Contributor: Raul Seballos, MD
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The popularity of electronic cigarettes (e-cigs) has outpaced available scientific data – especially when it comes to answering two questions: Are they safe? Can they help people quit conventional cigarettes?
Now, a new analysis of 81 studies supports e-cigs as a safer alternative to conventional cigarettes, and there is some evidence that e-cigs may even help smokers quit, researchers say.
More people using e-cigs
This review article, published in Addiction, finds more people are using e-cigarettes, particularly those who already smoke conventional cigarettes.
Other research supports this finding. Earlier this year, the Centers for Disease Control and Prevention (CDC) reported that 1 in 5 U.S. cigarette smokers have tried the readily available e-cigs. In addition:
- E-cig sales have doubled every year since their introduction in 2007
- The $1.5 billion U.S. e-cig industry tripled its sales in 2013
- E-cig use also doubled among high school students, from 4.7 percent in 2011 to 10 percent in 2012
Researchers also compared the toxicant levels in both e-liquids and aerosols versus tobacco smoke. They found that e-liquids and aerosols were much lower in toxicants and that their carcinogen content was “negligible.” This is supported by a finding by Roswell Park Cancer Institute researchers. They reviewed 12 e-cig brands and found that toxicant levels were 9 to 450 times lower than in cigarette smoke.
While this may mean e-cigs are less harmful than conventional cigarettes, this does not mean they are carcinogen-free. Notably, some e-cigs emit different amounts of nicotine with each puff, perhaps due to inconsistency or lack of quality control in manufacturing.
Also, despite the finding in this analysis that humectants (such as propylene glycol) seem safe to inhale, repeated inhalation of propylene glycol or vegetable glycerin is known to cause airway irritation. No long-term data is available on the overall effects of e-cigs on the lungs. In particular, the effects in people with respiratory diseases are still unknown.
Can e-cigs help you quit smoking?
In this latest review, the authors recommend clinicians to support smokers who either aren’t able or willing to stop tobacco use and who wish to switch to e-cigs to reduce harm from smoking. Of note, two of the five authors have links to e-cig manufacturers. However, they say clinicians should continue to stress the importance of quitting cigarettes and nicotine altogether.
Other research supports the idea that e-cigarettes can reduce smoking urges and could help motivated smokers to quit. E-cigs have been shown to be as effective as nicotine inhalers in reducing both craving and withdrawals effects. Another study found that e-cigs may be comparable but were no more effective for smoking cessation than nicotine patches or placebo e-cigs after six months.
Whether e-cigs can safely help people quit smoking remains to be seen. Since e-cig manufacturers have not submitted an application to the FDA for their use in smoking cessation, e-cigs are not currently FDA-approved for such use
One concern is whether e-cigs may increase nicotine addiction among younger users. Flavored e-cigs have the potential to entice new smokers — especially students in middle school and high school. During 2011–2012, the number of U.S. middle and high school students who experimented and used ecigs doubled, resulting in an estimated 1.78 million students having ever used e-cigarettes as of 2012, according to the CDC.
Recently, the American Medical Association (AMA) requested tighter restrictions on the sale and marketing of e-cigarettes. The AMA’s recommendations include a minimum age of purchase; childproof packaging; restrictions on flavors that appeal to young people, and a ban on unsupported claims that the devices help people quit smoking. Preventing the marketing of e-cigarettes to minors is another priority, the AMA says.