E-cigarette usage has grown immensely in the last ten years, with now approximately 2.5 million Vapers in the U.S. alone. The industry is worth 1.5 billion dollars. Although this is only a drop in the bucket of the 45 million tobacco smokers in the U.S., the worldwide movement toward electronic cigarettes has some people questioning the safety of what is being regarded as an effective means of cessation or replacement for tobacco smoking. Lets are the electronic cigarette health risks people should be aware of? Lets take a look.
There are a number of different types of electronic cigarettes. They can be classified by generations, based on technological evolution.
These most closely resemble real cigarettes in shape and size, and have an LED tip that lights up when a person inhales. Nicknamed “cig-a-likes,” these are battery operated and come with three parts: the cartridge, the atomizer and the battery.
In general, this generation electronic cigarette does not resemble real cigarettes, are larger and have rechargeable batteries that pack more power. The cartridges or “tanks” contain liquid nicotine that the Vaper fills. The user can easily change flavor, or mix different flavors to create a custom blend.
Third generation devices are bigger still, and the vaping experience is more customizable. With some devices, the cartomizer resistance can be adjusted to burn hotter to create more vapor, they may have variable voltage, or the inhalation tension can be modified. There are even atomizers that can be built and re-built by the user.
Electronic Cigarette Liquids
The newest generation electronic cigarettes use tanks that are custom filled by the user. On the models which use Rebuildable Drip Atomizers (RDA), small cotton wicks are saturated manually with liquid. There are many flavors of liquids that a vaper can purchase, and they range from spicy or sweet, to tobacco and tobacco variations and mixtures. These liquids contain water, flavorings, nicotine, and some combination of vegetable glycerin (VG) and propylene glycol (PG). More VG means more vapor output. More PG allows for more throat hit, and leads to a more realistic smoking sensation.
Primary Concerns About Electronic Cigarette Health Risks
A number of issues are cited when considering the safety of electronic cigarettes. As consumers it is our responsibility to sort out the hype from the facts. Here are some of the main concerns:
- Contaminants – These are elements that vapers are NOT intending to get into their bodies, and may include trace amounts of metals, plastics or lead, chromium, flavorings, TSNA (tobacco specific nitrosamines), VOC – volatile organic compounds (acrolein, formaldehyde).
- Glycerin and Propylene Glycol – Most Vapers are aware that these carriers exist in e-liquids. These products are used extensively in topical applications such as soaps and cosmetics. Vegetable glycerin is derived from the glycerol fats in plant-based oils like coconut and palm. Propylene Glycol is an organic compound, and is used in foods, such as ice cream, pharmaceuticals, and vaporizers. It is considered to be “generally recognized as safe” by the FDA, and is generally non-toxic when used in products for consumption. The question remains regarding safety of these additives when inhaled in aerosol form.
- Nicotine – Can a person overdose on nicotine or transfer nicotine through second hand vapor? Also, nicotine levels may correspond to TSNA (tobacco specific nitrosamines, a carcinogen) levels, due to the fact that TSNA is a contaminant of nicotine, which comes from the tobacco leaf. Additionally, nicotine ingested by children can be fatal.
- Second hand vapor for bystanders – Some people voice concern about second hand vapor in the workplace or in restaurants, about whether bystanders inhale nicotine, and whether the VG and PG are harmful.
What Does The Research Indicate?
In a study published on January 9, 2014 by Professor Igor Burstyn, PhD., of Drexel University, Dr. Burstyn acknowledges the presence of trace amounts of a number of contaminants in the aerosols of e-liquids, such as the ones described above. Some of these contaminants and their amounts are directly related to the degree to which the liquid is heated up, and have been shown in highly variable amounts in different studies. Dr. Burstyn indicates that in some studies the liquid was heated to unusually high levels. These contaminants include formaldehyde and acrolein – substances that arise from the heating process of the solvents. In the Key Conclusions section of Dr. Burstyn’s research article he reports:
There is no serious concern about the contaminants such as volatile organic compounds (formaldehyde, acrolein, etc.) in the liquid or produced by heating. While these contaminants are present, they have been detected at problematic levels only in a few studies that apparently were based on unrealistic levels of heating.Dr. Burstyn
Regarding vegetable glycerin and propylene glycol, Dr. Burstyn reports that further research is warranted to determine the effects of inhalation of the aerosol, since most of the research to date involves their effects through ingestion and topical applications. Plus, these concerns only apply to the Vapers themselves, not to bystanders. “Exposure of bystanders to the listed ingredients, let alone the contaminants, does not warrant a concern as the exposure is likely to be orders of magnitude lower than exposure experienced by vapers.” However, these substances are known irritants to the lungs. Again, further research must be conducted using realistic levels of heating based on real life usage patterns of electronic cigarette devices.
Different patterns of usage can lead to a highly variable level of nicotine intake. Can a Vaper get too much nicotine? It appears to be unlikely. Two studies discussed by Lynne Dawkins in her presentation, “Electronic Cigarettes: What We Know So Far,” shows that “naïve” Vapers, or people who were not cigarette smokers who vaped did not increase their blood nicotine. This was attributed to the fact that they did not draw on the e-cigarette deeply enough. The finding also indicated that e-cigarettes are very different than tobacco cigarettes in that the Vaper must draw on the e-cigarette much longer – 20 minutes to get the blood nicotine level up to the same level as tobacco smoking. The American Heart Association reports that after five minutes of vaping, the electronic device had delivered only one fourth to one third of the nicotine that one tobacco cigarette had delivered. Another reason it is unlikely that Vapers will ingest too much nicotine is due a self-regulating mechanism. The side effects of nicotine intoxication include nausea, dizziness, and other unpleasant sensations. However, ingesting nicotine is a different story.
The American Heart Association Policy Statement indicates that the amount of nicotine in a typical bottle of e-liquid is enough to kill a child, and that the number of poison control center calls regarding e-liquid exposure by children has risen 161%-333%. There is one known case of a child dying due to ingestion of e-liquid in Isreal (Lynne Dawkins, “Electronic Cigarettes: What We Know So Far”). Nicotine is also absorbed through the skin.
What Does This Mean?
One thing that is not being disputed is that vaping is far safer than smoking cigarettes. The majority of Vapers transitioned from smoking tobacco. There are very few Vapers who have never been tobacco smokers, and it is shown that vaping is effective in helping people to quit smoking because not only does it provide nicotine replacement, it also allows the user to engage in the hand to mouth behavior.
Another thing that is not being disputed is that more research must be conducted to determine the effects of VG and PG when inhaled in aerosol. However, as Dr. Burstyn points out, it is easier to monitor e-liquid production for quality and purity than it is to research the effects of the aerosol in the body.
It does not appear that we have to be worried as bystanders, based on the research, however, every measure should be taken to prevent e-liquids from being ingested by children. This includes requiring that child-proof bottles be used for liquids. At this time some companies use child-proof bottling and some do not. Children should never play with nicotine products.
Like so many things we put into our bodies, including fast food or bottled water, we must weigh the electronic cigarette health risks and the benefits. Further research is warranted and will tell us more about vaping, and its specific effects. Until then, do the research, look at the pros and cons, the alleged costs and benefits, take precautions, and make up your own mind to do what you think is best for you.
1. Dr. Lynne Dawkins, presentation “What We Know So Far” University of East London, July 2013.
2. The American Heart Association, “A Policy Statement From The American Heart Association,” Aruni Bhatnagar, et al., August 2014.
3. “Peering through the mist: What does the chemistry of contaminants in electronic cigarettes tell us about health risks?” Igor Burstyn, PhD, January 2014.