Electronic cigarettes, a better alternative or a well-advertised product

This article was exclusively written for The European Sting by Ms. Maha Mezouar, a second year medical student in Marrakech, Morocco. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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The first patent for a “smokeless, non-tobacco cigarette” was requested by Herbert  A. Gilbert in 1963, but the current device known as Electronic cigarettes (E-cigarettes) did not appear until 2004 and has been advertised ever since as a healthier and cheaper alternative for conventional cigarettes. E-cigarettes are devices that can vaporize a nicotine solution combined with liquid flavors instead of burning tobacco leaves. Since their emergence, they have become widely available, and their use has increased exponentially worldwide which is one of the reasons why some studies have been conducted in order to learn more about this device. E-cigarette smoke delivers stimulant nicotine as aerosol without tobacco or the burning process. It contains neither carcinogenic incomplete combustion byproducts nor tobacco nitrosamines, the nicotine nitrosation products, which is why some researchers choose to directly measure DNA damage induced by nitrosamines in different organs of  E-cigarette smoke-exposed mice instead of detecting nitrosamines. The results that were published in January 2018 showed that the ability of lung cells to repair after exposure to e-cigarette smoke was significantly reduced in the lung. In addition to this, it has been found that nicotine and its metabolite, nicotine-derived nitrosamine ketone, can induce the same effects and enhance mutational susceptibility and tumorigenic transformation of cultured human bronchial epithelial and urothelial cells; the smoke damaged the lungs, bladder, and heart in mice. These results indicate that nicotine nitrosation occurs in vivo in mice and that E-cigarette smoke is carcinogenic to the murine lung and bladder and harmful to the murine heart. It is therefore possible that E-cigarette smoke may contribute to lung and bladder cancer, as well as heart disease, in humans. In 2015, 58.8 percent of adult users continued to smoke regular cigarettes. They did not use vaping as a complete substitute for tobacco, which makes us doubt the efficiency of E-cigarettes as an alternative. Besides, they may help some people quit, but there is growing evidence that vaping may be harmful in some cases, and even more harmful than avoiding smoking altogether. Some recent studies have found that levels of toxicants such as formaldehyde can be quite high under some circumstances, for example, under higher power conditions available on variable wattage devices.  Studies also suggest that e-cigarettes may be a source of secondary exposure to nicotine.  Due to increased popularity of e-cigarettes and lack of product regulation, these devices are prone to misuse. The e-liquids may contain nicotine in high concentrations, thus inappropriate handling of the products may result in accidental nicotine poisoning. In the US, calls to poison centers related to e-cigarettes increased from one call in September 2010 to 215 calls in February 2014. They were most commonly reported as ingestions of the e-liquids, less often as eye or skin exposures. What is certainly alarming is that more than half of the calls involved children aged 5 years old and younger. One must also consider the detrimental influence of nicotine on the developing brain. E-Cigarette use in pregnancy and children’s exposure to nicotine from e-cigarette aerosol may have behavioral or cognitive dysfunction consequences. Unfortunately, young people are the most vulnerable group to initiate use of e-cigarettes. The novelty of the e-cigarette, perceptions about the harmlessness of the product, a wide variety of flavors and peer-influence are just a few examples of factors contributing to the e-cigarette popularity among youth. The most concerning issues related to e-cigarette use by adolescents are mass marketing campaigns and easy access to the product. E-cigarette use in never-smoking youth may increase risk of subsequent initiation of cigarettes and other combustible products during the transition to adulthood when the purchase of tobacco products becomes legal. Stronger associations in participants with no intention of smoking suggest that e-cigarette use was not simply a marker for individuals who would have gone on to smoke regardless of e-cigarette use. Because electronic cigarettes generate less tar and carcinogens than combustible cigarettes, use of electronic cigarettes may reduce disease caused by those components. However, it is important to remember that they are nicotine-based products, and no nicotine use is safe and studies looking at whether electronic cigarettes can aid smoking cessation have had inconsistent results. Moreover, the availability of electronic cigarettes may have an overall adverse health impact by increasing initiation and reducing cessation of combustible nicotine delivery products. Therefore we should urge for an evidentiary review of the health and safety claims regarding electronic nicotine delivery. And since technical design, construction of the devices, and chemical composition of e-liquids are poorly regulated and most often proper production standards are nonexistent it would be better to restrict or to even ban electronic nicotine delivery devices as a precaution until more information about their safety is available. If they are allowed, they should be closely regulated as medicines or tobacco products. It is also crucial to implement marketing constraints in order to avoid direct and indirect advertising and promotion of e-cigarettes to young consumers, especially those who do not currently smoke or are under the legal age for smoking. In matter fact, such measures have already been taken in the US: “Actions could include incorporating e-cigarettes into smoke-free policies, preventing access to e-cigarettes by youth, price and tax policies, retail licensure, regulation of e-cigarette marketing likely to attract youth, and educational initiatives targeting youth and young adults.” (U.S. Department of Health and Human Services). As a result, nine states have already banned e-cigarette use in the same places where smoking is not allowed, and there is a growing call for vaping regulations to be stricter. Such rmeasures should be top priorities for public health and the debate must include all authorities and individuals if we want to guarantee the best for our health and for our children’s. About the author Maha Mezouar is a second year medical student in Marrakech, Morocco. She has joined IFMSA in order to nurture her passion for volunteering work and raise awareness about many subjects, such as human rights, by organizing campaigns and by writing articles.