Are e-cigarettes really less harmful than conventional cigarettes? Influential health organizations have stated that “electronic cigarettes are 95% safer than conventional cigarettes.” This claim originated from a single consensus meeting and associated publication without citing any specific evidence (Glantz & Bareham, 2018, Annual Review of Public Health).
The lack of hard evidence was generally ignored by those quoting this report, as well as potential financial conflicts of interest associated with individuals involved (Lancet 2015, E-cigarettes: Public Health England’s evidence-based confusion). Today, the electronic cigarettes safety claim stands in strong despite the 2019 epidemic outbreak with 2,290 cases of lung injury associated with the use of e-cigarette products in the United States (Center for Disease Control and Prevention Report).
The recent evidence suggests that e-cigarettes may pose their own unique health harms, and that comparison to cigarettes may not be the only relevant question for determining their impact on individual health.
What are electronic cigarettes?
Let us start with some basics. Electronic cigarettes are battery-powered devices that heat a liquid into an aerosol that the user inhales. E-cigarettes, as originally marketed in 2004, were developed in China as a less dangerous alternative to conventional cigarettes.
By 2014, all the major multinational tobacco companies had entered the e-cigarette market. Nowadays, they are available from various brands in various versions feature replaceable or refillable reservoirs and rechargeable batteries that generate smaller particles and more efficient nicotine delivery.
Users can buy the e-cigarette liquid separately, which has various nicotine levels and comes in a variety of flavors, with these refillable systems.
What are the health risks of e-cigarettes compared to regular cigarettes?
While vaping devices or electronic cigarettes, might be marketed as a safer alternative, they still pose health risks. The use of e-cigarettes has been linked to serious lung disease, especially among young adults. Recent studies have indicated that e-cigarettes produce an aerosol that can contain harmful chemicals not found in tobacco smoke. The long-term health effects are still being researched, but it’s essential to know that most contain nicotine, which has known health effects.
What is in the e-liquids and vapor apart from nicotine?
Because the majority of e-cigarettes contain nicotine, they are classified as tobacco products. However, vaporizing e-liquids at the heated coil not only ensures efficient nicotine delivery but also increases the amount of other vaporized chemicals, such as formaldehyde and other aldehydes produced naturally by heating up propylene glycol or vegetable glycerin, as well as other toxins produced in the e-cigarette aerosol.
Electronic cigarettes can additionally contain other harmful ingredients, including ultrafine particles that are inhaled deep into the lungs, volatile organic compounds, heavy metals, flavorants and other chemicals linked to serious lung diseases. At least 60 chemical compounds have been found in e-liquids, and still, more are present in the produced aerosol during vaping. The recent outbreak of vaping related lung injuries also supports caution with respect to e-cigarettes and e-liquids.
What are the health effects of vaping?
While e-cigarettes may contain fewer toxins than combustible cigarettes, short and long-term effects of their use are unclear. Most discussion regarding the health effects has focused on cancer, for instance, the formation of the nicotine-delivered nitrosamines potent lung carcinogen NNK (known as nicotine-derived nitrosamine ketone).
E-cigarettes also adversely impact the cardiovascular system, though the specific role of nicotine in cardiovascular disease remains debated. Nicotine, however, is not the only biologically active component in produced aerosol. Overall, evidence consistently indicates that exposure to aerosol has adverse effects on lungs and pulmonary function.
Repeated exposure to acrolein, which is produced by heating the propylene glycol and glycerin in e-liquids, causes chronic pulmonary inflammation, reduction of host defense, neutrophil inflammation, mucus hypersecretion, and protease-mediated lung tissue damage, which are linked to the development of chronic obstructive pulmonary disease.
How do e-cigarettes affect the health of young adults and youth?
E-cigarette use among youth and young adults has become a significant public health concern. These devices contain nicotine, which can harm the developing adolescent brain and lead to addiction. The Centers for Disease Control (CDC) and the Department of Health and Human Services have expressed concerns about the rising e-cigarette use among youth. Harmful chemicals found in vapor can have lasting health consequences, especially for the respiratory health of young users.
