Editor’s note: This article is a reprint. It was originally published on December 21, 2016.
Some people use e-cigarettes to reduce their risk of exposure to dangerous chemicals or to experience the sensation of smoking without the risks of smoking. However, either way, you may be at risk for dangerous health conditions.
For example, diacetyl is an artificial flavoring used to add buttery flavor to microwave popcorn. It has been linked to respiratory damage, including inflammation and permanent scarring of the airways, called “popcorn lung,” in microwave popcorn factory workers.1
Diacetyl is just one of the chemicals used to add flavor to e-cigarettes.2 Unfortunately, the perception that e-cigarettes are safe has led to a surge in e-cigarette use among middle and high school students.
From 2011 to 2015, e-cigarette use in middle schools increased from 0.6% to 5.3% of students.3 At the same time, students’ use of traditional cigarettes decreased from 4.3% to 2.3%.
The U.S. Surgeon General has begun to take a closer look at e-cigarettes and their health effects after seeing a rise in the number of students vaping and ingesting nicotine and other harmful chemicals at a young age.
The numbers are clear, but they fuel industry debate
In 2016, the U.S. Surgeon General released a report detailing the rise in e-cigarette use among children and calling for action to address the problem.4 E-cigarettes account for a significant portion of the tobacco industry’s marketing, generating $2.5 billion in revenue for the industry with $125 million in advertising spending.5
According to the U.S. Centers for Disease Control and Prevention (CDC), five out of 100 middle school students claim to have used e-cigarettes in the past 30 days, while 16 out of 100 high school students can say the same.6
When the tobacco industry evaluates future profits, the age group that is most important for new users and future revenue generation is teenagers.
The Surgeon General’s report made several recommendations to curb e-cigarette use among children, one of which was to use known strategies to reduce e-cigarette purchases, including including e-cigarettes in current tobacco control policies and introducing additional tax structures to discourage e-cigarette use.7
As expected, the report drew an angry response from groups that argue that e-cigarettes, which are loaded with the addictive substance nicotine, can help people quit combustible cigarettes.
Research on e-cigarettes has been done on first-generation products. Newer products deliver nicotine more effectively, but contain additional heat, chemicals, and particulates.
Dr. Pamela Ling of the University of California, San Francisco, points out that even if e-cigarettes are assumed to be safer to use than combustible cigarettes, safety measures set the safety bar very low compared to the world’s deadliest consumer product.8
Despite media attention to the potential health risks of e-cigarette use, e-cigarette sales continue to grow and are expected to reach $4.1 billion in 2016.9 Philip Morris International has filed an application to launch a new product that uses heated but not burned tobacco, claiming it is safer than traditional cigarettes.10
Reduce cigarette smoking
As e-cigarette prices have risen, the number of middle school students and teenagers who smoke combustible cigarettes has decreased.11 According to CDC statistics, tobacco product use often begins during adolescence.12
Nearly 90% start smoking before age 18, and 99% start smoking before age 26. Every day, more than 3,200 teenagers smoke their first cigarette, and 2,100 young adults start smoking every day.
Between 2011 and 2015, CDC statistics show that cigarette use among middle and high school students has declined, and more students are turning to e-cigarettes. Between 2011 and 2015, the percentage of high school students who have ever smoked cigarettes dropped from 15.8% to 9.3%.13
For the first time since statistics were first compiled, the number of smokers in the United States has fallen to an all-time low.14 In 2005, there were just over 45 million smokers, but by 2015 that number had fallen to 36 million.
But the decline in cigarette smoking was not consistent across groups. For example, the sharpest declines occurred among the youngest age groups, and among people receiving Medicaid, the number of smokers actually increased.15
The percentage of smokers decreased with increasing education level. Those with a GED were 34% smokers, compared to 4% with a graduate degree. Brian King, deputy director of the CDC’s Office of Smoking and Health, said:16
“We have made commendable progress in reducing smoking… but there is more work to be done. Making a difference requires implementing what we know works: raising prices, getting media attention, and providing preventive services.”
As smoking rates for combustible cigarettes decline, especially among the younger demographic that is most important to the tobacco industry, marketing is shifting to promoting e-cigarettes to young people as a healthy choice.
How electronic cigarettes work
E-cigarettes use heat, not combustion, to deliver nicotine and other chemicals into the body. Using heat generated by a battery, e-cigarettes heat liquid to create an aerosol containing nicotine, flavorings, and other chemicals.17
Inhaling this combination allows users to get the same benefits as from the nicotine in tobacco, without the chemicals commonly found in traditional cigarettes.
E-cigarettes come in a variety of shapes and sizes, but they all provide the same chemical ingredients. Advocates claim that e-cigarettes are healthier because they do not contain the hundreds of other chemicals found in cigarettes. Tobacco company marketing practices seem to emphasize this point to their intended consumers.
According to a 2016 report from the Surgeon General, 60% of high school students believe that e-cigarettes are of little to no harm unless they are used daily. Students who have used e-cigarettes are more likely to believe that they are of little to no harm than those who have never used e-cigarettes.
