that there is invaluable potential benefit for electronic cigarettes as a viable additional intervention for the elimination of second-hand smoke hazards, thus reducing the substantial overall societal harm consequent to the collateral damage of standard tobacco smoking products to others besides the actual smoker.
And although not dispositive, we have high-level robust evidence from the recently completed ECLAT trial, the first randomized controlled trial (RCT) addressing the impact of e-Cigarette use in relation to smoking reduction, smoking abstinence and safety long-term, which found that the use of e-cigarettes decreased cigarette consumption and elicited enduring tobacco abstinence, as well as reducing the frequency of reported symptoms, with withdrawal symptoms were infrequently reported, and all without causing significant side effects or safety issues [27.
In this connection, we however certainly also advocate more research into long-term effects, and into relative efficacies compared to competitive options such as NRTs, as well as rational regulation for the standardization of the design and manufacturing practices for electronic cigarettes to minimize or avoid variability in cartridge and vapor content, and to achieve a rigorous level of integrity in product labeling, as scientists pro [14-16,19,21-24] and con [1,20} have demanded sensibly. Note that the call for these further research agendas is no way incompatible with the stance of the greater comparative safety of electronic cigarettes over standard tobacco smoking products, the current evidence of minimal potential for adverse events, and the call to harness this technology for the greater societal / interpersonal, and personal benefits (including avoidance for the smoker to exposure to tobacco smoke carcinogens), that can positively bring to the current stage of adverse smoking behavior and its vast ills, present and future. This is in consensus with what the American Council on Science and Health (ACSH) has legitimately labeled by the FDA's "hyper-precautionary position on electronic cigarettes" [21] and its failure to acknowledge that despite its addiction potential, electronic cigarettes nonetheless indisputably offer at the very least the potential for nicotine addiction without the staggeringly massive harms of smoking [22]. And from the perspective of the prevention of cancer, it would be wise to heed the injunction of Dr. Ron Borland distinguished fellow in cancer prevention (Cancer Council Victoria) to "allow them, but research and monitoring are needed so that the risks can be regulated", acknowledging that "although it is better not to use any form of nicotine long term, if patients must, e-cigarettes are a lower risk option than continuing to smoke" [24].
In sum, electronic cigarettes are designed to mitigate tobacco-related disease by reducing cigarette consumption and smoking rates, and despite statements, against the best evidence, issued by the FDA and various other associations, a systematic review of the cumulative data to date provides strong evidence for both their effectiveness and for their safety, and the FDA has not offered convincing data of their legal burden to demonstrate that electronic cigarettes are unreasonably dangerous for their intended use, nor has it demonstrated that electronic cigarettes do not yield the anticipated reduction in harm to the user and, at least as importantly, to other nearby users who are currently significantly and adversely affected by standard tobacco smoke by virtue of second (and third) hand smoke. Given the evidence for the unquestionable harm of second-hand smoke, as we presented above, there is no substantive doubt that electronic cigarettes represent a significantly and proportionately very large reduction in the collateral damage that standard smoking inevitably entails as a cost on society. The FDA (and others like the ACS, ALA, etc.) are committing here a category mistake, in constraining their focus of safety to solely the intrapersonal dimension, while in fact due to the broad spectrum of derivative harm from tobacco smoking to others via the adverse sequelae of second and third hand smoke, the proper domain of focus of safety research and associated concerns is not just the intrapersonal domain but critically also the interpersonal and societal sphere, these now collaterally being benefited rather than harmed by furtherance of electronic cigarette adoption by current, and intended, smokers, and it may even as we have suggested, based on preliminary but compelling data, form a viable and effective new modality for smoking cessation.
METHODOLOGY OF THE REVIEW
A search of the PUBMED, Cochrane Library / Cochrane Register of Controlled Trials, MEDLINE, EMBASE, AMED (Allied and Complimentary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, ISI Web of Science (WoS), BIOSIS, LILACS (Latin American and Caribbean Health Sciences Literature), ASSIA (Applied Social Sciences Index and Abstracts), and SCEH (NHS Evidence Specialist Collection for Ethnicity and Health) was conducted without language or date restrictions, and updated again current as of date of publication, with systematic reviews and meta-analyses extracted separately. Search was expanded in parallel to include just-in-time (JIT) medical feed sources as returned from Terkko (provided by the National Library of Health Sciences - Terkko at the University of Helsinki). Unpublished studies were located via contextual search, and relevant dissertations were located via NTLTD (Networked Digital Library of Theses and Dissertations) and OpenThesis. Sources in languages foreign to this reviewer were translated by language translation software.