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Why are people using e-cigarettes?
Adults cite predominantly three reasons for trying and using e-cigarettes:
- as an aid to smoking cessation,
- as a safer alternative to conventional cigarettes,
- and to get around smoke-free laws.
Initial hopes that e-cigarettes would be both a less toxic competitor to conventional cigarettes and a help to people who attempt to quit smoking cigarettes have not translated into real-world positive effects. Instead, they have simply become another class of tobacco products that are maintaining and expanding the tobacco epidemic.
In addition, electronic cigarettes also became very popular with young people. Their use has grown dramatically in the last years. Today, more high school students use e-cigarettes than regular cigarettes and therefore, the use of e-cigarettes is higher among high school students than adults. The propagation of well-established marketing themes including freedom, good taste, romance, sexuality, and sociability as well as messages claiming that e-cigarettes are healthy, provide convincing reasons for adults and youth to start using e-cigarettes.
Who is regulating the e-cigarette market?
The legal status of e-cigarettes is currently pending in many countries. In some countries, the use of e-cigarettes is banned. In other nations, the e-cigarettes are regulated in some way. In 2016, the FDA finalized its regulation, asserting the agency’s authority to regulate e-cigarettes and any product meeting the definition of “tobacco product” under the Tobacco Control Act.133. To protect human health, and to meet the obligations of the European Union under the WHO Framework Convention on Tobacco Control, the Tobacco Products Directive 2014/14/EU (TPD) in Article 20, contains rules for nicotine-containing electronic cigarettes and refill containers. The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for implementing the majority of the provisions under Article 20, including the restrictions on the nicotine strength of no more than 20 mg/mL.
How to analyze and characterize e-cigarette liquids?
Common technologies that can be used for the qualitative and quantitative assessment of e-cigarette liquids are liquid chromatography (LC) and gas chromatography (GC). Quantitative assessments of current analytical technologies for e-liquids include LC and GC coupled to both analog detectors (GC-FID, LC-UV) as well as mass spectrometry (MS). They are, therefore, the instruments of choice in routine analysis. Whereas a high-resolution accurate mass (HRAM) approach — for instance the Orbitrap technology — is able to provide both confident compound quantification and identification of unknown or unexpected compounds in e-cigarette liquids. This technique is therefore is in particular useful in research.
Even if vaping can help people quit smoking cigarettes, it has not been certified as safe and effective by the FDA, and there is no evidence that it works in the long term. Because e-cigarettes have been on the market for only a few years, the long-term population health effects are not known. To minimize harm, e-cigarettes should be regulated like other tobacco products.
In conclusion
While e-cigarettes are potentially less harmful than smoking cigarettes, they are not risk-free. The aerosol from e-cigarettes can contain substances like formaldehyde and acrolein. It’s essential to be informed about the potential risks and health effects of e-cigarettes before making a decision to use them.
Recommended Resources
Webinar – Orbitrap GC-MS – Unknowns discovery workflows for the characterization of e-cigarette liquids
Webinar – Use of LC-MS/MS for testing of nicotine in e-cigarette vapors
Application Note (AN 10708) – Comprehensive chemical characterization of e-cigarette liquids using high-resolution Orbitrap GC-MS
Technical Note (TN 10709) – A simplified approach for nicotine quantification in electronic cigarette liquids using GC-Orbitrap …
References:
- Stanton A. Glantz and David W. Bareham 2018 E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications. Annual Review of Public Health.
- McNeill A, Brose LS, Calder R, Hitchman SC, Hajek P, McRobbie H. 2015. E-Cigarettes: An Evidence Update. A Report Commissioned by Public Health England.
- Grana R, Benowitz N, Glantz SA. 2014. E-cigarettes: a scientific review. Circulation 129:1972–86
- 2016. E-cigarettes. Updated July 5, Univ. Bath, Bath, UK.
- US DHHS (Dep. Health Hum. Serv.). 2016. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta: Dis. Control Prev., Natl. Cent. Chronic Dis. Prev. Health Promot, Off. Smok. Health.
