By Erin Golden
At first glance, the e-cigarette (electronic cigarette electronic nicotine delivery systems (ENDS) could seem like a cleaner, safer alternative for smokers looking to avoid the nasty risks that come with the real thing.
But experts say swapping smoking a regular cigarette for inhaling the vapor from the electronic version doesn’t exactly clear the air — or help people kick the habit. Amid increasing concerns about the potential for poisoning and uncertain findings on the toxins inhaled by e-cigarette users, doctors say one thing is clear: the e-cigarette trend isn’t making us healthier.
Designed to look and feel like regular cigarettes, e-cigarettes are a smoke-free, tobacco-free means of delivering nicotine through vaporization. E-cigarettes contain a cartridge of liquid nicotine that is packaged with liquid vegetable fat and flavoring. The device’s built-in batteries heat the liquid nicotine, turning it into vapor that is inhaled by the user. (That is why smoking e-cigarettes is often called “vaping.”) Though they’ve been around for more than a decade, e-cigarettes have become increasingly popular in the U.S. over the last few years, with global sales expected to hit $27 billion by 2022, according to a recent study.
Starting Aug 1, 2016, the FDA can now regulate all all tobacco products, including e-cigarettes, cigars, and hookah and pipe tobacco.
It extends the FDA’s regulatory authority to all tobacco products, including e-cigarettes, all cigars, hookah or waterpipe tobacco, pipe tobacco, nicotine gels, and dissolvables that did not previously fall under the FDA’s authority.
There must now be health warnings on roll-your-own tobacco, cigarette tobacco, and certain newly regulated tobacco products and also bans free samples. In addition, because of the rule, manufacturers of newly regulated tobacco products that were not on the market as of February 15, 2007, will have to show that products meet the applicable public health standard set by the law. Any of those manufacturers will also have to receive marketing authorization from the FDA.
The new rule also restricts youth access to newly regulated tobacco products by: 1) not allowing products to be sold to those younger than 18 and requiring age verification via photo ID; and 2) not allowing tobacco products to be sold in vending machines (unless in an adult-only facility).
While doctors are quick to say that inhaling the vapor generated by e-cigarettes isn’t good for you, they do acknowledge that it contains fewer chemicals than you’d find in a typical cigarette.
Stanton Glantz, MD, the director of the Center for Tobacco Control, Research and Education at the University of California, San Francisco, said that’s because of the way those toxic chemicals get to your lungs. When a cigarette burns, it creates an aerosol of ultrafine particles that carries nicotine through a person’s airway into the lungs where it gets absorbed into the bloodstream. That process creates more than 7,000 chemicals — including 69 known to cause cancer, according to the American Lung Association. The lineup includes arsenic, carbon monoxide, formaldehyde, lead and tar.
Heating up an e-cigarette, on the other hand doesn’t require the combustion that gets a regular cigarette burning. “Overall, you’re getting much less bad stuff,” he said.
How much, however, is up for debate. Dr. Glantz said e-cigarette enthusiasts might claim that the percent of toxins you breathe in is just a single-digit percent of what you get from typical smoking — but he believes it’s considerably higher.
Plus, e-cigarettes don’t remove the risk of secondhand exposure to others who happen to be nearby. Even without smoke, the chemicals in the vapor emitted by e-cigarettes can amount to a harmful irritant.
“If I had asthma or allergies, being exposed to that vapor could potentially cause me some harm,” said Daniel Neides, MD, medical director of Wellness Institute at the Cleveland Clinic.
Dr. Neides said his institution — and an increasing number of others — treat e-cigarette use just like any other form of smoking: smoking e-cigarettes is banned anywhere smoking is banned because of the risk to others.
As researchers try to pin down the specifics of both firsthand and secondhand risks, Dr. Glantz said the biggest hazard is already clear.
“The real issue with these cigarettes, the real health effect, is they keep people smoking regular cigarettes,” he said.
In fact, Dr. Glantz said, studies aimed at figuring out how well e-cigarettes work as a tool to help people quit smoking have shown that there’s actually a negative association. In other words, people who take up e-cigarettes are actually less likely to have stopped smoking after a year, when compared to those who didn’t dabble with e-cigarettes.
Dr. Neides said he’s particularly troubled with the marketing tactics used by makers of e-cigarettes. With flavors like bubble gum and Captain Crunch, he said it’s clear the companies are going after a specific market: young people.
While the federal government now bans companies from making flavored cigarettes because of their marketability to children and teenagers, it doesn’t have as much reach over the e-cigarette market. And the proposed regulation by the FDA does not address flavored e-cigarettes, a point of much criticism by e-cigarette opponents.
Dr. Neides believes it’s crucial to turn kids off to the idea of e-cigarettes before those products turn them on to smoking.
“(Cigarette companies) are directly marketing to young children as a means to get them from e-cigarettes to regular cigarettes,” he said. “Period.”
Lack of regulatory oversight has a number of major health organizations worried for another reason: A growing number of reports of poisonings related to accidental ingestion of the liquid in e-cigarettes.
Recently, a group that included the American Cancer Society, American Lung Association and the Campaign for Tobacco-Free Kids sent a letter to the White House pushing for FDA oversight of e-cigarettes.
In their letter, the organizations point to new data from the National Poison Data System that shows the rate of “e-liquid” poisonings tripling between 2012 and 2013. The Centers for Disease Control and Prevention recently reported that calls to poison centers for e-cigarette exposure poisonings is climbing steadily — from one call in September 2010 to more than 200 in February 2014.
Meanwhile, the American Lung Association noted that e-cigarette containers aren’t marked with poison symbols. Instead, the group said, they’re often labeled with pictures of fruits and smell like fruits — creating big risks for curious kids.
The group said poison centers reported that about half of all calls about e-cigarette poisoning involved a child under the age of six.
Published April 28, 2014. Medically reviewed and updated October 3, 2018.
Erin Golden is a writer based in Nebraska. She is a graduate of Northwestern University’s Medill School of Journalism.
Joseph Palermo, D.O.
Board Certificate: Internal Medicine/Geriatric Medicine
Reviewed on 10/3/18
Statistics have been verified
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