REFERENCES
1. Westenberger, B.J. Evaluation of e-Cigarettes.. St Louis, MO: Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Division of Pharmaceutical Analysis, 2009.
2. Laugesen, M. Safety Report on the Ruyan e-Cigarette Cartridge and Inhaled Aerosol. Christchurch, New Zealand: Health New Zealand, 2008.
3. Laugesen, M. Ruyan E-cigarette Bench-Top Tests. Christchurch, New Zealand: Health New Zealand, 2009.
4. Alliance Technologies LLC. Characterization of Liquid “Smoke Juice” for Electronic Cigarettes. Monmouth Junction, NJ: Alliance Technologies LLC, 2009.
5. Coulson, H. Analysis of Components from Gamucci Electronic Cigarette Cartridges, Tobacco Flavour Regular Smoking Liquid. Lancashire, UK: Blackburn MicroTech Solutions, 2009.
6. Exponent. NJOY e-Cigarette Health Risk Assessment. Menlo Park, CA: Exponent, 2009.
7. Alliance Technologies LLC. Characterization of Regal Cartridges for Electronic Cigarettes. Monmouth Junction, NJ: Alliance Technologies LLC, 2009.
8. Alliance Technologies LLC. Characterization of Regal Cartridges for Electronic Cigarettes – Phase II. Monmouth Junction, NJ: Alliance Technologies LLC, 2009.
9. Ellicott, M. Analysis of Components from “e-Juice XX HIGH 36 mg/ml Rated Nicotine Solution” ref S 55434. Lancashire, UK: Blackburn MicroTech Solutions, 2009.
10. Valance, C. and Ellicott, M. Analysis of Chemical Components from High, Med & Low Nicotine Cartridges. Lancashire, UK: Blackburn MicroTech Solutions, 2009.
11. Alliance Technologies LLC. Chemical Composition of ‘Instead’ Electronic Cigarette Smoke Juice and Vapor. Monmouth Junction, NJ: Alliance Technologies LLC, 2009.
12. Cai, X. and Kendall, M.W. Gas Chromatography Mass Spectrometry (GC-MS) Analysis Report. Sunnyvale, CA: Evans Analytical Group, 2009.
13. Tytgat, J. “Super Smoker” Expert Report. Leuven, Belgium: Catholic University of Leuven, 2007.
14. Caponnetto P, Polosa R, Russo C, et al. Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series. J Med Case Rep 2011; 5(1):585.
15. Siegel MB, Tanwar KL, Wood KS. Electronic cigarettes as a smoking-cessation: tool results from an online survey. Am J Prev Med 2011 Apr; 40(4):472-5.
16. Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? J Public Health Policy 2011 Feb; 32(1):16-31.
17. Regulation of E-Cigarettes and Other Tobacco Products. Department of Health and Human Services, Food and Drug Administration. Letter from Lawrence R. Deyton, Director, Center for Tobacco Products, U.S. Food and Drug Admin., to Stakeholders (April 25, 2011).
18. Robertson O. H., Loosli C. G., Puck T. T., Wise H., Lemon H. M., Lester W. Tests for the chronic toxicity of propylene glycol and triethylene glycol on monkeys and rats by vapor inhalation and oral administration. J Pharmacol Exp Ther 1947; 91: 52–76.
19. Wagener TL, Siegel M, Borrelli B. Electronic cigarettes: achieving a balanced perspective. Addiction 2012 Apr 4.
20. Riker CA, Lee K, Darville A, et al. E-cigarettes: promise or peril? Nurs Clin North Am 2012 Mar; 47(1):159-71.
21. Dr. Whelan and Dr. Ross ask the FDA to reconsider e-cigarettes. Elizabeth M. Whelan & Gilbert Ross. American Council on Science and Health (ACSH). May 29, 2012.
