7 Common Questions About E-Cigarettes

Wednesday, March 19, 2014
Bill Bowerfind, MD

What is an e-cigarette?

Known by many names, the electronic cigarette (e-cigarette, electronic vaping device, personal vaporizer, digital vapor device) is, at its most basic level, an electronic nicotine delivery system or ENDS.  They are battery powered or USB rechargeable devices designed to simulate tobacco smoking.  The size and shape of cigarettes, they have a heating element, or atomizer, that vaporizes liquid in a small chamber or cartridge, producing a vapor that is inhaled.  Some of the vapor is also exhaled, giving the impression of “smoke”.  Most also have a tip that lights up during inhalation to further simulate the ash of a conventional cigarette. 

What is in the liquid and vapor?

The liquid nearly universally contains nicotine, the highly addictive chemical responsible for life-long habitual smoking. The vapor commonly contains potentially harmful substances including propylene glycol and glycerin.  Some (certainly not all) have been found to contain arsenic, lead and carcinogens.

Are they safe?

Compared to what? There is significant debate about the safety of e-cigarettes. While e-cigarettes are undoubtedly safer than their tobacco containing counterparts (which are known to contain more than three dozen carcinogens and more than two thousand other chemicals), significant health concerns persist. Currently the FDA has not acted to regulate e-cigarettes so there are no standards regarding quality and safety of the liquid and resultant vapor.   E-cigarettes from different vendors vary widely in the amount of nicotine and other chemicals they contain. The long term effects of continued exposure to many of the substances are unknown.  Studies have shown that exposure to e-cigarettes causes a narrowing of the airways which could be harmful to individuals with certain respiratory diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD).  The use of e-cigarettes invites a potential for life-long nicotine addiction.  However, it must be stated that the majority of these potentially harmful effects are far less damaging than equivalent exposure to conventional cigarette smoke. There is the second-hand component of the vapor to contend with and we simply do not know enough at this point to reassure the public that the vapor is safe.

The World Health Organization recommends that “consumers should be strongly advised not to use” e-cigarettes until more is known about their long-term safety.

Will they help me quit smoking?

With the rising popularity of electronic cigarettes, many current tobacco smokers are wondering if e-cigarettes might be their ticket to becoming smoke-free.   There is sparse data to support the use of e-cigarettes for smoking cessation. In my opinion, they do not offer a substantial departure from the habitual behaviors of smoking.  The oral and tactile component of smoking persists as one holds and manipulates the “cigarette” and continues to puff.  It provides an all too easy transition back to conventional tobacco cigarettes.  I caution patients that when the battery dies or they run out of vapor with a dry cartridge it will be much easier and less expensive to “bum” or buy a tobacco cigarette, thus “reigniting” the addiction.

Are they a step in the right direction for public health?

E-cigarette companies are marketing their product as an effective and fashionable nicotine delivery device designed to enable and promote nicotine addiction in current smokers and, more importantly, and of greater concern, to nonsmokers and youths.  I have grave concerns about e-cigarettes from a public health perspective.  E-cigarette use among youths has doubled in the last year. The nicotine cartridges come in a variety of candy and fruit flavors specifically designed to appeal to children.  The devices themselves are made in an array of colors and materials, fostering an element of intrigue and individualization popular amongst kids.

E-cigarettes are marketed to be smoked like traditional tobacco cigarettes with the “advantage” that they might be used indoors and in venues where traditional cigarettes are now prohibited.  This is leading to a re-normalization of smoking and threatening to undo decades of progress in reducing smoking rates, particularly in youths.  This, I fear is the greatest danger of the popularity of e-cigarettes

Should I try an e-cigarette?

That depends.  In most cases, my answer is a clear no.

If you are a current nonsmoker then my answer is clear:  ABSOLUTELY NOT!  Even if they are safer than their tobacco counterparts, they still may pose a significant health risk and clearly put one at risk of lifelong nicotine addiction. 

If you are a current smoker and motivated to quit then my advice would be: No.  Currently, we do not know enough about the potential for e-cigarettes to help in smoking cessation. Lastly, I feel very strongly that e-cigarettes model dangerous smoking behavior to impressionable children and teens.   They threaten to normalize deadly smoking behavior and act as a “gateway” to nicotine addiction and tobacco use.

If you are a current smoker who is unwilling to quit smoking tobacco or who has been unable to quit with despite a desire to do so and despite medical counseling and the use of other pharmaceutical methods, then ABSOLUTELY YES, try the e-cigarette.  Particularly if you are suffering from lung disease, heart disease or other smoking-related illness.  This population may have much to gain and little to lose.  While they will, most likely, perpetuate their nicotine addiction they will, at least, be spared ongoing exposure to several dozen cancer-causing agents and scores of other harmful compounds so clearly damaging to their health.

However, there are many other PROVEN methods of smoking cessation for the individual who is motivated to quit smoking.  In addition to a strong desire to quit, counseling from your provider coupled with nicotine replacement (with patches, gum or lozenges), or other pharmacologic agents (such as Chantix or Zyban) can help to improve success in quitting tobacco.  We, at The Oregon Clinic, want to help you to quit.  Please talk to your doctor or other health care professional for tips on smoking cessation.