Electronic or conventional cigarettes – which is safer?

smoking vaping.png

(Chloe Andrews, Unsplash)

This article was exclusively written for The European Sting by Ms. Mariana Marçal, a 23-year-old medical student from Lisbon, currently attending the 4th year at NOVA Medical School. 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.


When it was suggested back in 1939 that cigarettes were a responsible factor for the rise in lung cancer, this idea seemed laughable at the time. Today, it is well established that tobacco is harmful and is strongly linked to cancer [1]. The recent rise in alternative products such as electronic cigarettes, however, has led to uncertainty about its true long-term effects on health. Electronic cigarettes (or e-cigarettes) are battery-operated devices that electrically heat and vaporize “e-liquids” to produce inhalable vapours without combusting tobacco. E-cigarettes started being commercialized in 2003 in China and entered the European markets in 2006.

These products present a challenge for public health due to their alarming increase in popularity. In 2017, about 15% of the European population had tried e-cigarettes at least once in their life [2]. Another study from the US showed that between 2017 and 2018, the number of high school students that reported current use of e-cigarettes increased from 12% to 21% [3]. Evidence suggests that e-cigarettes are being used among teenagers for alternative behaviours such as dripping, smoke tricks, use of flavours, and use of other substances such as marijuana [4].

The effects of chronic use of e-cigarettes are still largely unknown, and levels of toxic and carcinogenic compounds may vary greatly depending on the brand. Many e-cigarettes contain misleading or missing information on product ingredients, but across all brands, the main components are nicotine, propylene glycol, glycerol, and flavourings. Many studies found other harmful substances such as metals, carcinogenic tobacco-specific nitrosamines and carbonyls [5]. E-cigarettes do not produce the tar that is contained in traditional cigarettes. However, studies have found that it produces formaldehyde, acetaldehyde and acetone a known carcinogen at levels above recommended levels [6]. The overall health risks associated with e-cigarettes remain uncertain but they cannot be considered safe. A recent study found daily e-cigarette use is associated with increased risk of myocardial infarction [7]. In 2018, a study of mice found that e-cigarette smoke could cause mutations in DNA that could increase the risk of cancer [8]. However, we remain shockingly ignorant about the toxicity of chronic exposure to these products.

E-cigarettes have been widely marketed as a tool for smoking cessation and a safer alternative to conventional cigarettes. Although some small studies suggest that e-cigarettes could be an effective strategy to quit smoking in some people [9], there are no large, high-quality studies to support this claim thus far. There are also some concerns that e-cigarette use may be a gateway to nicotine dependence among adolescents. In 2016, the World Health Organization (WHO) urged countries to restrict the sale, promotion, and use of electronic cigarettes [10].

Overall, more research is needed in order to compare the risks and long-term effects of e-cigarettes with tobacco products. As a society, we need to get ahead of this real public health issue. More regulation and restrictions are needed, as well as an international effort to make new policies, promote more research and educate citizens on this issue.

References

[1] Viswanath, Kasisomayajula, et al. “Tobacco and Cancer: An American Association for Cancer Research Policy Statement.” Cancer Research, American Association for Cancer Research, 1 May 2010, cancerres.aacrjournals.org/content/70/9/3419.

[2] Special Eurobarometer 458 – Attitudes of Europeans towards tobacco and electronic cigarettes. Available at http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146. (accessed 25th April 2019)

[3] Cullen, Karen A., et al. “Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018.” MMWR. Morbidity and Mortality Weekly Report, 2018, doi:10.15585/mmwr.mm6745a5.

[4] Krishnan-Sarin, Suchitra, et al. “E-Cigarettes and ‘Dripping’ Among High-School Youth.” Pediatrics, vol. 139, no. 3, 2017, doi:10.1542/peds.2016-3224.

[5] Orellana-Barrios, Menfil A., et al. “Electronic Cigarettes—A Narrative Review for Clinicians.” The American Journal of Medicine, vol. 128, no. 7, 2015, pp. 674–681., doi:10.1016/j.amjmed.2015.01.033.

[6] Kosmider, Leon, et al. “Carbonyl Compounds in Electronic Cigarette Vapors: Effects of Nicotine Solvent and Battery Output Voltage.” Nicotine & Tobacco Research, vol. 16, no. 10, 2014, pp. 1319–1326., doi:10.1093/ntr/ntu078.

[7] Alzahrani, Talal, et al. “Association Between Electronic Cigarette Use and Myocardial Infarction.” American Journal of Preventive Medicine, vol. 55, no. 4, 2018, pp. 455–461., doi:10.1016/j.amepre.2018.05.004.

[8] Lee, Hyun-Wook, et al. “E-Cigarette Smoke Damages DNA and Reduces Repair Activity in Mouse Lung, Heart, and Bladder as Well as in Human Lung and Bladder Cells.” Proceedings of the National Academy of Sciences, vol. 115, no. 7, 2018, doi:10.1073/pnas.1718185115.

[9] Kulik, Margarete C., et al. “E-Cigarettes Associated With Depressed Smoking Cessation: A Cross-Sectional Study of 28 European Union Countries.” American Journal of Preventive Medicine, vol. 54, no. 4, 2018, pp. 603–609., doi:10.1016/j.amepre.2017.12.017.

