E-cigarettes raise new questions about smoking


Battery-powered e-cigarettes deliver nicotine when a user takes a puff. (Reuters)
September 9, 2013

When a friend sitting at my kitchen table pulled out what looked like a cigarette, I was about to direct her to the front porch. But then I realized that what she was blowing was an odorless vapor, not smoke. It was an electronic cigarette.

Electronic cigarettes come in a variety of shapes and models, but most consist of a battery, a heating element, and a liquid that contains nicotine, propylene glycol and flavorings. The heating element warms and aerosolizes the liquid, turning it into a vapor the user inhales. Smoking an e-cigarette (called “vaping”), gives users a nicotine hit without exposing them, or those around them, to tobacco smoke. The lack of odor is one of the biggest selling points, says Craig Weiss, chief executive of NJoy electronic cigarettes.

Though e-cigarette makers do not make safety or health claims, many users assume that eliminating the smoke of burning tobacco also eliminates the harm. “There’s no question that e-cigarettes deliver fewer [toxic substances] than conventional cigarettes, but the question of how much less is still not clear,” says Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California at San Francisco. Though sales of e-cigarettes are expected to reach $1 billion this year, with many different brands available. vaping is new enough that there haven’t been many studies done yet — certainly none of the large-scale, randomized trials that would be necessary to offer conclusive answers about the safety of e-cigarettes, Glantz says.

While there’s little doubt that electronic cigarettes expose users to far fewer carcinogens and irritants than conventional cigarettes, the ingredients found in the liquids can vary greatly from product to product, says behavioral scientist Alexander Prokhorov at the University of Texas MD Anderson Cancer Center. “The companies improvise to come up with new flavorings and every time they introduce a new flavor, you don’t really know what’s in it,” he says. An analysis by researchers at the FDA found very low levels of nitrosamines, ethylene glycol and diethylene glycol — chemicals associated with cancer and other health risks — in some electronic cigarette products, but the levels were a tiny fraction of what a smoker would get from a tobacco cigarette.

Unlike tobacco cigarettes, electronic cigarettes aren’t currently subject to regulation in the United States, which means their ingredients aren’t standardized. The FDA is working on a proposed rule to regulate the devices, wrote agency spokesperson Jenny Haliski in a prepared statement. Though the FDA did not provide a timeline for regulation, Glantz suspects political pressure makes regulation unlikely to happen anytime soon.

For now, researchers are trying to get a handle on the risks and benefits of e-cigarettes. “It’s a new product, and there’s still a lot we don’t know,” says Pallav Pokhrel, a public health scientist at the University of Hawaii Cancer Center. For instance, it’s unclear what effects electronic cigarettes may have on smoking initiation among youth or cessation among current smokers.

Some electronic cigarettes allow users to adjust the amount of nicotine they’re getting, and even adjust it down to zero over time, and it seems plausible that a device that lets people reduce the amount of nicotine they’re consuming could help them cut their dependence, Prokhorov says. However, right now there aren’t good studies to show that they outperform existing nicotine cessation products, nor are they FDA-approved for this purpose.

Lauren Odum, a pharmacist at the University of Missouri at Kansas City, recently published a review of the scientific literature on using e-cigarettes to quit smoking. “We came up with a lot of anecdotal evidence from patients saying that these are very helpful, but it’s mostly surveys and the data is skewed, because people who have a positive experience are more likely to report back,” she says. “The ones who weren’t able to quit smoking were probably less likely to respond these surveys.”

Odum works at a smoking cessation clinic and says that patients have told her that e-cigarettes helped them quit or cut back on regular cigarettes. “One of the reasons that people like them is that they don’t have to stop the smoking habit,” she says. “They still get the hand-to-mouth motion and they still get the nicotine, which is the addictive component.”

Nick Capodice never wanted to stop smoking: “I really loved smoking. I loved the act of it, the taste of it — everything” says the Brooklynite. He had no intention of quitting. But after his father was diagnosed with cancer, Capodice spent three “miserable” months attempting to give up cigarettes, before giving up. He didn’t try vaping in hopes of quitting smoking altogether, but after a few e-cigarettes, he lost his urge for tobacco. He hasn’t smoked in more than 16 months and has tapered down the amount of nicotine he’s using in his e-cigarettes to zero.

But not everyone who uses e-cigarettes stops smoking — NJoy’s Weiss says that most of his company’s customers also use tobacco cigarettes — and some public health researchers worry that vaping may actually prevent some people from kicking their nicotine habit if it allows them to get their fix in circumstances where they can’t smoke. Another concern is that e-cigarettes might be a gateway to traditional cigarettes for kids, getting them hooked on nicotine, Prokhorov says. (A report last week by the Centers for Disease and Control found that use of e-cigarettes among middle and high schoolers doubled between 2011 and 2012, with about 1.78 million students having tried them, among whom 160,000 had never used conventional cigarettes.) Finally, people who would never smoke a regular cigarette might take up the habit if they think that electronic cigarettes are safe, says Odum.

But Richard Carmona, who crusaded against tobacco during his term as U.S. surgeon general from 2002 to 2006, views e-cigarettes as a potential tool for improving public health. About 20 percent of Americans smoke, and the number of smokers has hit a plateau, Carmona says. “We still need to do more research,” he says, but “this is the first thing I’ve seen in years that has promise for decreasing tobacco use in our country.” Carmona, who recently joined the NJoy board (it’s a paid position), says that the company is committed to conducting and publishing the research necessary to answer the important scientific questions that remain about e-cigarettes.


E-cigarettes growing in popularity among teens

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