Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

E-Cigarettes

 

 

Electronic Cigarettes (E-Cigarettes or E-cigs) or Electronic Nicotine Delivery System (ENDS):

  • Are battery-powered devices designed to look similar to cigarettes in shape, size, and general appearance.
  • Operate by vaporizing a solution containing nicotine, creating a mist that is then inhaled.1
  • Are available in various flavors, such as vanilla,2 menthol,2 and pina colada2.
  • Nicotine cartridges contain various levels of nicotine, anywhere from 6-48 mg. This is significantly more nicotine compared to the typical range of 0.5-1.2 mg of nicotine in a single cigarette.1
  • The act of puffing an e-cigarette is often referred to as “vaping”.

 

E-Cigarette Components

Source: Tobacco-Free Partnership of Levy County. Frequently-Asked Questions About E-Cigarettes. 

Current awareness of e-cigarettes3:

  • Adult awareness of e-cigarettes has nearly doubled from 40.9% in 2010 to 79.7% in 2013 (awareness of e-cigarettes was assessed by asking, “Which, if any, of the following products have you heard of”? Those who selected e-cigarettes were considered to be aware)
  • Women are less likely to be aware than men
  • Non-Hispanic Blacks less likely to be aware than non-Hispanic Whites
  • Current smokers more likely to be aware than never smokers

Ever use of e-cigarettes3:

  • Nearly 1 in 10 adults have tried these products
  • Ever use of e-cigarettes has increased from 3.3% in 2010 to 8.5% in 2013
  • Ever use of e-cigarettes is higher among current smokers than former or never smokers

Current use of e-cigarettes3:

  • Despite controversy about their health effects4, e-cigarette use is on the rise
  • Current use of e-cigarettes has increased from 1% in 2010 to 2.6% in 2013
  • Among current cigarette smokers, current e-cigarette use increased from 4.9% in 2010 to 9.4% in 2013
    • ​Among ever e-cigarette smokers, 63.4% were current smokers in 2013
    • 76.8% of current e-cigarette users are current cigarette smokers compared to 72% in 2010

Are e-cigarettes regulated?5

  • Currently, only e-cigarettes marketed for therapeutic use are FDA-regulated. However, currently there are no e-cigarettes approved by FDA for therapeutic uses, therefore they cannot be recommended or marketed as a smoking cessation aid.6
  • FDA has recently proposed a rule to extend their regulatory authority to additional products, including e-cigarettes. This rule is still under the process of review and finalization.5   

Are e-cigarettes safe?

Currently, the research concerning the safety of electronic cigarettes is ambiguous.

  • E-cigarettes do not produce smoke like conventional cigarettes.7 Although the long-term effects of e-cigarette use are not known, current research indicates that e-cigarettes are likely safer than conventional cigarettes.3
  • Some toxins (e.g., nitrosamines, formaldehyde, and diethylene glycol) have been found in e-cigarettes indicating they may not be harmless.7-9
  • Other studies have found a correlation between conventional cigarette use and e-cigarette use.10-11 This suggests that some may not use e-cigarettes to quit conventional cigarette use, since the majority of e-cigarette users are also current smokers, which has a number of well-documented health risks.

Possible Benefits:

  • Some research indicates that e-cigarettes can help individuals cut down or quit smoking conventional cigarettes.12-14
  • In 2010, an online survey was conducted to determine possible electronic cigarette use patterns and the effectiveness of electronic cigarettes as a smoking-cessation tooll.
  • Results of the study indicated that more frequent use of e-cigarettes was associated with a number of positive outcomes:
    • ​Less cigarette smoking (66.8% of participants)
    • Longer periods of abstinence from cigarette smoking (48.8% of participants)
    • Increased likelihood of quitting cigarettes if e-cigarette use was >20 times per day (70% of participants)

Possible Disadvantages and Concerns4:

  • Potential initiation of nicotine addiction in adolescents
  • Potential progression to combusted tobacco use among non-tobacco users
  • May lead to long-term co-morbid use of e-cigarettes and conventional cigarettes among current smokers
  • May lead to relapse to cigarette smoking among current cigarette smokers

Conclusions:

  • More research is needed on electronic cigarettes.
  • The field of tobacco research has begun to examine the utility and health effects of these products, but is only at the beginning.
  • To date, research has not shown consistent findings that these products are safe and able to reduce cigarette consumption. 
References: 

1 Kuschner, W.G., Reddy, S., Mehrotra, N., & Paintal, H.S. (2011). Electronic cigarettes and thirdhand tobacco smoke: Two emerging health care challenges for the primary care provider. International Journal of General Medicine, 4, 115-120. doi: 10.2147/IJGM.S16908.

 

2 blu Cigs (2014). blu Rechargeable Pack, Original and Premium Electronic Cigarette Flavor Cartridges. Retrieved from: http://www.blucigs.com/cartridges.

 

3 King, B.A. et al. (2014). Trends in Awareness and Use of E-Cigarettes Among Adults, 2010-2013. Nicotine and Tobacco Research. Advance online publication.  doi: 10.1093/ntr/ntu191

 

4 Sutfin, E.L., et al. (2013).  Electronic cigarette use by college students. Drug & Alcohol Dependence, 131, 214-221.

 

5 U.S. Food and Drug Administration (2014). Electronic Cigarettes. Retrieved from: http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm

 

6 Goniewicz, M.L., et al. (2014).  Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control, 23, 133-139.

 

7 U.S. Department of Health and Human Services (2014). Electronic Cigarettes. Retrieved from http://betobaccofree.hhs.gov/about-tobacco/Electronic-Cigarettes/

8 Burstyn, I. (2013).  Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health, 14: 18. doi:10.1186/1471-2458-14-18 

9 U.S. Food and Drug Administration (2014). Summary of results: Laboratory analysis of electronic cigarettes conducted by FDA. Retrieved from http://www.fda.gov/newsevents/publichealthfocus/ucm173146.htm

 

10 Lee, S., Grana, R.A., & Glantz, S.A. (2013). Electronic-cigarette use among Korean adolescents: A cross-sectional study of market penetration, dual use, and relationship to quit attempts and former smoking. Journal of Adolescent Health, 54, 684-90.

 

11 Regan, A.K., Promoff, G., Dube, S.R. & Arrazola, R. (2011). Electronic nicotine delivery systems: Adult use and awareness of the 'e-cigarette' in the USA. Tobacco Control, 22, 19-23. doi:10.1136/tobaccocontrol-2011-050044 

 

12 Bullen, C., et al. (2013).  Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet, 382, 1629 – 1637.

 

13 Siegel, M.B., Tanwar, K.L., & Wood, K.S. (2011). Electronic Cigarettes As a Smoking-Cessation Tool. American Journal of Preventive Medicine, 40, 472-475.

 

14 Etter, J.-F. &Bullen, C. A longitudinal study of electronic cigarette users. Addictive Behaviors, 2, 491-494.