[10] WHO Report to COP7 on ENDS/ENNDS. Available at http://www.who.int/tobacco/communications/statements/eletronic-cigarettes-january-2017/en/.

About the author

Mariana Marçal is a 23-year-old medical student from Lisbon, currently attending the 4th year at NOVA Medical School. In 2018, she joined Education Against Tobacco (EAT), an international non-governmental organisation run entirely by volunteer medical students and physicians from over 80 medical schools around 14 countries, whose work focuses mainly on school-based prevention of tobacco use. She is now the head of Scientific Department at her school’s EAT group and hopes their work reaches more students and further expands across more schools and countries.

the sting Milestones

Featured Stings

Can we feed everyone without unleashing disaster? Read on

These campaigners want to give a quarter of the UK back to nature

How to build a more resilient and inclusive global system

Stopping antimicrobial resistance would cost just USD 2 per person a year

Here’s how to achieve growth in the Middle East and North Africa

UN Security Council condemns Taliban offensive as a blow against ‘sustainable peace’

Facebook and Google to treat Europe as the 51st State of the USA

European Solidarity Corps 2021-2027: First call for proposals to support youth volunteering activities

How music can help children with autism connect

To Bing or Not to Bing? That is the question

Gender equality: an issue much talked about but less acted upon

Terrorism and migrants: the two awful nightmares for Europe and Germany in 2016

Portugal can use its economic recovery to build up resilience

Pharmaceuticals spend millions to push TTIP while consumer groups spend peanuts

The EU Parliament slams Commission on economic governance

An economist explains the pros and cons of globalization

Protecting the front line: the healthcare of health professionals

State aid: Commission approves French scheme deferring payment by airlines of certain taxes to mitigate economic impact of coronavirus outbreak

Low productivity jobs continue to drive employment growth

“Fortress Europe”, “Pegida” and its laughing stocks

New challenge: Not going through “burnout” in times of quarantine

Mental and comportamental health in the pandemic context

An Easter Special: Social protection of migrants in Europe as seen through the eyes of European youth

Pharmaceuticals conceal drug side effects with the EU’s Court blessing

European Citizens’ Initiative: Commission registers ‘Mandatory food labelling Non-Vegetarian / Vegetarian / Vegan’ initiative’

Greenery: the miracle cure for urban living

Italy should boost investment in training for the future of work

Sustainable Finance: Commission welcomes the adoption by the European Parliament of the Taxonomy Regulation

Macro-Financial Assistance: Europe’s way to control Ukraine?

Companies can help build a more inclusive world. Here’s how

Joris in Indonesia

5 steps businesses can take to protect air quality after COVID-19

5 charts that show renewable energy’s latest milestone

Devastating storms like Hurricane Florence ‘unusual this far north’: UN weather agency

Inflammation is the fuel that feeds the cancer flame. So how do we fight back?

Digital democracy: a Swiss view on digital trust

Four in five adolescents failing to exercise for even 60 minutes a day, UN health agency warns

Gaza: deadly violence continues to escalate, top UN officials work to restore calm

This is Germany’s $45 billion, 18-year plan to move away from coal

‘Time is of the essence’ for refugees on Greek islands – UN agency

Huawei answers allegations about its selling prices

Break taboo around menstruation, act to end ‘disempowering’ discrimination, say UN experts

Can the whole world live in peace?

From Russia with love: Brussels and Moscow close to an agreement on Ukraine’s gas supplies

Innovations for Content Professionals at the DCX exhibition 2018 in Berlin, in association with The European Sting

EU prolongs economic sanctions on Russia by six months

Business is a crucial partner in solving the mental health challenge

UN chief welcomes event reuniting families on the Korean Peninsula

Rule of Law: Commission launches infringement procedure to protect the independence of the Polish Supreme Court

Auditors say EU spending delivers limited value for money but the timing of their report poses questions

Ebola Outbreak in Democratic Republic Congo is ‘largely contained’: WHO

Mergers: Commission refers acquisition of newly created joint venture by Telefónica and Liberty Global to the UK competition authority

Brexit: visa-free access to the EU for UK nationals and to the UK for Europeans

Statement following the European Medicines Agency review of the COVID-19 vaccine AstraZeneca

“Decisions taken in the coming weeks will shape Europe’s experience of the internet”, Joe Mcnamee from EDRi says live from European Business Summit 2015

We must rethink and repurpose cybersecurity for the COVID-19 era

Free and secure access needed in DR Congo conflict zone to tackle Ebola – WHO

Here’s what keeps CEOs awake at night (and why it might be bad news for your next job)

President Ursula von der Leyen welcomes the first official submission of a recovery and resilience plan by Portugal

THE COMMITTEES: ‘All roads lead to the Fifth’

EU summit: step up work for recovery, and update migration and asylum system

The Bavarians threaten Berlin and Brussels with immigration crisis

EU lawmakers vote to reintroduce visas for Americans over “reciprocity principle”

EU helps tackle air pollution in Kosovo with €76.4 million

More Stings?

Speak your Mind Here

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s