NEW YORK (MainStreet) I don't know about you, but e-cigarettes seem a lot more glamorous and a lot less smelly and dirty than tobacco cigarettes. If I were a teenager, I'd definitely be intrigued; especially if I saw celebs smoking them on TV, thought I could easily buy them, considered them not as dangerous as tobacco cigarettes .
Also See: E-Cigarettes -- Weapons of Non-Combustion
That's the biggest problem with e-cigarettes, according to Dr. Philip McAndrew, a Loyola University Health System physician and smoking cessation expert.
"Teens who might never consider smoking tobacco cigarettes are picking up e-cigarettes, thinking they are not dangerous, and getting addicted to the oral fixation and the nicotine habit," he said. "After 40 years of declining tobacco smoking rates among adolescents, we are seeing a steady rise in e-cigarette use."
According to the most recent data published by the Centers for Disease Control (CDC), the percentage of U.S. middle and high school students who use electronic cigarettes, commonly called e-cigarettes, more than doubled from 2011 to 2012. The National Youth Tobacco Survey found the amount of high schoolers who used e-cigarettes rose another one percent in just the last 30 days. The study also found 76.3% of middle and high school students who used e-cigarettes within the past 30 days also smoked conventional cigarettes in the same period.
"What's troubling is the e-cigarette use numbers are growing quickly and steadily," says McAndrew.
According to the CDC, tobacco cigarette smoking remains the leading preventable cause of disease, disability and death in the U.S., responsible for around 443,000 deaths every year. For every one death, 20 people are currently living with a smoking-related disease.
"The point is we want less smoking of any kind among teens who will grow into adult smokers and e-cigarettes are hooking teens," McAndrew said.
But that's not the only problem with e-cigarettes.
E-cigarette sales and advertising are unregulated by the FDA
E-cigarettes are currently unregulated by the U.S. Food and Drug Administration (FDA). The FDA Center for Tobacco Products has announced that it intends to extend its authorities beyond tobacco products to include e-cigarettes, but has not issued regulations yet.
Because e-cigarettes are unregulated, the FDA does not have good information about the amounts and types of components and potentially harmful ingredients they contain. According to the FDA, because e-cigarettes and their ingredients have not been fully studied, consumers responding to positive marketing messages and health claims by e-cigarette marketers are currently unaware of potential risks of e-cigarette use or how much nicotine or other potentially harmful chemicals are being inhaled during use.
"The FDA regulates what manufacturers can say about tobacco cigarettes and where they cannot be advertised - such as on TV - or sold and who cannot buy them," McAndrew says. Currently there are no age restrictions on who can buy e-cigarettes, although states, most recently Georgia, are beginning to ban the sale to minors.
According to a review of e-cigarette marketing messages published in the American Journal of Preventive Medicine, consumers need to watch out for overly-stated, scientifically unsupported and unregulated health claims and smoking cessation claims in e-cigarette advertising. In the review, which included 59 e-cigarette websites in 2011 (there are more than double the number of brands now), 13 marketing claims stood out. Among the most misleading:
- 95% made explicit or implicit health-related claims
- 95% said e-cigarettes were cleaner
- 88% stated e-cigarettes could be smoked anywhere
- 76% claimed e-cigarettes do not produce secondhand smoke
- 71% mentioned using e-cigarettes to circumvent clean air policies
- 64% had a smoking cessation-related claim
- 22% featured doctors
- 22% claimed use by celebrities
- Candy, fruit and coffee flavors were offered on most sites.
In fact, these marketers are doing a great job: e-cigarette sales were $20 million in 2008 and have grown steadily every year with many sources projecting sales way over $1 billion in 2013.
E-cigarettes have dangerous components and ingredients
The e-cigarette industry often touts a 2009 FDA analysis which found far fewer dangerous ingredients in the two brands analyzed versus the 93 established harmful and potentially harmful constituents (HPHCs) in tobacco products and tobacco smoke.
But e-cigarette smokers beware
An e-cigarette is a battery-operated device that generally contains a cartridge (the atomizer) filled with a liquid including nicotine, the chemical propylene glycol, flavors and other chemicals. When you puff, the device is heated to activate the chemicals to create the vapor and you inhale the nicotine along with those other chemicals into your lungs.
"The largest chemical component is propylene glycol that's one thing all e-cigs use to create the vapor you inhale," said McAndrew. "It's the same ingredient that causes the smoke in fog machines." The Material Safety Data sheets for this chemical state it is flammable when exposed to heat and upon inhalation to move the person to fresh air immediately. Also the carcinogenic effects, harm to a developing fetus or whether it can mutate your genetic material is currently unknown. In one sample, the FDA's analysis found diethylene glycol, a toxic chemical in antifreeze, and in several other samples, the FDA found other known carcinogens, including nitrosamines.
This nicotine liquid cocktail can be bought in giant gallon-sized re-fill containers, and a warning to keep these containers away from contact with children and pets was just released by the American Association of Poison Control Centers (AAPCC), in response to the growing number of reports of contact exposure injuries from that liquid. Slightly more than half of reported exposures have occurred in young children under the age of six.
"When it comes to concentrated liquid nicotine, the danger is not just ingestion but with simple contact with the skin," said Ashley Webb, director of the Kentucky Regional Poison Center, in the AAPCC press release. Because the nicotine is so concentrated, it is significantly toxic in very small doses.
"Because the e-cigarettes are unregulated, whether they contain the nicotine or not, you won't know what other chemicals are in the one you, or worse, your child, is smoking," warns McAndrew. "What we do know is they can lead a child to a lifelong nicotine addiction and kids using these e-cigarettes are unaware of this danger."
E-cigarettes are not proven to help you quit smoking the tobacco cancer sticks
The only thing the FDA does say about e-cigarettes is that marketers can't promise they will help you quit smoking.
But the e-cigarette marketers will site a study published in The Lancet in 2013 which concludes e-cigarettes were modestly e¿ective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events. The study admits that findings are statistically insignificant and concludes uncertainty exists about the place of e-cigarettes in tobacco control, and more research is urgently needed to clearly establish their overall bene¿ts and harms.
In 2014, some commentary on that study was again published in The Lancet which states the original study authors disclosed connections with smoking cessation manufacturers, including e-cigarette manufacturers. And, that e-cigarettes are not suitable as a universal harm reduction measure because they might generate a new market for nicotine dependence.
McAndrew, a smoking cessation expert, warns if you're trying to quit smoking using e-cigarettes, it probably won't work.
"To kick the smoking habit for good, you need to reduce the oral habit while reducing the nicotine gradually," McAndrew says.
He says to stick with the most effective proven treatment which currently includes using an FDA-approved oral medication or the nicotine patch to reduce your oral and hand fixation on the smoking habit while reducing your exposure to the addictive nicotine gradually, coupled with aggressive counseling.
"The nicotine exposure and the oral habit is what causes the addiction and you are continuing both when using e-cigarettes," McAndrew added.
So, stick with the cancer sticks you know? No, they're called cancer sticks for a reason. And, don't kid yourself that any other kind of cigarette ("e" or otherwise) is any better.
--Written by Naomi Mannino for MainStreet