E-Cigarettes May Be Unsafe

This week, the American Heart Association (AHA) and the World Health Organization (WHO) released official statements on electronic cigarettes, or e-cigarettes, in light of their rapid rise to popularity. Recommendations include increased oversight as well as further research into whether the devices are safe for use.

In just a decade, tobacco control efforts cut the youth smoking rate in half. Still cigarettes kill half a million Americans each year and cause smoking-related illnesses in another 16 million. A new smoke-free alternative to traditional cigarettes is causing concern among health advocates who fear their efforts may soon be reversed.

E-cigarettes are battery-powered devices that have cartridges containing a liquid mixture used to simulate tobacco smoking through an aerosol resembling smoke. The concept of e-cigarettes first emerged in 1965 with a later version entering the U.S. marketplace in 2007. Currently, there are 466 brands of e-cigarette products on the market. Although widely available online and in retail outlets around the world, they are more likely to be found in areas with higher median household income and a lower percentage of black and Hispanic residents compared to traditional cigarettes. Sale of e-cigarettes is prohibited in Australia, Brazil, Canada, Mexico, Singapore, and Switzerland. Predictions estimate that e-cigarettes could surpass traditional cigarettes in profits by 2017, with many large tobacco companies purchasing smaller e-cigarette manufacturers including Philip Morris, one of the world’s largest tobacco companies.

E-Cigarette use on the rise

With millions of users and nearly $2 billion in annual sales, many organizations and governments are taking a serious look at the potential uses and harm of e-cigarettes. The AHA’s recommendations, published in the journal Circulation, amounted to a mixed bag of possibilities ranging from potential use in cessation to a dangerous gateway drug. However, on the topic of regulation, they delivered a clear message: regulate e-cigarettes with the same rules applied to conventional cigarettes.

A Concerning Future

Some of the greatest concerns expressed by the AHA were around the potential of e-cigarettes to effectively serve as recruitment for new smokers. With an array of flavors and heavy marketing, researchers found that teen use is on the rise. Adolescents surveyed said they consider the device high-tech, accessible and convenient– especially in places where smoking is prohibited. The association and the WHO are hoping to see restrictions on the sell and marketing to minors. A recent study found that youth exposure to e-cigarette advertising rose 250 percent in just two years, and now reaches roughly 24 million young people.

Researchers from the U.S. Center for Disease Control and Prevention found that the number of nonsmokers who used e-cigarettes jumped from 79,000 in 2011 to 263,000 in 2013. Even more troubling, nonsmoking children who used e-cigarettes were nearly twice as likely to have intentions to start smoking conventional cigarettes compared to those who never used e-cigarettes. Given nicotine’s harmful effects on developing brains, including lasting cognition and memory deficiencies, experts are concerned about the addictive nature which leads three-quarters of teen smokers to become adult smokers. “We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes or other tobacco products. Not only is nicotine highly addictive, it can harm adolescent brain development,” said Dr. Tim McAfee, director of CDC’s Office on Smoking and Health. These findings come from an analysis of data from the 2011 to 2013 National Youth Tobacco surveys of students in grades 6-12 in the United States.

Nicotine in most e-cigarettes is somewhere between 6-24mg, with regular cigarettes containing about 10-15 mg and delivering a dose of only 1 mg. Testing showed a lack of accuracy in the advertised nicotine content in e-cigarettes, adding evidence that oversight is needed. Additionally, the extent to which nicotine is absorbed through e-cigarettes is also unknown. However, there have been isolated instances of poisoning and death. The number of calls to poison control centers due to e-cigarette concerns rose from once a month in 2010 to 215 per month in 2014, which includes more than half concerning children under 5 years old.

The Debate over E-Cigarettes

While experts believe e-cigarettes to possess many harmful properties, the AHA did find some potential benefits. They suggest that it may be helpful for smoking cessation in rare cases when other methods have failed. Additionally, e-cigarettes may have fewer health impacts on asthmatic smokers. Still, the AHA hopes to see e-cigarettes included in smoke-free air laws in ways that will not weaken existing laws. Some studies have actually found that bystanders have greater exposure to toxins from e-cigarettes compared to tobacco smoke.

There is debate surrounding the health effects of vaping, as some call it, and it may take years to determine whether it causes cancer or other deadly illnesses. The U.S. smoking cessation website smokefree.gov states in no uncertain terms: “The bottom line is that we just don’t know enough about e-cigs, so we don’t recommend that you use them. There are other quit aids, with or without nicotine, that have been proven to be safe and effective at helping people quit smoking. But if you do choose to use an e-cig, we recommend that you be very careful!”

e-cigarettes - E-Cigarettes come in many flavors, which are often targeted at youth (Photo Credit: Lindsay Fox / ecigarette reviewed).

The Food and Drug Administration recently proposed treating e-cigarettes as tobacco products. The American Medical association and attorneys general from two dozen states requested that the agency also ban flavors — which increases appeal to youth as well as wider audiences. This is in line with the WHO’s recommendation that flavors be banned until proof is provided that it does not attract adolescents. Some flavors include bacon and bubble gum. (Photo Credit: Mr. Good Vape E-Juice selection [2013-11-24; Lindsay Fox, flickr]).

“Over the last 50 years, 20 million Americans died because of tobacco. We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers,” Nancy Brown, CEO of the American Heart Association (AHA), said in an association news release regarding the appeal of e-cigarettes to teens.


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The Michelson Medical Research Foundation‘s Groundwork blog is brought to you thanks to the generous support of Dr. Gary K. Michelson and his wife, Alya Michelson.
The Michelson Medical Research Foundation‘s Groundwork blog is brought to you thanks to the generous support of Dr. Gary K. Michelson and his wife, Alya Michelson.
The Michelson Medical Research Foundation‘s Groundwork blog is brought to you thanks to the generous support of Dr. Gary K. Michelson and his wife, Alya Michelson.
The Michelson Medical Research Foundation‘s Groundwork blog is brought to you thanks to the generous support of Dr. Gary K. Michelson and his wife, Alya Michelson.