E-Cigarettes: Positive Smoking Substitute or a New Problem Replacing the Old?

May 4, 2012

By Michael Fergenson, senior editorial coordinator
The dangers of smoking cigarettes are well documented, from the terrifying commercials about what smoking does to our bodies to the warnings right on the pack. Yet the Centers for Disease Control and Prevention estimates that 45.3 million people in the United States smoke.
Now, a new trend in tobacco products has become the center of much debate. I’m referring to the electronic cigarettes, or e-cigarettes, that are gaining popularity as a smoking alternative and, for many, as a tool to quit.
I personally know two people who are using this device in an attempt to stop smoking. An article published in the New York Times last November reports that the number of Americans trying e-cigarettes “quadrupled from 2009 to 2010.” The article also cites the results of a  survey published in Tobacco Control last year, which found that 1.2% of adults, or close to 3 million people, had reported using these products in the previous month. But are e-cigarettes really a positive smoking substitute and aid to quitting?
How they work. Most e-cigarettes are shaped like a real cigarette, but some have a unique look. They work by heating up a liquid—purchased separately from the device—until it turns into an inhalable vapor. These liquids are available in a variety of flavors, scents, and levels of nicotine content. Some have no nicotine in them at all. Even though e-cigarettes don’t emit real smoke, they can’t be used everywhere—local governments can ban their use, as can private owners of buildings or transportation services. Because these products are fairly new, there’s no way to conclusively know whether or not they are healthier than cigarettes.
Proponents say that the vapor produced is as harmless as fog-machine smoke. The liquid usually contains five to 10 ingredients, all of which are licensed for human consumption and considered safe. This is compared to the more than 5,300 ingredients that have been identified in cigarette smoke, most of which are harmful. Most people use e-cigarettes as an aid to help quit cigarettes, but some just use them as an alternative nicotine delivery system.
What the critics say. One of the arguments against e-cigarettes is that it may lead to children smoking. Since the liquid packs come in many different flavors, this may appeal to a younger demographic. It would also be easier for teenagers to hide the fact that they are using e-cigarettes, since they don’t produce the tell-tale odor of tobacco smoke. There’s also a new “smart” cigarette pack, designed for use with e-cigarettes, that sets up a social network between smokers. Also seeming to target the younger demographic, this device connects wirelessly to social networking sites, and even flashes a blue light and vibrates when it detects another smart pack nearby.
The FDA’s Web site warns against the use of e-cigarettes, stating that they may contain ingredients that are known toxins (for example, diethylene glycol, an ingredient in antifreeze) or contain small amounts of nicotine or tobacco-specific byproducts even when listed as having no nicotine. The agency also says that there have been no clinical studies evaluating the product’s safety and efficacy. An analysis of the product carried out by the FDA’s Division of Pharmaceutical Analysis tested the liquid of two leading brands and found detectable levels of carcinogens and toxic chemicals that users could be exposed to. The report also notes that there are inconsistent or nonexistant quality control processes in the manufacturing of these products.  Read the full report here
Further questions were raised about the product this February, when an e-cigarette exploded in a man’s mouth. The man suffered severe burns, and lost his front teeth and a chunk of his tongue. Fire officials found that this was caused by a faulty battery. 

Nurses (editor's note... and oral health professionals!) can help. Only time will tell if e-cigarettes are safer than cigarettes and a viable option as an aid to quit smoking. In the meantime, nurses can help patients by being knowledgeable about these devices so they can provide accurate guidance regarding their use. By keeping up to date on e-cigarettes, nurses can offer informed advice when a smoker asks about using these devices as an aid for quitting smoking.


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