E-cigarettes: The lesser of two evils

Many smokers have made the switch to e-cigarettes in order to reduce the negative health effects of cigarette smoking while maintaining the social aspect of being a smoker, but there is little research regarding toxicant exposure and effects of e-cigarettes. The question remains: Are e-cigarettes just as bad?

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Worldwide, people are increasingly being exposed to electronic cigarettes, whether by choice or by proximity. Many smokers have made the switch to e-cigarettes in order to reduce the negative health effects of cigarette smoking while maintaining the social aspect of being a smoker, but there is little research regarding toxicant exposure and effects of e-cigarettes. Numerous e-cigarette brands and options are not manufactured or distributed by the tobacco industry or by the pharmaceutical industry; they are obtained widely throughout the United States and Europe in retail stores or online.

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How they work
The elusive e-cigarette uses heat from the battery to produce a vapor that can be inhaled by the user. The product is designed to look like a traditional cigarette and simulates the visual, sensory, and behavioral aspects of smoking traditional cigarettes.

Nearly as bad as the real thing?
While it is implied that smoking e-cigarettes is not as bad as smoking the real thing, there are still adverse health effects. The cartridge of the e-cigarette contains nicotine, though the content can vary from 0mg to 18mg (the manufacturer is not required to identify the exact amount). It is found in the tobacco plant and has been used as an insecticide in the past. Along with the drastic life-threatening effect on the lungs and smoker’s cough due to increase in phlegm, some of the other remarkable effects are an increase in saliva, sweating, heart rate, and blood pressure. Nicotine also increases metabolism, which could hinder a person’s willingness to quit for fear of gaining weight. It stimulates memory and alertness, which could lead to people depending on it to aid in accomplishing certain tasks and performing well. It’s also well known that it is highly addictive. Within only a matter of two to three hours of a person’s last ingestion or decrease in nicotine, a person experiences withdrawal symptoms of increased appetite, headaches, depression, drowsiness, trouble sleeping, and nightmares. Significant anxiety with a feeling of restlessness, tenseness, and frustration are experienced as well.

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E-cigarettes also contain guaiacol, which is added as a flavoring and aroma agent. Guaiacol is derived from guaiacum or wood creosote and is used chiefly as an expectorant, a local anesthetic, and an antiseptic. Cotinine is added to assist in metabolism of nicotine. It has also been sold as an antidepressant. The antidepressant effect creates a vicious cycle that does not help with smoking cessation due to the user becoming depressed when the effect of cotinine has worn off; therefore, the user lights up again to feel better.

Propylene glycol, the primary ingredient in e-cigarettes that allows for viscosity control, is used in several pharmaceutical and personal care products. Although the Food and Drug Administration recognizes it as safe, it has been associated with contact dermatitis, urticaria, possible respiratory depression, arrhythmias, hypotension, and seizures.

The FDA has targeted potential carcinogens in e-cigarettes: tobacco-specific nitrosamines and diethylene glycol (DEG). Nitrosamines exhibit tumor effects through any route of administration (pulmonary, oral, esophagus, nasal, and trachea). DEG, added for its sweet flavor, is also used in a variety of industrial products and has been involved in a number of prominent mass poisonings spanning back to 1937. According to Schep et al (2009) “despite DEG’s toxicity and associated epidemics of fatal poisonings, a comprehensive review has not been published.”

Regulating e-cigarettes in public places
Electronic cigarette use is not currently regulated the way cigarette smoking is. Currently there are no federal regulations banning the use of e-cigarettes in public spaces or businesses. It is generally up to the individual property or business owner to determine whether e-cigarette use is prohibited. Many large cities such as Los Angeles, New York, and Chicago are planning ordinances to either classify e-cigarettes the same as cigarettes or to impose separate specific regulations. In a November 2013 New York Post article describing the proposed New York ban, opponents point to more difficult enforcement of current smoke-free laws and limited data on the long term effects of exposure to electronic cigarette vapor as reasons for needing the ban. As it stands right now, a large percentage of work places, restaurants, and other businesses allow e-cigarette use, as they are just not sure how to proceed and are watching and waiting for more concrete ordinances to evolve.

In conclusion
How effective are e-cigarettes for the cessation of smoking? The data points to the e-cigarette being a more effective cessation method than other cessation programs such as patches or gums; as the e-cigarette maintains the physical, behavioral and social aspects of smoking conventional cigarettes, making a smoother transition with less withdrawal. But the data appears to correlate that while the aerosol produced by e-cigarettes is generally less toxic than the smoke created by burning and inhaling conventional tobacco products, it still carries a number of side effects. However, they appear to be minor compared to the long-term serious conditions associated with smoking, such as cancer and stroke. This data points to e-cigarettes as having more application as a smoking cessation device than as a harmless recreational activity. It appears to be the lesser of two evils and has valid use as a smoking cessation tool but will still cause symptoms similar to, although generally milder than, smoking in new users.

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