Electronic Cigarettes: Healthy or Hazardous?

 

The struggle against cigarette smoking has been an impossible one. Smoking is an important social and health issue today as it was a century ago. In fact, the past century was dubbed the cigarette century.

Despite the perceived extraordinary success in controlling combustible tobacco use, progress has stalled in reducing premature deaths from tobacco; primarily caused by cigarettes or other combusting tobacco products and not necessarily by nicotine. And the dominance of cigarettes over the past 100 years threatens to persist for another century.

Two philosophies have dominated tobacco control: abstinence and harm reduction. Abstinence implies avoiding all tobacco use behavior because there is no safe tobacco or nicotine level. If avoidance is not practical or realistic, harm reduction sets a goal that minimizes the harm caused by the behavior. Tension between reduction and abstinence advocates can be divisive.

The rapid rise in the use and popularity of e-cigarettes has substantially increased this tension because of their potential for harm reduction. This viewpoint examines e-cigarettes and the potential respiratory risks they may pose, as well as the subtle risks that might be associated with the newer flavoured e-cigarettes.

Electronic cigarettes (e-cigarettes or electronic nicotine delivery systems ENDS) heat a nicotine solution to generate vapor that is inhaled, without the combustion of tobacco and its toxic constituents. Use of electronic cigarettes (e-cigarettes), vape pens, e-hookah, e-cigars, e-pipes, or other electronic nicotine delivery systems (ENDS) has increased rapidly since their introduction in the United States in 2007, growing to a $2 billion market. Use of e-cigarettes is increasing, not only in the United States but also around the world.

There is however the expected controversy concerning the utility of ENDS – do they actually qualify as a harm reduction strategy? Are there evidences on the potential benefits and harms of these products? Does e-cigarette cause cancer?

Exclusive use of ENDS is generally considered to be less risky for individuals – they likely pose less direct hazard to the individual smoker than smoking cigarettes/combustible tobacco products; and they might help smokers quit smoking or reduce harm by smoking fewer tobacco cigarettes.

There growing concern include the fact that their availability may both lead to dual product use (ie, ENDS and cigarettes) and on the long run, reduce tobacco cessation. Additionally, there is concern that ENDS may be used by non-smoking adolescents and young adults who might not otherwise have used nicotine-delivering products, and dual use may also follow. Besides, promoting continued smoking of cigarettes and renormalizing cigarette smoking behaviors. Numerous flavored products that have seeming appeal to adolescents and young adults are on the market, such as Cherry Crush, Chocolate Treat, Snappin’ Apple, and Vanilla Dreams flavors; their availability may generate an entirely new population of nicotine-addicted users among never-users of combustible tobacco products.

Although still variable in quality, appeal, and efficient nicotine delivery, e-cigarettes represent an evolving frontier, filled with promise and peril for tobacco control practitioners, policy makers, and regulators. I believe there is the need for the agencies authorized to regulate tobacco use in all countries to regulate e-cigarettes as tobacco products. And also to make other regulatory decisions about the product safety, where and when it could be used or should be prohibited. Likewise, adequate publicity is needed on major effects e-cigarettes could have on the health of the public.

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