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Health effects of e-cigarettes

June 21, 2013
Publicized as a safer alternative to traditional smoking, electronic cigarettes are supposed to give smokers a nicotine fix without the cancer-causing side effects of tobacco. But some people have serious concerns that the battery-operated devices may actually pose more dangers to users than traditional smoking. Maria Perno Goldie, RDH, MS, examines what’s known about the health effects of e-cigarettes.
Over the past few years, innovations in nicotine delivery have enabled smokers to obtain their nicotine without the carcinogens found in cigarette smoke. Electronic cigarettes are becoming very popular, as they have the look and feel of real cigarettes. Publicized as a safer alternative to traditional smoking, electronic cigarettes are supposed to give smokers their nicotine fix without the cancer-causing side effects of tobacco. However, there are some serious concerns that the battery-operated devices may actually pose more dangers to users. There are many things we have yet to determine about the possible impact of electronic cigarettes on the health of the public.

E-cigarettes are battery-powered devices that convert nicotine into vapor.(1) The products are sold over the counter and are not subject to the same regulation as actual cigarettes. A 2011 survey showed that about 21 percent of smokers had used e-cigarettes at least once up from about 10 percent of smokers who took the same Web survey in 2010, according to a Centers for Disease Control and Prevention (CDC) study published online in February in Nicotine & Tobacco Research.(2,3)

About 7 percent of smokers who received the same survey in 2010 via postal mail also said they had tried e-cigarettes at least once. The Food and Drug Administration announced that the agency plans to propose regulating e-cigarettes as a tobacco product.(4)

The health risks associated with smoking are many. Each year, 430,000 Americans die of smoking-related illnesses, more than all American deaths in wars in the 20th century combined; around the world, 5 million people die each year.(4) A common misperception is that nicotine is a carcinogen, and it is not. Rather, the 7,000 other chemicals in combustible cigarettes, at least 70 of which are known carcinogens, are responsible for tobacco-related death and disease. At its core, the cigarette continues to use the same 5,000-year-old technology, fire, to deliver nicotine as well as a host of cancer-causing compounds.(4) In June 2009, President Obama signed into law the Family Smoking Prevention and Tobacco Control Act, which gave the FDA’s Center for Tobacco Products the authority to regulate the manufacture, labeling, distribution and marketing of tobacco products. However, it does not encompass electronic nicotine-delivery devices, including e-cigarettes. (5)
According to the American Lung Association, some manufacturers and retailers of e-cigarettes claim these products are healthier than normal cigarettes and can help you quit smoking. However, in the absence of scientific evidence to support those contentions, it's best to avoid e-cigarettes until more research has been done.(6) Their advice, if one is trying to quit smoking, stick with proven, FDA-approved stop-smoking strategies. Not everyone agrees with the American Lung Association. While the nicotine abstinence approach may be the ideal, it simply does not reflect the reality that 80% of smokers do not even wish to quit in the immediate future. Some ask that it might make sense to encourage those smokers to switch to a less harmful alternative until more research is completed.(7) Hopefully the upcoming FDA ruing will help with those decisions.

Currently, e-cigarettes that are marketed for therapeutic purposes are regulated by the FDA Center for Drug Evaluation and Research (CDER). The FDA Center for Tobacco Products (CTP) currently regulates: cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. FDA has stated its intent to issue a proposed rule that would extend FDA’s tobacco product authorities to products that meet the statutory definition of “tobacco product.”

For further details, please see the Unified Agenda entry describing this rulemaking.(8)

1. McGill N. Research on e-cigarettes examining health effects: Regulations due.
2. King BA, Alam S, Promoff G, Arrazola R, and Dube SR. Awareness and Ever Use of Electronic Cigarettes Among U.S. Adults, 2010–2011. Nicotine Tob Res. First published online February 28, 2013.
3. Centers for Disease Control and Prevention. Quitting Smoking Among Adults—United States, 2001–2010. Morbidity and Mortality Weekly Report 2011; 60(44):1513–19 [accessed 2013 June 17].

Maria Perno Goldie, RDH, MS

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