Public health concerns are focused on potential risks to the population as a whole. Scientists are still determining whether e-cigarettes increase the risk of smoking combustible cigarettes, maintain the habit by consuming nicotine from other delivery systems, and increase the likelihood that former smokers will become addicted to nicotine again.
Although e-cigarettes contain other chemicals that scientists are continuing to study, the risks associated with nicotine are well-researched and documented. The surgeon general’s report criticized the industry for using candy flavorings in nicotine liquids and marketing them blatantly to middle schoolers and adolescents.18
Scientists have discovered that just one is all you need.
A 2016 study found that smoking just one cigarette a day increases your lifetime risk of premature death by 64 percent, confirming the belief that there is no safe level of smoking.19
The National Cancer Institute in the United States evaluated smoking patterns over a lifetime and found that people who smoked one to 10 cigarettes a day had an 87 percent higher risk of premature death.20
The study is a reminder that even smoking a small amount of cigarettes poses a significant health risk, said lead author Dr. Maki Inoue-Choi of the Department of Cancer Epidemiology and Genetics.21
“Taken together, these results provide further evidence that smoking even a small number of cigarettes per day has substantial negative health effects and that quitting smoking is beneficial for all smokers, regardless of the number of cigarettes smoked.”
Researchers found that smoking just 10 e-cigarettes increased the risk of heart disease.22 Researchers found that within just one hour of smoking an e-cigarette, endothelial progenitor cells (EPCs) increased by the same amount as smoking a regular cigarette.
These cells indicate damage to the lining of blood vessels. It took 24 hours for the numbers to return to normal, said Dr. Geoff Perk, a spokesperson for the European Society of Cardiology.23 ‘It’s amazing how little vapor from an e-cigarette is needed to get the heart disease ball rolling. It’s concerning that one e-cigarette could cause such a reaction.”
There is significant concern that diseases linked to chemicals in e-cigarettes could emerge within just 10 years, posing significant health risks to children as they grow into adulthood.
Do e-cigarettes help you quit smoking?
E-cigarette advocates claim that vaping can help people quit smoking, but they don’t tell you the whole story. Ring advises doctors to use safe and effective strategies to help patients quit smoking, and he believes e-cigarettes are none of those.24 She points to randomized clinical studies comparing nicotine patches to e-cigarettes, which showed virtually no difference between the two methods.25
That means you don’t have to inhale additional chemicals or continue to be physically active to quit smoking. In a major review of medical evidence, the U.S. Preventive Services Task Force found insufficient evidence to recommend using e-cigarettes as a way to help people quit smoking.26 Other major health and medical organizations have followed suit, citing a lack of evidence on the effectiveness of e-cigarettes.27,28
Unfortunately, not only do studies not support the idea that e-cigarettes help people quit smoking, but scientists have also found that by using e-cigarettes while continuing to smoke, people are adding yet another way to deliver nicotine to their daily routine.29
Most of the major tobacco companies in the United States have made e-cigarette products. It would be business suicide to believe that the tobacco industry would develop and market a product that they believe would harm their profits. E-cigarette companies claim that their products are safer than traditional cigarettes and offer a realistic compromise to the risks associated with combustible cigarettes. But these compromises have real consequences.
Nicotine is addictive no matter how it is delivered.
In this short video, you can learn about the side effects of nicotine from cigarettes or e-cigarettes. Studies have proven health risks associated with nicotine, the active ingredient in e-cigarettes. The risks may be slightly different, but they are no less dangerous than smoking cigarettes.
Studies have shown that people who quit smoking for at least three to six months are most likely to quit permanently.30 This means not smoking or vaping for 3-6 months. You may think that using e-cigarettes will help you quit smoking, but in reality, you are still addicted to nicotine and doing the same physical activities.
E-cigarettes deliver nicotine, the addictive drug found in cigarettes, through an electronic mechanism. Many people believe that the jury is still out on whether vaping is harmful to health, but data from several studies published in early 2015 suggest otherwise.
Nicotine is one of the oldest plant-based pesticides.31 And a powerful poison32 This has been linked to a variety of health problems.33 Researchers conducted searches of Medline and PubMed databases with specific keywords, collecting data from more than 3,400 different articles and studies.
This evidence suggests that nicotine has negative effects on the cardiovascular, respiratory, renal, and reproductive systems. Preliminary studies have shown that nicotine causes direct damage to heart cells and blood vessel cells.34 This damage can trigger an inflammatory response and lead to atherosclerosis.35 Nicotine also affects cell proliferation, promoting tumors and increasing resistance to anticancer drugs.36
According to the CDC, more Americans are addicted to nicotine than any other drug, and nicotine can be as addictive as heroin, cocaine, or alcohol.37 It’s unclear whether taking nicotine into your body actually helps you quit smoking, or whether e-cigarettes help or just hinder you.38 For the reasons already mentioned, they are most likely not helpful.