22. Bell K, Keane H Nicotine control: E-cigarettes, smoking and addiction. Int J Drug Policy 2012 May; 23(3):242-7.
23. Foulds J, Veldheer S. Commentary on Etter & Bullen (2011): could E-cigs become the ultimate nicotine maintenance device? Addiction. 2011 Nov; 106(11):2029-30.
24. Borland R. Electronic cigarettes as a method of tobacco control. BMJ 2011.:d6269.
25. Werley MS, McDonald P, Lilly P, et al. Non-clinical safety and pharmacokinetic evaluations of propylene glycol aerosol in Sprague-Dawley rats and Beagle dogs. Toxicology 2011 Sep 5; 287(1-3):76-90.
26. Propylene glycol monostearate. Database of Select Committee on GRAS Substances (SCOGS) Reviews. Food and Drug Administration. U.S. Department of Health & Human Services. October 31, 2006.
27. Caponnetto P, Campagna D, Cibella F, et al. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One 2013; 8(6):e66317.
Dear Nicolette,
You can access the report produced in France (May 2013) at the request of the French Health authority on this subject on the site of l'Office Français de Prévention du Tabagisme (OFT): www.ofta-asso.fr
Best Regards.
Jean.
You might want to check the work done by Stan Glantz, Pam Ling and their team at the Centre for Tobacco Control Research and Education. They have examined e-cigarettes in detail and have published several important studies. I think their most crucial contribution is that they examine public health effects and do not limit their enquiry to questions of harm reduction alone. You can see more about them here: http://tobacco.ucsf.edu/
Best wishes
Janet
Dear Nicolette,
References of three recent papers on the question:
Grana R , et al. Circulation. 2014;129:1972-86.(open)
Frank C , et al. Circulation. 2014;129: 1924-36.
Grana R , et al. Circulation. 2014;129: 1945-52.
Jean.
Stan Glantz's blog (which you can follow here: http://www.tobacco.ucsf.edu/blogs/sglantz) , often has thoughtful commentaries on e-cigarette research.
To begin, here are few
Article Electronic cigarettes: Human health effects
Article A systematic review of health effects of electronic cigarettes
Dear Dr. Nicolette Vanessa Roman
Please see the following ResearchGate links.
Article Potential Health Effects of Electronic Cigarettes: A Systema...
Article Effects of electronic cigarette smoking on human health
Article Health impact of E-cigarettes: A prospective 3.5-year study ...
Article The impact of electronic cigarettes on the paediatric population
Article PS007 Cardiovascular Effects of E-Cigarette Use
Article A review of the current literature regarding the cardiovascu...
Article The perceived effects of electronic cigarettes on health by ...
Chapter Effects of Electronic Cigarettes on Men’s Reproductive and S...
Good luck!
Besides nicotine, e-cigarettes can contain harmful and potentially harmful ingredients, including: ultrafine particles that can be inhaled deep into the lungs. flavorants such as diacetyl, a chemical linked to serious lung disease. E-cigarette vapor potentially contains harmful substances not found in tobacco smoke. The majority of toxic chemicals found in tobacco smoke are absent in e-cigarette vapor. ... E-cigarette use by a parent might lead to inadvertent health risks to offspring.
Low doses may cause nausea, vomiting, abdominal pain, and eye irritation. High doses of nicotine may cause tachycardia, high blood pressure, seizures, coma, and death. Moreover, the FDA reported detecting ethylene glycol in some of the e-cigarettes and cancer-causing substances called nitrosamines in others. Nicotine in e-cigarettes may have several negative health effects. Chronic nicotine exposure may lead to insulin resistance and type 2 diabetes, although this risk may be offset by the well-known appetite suppressant effects of nicotine. Inhaled nicotine increases heart rate and blood pressure.
E-cigarettes, sometimes called vapes, run on batteries and heat up nicotine, flavorings, and other chemicals. They turn them into a vapor you can breathe in. Many chemicals that cause cancer are in this vapor. That includes formaldehyde, heavy metals, and particles that can get stuck in the deepest parts of your lungs. The chemicals found in e-cigarette liquid, known as "e-juice," may be a potential cause of popcorn lung. According to the American Lung Association, using electronic cigarettes or vaping, particularly the flavored varieties, can cause popcorn lung. ... However, e-cigarette vapor has been proven to contain diacetyl.
Regards
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