• E-Cigarettes: A Safe Substitute for Smokers?

    IMAGE Maybe you have seen electronic cigarettes (“e-cigarettes”) being sold at a kiosk at your local mall, but are not sure what they are or how they work. Here is the information you need to decide if e-cigarettes are a good option for you.

    What Are E-Cigarettes?

    E-cigarettes are battery-powered devices that are available in a range of sizes and shapes. For example, some look just like real cigarettes, cigars, or pipes, while others are designed to look more like pens.
    In general, the devices are made up of:
    • A mouthpiece
    • A replaceable (or refillable) cartridge—The cartridge contains a liquid solution of nicotine (available in different strengths), flavoring, water, and chemicals.
    • An atomizer—This transforms the liquid solution into a vapor.
    • A rechargeable battery—Depending on the style, the battery end of the cigarette may have an LED light on the tip to look like the burning ember on a real cigarette. However, the LED light does not get hot, so it does not pose a fire hazard.

    How Do They Work?

    When the user inhales on the mouthpiece, this triggers the liquid to be heated, and the atomizer turns the liquid into a vapor. This vapor is then inhaled by the user, which feels like smoking a real cigarette. When the user exhales, the vapor quickly disappears.

    What Is the Cost?

    With lots of e-cigarette brands on the market, the prices for starter kits vary. There are some for around $65, while others cost $150 or more. A starter kit typically includes disposable cartridges, atomizers, rechargeable batteries with a wall adapter and a USB charger, and a carrying case.
    The monthly or yearly expense for smoking (or “vaping”) e-cigarettes can also vary greatly depending on how often you light up and which brand you choose. For example, a pack of 10 disposable cartridges can cost $15-$30. If you want to go a cheaper route, you can purchase a bottle of liquid nicotine solution for $20-$30 and refill the cartridges yourself, but the process of refilling can be potentially dangerous since nicotine is toxic at high levels. Other items that you may need to replace for your e-cigarette include the atomizer ($10-$30) and the battery ($10-$30).
    If you are considering switching from regular cigarettes to an electronic version, it is be a good idea to calculate how much you typically spend on cigarettes. This can help you decide if e-cigarettes are a more affordable choice for you.

    What Is the Controversy Surrounding E-Cigarettes?

    Before you log onto the numerous websites that sell e-cigarettes, keep in mind that these products are still undergoing scrutiny.
    Many countries have prohibited their sale or severely restricted them. Some argue that, for people who want to smoke, e-cigarettes are a safer option because the vapor may not contain some of the thousands of chemicals that are found in tobacco smoke. And those around the person “vaping” will not be exposed to secondhand smoke. (But, they will be exposed to the chemicals that are exhaled into the air.) E-cigarettes can also be used as a bridge that helps someone kick the habit for good. Puffing on an e-cigarette is supposed to lessen the craving for a real cigarette.
    However, not everyone supports e-cigarettes. When the Food and Drug Administration (FDA) analyzed two e-cigarette brands, they found diethylene glycol and other cancer-causing agents in some samples. The agency is also concerned that the cartridges are not consistent in the amount of nicotine they provide. For example, you may use a low-strength nicotine cartridge, but actually receive a higher dose (or vice versa). If you are thinking about using e-cigarettes as a way to help kick the habit, other nicotine replacement products, like gum or patches, could provide a more consistent level of nicotine.
    In addition, there has been concern about second- and third-hand exposure. Not all of the chemicals in e-cigarettes remain in the lungs. The person "vaping" exhales into the air where others can breathe in these chemicals. The particles can also land on surfaces, like clothes, furniture, and carpets. Studies need to be done to find out how second- and third-hand exposure affects the safety of people and the environment.
    The World Health Organization (WHO) and other agencies, like the American Cancer Society, the American Heart Association, and the American Lung Association, have all highlighted that there has not been enough research on e-cigarettes to make any claims about their safety or effectiveness in helping people quit smoking.

    Making a Decision About Vaping

    If you are thinking about kicking the habit, your best option would be to make an appointment with your doctor to talk about smoking cessation strategies, like nicotine replacement products, prescription medicines, programs, support groups, and other quitting options. If you are considering e-cigarettes, discuss this with your doctor, too. She can provide you with more information and help you to make a healthy choice.

    RESOURCES

    Smoke Free.gov http://www.smokefree.gov/

    US Food and Drug Administration http://www.fda.gov/

    CANADIAN RESOURCES

    Canadian Lung Association http://www.lung.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    American Lung Association supports Food and Drug Administration finding that e-cigarettes are harmful and contain carcinogens. American Lung Association website. Available at: http://www.lungusa.org/press-room/press-releases/lung-assn-supports-fda-ecigarette-findings.html. Updated July 22, 2009. Accessed June 27, 2011.

    Cahn Z, Seigel M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes. Harvard School of Public Health website. Available at: http://www.hsph.harvard.edu/centers-institutes/population-development/files/article.jphp.pdf. Published 2010. Accessed June 27, 2011.

    Claims of e-cigarettes safety unproven at best, experts say. UK Health Care website. Available at: http://ukhealthcare.uky.edu/publications/AI/general/ecigarette.asp. Published December 7, 2009. Accessed June 27, 2011.

    Conway C. E-cigarette regulation still pursued by FDA. University of Houston Law Center website. Available at: http://www.law.uh.edu/healthlaw/perspectives/2010/%28CC%29%20E-cigs.pdf. Accessed June 27, 2011.

    E-cigarettes: questions and answers. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm225210.htm. Published September 9, 2010. Accessed June 27, 2011.

    Electronic cigarette (“e-cigarette”) fact sheet. American Legacy Foundation website. Available at: http://www.purdue.edu/swo/healthshop/atod/tobacco/AmericanLegacyFactSheet.pdf. Published September 2009. Accessed June 27, 2011.

    Electronic cigarette—a potential health hazard. University Health Care website. Available at: http://healthcare.utah.edu/pharmacy/alerts/400.htm. Published July 28, 2009. Accessed June 27, 2011.

    Electronic cigarettes. Tobacco Harm Reduction.org website. Available at: http://www.tobaccoharmreduction.org/faq/ecigs.htm. Accessed June 27, 2011.

    Electronic cigarettes hold promise as aid to quitting. Boston University School of Public Health website. Available at: http://sph.bu.edu/insider/Recent-News/electronic-cigarettes-hold-promise-as-aid-to-quitting.html. Published February 8, 2011. Accessed June 27, 2011.

    Electronic cigarettes—risky business? Quit Tobacco website. Available at: http://www.ucanquit2.org/facts/ElectronicCigarettes.aspx. Accessed June 27, 2011.

    FDA and public health experts warn about electronic cigarettes. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm173222.htm. Published July 22, 2009. Accessed June 27, 2011.

    Kuschner WG, Reddy S, Mehrotra N, Paintal HS. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider. Int J Gen Med. 2011;4:115-120.

    Marketers of electronic cigarettes should halt unproved therapy claims. World Health Organization website. Available at: http://www.who.int/mediacentre/news/releases/2008/pr34/en/index.html. Updated September 19, 2008. Accessed June 27, 2011.

    Study: e-cigarettes are unsafe & pose health risks. University of California Health website. Available at: http://health.universityofcalifornia.edu/2010/12/03/study-e-cigarettes-are-unsafe-pose-health-risks/. Published December 3, 2010. Accessed June 27, 2011.

    What are electronic cigarettes? Are they safer than conventional cigarettes? Mayo Clinic website. Available at: http://www.mayoclinic.com/health/electronic-cigarettes/AN02025. Updated December 1, 2009. Accessed June 27, 2011.

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