The increasing popularity of electronic cigarettes raises some tough issues for health officials and medical researchers as they try to come to grips with the controversial phenomenon.
On one hand, some researchers (and smokers) believe e-cigarettes can be an effective way to stop smoking tobacco, a devil that everyone knows. But there are concerns e-cigarettes could be a devil we don’t know, because studies are lacking.
Variations in manufacturing and the prospect they might entice children to start on a lifetime of nicotine addiction mean they have peril as well as promise, which helps explain efforts by authorities at all levels to regulate them. What’s clear is that more people are trying them, young people among them.
According to Barry Hummel, Jr., pediatrician and Communications Director of the Tobacco Prevention Network, regular use of e-cigarettes by Florida high school students doubled over the last two years. If current trends continue, he says,
e-cigarettes will be the most common form of “smoking” among Florida high school students by 2016.
In part, that’s because the smoking of traditional cigarettes has been on a decades-long downward trend, reported now by less than 10 percent of Florida high-schoolers and less than 4 percent in middle school.
E-cigarettes produce no smoke, but rather a vapor caused when liquid is heated, so many of the worst compounds of tobacco are missing. But highly addictive nicotine is still delivered, except in nicotine-free varieties, and the effect of inhaling the different compounds found in e-cigarettes is not fully understood.
Dr. John Suen, board-certified pulmonologist at Vero Lung Center, says e-cigarettes can be helpful in reducing cravings for cigarettes, but so much is unknown.
“It’s controversial,” he said. “Will it be better? The jury is still out. The science hasn’t proven that e-cigarettes make a big difference in quitting.”
Similarly, national health organizations are voicing concerns about e-cigarettes yet not dismissing their possible benefits out of hand.
Last month, the American Heart Association said electronic cigarettes might help people quit smoking when all the usual smoking-cessation methods fail. Other methods include nicotine gum and patches.
The American Cancer Society also has held out the possibility that they may help some people quit. Yet neither group endorses them as a method to quit smoking and both are concerned that e-cigarettes could be a gateway to nicotine addiction for the young. Officials also worry that e-cigarettes are used as a second and more socially acceptable vehicle for nicotine by people who continue smoking, not just those who give it up.
Hummel, whose advocacy organization focuses on reducing youth access and exposure to tobacco products through public policy, says there are hundreds of models of electronic drug delivery devices (e-cigarettes and vaporizers), and thousands of independently manufactured chemicals currently on the market. Very few of these have been adequately tested for short-term or long-term safety.
Early studies have revealed increased inflammation and airway obstruction in the lungs of users inhaling the chemical emissions from the devices, he said. “For now, we have more questions than answers.”
It’s possible it will take many years to determine how harmful these devices may be. In the meantime, he suggests using an FDA-approved tobacco-cessation method if you are trying to quit. He also suggests avoiding the chemical emissions if you are a bystander.
Is this a good way to stop smoking? “Most current studies show that e-cigarettes are being used to switch from combustible tobacco products, thus maintaining nicotine addiction,” he said. “So, while the users have technically ‘quit smoking’, they remain addicted to a drug that has profound effects on the heart and cardiovascular system.”
Most importantly, many of the chemical additives, such as propylene glycol and flavorings, have never been tested for safety when being inhaled, Hummel said.
“E-cigarettes are marketed as a replacement for your regular cigarettes, with advertising that suggests that they are less harmful. This gives nicotine addicts a ‘path of least resistance,’ a choice that is much easier than actually overcoming the powerful addiction to nicotine. If your goal is to quit nicotine, you should avoid the use of
e-cigarettes.”
A recent study from the Centers for Disease Control and Prevention revealed that 263,000 non-smoking teens started using e-cigarettes in 2013. That was three times the number who reported starting an e-cigarette habit in 2011.
Sue Marshbanks, co-owner of Pipe Den and Cigars on 20th Street, sells and uses
e-cigarettes.
She said e-cigarettes are growing increasingly popular among customers who range from their 20s to seniors. Even non-smokers are purchasing e-cigarettes – for example, older women who enjoy flavorings such as watermelon, pomegranate or lemonade, after a meal. The reasons: “They are less expensive than real cigarettes, have no ash, no tar, no smell, no ashtray, no secondhand smoke, no carbon monoxide,” she said.
A traditional cigarette smoker for 20 years, she is a relatively new user of e-cigarettes, which she enjoys but does not plan to use as a replacement for the others.
“My intention is not to quit because I do enjoy smoking,” she said. “I’m finding with the 40-year-old crowd, they do want to quit. Liquids come in different strengths of nicotine, they can wean themselves off. You can still satisfy that habit you get yourself into, out with friends and people who are drinking, talking, having fun and smoking, and can still do it but with no nicotine.”
